[en] A 41 year-old male was admitted to our hospital, complaining of slight fever, dry cough and general fatigue. On auscultation, bubbling rales were audible at the mid to lower portion of left posterior chest. Plain chest roentgenogram showed multiple cystic shadows with an air-fluid level in the left lower lobe. An abnormal finger-like shadow, which extended from the left hemidiaphragm to the multiple cysts, was found on lateral chest tomogram. Bronchogram revealed cystic dilatation of left B6 and B10. Computed tomogram with contrast enhancement demonstrated multiple cysts and an abnormal round-shaped structure, consisted of high density material, in the left lower lung. At the level of 12 mm below the round-shaped structure, an abnormal finger-like structure contiguous to the thoracic descending aorta was demonstrated. The density of these abnormal structures was 80 Hounsfield units, which was the same as that of the descending aorta. Thoracic aortogram disclosed an abnormal artery arising from the thoracic descending aorta, just above the left hemidiaphragm, which proceeded to the left lower lung horizontally, and extended to superior direction and divided into multiple branches. These vessels drained into the left atrium via left lower pulmonary vein. Diagnosis of intralobar pulmonary sequestration was confirmed by operation and consequently, the sequestered lung and the abnormal artery were successfully removed. It is emphasized that computed tomography with contrast enhancement is useful to detect the abnormal artery of pulmonary sequestration and that this method should be used to evaluate the vascular relationship of lung lesions. (author)

[en] Five patients with thoracic aortic aneurysms, two saccular and three dissecting aneurysms, were examined by dynamic computed tomographic (CT) scanning. A Siemens Somatom 2 was employed. Dynamic scanning is the method by which plural serial images can be obtained in single operation. We used three serial images in a 5-second scan following a 3-second interval. After rapid manual injection of 30 ml of 76% meglumini natriamidotrizoici into the right antecubital vein, scans of 4 mm section were performed three times and subsequently conventional scans four times. Serial changes in the same section and changes in the CT number against time in regions of interest in the image were investigated. Saccular aneurysms was difficult to distinguish from mediastinal tumors on the plain chest X-ray films. However, it was confirmed by the dynamic CT scanning demonstrating free communication between the aorta and the abnormal lumen, because the latter was filled with contrast medium, and the time of appearance, and the peak and washout of a contrast medium were almost the same between two lumens. In dissecting aneurysms, it was able to recognize both the false and true lumens as double channels in the aorta. We observed the different mode of dissection between the ascending and descending aorta in one case, and observed the twisting of an intimal flap in variable parts of the aorta in another case. Furthermore, it was possible to confirm the difference of blood flow pattern between the false and true lumens by dynamic CT. Because CT has a high quality image resolution, and especially, dynamic CT provides the serial changes in the same section after injection of contrast medium, both CT and dynamic CT are useful non-invasive imaging techniques for evaluating thoracic aortic aneurysms. (author)

[en] Dynamic computed tomography was performed to assess its diagnostic significance in thoracic aortic aneurysm, atrial septal defect and pulmonary sequestration, and to evaluate the patency of aortocoronary bypass graft; the following results were obtained: 1) In thoracic aortic dissection, there was delayed filling and washout in false lumen compared to true lumen, while there was simultaneous filling and washout between aneurysm and aorta in thoracic saccular aneurysm. These different flow patterns were clearly demonstrated by the time-density curve made from dynamic scanning. 2) Comparison of the phase of opacification between graft and thoracic ascending aorta permitted correct diagnosis of patency of aortocoronary bypass graft in post-operative asymptomatic patients. 3) Presence of left to right shunt was confirmed by reopacification of right atrium and right ventricle in atrial septal defect with dominant left to right shunt. 4) In a patient with pulmonary sequestration, an abberant artery reached peak opacification during that of the descending aorta. In conclusion, dynamic computed tomography is a very useful non-invasive procedure and should be used to diagnose thoracic aortic aneurysm and pulmonary vascular lesions such as pulmonary sequestration, to evaluate the patency of aortocoronary bypass graft in asymptomatic patients and the presence of left to right shunt in atrial septal defect as a screening test. (author)

[en] Computed tomographic findings between left atrial mural thrombi associated with valvular disease (especially mitral stenosis) and left atrial myxomas were compared. Differential diagnosis might be possible by comprehensive evaluation on the shape and inside structure of the left pulmonary atrium, CT values, the presence of calcification and the movement of mitral valve. It is recommended that CT and postoperative findings should be compared and evaluated to determine the presence of thrombi in cases of valvular disease associated with hypervascularity in the left cardiac auricle detected by coronary arteriography. (Namekawa, K.)

[en] To estimate pulmonary hypertension in patients with various heart diseases, we devised a new method using perfusion lung scintigraphy with ^99mTc-labelled macroaggregated albumin. In this method, changes in the distribution of pulmonary perfusion caused by gravitational effects, namely, changes in the total count ratios of the right lung against the left lung between right and left lateral decubitus positions (rt/lt), were assessed in 62 patients and in 10 normal subjects. The rt/lt ratios were calculated as indices of the above changes. They correlated significantly with mean pulmonary arterial pressure (mPAP) (γ=-0.62, P<0.001), pulmonary capillary wedge pressure (γ=-0.63, P<0.001) and pulmonary arteriolar resistance (γ=0.50, P<0.001) in all subjects. In 17 patients with valvular heart diseases, the ratio correlated significantly with mPAP (γ=-0.84, P<0.001). In 10 patients with various heart diseases, the U/S ratio, i.e. the index of changes in the count ratios of the upper field against the lower field for the right lung following postural change from the uprigth to the supine position, was also obtained as well as the rt/lt ratio. The latter evidenced a better correlation with mPAP (γ=-0.90, P<0.001) than the former (γ=-0.64, P<0.05). We conclude that this method is valuable as a noninvasive approach for the estimation of pulmonary hypertension. (orig.)

