• Title/Summary/Keyword: Chest computed tomography

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Organ dose conversion coefficients in CT scans for Korean adult males and females

  • Lee, Choonsik;Won, Tristan;Yeom, Yeon Soo;Griffin, Keith;Lee, Choonik;Kim, Kwang Pyo
    • Nuclear Engineering and Technology
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    • v.54 no.2
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    • pp.681-688
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    • 2022
  • Dose monitoring in CT patients requires accurate dose estimation but most of the CT dose calculation tools are based on Caucasian computational phantoms. We established a library of organ dose conversion coefficients for Korean adults by using four Korean adult male and two female voxel phantoms combined with Monte Carlo simulation techniques. We calculated organ dose conversion coefficients for head, chest, abdomen and pelvis, and chest-abdomen-pelvis scans, and compared the results with the existing data calculated from Caucasian phantoms. We derived representative organ doses for Korean adults using Korean CT dose surveys combined with the dose conversion coefficients. The organ dose conversion coefficients from the Korean adult phantoms were slightly greater than those of the ICRP reference phantoms: up to 13% for the brain doses in head scans and up to 10% for the dose to the small intestine wall in abdominal scans. We derived Korean representative doses to major organs in head, chest, and AP scans using mean CTDIvol values extracted from the Korean nationwide surveys conducted in 2008 and 2017. The Korean-specific organ dose conversion coefficients should be useful to readily estimate organ absorbed doses for Korean adult male and female patients undergoing CT scans.

Morphological Adaptation after Bilateral Lung Transplantation in a Patient with Kartagener Syndrome: A Case Report

  • Kim, Chang Hun;Son, Bong Soo;Son, Joohyung;Kim, Do Hyung
    • Journal of Chest Surgery
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    • v.55 no.1
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    • pp.77-80
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    • 2022
  • Kartagener syndrome (KS) is a rare disease with an incidence of 1 in 20,000 to 30,000 births. There is no cure for KS, and conservative medical treatments are used to relieve symptoms and prevent disease progression. Lung transplantation (LT) is the only treatment option for end-stage KS. Since patients with KS have anatomical abnormalities such as situs inversus totalis, which often require surgery to correct, most reports are related to surgical techniques. Reports about morphological adaptations and changes in transplanted lung structure after LT in patients with KS are rare. We performed LT in a patient with KS and observed morphological adaptation of the lungs for 6 months on chest computed tomography using a quantitative evaluation tool (Chest Image Platform; Harvard University Disability Resources, Cambridge, MA, USA).

Atypical presentation of DeBakey type I aortic dissection mimicking pulmonary embolism in a pregnant patient: a case report

  • Sou Hyun Lee;Ji Hee Hong;Chaeeun Kim
    • Journal of Yeungnam Medical Science
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    • v.41 no.2
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    • pp.128-133
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    • 2024
  • Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.

Staging of Esophageal Cancer Using Positron Emission Tomography : Comparing to Computed Tomography (양전자방출단층촬영술(PET)을 이용한 식도암 환자의 병기 결정 -전산화단층촬영술(CT)과의 비교-)

  • 심영목;박승준;김병태;김성철
    • Journal of Chest Surgery
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    • v.32 no.4
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    • pp.388-393
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    • 1999
  • Background: Correct preoperative staging of esophageal cancer is a prerequisite for adequate treatment. We prospectively compared the accuracy of positron emission tomography (PET) with [fluorine-18]FDG in the staging of esophageal cancer to that of computed tomography (CT). Material and Method: The findings of FDG PET and of chest CT including lower neck and the upper abdomen of 20 biopsy-proven squamous cell carcinoma patients (male, 19; female, 1; mean age, 61) were compared with the pathologic findings obtained from a curative esophagectomy with lymph node dissection. Result: The sensitivities of FDG PET and CT for diagnosis of primary tumor were the same, 90.0% (18/20). Both FDG PET and CT failed to show the primary tumor in 2 of 20 patients; one had a 1cm sized carcinoma in situ and the other had T1 stage cancer. By using the results of the pathologic examinations of 193 removed lymph node groups, we calculated the diagnostic sensitivities, specificities and accuracies of PET and CT (*$\chi$2 p < 0.005). Sensitivity** Specificity Accuracy* PET 55.6%(30/54) 97.1%(135/139) 85.5%(165/193) CT 13.0%(7/54) 98.6%(137/139) 74.6%(144/193) One of four patients with a false-positive for PEThad had active pulmonary tuberculosis. Among the 24 tumor involved lymph node groups, PET failed to show tumor metastasis in 5 lymph node groups abutting the tumor and in 14 lymph node groups located where the decay correction was not performed. Conclusion: Based on the above findings, it is suggested that [F-18]FDG-PET is superior to CT in the detection of nodal metastases and in the staging of patients with esophageal cancer.

