• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.279-284
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• 2017

Pulmonary artery sarcoma (PAS) is a rare and fatal disease that often mimics chronic thromboembolic pulmonary hypertension (CTEPH); therefore, diagnosis of PAS is often delayed. Herein, a healthy 74-year-old man was presented with a 4-month history of dyspnea. Chest computed tomography showed wall thickening and stenosis in the main pulmonary artery as well as in both proximal pulmonary arteries. In order to differentiate between unusual CTEPH, vasculitis, and PAS, we performed right heart catheterization and pulmonary angiography. The mean pulmonary arterial pressure was 21 mmHg, and there was severe pulmonary artery stenosis. Thrombi on the pulmonary arterial wall lesions were observed in intravascular ultrasound and optical coherence tomography. Furthermore, the patient had a history of deep vein thrombosis. Therefore, we diagnosed unusual CTEPH. After 6 months of rivaroxaban anticoagulation therapy, a chest X-ray revealed a left lower lobe lung mass, and a positron emission tomography later showed hypermetabolic lesions in the main pulmonary artery wall, in both pulmonary arteries walls, in the lung parenchyma, and in the bones. A biopsy of the right proximal humerus lesion revealed undifferentiated intimal sarcoma. Pulmonary sarcoma is rare, but should be considered when differentially diagnosing main pulmonary artery wall thickening and stenosis. A positron emission tomography may aid in this diagnosis.

• Journal of the Korean Society of Radiology
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• v.15 no.2
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• pp.109-115
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• 2021

This study is a study on the difference in dose according to the presence or absence of gonadal shielding of scattered rays generated during chest computed tomography examination, and the scattered dose of the examination site was measured by placing the RadEye G-10 device in the center of the phantom. When the gonads are not shielded, the scattering lines of the whole, both sides, posterior and gonads are measured and Xenolite nolead Apron (0.35 mm PB), Xenolite nolead Apron (front 0.35 mm PB Mix back 0.25 mm PB, Skirt overlap), Half Apron After shielding with (0.5 mm PB), each scattered dose was measured. During chest computed tomography, the scattered dose of the test site was measured at 272 μSv, and when not shielded with Apron, the average total was 43 μSv, left 81 μSv, right part 82 μSv, posterior part 38.8 μSv, and Gonad part 16 μSv. Became. Xenolite nolead Apron shielded only the upper part and measured all 11.2 μSv, left part 43.1 μSv, right part 45.3 μSv, posterior part 12 μSv and Gonad part 5.2 μSv. Xenolite nolead Apron (Skirt overlap) covered the Pelvis area 360° and the dose was measured to be 5.6 μSv in the whole, 22.4 μSv in the left, 15.7 μSv in the right side, 6 μSv in the posterior part, and 3.2 μSv in the Gonad part. Xenolite nolead Apron (Skirt overlap) covered the Pelvis area 360° and the dose was measured to be 5.6 μSv in the whole, 22.4 μSv in the left, 15.7 μSv in the right side, 6 μSv in the posterior part, and 3.2 μSv in the Gonad part. When measuring only the upper part with Half Apron, the total measurement was 10.7 μSv, the left part 42.6 μSv, the right part 40.6 μSv, the posterior part 11.3 μSv, and the Gonad part 4.7 μSv. The method of 360° shielding of the pelvic area showed a dose reduction of more than 80%, and a dose reduction effect of more than 70% was shown when all shielding was performed. In all computerized tomography examinations, research to reduce the exposure dose and various shielding devices were used. It is believed that continuous research on the technique is needed.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1070-1075
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• 1992

Bilateral intralobar and extralobar pulmonary sequestration is an extremely rare anomaly. At present, four pathologically proven cases and two possible cases have been reported in the literature insofar as we know. We have found no previous reports in the literature in which simultaneous bilateral intralobar and extralobar pulmonary sequestration were present. We report a first case presenting as bilateral intralobar and extralobar pulmonary sequestration, recently performed staged bilateral resection, and emphasize the importance of computed tomography and angiography in diagnosis and operation.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1066-1069
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• 1992

The bronchogenic cyst is not so rare in incidence, but it is rare for this cyst to cause compression of trachea and main bronchi. A 6-year old female child was evaluated for coughing, fever and left total atelectasis. This patient had a history of frequent upper respiratory symptom like bronchial asthma since 6month after birth. Fiberoptic bronchoscopy revealed external compression at distal trachea and both main bronchi. Computed Tomography revealed well demarcated homogeneous mass compressing distal trachea and main bronchi. The pathological examination showed bronchogenic cyst and this patient had uneventful recovery.

• Journal of Chest Surgery
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• v.48 no.4
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• pp.231-237
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• 2015

Surgical procedures on the trachea have only been undertaken within the past 50 years. Knowing the unique blood supply of the trachea and how to reduce tension on any anastomosis are key to a successful outcome. Tracheal conditions requiring surgery usually present with shortness of breath on exertion, and preoperative evaluation involves computed tomography and rigid bronchoscopy. Tracheal resection and reconstruction can be safely performed with excellent outcomes by following a well-described technique.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.143-145
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• 2021

In a newborn in whom cor triatriatum was missed on echocardiography, infracardiac total anomalous pulmonary venous connection was successfully repaired with the aid of cardiac computed tomography (CT). In rare combinations, as in this case, an accurate diagnosis prior to surgery, which is of vital importance for successful repair, can be made through a high index of suspicion and the use of a supplemental imaging modality such as CT.