[en] We reported a case of hypereosinophilic syndrome with an apical thrombus obstructing left ventricular cavity near the apex and apical hypertrophy of the left ventricle de monstrated by echocardiography and computed tomography. Abnormal laboratory findings included a white blood cell count of 22,800/mm³ with 64 per cent of eosinophils, high serum IgE level, and eosinophilic abscess formation in the lymph node specimen. The electrocardiogram showed left precordial high voltage and giant negative T waves in leads Vsub(4--5). Two-dimensional echocardiograms revealed an abnormal mass obstructing the left ventricular cavity. Computed tomography demonstrated marked apical hypertrophy of the left ventricle and a filling defect of 24 x 31 mm, which attached to the interventricular septum. Because of the lack of its movement on echoardiograms and significant differences in CT numbers from various portions of the myocardium, the abnormal mass in the left ventricle was considered to be a thrombus. In this case, both echocardiography and computed tomography were very useful to understand structural relationship among the thrombus, interventricular septum and surrounding left ventricular walls, and to assess myocardial thickness of the apex. In addition, it is of particular interest that hypereosinophilic syndrome was associated with marked apical hypertrophy of the left ventricle. (author)

[en] Dynamic scan by x-ray CT was performed in 5 cases of thoracic aortic aneurysm (2 saccular and 3 dissecting). In saccular aortic aneurysm, the phases of appearance, peak and disappearance of the contrast medium almost concurred in the aorta and the lumen of the abnormal shadow. In dissecting aortic aneurysm, the technique differentiated a dissecting lumen from the true lumen and depicted differences in their blood flow patterns. Since CT has high resolution, dynamic scan permitting comparisons of the blood flow pattern between normal sites and an abnormal sites, it is a useful non-invasive method for the diagnosis and follow-up thoracic aortic aneurysm. (Chiba, N.)

[en] Twelve patients with biopsyproved systemic amyloidosis (seven with familial amyloid polyneuropathy (FAP) and five with primary amyloidosis) were investigated. The results obtained were as follows: 1. In 10 patients (six with FAP and four with primary amyloidosis) studied by Tc-99m-PYP scintigraphy, two (FAP one, primary amyloidosis one) had diffusely positive myocardial uptake, which was of greater intensity than that of the sternum. Six (four FAP; two primary amyloidosis) also had diffusely positive myocardial uptakes, but the intensity was less than that of the sternum. The remaining two (one FAP; one primary amyloidosis) had only equivocal myocardial uptakes. Two of these patients also had hepatic uptakes and another had both hepatic and thyroid uptakes. The intensity of myocardial uptake of Tc-99m-PYP in patients with echocardiographic left ventricular hypertrophy and/or highly refractile myocardial echoes, so-called granular sparkling appearance (GS) was slightly greater than that in patients with neither myocardial hypertrophy nor GS. In 29 persons with other cardiac diseases and normal subjects examined by Tc-99m-PYP scintigraphy. 2. Both Tc-99m-PYP and -MDP scintigraphic studies were performed in four patients (three FAP; one primary amyloidosis). In Tc-99m-MDP scintigraphy, diffusely positive myocardial uptakes were observed in two patients with FAP and the remaining two had negative scans. The intensity of Tc-99m-MDP myocardial uptake in each patient was significantly lower than that of Tc-99m-PYP uptake. 3. Tl-201 scintigraphy was carried out in 10 patients (six FAP; four primary amyloidosis). Left ventricular hypertrophy was found in six patients and right ventricular visualization in five. Although electrocardiograms in seven of 10 patients showed QS patterns in the right to mid precordial leads. (J.P.N.)

[en] A 57-year-old female was admitted to our hospital, complaining of hemoptysis. On auscultation, moist rales were audible at the lower portion of left posterior chest. Plain chest roentgenogram showed a round shadow in the left lower lung field. Computed tomography with contrast enhancement revealed an abnormal structure which was contiguous to a strand structure. Dynamic scanning demonstrated opacification of the strand structure and that of the greater part of the abnormal structure during peak opacification of the descending aorta. A part of the abnormal structure was opacified during the same phase as the opacification of the right ventricle and pulmonary artery. A diagnosis of intralobar pulmonary sequestration associated with pulmonary arterio-venous malformation was confirmed by thoracic aortography and left pulmonary arteriography. The hemoptysis was found to be caused by chronic bronchitis. It was emphasized that dynamic computed tomography is very useful to diagnose intralobar pulmonary sequestration and to assess the presence of pulmonary arterio-venous malformation. In addition, it is of particular interest that this case cannot be assigned to any category of Pryce's classification although it resembles both type I and IV. (author)

[en] A total of 18 patients with systemic amyloidosis (7 with AL amyloidosis and 11 with familial amyloid polyneuropathy) underwent Tc-99m-pyrophosphate scintigraphy (Tc-99m-PYP SG), Tc-99m-methylene diphosphonate scintigraphy (Tc-99m-MDP SG), and Ga-67-citrate scintigraphy (Ga-67 SG). Tc-99m-PYP SG showed diffusely increased RI uptake in the myocardium in 12 patients. Four of the patients had also diffuse RI uptake in the liver and/or thyroid gland. Although similar RI uptake was seen in the myocardium in 13 patients with dilated cardiomyopathy, it was not seen in the liver or thyroid gland. Myocardial uptake of RI was slight or negative on Tc-99m-MDP SG. Ga-67 SG failed to visualize the myocardium. The results indicate that Tc-99m-PYP SG is more helpful than the other SGs in the diagnosis of amyloid heart diseases. RI uptake in the liver and thyroid gland, as well as in the myocardium, should be taken into account. (Namekawa, K.)