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Efficacy of Positron Emission Tomography in Diagnosing Pulmonary Tumor and Staging of Lung Cancer : Comparing to Computed Tomography (폐종양과 폐암의 병기결정에 대한 양전자단층촬영(PET)의 유용성 -전산화단층촬영 (CT)과의 비교-)

  • 김오곤;조중행;성숙환
    • Journal of Chest Surgery
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    • v.36 no.2
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    • pp.79-85
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    • 2003
  • Diagnosing and determining the stage of lung cancer by means of positron emission tomography (PET) ha.. been proven valuable because of the limitations of diagnosis by computed tomography (CT). We compared the efficacy of PET with that of CT in diagnosing pulmonary tumor and staging of lung cancer Material and Method: We performed F-18 FDG PET to determine the malignancy and the staging on patients who have been suspicious or were diagnosed as lung cancer by chest X-ray and CT. The findings of PET and of CT of 41 patients (male, 29: female, 12: mean age, 59) were compared with pathologic findings obtained from a mediastinoscopy and thoracotomy. Result: Out of 41 patients, 35 patients had malignant lesions (squamous cell carcinonla 19 cases, adenocarcinoma 14 cases, adenosquamous cell carcinoma 2 cases) and 6 patients had benign lesions. Diagnosing of lung cancer, the sensitivity, specificity and accuracy of CT and PET were the same for two method and the numbers were 100%, 50%, and 92.7% respectively. Eighteen LN groups out of 108 mediastinal LN groups who recieved histologic examination proved to be malignant. Pathologic lymph node (LN) stage was N0-Nl 31 cases, N2 8 cases, N3 2 cases. The correct identification of the nodal staging with CT, PET scans were 31 cases (75.6%), 28 cases (68.3%) respectively. The LN group was underestimated in each 6 cases of CT and PET. In 4 cases of CT and 7 cases of PET, they were overestimated in compare to histologic diagnosis. In the detection of mediastinal LN groups invasion, the sensitivity, specificity and accuracy of CT were 39.8 %, 93.3 %, and 84.3 % respectively. For PET, they were 61.1 %, 90.0 %, and 85.2 %. When two methods considered together (CT+PET), they were increased to 77.8 %, 93.3 %, and 90.7 % respectively. Conclusion: PET appears to be similar to CT in the diagnosis and the nodal taging of pulmonary tumor. Two tests may stage patients with lung cancer more accurately than CT alone.

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

  • Porcel, Jose M.
    • Tuberculosis and Respiratory Diseases
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    • v.81 no.2
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    • pp.106-115
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    • 2018
  • Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (${\leq}14F$) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

Suspected Intimal Sarcoma in the Abdominal Aorta -A case report- (복부 대동맥에 발생한 혈관 내막 육종 의증 - 1예 보고 -)

  • Choi, Eun-Seok;Kim, Kyung-Hwan;Choi, Jin-Ho;Lee, Jae-Hang;Hwang, Ho-Young;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.204-207
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    • 2010
  • A 68 year-old man visited our institution due to chest pain. Coronary angiography revealed triple vessel disease. A computed tomographic angiogram performed as a routine preoperative examination demonstrated an intraluminal spider-web-like mass from the infrarenal abdominal aorta to both common iliac arteries. The infrarenal aorta and both common iliac arteries were excised and replaced with concomitant off-pump coronary artery bypass grafts. Histologic examination of the aorta suggested an intimal sarcoma. A postoperative computed tomographic angiogram performed 3 months postoperatively showed no evidence of a residual or a recurred lesion.

