大韓放射線뽑學會훌 第 24 卷第 6 號 pp , 1988 Journal of Korean Radiological Society, 24(6) , 1988 大網케익의超音波所見慶熙大學校醫科大學放射線科學敎室朴基淳朴容兌李東鎬高永泰李善

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1 大韓放射線뽑學會훌 第 4 卷第 6 號 pp , 1988 Journal of Korean Radiological Society, 4(6) , 1988 大網케익의超音波所見慶熙大學校醫科大學放射線科學敎室朴基淳朴容兌李東鎬高永泰李善和林在勳 - Abstract- Ultrasonographic Findings of Omental Cake Ki 500n Park, M.D., Yong Tai Park, M.D., Dong Ho Lee, M.D., Young Tae Ko, M.D. 5un Wha lee, M.D., Jae Hoon Lim, M.D. Department of Diagnostic Radiologκ Kyung Hee University Hospital Om ental cake is defined as a pancake' like diffuse thickening of the greater omentum, stretching from the greater curvature of the stomach down to the lower abdomen. The causes of omental cake are metastatic ab. dominal tumor, mesothelioma and peritonitis The authors evaluated the sonographic findings of omental cakes in 9 patients with metastatic cance r and 17 patients with bacterial o r tuberculous peritonitis. Omental cakes were diffuse (78%) or localized (%), hyperechoic (78%) or heterogenous echogenic (%), and irregular or smooth. There was no differential point between malignant tumor and inf.la:mmation. The authors stress that a rad iologist sho비 d be al ert to detect an omental cake as a staging work-up in patients with cancer or peritoneal inflammatory disease. 에서경험한총 4 례의大網케익의初音波소견을文敵 1. 絡를 t a 뼈 考察파함께보고하는바이다. 大網케익은大網이횡행결장앞으로톱의大變으로 부터下題部까지마치펀펀한반대떡처럼 ßEI 享되어있 는것으로난소암을비롯한자웅암, 대장암, 혜장암유 방암동에의한轉移性題部睡場이나一次性中願體찢 에서도나타난마, 4, 5 ) 大網케익의電算化斷層握影 ( 이후 CT 로약함 ) 소견 에대한보고들은있으나 1-4) 初音波소견에대한보고 는거의없는실정이다 5 ) 이에著者들은최근 4 년간慶熙大學病院放射線科 이논운은 1988 년 10 월 1 일에접수하여 1988 년 1 월 7 일에채택되었음. n. 對象및方法 1985 년 6월부터 1988년 1 0월까지 4년간慶熙大學病院放射線科에서初훌波檢흉를받은환자중수술둥으로확진펀 46 례를대상으로하였고각각의확진방엽은다음과같다. 惡性睡場 9명중 14 명은개복술을시행한바그중 9 례에서는직접大網의 ßE훔所見을확인하였다. 또 8 명은세청흉업생검및천자검사에서輯移性홉임을확인하였으며나머지 7영은原發性惡性睡場의파거력이있던愚者였다. *!Æ 性 8흥體 * 愚者 17 영으l 경우穿孔性蟲畢淡 명파擔覆좁體!Æ. 結核性題體 * 및原發性

Q) a- 朴基淳外 : 大網케익의超흡波所見 - 8 흉體찢각 1 명씩 5 명은개복술상에서, 다른 명의結 Table 1. of Omental Cake 核性題體찢愚者와 g 市吸蟲性願體찢愚者에서는복강경하에서역시大網 ßE훔를확인하였고생검에서원인질환이확진되었다. 그외結核性및原發性題體찢愚者와睡魔씻愚者에서는 paracentesls 및임상적경파로서원발성원안을알수있었다.

