• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.528-531
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• 2010

Ehlers-Danlos syndrome (EDS) type IV is characterized by its clinical manifestations, which are easy bruising, thin skin with visible veins, and rupture of arteries, uterus, or intestines. Arterial complications are the leading cause of death in vascular EDS because they are unpredictable and surgical repair is difficult due to tissue fragility. The authors report a case presented with cervical radiculopathy due to a segmental fusiform aneurysm of the cervical vertebral artery. Transfemoral cerebral angiography (TFCA) was done to verify the aneurysmal dilatation. However, during TFCA, bleeding at the puncture site was not controlled, skin and underlying muscle was disrupted and profound bleeding occurred during manual compression after femoral catheter removal. Accordingly, surgical repair of the injured femoral artery was performed. At this time it was possible to diagnose it as an EDS with fusiform aneurysm on cervical vertebral artery. Particularly, cervical fusiform aneurysm is rare condition, and therefore, connective tissue disorder must be considered in such cases. If connective tissue disorder is suspected, the authors suggest that a noninvasive imaging modality, such as, high quality computed tomography angiography, be used to evaluate the vascular lesion to avoid potential arterial complications.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.461-466
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• 2007

Two dogs were admitted with a history of anorexia, ataxia, shivering, lethargy, hypersalivation and seizure. Patients were suspected for portosystemic shunts on the basis of clinical signs, increased hepatic serum profiles on the blood test, microhepatica on plain abdominal radiographs, and an abnormally dilated and tortuous vessel on abdominal ultrasonographs. To diagnose PSS and to further evaluate type, shape, and location of shunt and hepatic vasculatures, the computed tomography (CT) angiography for portal and systemic circulation was performed. The shape, location and pathway of extrahepatic single shunt were confirmed in two dogs. Dual phases (the arterial phase and the venous phase) CT angiography and reformatted and three-dimensional images offered good understanding of PSS and planning surgical treatment.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.165-171
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• 2023

Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.948-952
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• 2021

The absence of the common carotid artery (CCA) and the common origin of the left external carotid artery (ECA) and the right CCA are rare anomalies of the cervical vascular system. We report here a case involving the coexistence of these vascular anomalies with an aberrant right subclavian artery, which is a common congenital anomaly in the aortic arch, and review the embryologic mechanism and clinical importance of this case.

• Journal of the Korean Society of Radiology
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• v.84 no.1
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• pp.286-290
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• 2023

Various branch anomalies of the aortic arch have been reported, but cases with separate origins of the internal and external carotid arteries with combined direct aortic arch origin of the left vertebral artery are extremely rare. Herein, we present a rare case of aplasia of the left common carotid artery with separate origins of the ipsilateral internal and external carotid arteries and vertebral artery from the aortic arch in a 10-year-old girl. In addition, we review the embryological development and clinical implications of these anatomical variations.

• 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 Veterinary Clinics
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• v.34 no.5
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• pp.330-334
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• 2017

The aim of this study was to establish an injection protocol of a test bolus and a main bolus of contrast material for computed tomographic pulmonary angiography (CTPA) for visualizing optimal pulmonary arteries in normal beagle dogs. CTPA using a test bolus method from either protocol A or B were performed in each of four normal beagle dogs. In protocol A, CTPA was conducted with a scan duration for around 8 s, setting the contrast enhancement peak of the pulmonary trunk in the middle of the scan duration. The arrival time to the contrast enhancement peak was predicted from a previous dynamic scan using a test bolus (150 mg iodine/kg) injected with the same injection duration using for a main bolus (450 mg iodine/kg). In protocol B, CTPA was started at the predicted appearance time of contrast material in the pulmonary trunk based on a previous dynamic scan using a test bolus injected with the same injection rate as a main bolus. CTPA using protocol A showed the optimal opacification of the pulmonary artery with pulmonary venous contamination. Proper CTPA images in the absence of venous contamination were obtained in protocol B. CTPA with a scan duration for 8 s should be started at the appearance time of contrast enhancement in the pulmonary trunk, which can be identified exactly when a test bolus is injected at the same injection rate used for the main bolus.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.159-167
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• 2022

Purpose: The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea. Methods: In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study. Results: VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3-5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0-2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3-5) for VTE was 1.891 (95% confidence interval, 1.043-3.430). Conclusions: Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.

• Journal of Korean Neurosurgical Society
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• v.39 no.2
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• pp.125-129
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• 2006

Objective : The purpose of this study is to identify any differential point in computerized tomographic[CT] findings between aneurysmal subarachnoid hemorrhage[ASAH] and traumatic subarachnoid hemorrhage[TSAH], which sometimes make us not confident in differentiation. Methods : CT of 142 ASAH and 82 TSAH patients over the last 2 years were retrospectively reviewed. We evaluated the thickness of SAH, the laterality of sylvian cisternal hemorrhage, the location, the number of involved cisterns, and the associated other lesions between two types of SAH. Results : Suprasellar cisterns and sylvian cisterns were most prominently and frequently involved cisterns in ASAH but cortical sulci and sylvian cisterns were most frequently involved in TSAH. Intraventricular and intracerebral hemorrhage were frequently seen in ASAH. Thickness of SAH over 1mm, bilateral sylvian SAH, multiple cisternal SAH were in favor of ASAH. The number of involved cisterns were more frequently seen in ASAH than in TSAH. In ASAH, bilateral sylvian hemorrhages were more frequently seen than in TSAH. Skull fracture, subdural hematoma, subgaleal hematoma, and hemorrhagic contusion were frequently associated with TSAH. Conclusion : As a result of our study, the authors conclude that when IVH, hydrocephalus, thick SAH > 1mm bilateral sylvian SAH, and multiple cisternal SAH are seen in CT, immediate angiography should be performed to rule out cerebral aneurysms whether associated with other traumatic lesions or not.

• Progress in Medical Physics
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• v.9 no.1
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• pp.1-9
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• 1998

In order to provide complementary image data, CT(computed tomography), MR(magnetic resonance) and angiography have been used in the field of Stereotactic Radiosurgery(SRS) and neurosurgery. The aim of this work is to develop 3-D stereotactic localization system in order to determine the precise shape, size and location of the lesion in the brain in the field of Stereotactic Radiosurgery(SRS) and neurosurgery using multi-image modality and multi purpose QA phantom. In order to obtain accurate position of a target, Hitchcoke stereotactic frame and CT/angiography localizers were rigidly attached to the phantom with nine targets dispersed in 3-D space. The algorithms to obtain a 3-D stereotactic coordinates of the target have been developed using the images of the geometrical phantom which were taken by CT/angiography. Positions of targets computed by our algorithms were compared to the absolute position assigned in the phantom. Outlines of targets on each CT image were superimposed each other on angiography images. A spatial mean distance errors were 1.02${\pm}$0.17mm for CT with a 512${\times}$512 matrix and 2mm slice thickness, 0.41${\pm}$0.05mm for angiogra- phy localization. The resulting accuracy in the target localization suggests that the developed system has enough Qualification for Stereotactic Radiosurgery (SRS).