Ex vivo High-resolution Optical Coherence Tomography (OCT) Imaging of Pleural Reaction after Pleurodesis Using Talc

  • Ahn, Yeh-Chan;Oak, Chulho;Park, Jung-Eun;Jung, Min-Jung;Kim, Jae-Hun;Lee, Hae-Young;Kim, Sung Won;Park, Eun-Kee;Jung, Maan Hong
    • Journal of the Optical Society of Korea
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    • v.20 no.5
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    • pp.607-613
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    • 2016
  • The pleura is known as an end target organ of exposure to toxic environmental materials such as fine particulate matter and asbestos. Moreover, long-term exposure to hazardous materials can eventually lead to fatal lung disease such as diffuse pleural fibrosis or mesothelioma. Chest computed tomography (CT) and ultrasound are gold standard imaging modalities for detection of advanced pleural disease. However, a diagnostic tool for early detection of pleural reaction has not been developed yet due to difficulties in imaging ultra-fine structure of the pleura. Optical coherence tomography (OCT), which provides cross-sectional images of micro tissue structures at a resolution of 2-10 μm, can image the mesothelium with a thickness of ~100 μm and therefore enables investigation of the early pleural reaction. In this study, we induced the early pleural reaction according to a time sequence after pleurodesis using talc, which has been widely used in the clinical field. The pleural reaction in talc grouped according to the time sequence (1st, 2nd, 4th weeks) showed a significant thickening (average thickness: 45 ± 7.5 μm, 80 ± 10.7 μm, 90 ± 12.5 μm), while the pleural reaction in sham and normal groups showed pleural change from normal to minimal thickening (average thickness: 16 ± 5.5 μm, 17 ± 4.5 μm, 15 ± 6.5 μm, and 12 ± 7.5 μm, 13 ± 2.5 μm, 12 ± 3.5 μm). The measurement of pleural reaction by pathologic examinations was well-matched with the measurement by OCT images. This is the first study for measuring the thickness of pleural reactions using a biophotonic modality such as OCT. Our results showed that OCT can be useful for evaluating the early pleural reaction.

Factors Affecting Pneumonia Occurring to Patients with Multiple Rib Fractures

  • Byun, Joung Hun;Kim, Han Young
    • Journal of Chest Surgery
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    • v.46 no.2
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    • pp.130-134
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    • 2013
  • Background: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. Materials and Methods: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. Results: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). Conclusion: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.

DiGeorge syndrome who developed lymphoproliferative mediastinal mass

  • Kim, Kyu Yeun;Hur, Ji Ae;Kim, Ki Hwan;Cha, Yoon Jin;Lee, Mi Jung;Kim, Dong Soo
    • Clinical and Experimental Pediatrics
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    • v.58 no.3
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    • pp.108-111
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    • 2015
  • DiGeorge syndrome is an immunodeficient disease associated with abnormal development of 3rd and 4th pharyngeal pouches. As a hemizygous deletion of chromosome 22q11.2 occurs, various clinical phenotypes are shown with a broad spectrum. Conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcemia are the classic triad of DiGeorge syndrome. As this syndrome is characterized by hypoplastic or aplastic thymus, there are missing thymic shadow on their plain chest x-ray. Immunodeficient patients are traditionally known to be at an increased risk for malignancy, especially lymphoma. We experienced a 7-year-old DiGeorge syndrome patient with mediastinal mass shadow on her plain chest x-ray. She visited Severance Children's Hospital hospital with recurrent pneumonia, and throughout her repeated chest x-ray, there was a mass like shadow on anterior mediastinal area. We did full evaluation including chest computed tomography, chest ultrasonography, and chest magnetic resonance imaging. To rule out malignancy, video assisted thoracoscopic surgery was done. Final diagnosis of the mass which was thought to be malignancy, was lymphoproliferative lesion.