2 Q) a- 朴基淳外 : 大網케익의超흡波所見 - 8 흉體찢각 1 명씩 5 명은개복술상에서, 다른 명의結 Table 1. of Omental Cake 核性題體찢愚者와 g 市吸蟲性願體찢愚者에서는복강경하에서역시大網 ßE훔를확인하였고생검에서원인질환이확진되었다. 그외結核性및原發性題體찢愚者와睡魔씻愚者에서는 paracentesls 및임상적경파로서원발성원안을알수있었다. 初音波檢훌는 T oshiba SAL 0A, 55A와 SSA 90A 를사용하였고. 5MHz linear array tr a n s duc e r를사용하였다. 初音波檢흉상大網케익의양성소견은大網이두께 1 cm 이상, 크기는 One linear transducer 조사범위 ( 약 Malignancy stomach cancer colon cancer pancreas cancer liver cancer lung cancer breast cancer ovary cancer retroperitoneal cancer unknown Case ζu9 4 ι1i 1l 1i 1i Numer 9 8cm) 이상服原되어小陽을전복벽에서轉位시키는경우로하였다. m. 結果총 46례중男子가 영女子가 4영이었고연령분포는 4세에서 71세까지였다. 46 영의환자중 9명은轉移性獨이었고 (Fig 1, ) tuberculosis peritonitis pyogell1c pentoll1tls parag0ll1mlas1s pancreatltls gallbladder empyema Total --1i 끼/ 1i 영은 ØHE 性 R 흥模찢이었으며 (Fig -5) 各各의원인 은 Table 1 파같다. 大網케익은미만성大網 ßE 훔소견을보인경우가 6 례 ( 7 8%) 로대부분이었고 1 0 례 (%) 에서는국소성이 였으며各各의부위는 Table 와같다. 에코樣相은전체 46 례중 6 례 (78%) 에서高에코型 (Hyperecholc ) 으로관창되었고 10 례 (% ) 에서는高 B Fig.l. Case 1. Metastatic adenocarcinoma A.US finding. Midline longitudinal scan shows thickened greater omentum(arrowheads), forming 8.1 x 8.7 cm sized hyperechoic mass and which is bounded by posteriorly located bowel and anterior abdominal wall in lower mid-abdomen. A small amount of ascites is also noted in pelvic cavity B. CT finding. Postcontrast CT scan reveals a pan-cake like diffuse thickening of omentum(arrowheads) in lower mid-abdomen

- 大韓放射線뿔學會誌 : 第 4 卷第 6 號 1988 - Table. Extent of Omental Cake Diffuse Locaized Upper abd RUQ RLQ Pelvis Malignancy 6 Tuberculous peritonitis 5 Pyogenic peritonitis Perforated appendicitis Parag.

3 - 大韓放射線뿔學會誌 : 第 4 卷第 6 號 Table. Extent of Omental Cake Diffuse Locaized Upper abd RUQ RLQ Pelvis Malignancy 6 Tuberculous peritonitis 5 Pyogenic peritonitis Perforated appendicitis Parag.;mimiasis Pancreatitis Gallbladder empyema Total 6(78%) 10(%) 4 Fig.. Case. Overian serous cystadenocarcinoma, right A, US finding. S light oblique midline longitudial scan shows diffusely thickened omejltum(arrows) with mixed echogenecity in mid lower abdomen. The inner margin is irregular. Below it right ovary(o) shows round cystic mass with multiple septations and sold components, attached to right side of uterus. UB= Urinary bladder B. CT finding. Postcontrast CT scan shows irregular thickening with modularity of right side greater omentum(arrows), so called omental cake". A large right ovarian mass(o) and small amount of ascites are also seen 에코와低에코가동시에나타냐는複合에코型 (mixed debris 냐 septat lo n의소견을보였고 (88 %) se ptation 이 echogenic ) 이었다 ( Table ) 있는경우 5 례모두 debris 소견이있었마. 또惡性睡大網케익의內測경계는 8 례 (8%) 에서불규칙하였 場과 ~i1e j 生碩體졌원인에의한題水구별은큰의의가 마 (Table 4 ) 없었마 (Tab l e 5) 4 례 (9% ) 에서 R흥水가동반되었고대부분題水內