• Journal of Chest Surgery
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• v.50 no.2
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• pp.71-77
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• 2017

Background: Cardiac computed tomography (CT) has emerged as an alternative to magnetic resonance imaging (MRI) for ventricular volumetry. However, the clinical use of cardiac CT requires external validation. Methods: Both cardiac CT and MRI were performed prior to pulmonary valve implantation (PVI) in 11 patients (median age, 19 years) who had undergone total correction of tetralogy of Fallot during infancy. The simplified contouring method (MRI) and semiautomatic 3-dimensional region-growing method (CT) were used to measure ventricular volumes. Results: All volumetric indices measured by CT and MRI generally correlated well with each other, except for the left ventricular end-systolic volume index (LV-ESVI), which showed the following correlations with the other indices: the right ventricular end-diastolic volume index (RV-EDVI) (r=0.88, p<0.001), the right ventricular end-systolic volume index (RV-ESVI) (r=0.84, p=0.001), the left ventricular end-diastolic volume index (LV-EDVI) (r=0.90, p=0.001), and the LV-ESVI (r=0.55, p=0.079). While the EDVIs measured by CT were significantly larger than those measured by MRI (median RV-EDVI: $197mL/m^2$ vs. $175mL/m^2$, p=0.008; median LV-EDVI: $94mL/m^2$ vs. $92mL/m^2$, p=0.026), no significant differences were found for the RV-ESVI or LV-ESVI. Conclusion: The EDVIs measured by cardiac CT were greater than those measured by MRI, whereas the ESVIs measured by CT and MRI were comparable. The volumetric characteristics of these 2 diagnostic modalities should be taken into account when indications for late PVI after tetralogy of Fallot repair are assessed.

• Journal of Chest Surgery
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• v.52 no.2
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• pp.91-99
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• 2019

Background: The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment. Methods: A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT. Results: The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<$20kg/m^2$), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor. Conclusion: The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.487-493
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• 2021

Background: Predicting postoperative lung function after pneumonectomy is essential. We retrospectively compared postoperative lung function to predicted postoperative lung function based on computed tomography (CT) volumetry and perfusion scintigraphy in patients who underwent pneumonectomy. Methods: Predicted postoperative lung function was calculated based on perfusion scintigraphy and CT volumetry. The predicted function was compared to the postoperative lung function in terms of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁), using 4 parameters: FVC, FVC%, FEV₁, and FEV₁%. Results: The correlations between postoperative function and predicted function based on CT volumetry were r=0.632 (p=0.003) for FVC% and r=0.728 (p<0.001) for FEV₁%. The correlations between postoperative function and predicted postoperative function based on perfusion scintigraphy were r=0.654 (p=0.002) for FVC% and r=0.758 (p<0.001) for FEV₁%. The preoperative Eastern Cooperative Oncology Group (ECOG) scores were significantly higher in the group in which the gap between postoperative FEV₁ and predicted postoperative FEV₁ analyzed by CT was smaller than the gap analyzed by perfusion scintigraphy (1.2±0.62 vs. 0.4±0.52, p=0.006). Conclusion: This study affirms that CT volumetry can replace perfusion scintigraphy for preoperative evaluation of patients needing pneumonectomy. In particular, it was found to be a better predictor of postoperative lung function for poor-performance patients (i.e., those with high ECOG scores).

• Journal of Chest Surgery
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• v.57 no.3
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• pp.231-239
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• 2024

Background: Although the modified Blalock-Taussig shunt remains the mainstay method of palliation for augmenting pulmonary blood flow in various congenital heart diseases, the shunt must be carefully designed to achieve the best outcomes. This study investigated the effect of shunt configuration on pulmonary artery growth and growth discrepancy. Methods: Twenty patients with successful modified Blalock-Taussig shunt takedown were analyzed. Pulmonary artery and shunt characteristics were obtained using computed tomography scans. Differences in the baseline and follow-up diameter ratios and growth in the ipsilateral and contralateral arteries were calculated. The angle between the shunt and pulmonary artery, as well as the distance from the main pulmonary artery bifurcation, were measured. Correlations between pulmonary arteries and shunt configurations were analyzed. Results: The median interval time between shunt placement and takedown was 154.5 days (interquartile range, 113.25-276.25 days). Follow-up values of the ipsilateral-to-contralateral pulmonary artery diameter ratio showed no significant correlation with the shunt angle (ρ=0.429, p=0.126) or distance (ρ=0.110, p=0.645). The shunt angle and distance from the main pulmonary bifurcation showed no significant correlation (ρ=-0.373, p=0.189). Pulmonary artery growth was negatively correlated with shunt angle (ipsilateral, ρ=-0.565 and p=0.035; contralateral, ρ=-0.578 and p=0.030), but not with distance (ipsilateral, ρ=-0.065 and p=0.786; contralateral, ρ=-0.130 and p=0.586). Conclusion: Shunt configuration had no significant effect on growth imbalance. The angle and distance of the shunt showed no significant correlation with each other. A more vertical shunt was associated with significant pulmonary artery growth. We suggest a more vertical graft design for improved pulmonary artery growth.