4 朴基淳外 : 大網케익의超音波所見 N. 考察大網케익은난소암을비롯한자웅암, 대장암, 혜장 암, 유방암둥轉移性題홈睡傷이나일차성中 R조葉上皮睡에서발견되며 1. ) 그외結核性題體졌에서도냐타난다 -5) 그러나이론적으로大網케익은轉移性睡場을칩범하는모든질환에서나타날수있마. 愚者들의경우轉移性惡生睡場에의한경우가 9 례 (6%) 였고원말부위는몹 9 례, 大陽및睡魔各 4 례, 8구 례, 그외師, 유방, 난소, 後題願 R호이各各 1 례씩이었다. 졌뾰性題體졌은 17 례 ( 7% ) 로원인별로보연結核이 9 례로가장않았고細園性題體갖이 례, 穿空性題體 * 이 례였고師吸蟲性願體찢, H쭉職왔및 R홈훌훌훌 g홈tje O 1 各 1 례씩이었마. 근본적으로大網케익의初音波소견은 CT소견과크게다를바는없마. 大網이앞치마처럼미만성 ßE훔를보여톱의大變에서下題部까지이행되어初音波檢흉상펀펀한睡塊로高에코또는複合에코型으로천복벽으로부터小陽이냐大陽을전위시킨다. Yeh 6 ) 는이차성악성종양에의한願體睡塊를결철행 (nodula r), mantle 또는 sheetlik e형, 불규칙형 (i rreg ul앙 ) 등 가지유형 A로분류하였는데大網케익은이중큰 mantle or s h ee tlike 형에해당된다고볼수있다. 著者들의경우는두께가 1cm 크기는직경 8cm (one linear tr- Fig.4. Case 4. Pyogenic peritonitis. Transverse abdominal scan discloses diffuse thickening of the greater ornenturn(between arrows). The ornental cake cornes in direct contack with the anterior abdorninal wall, but transversalis fascia-parietal peritoneal cornplex of echogenic line is well preserved. Fig.5 Case 5. Post-appendectorny abscess. Transverse scan at both side of urnbilicus. Band-like ornental cake(between arrowheads) is located at rnid-abdornen. Below it there is a fluid collection containing echogenic debris and sorne air indicating the fluid is pussy. '=Abscess Fig.. Case. Tuberculous peritonitis. Transverse scan of mid-abdornen shows a diffusely thickened omenturn(between arrowheads). Moderate amout f ascites is also noted in left abdornen ansducer 조사범위 ) 이상大網服훔시大網케익소견으로분류하였마. 총 46례중 6 례 ( 78% ) 에서미만성 ßE j 享소견을보였으며국한성인경우는 10 례였마. 에코樣相은 6 례 (78%) 에서高에코型을보였고 10 례 (%) 에서는複合에코型이었다. 이는 Yeh 51 가보

5 Table. Malignancy Echo Pattem of Omental Cake tubercul ous peritonitis pyogemc pentomtls paragoolmlas ls pancreatltls gajlbladder empyema - 大韓放射線훌훌學會註 : Hyperechoic Mixed l Total 6(78%) 10(%) Table 4. Malignancy Inner Mrgin of Omental Cake tuberculous peritonitis pyogeolc pentomtls paragoolmlasls pancreatjtls gajlbladder empyema Total Table 5. Malignancy. Smooth ζu끼jqι8(17%) Characteristics of Associated Ascites tuberculous peritonitis pyogeolc pentomtls paragoolmlasls pancreatl!ts gallbladder empyema Total 7 Irregular (8%) Clear Debris/ Septa 5(1%)?I δj i 14 8(88%) Three cases of malignancy show no ascites 고한다양한에코樣相파일치하며高에코型이많은것 은크기및침엄정도와판계가있을것으로사료된다. Levett 7 ) 은 CT상惡性睡場에의한大網케익은복부근육하정상지방증의소실을초래한다하였고임둥 5 ) 第 4 卷第 6 號 은결핵성大網케익의경우前願뿔의外뼈 ij 題體으l 보존 을보고하였으나著者들의경우이를확실히식별하기 가곤란하였다 Goldherg 8 ) 는願水의불규칙한축적이나 싸않犯所見이악성願水를시사하는소견이라하였고 Ede 1l 9 ) 은 d e hri s 냐 se pta t lo fl 은感씻性複水所見이며 loculated fluid, matted howel l oo p 파 8 주轉移둥은惡生願水의 소견이라하였다. 著者들의경우 4 례 ( 9% ) 에서娘水가동반되었는데 8 례 (9% ) 에서顆水가동반되었 는데 8 례 (88% ) 에서題水內 d e hri s 냐 septat lo fl 소견 이있었으며이들소견은惡性및 *tje l 生題水의쿠벨에 큰의의는없는것으로사료된다. v. 結 든 & ;;l1li 著者들은 1985년 6월부터 1988년 10월까지慶熙大學病院放射線科에서初音波檢훌를받은환자중원발성원인이확진된 46 례大網케익소견을바교분석하여마음파같은結果를얻었다 례의大網케익환자중轉移癡이 9 례 ( 6% ) 였고찢효性願體 * 이 17 례 (7%) 였다.. 미만성大網 REJ 享소견을보인경우가 6 례 (78% ) 로대부분이었다.. 에코樣相은 6 례 (78% ) 에서高에코型이었고 10 례 ( % ) 에서는複合에코型이었마. 4. 大網케익의內얘0경계는 8 례 ( 8% ) 에서불규칙하였마. 5. 願水는 4 례 (9%) 에서동반되었고 8 례 (88%) 에서 dehris냐 septatlon 소견이관찰되었으며惡性睡場파찢뾰性題睡찢원인에의한특징적인쿠 t셜은큰의의가없었다. 결흔적으로복부초음파검사시악성복부종양이나염증성질환에서동반될수있는大網케익의발견에주의를기울여야할것으로사료된다. REFERENCES 1. Levitt RG, Koehler RE, Sagel et al: Metastatic disease of the mesentery and omentum. Radiol Clinics North Am 0:10-510, 198. Cooper C, ]effrey RB, Silverman PM et al: Computed tomography of omental pathology. ] Compu

6 - 朴基淳外. 大網케익의超훌波所見 - ter Assist Tomogr 10:6-66, 1986 Radiology 1:419-44, Epstein BM, Mann JH: CT of abdominal tuber- 7. Levitt RG, Sagel SS, Stanley RJ: Detection of culosis. A]R 19: , 198 neoplastic involvement of the mesentery and omen- 4. Dahlene DH, Stanley RJ, Koehler RE et al: Abdo- tum by computed tomography. A]R 11:85-88, minal tuberculosis;ct findings. ] Computer Assis 1978 Tomogr 8:44-445, Goldberg BB: Ultrasonic evaluation of intraper- 5. 엄재훈, 성동욱, 이동호둥 : 결핵성대망케익. 대한 itoneal fluid. ]AMA 5:7-4α 1976 초음파의학회지 7-1 : 77-80, Edell SL, Gelfin WB: Ultrasonic dif[erentiation of 6. Yeh HC: Ultrasonography of peritoneal tumors. types of ascitc fluid. A]R 1: ,

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(49-54)Kjhps004.hwp Biliary Cystadenoma and Cystadenocarcinoma of the Liver Jae Hoon Lee, M.D., Dong Ho Choi, M.D. 1, Kyeong Geun Lee, M.D., Hwon Kyum Park M.D. and Kwang Soo Lee, M.D. Department of Surgery, College of Medicine,

大韓放射線뽑學會훌 第 24 卷第 6 號 pp , 1988 Journal of Korean Radiological Society, 24(6) , 1988 大網케익의超音波所見 慶熙大學校醫科大學放射線科學敎室 朴基淳 朴容兌 李東鎬 高永泰 李善

大韓放射線뽑學會훌 第 24 卷第 6 號 pp , 1988 Journal of Korean Radiological Society, 24(6) , 1988 大網케익의超音波所見慶熙大學校醫科大學放射線科學敎室朴基淳朴容兌李東鎬高永泰李善