Tumor Cerebellopontine Angle (CPA) merupakan jenis neoplasma terbanyak yang ditemukan di fossa posterior dengan angka kejadian sebesar 5-10% dari seluruh angka kejadian tumor intrakranial. Mayoritas tumor di CPA adalah schwannoma vestibular sebesar 70%-80%, diikuti meningioma 5-12% dan kista epidermoid 2-6%, serta tumor CPA lainnya, yang masing-masing menyumbang sekitar 1%. Angka kejadian tumor ganas atau tumor metastasis hanya 2% dari keseluruhan tumor CPA. Tumor CPA secara klinis tidak spesifik dan gejala yang muncul tidak terkait dengan sifat lesi itu sendiri, tetapi berhubungan dengan struktur neurovaskular atau struktur otak yang terlibat dengan lesi tersebut. Diagnosis mungkin sulit dibuat karena berbagai jenis sel dan asal tumor tersebut. Oleh karena tumor CPA yang berasal dari spektrum yang sangat luas sehingga menjadi tantangan dalam penegakkan diagnosis. Untuk dapat mencakup seluruh spektrum tumor yang berpotensi ditemukan di CPA, maka diperlukan pencitraan neuroimaging terkait yang perlu diketahui oleh ahli radiologi untuk membuat diagnosis yang relevan secara klinis. Melalui pencitraan radiologi tersebut akan dievaluasi lokasi asal dari tumor, bentuk dan margin, kepadatan, intensitas sinyal dan penyangatan kontras dalam menegakkan diagnosis pra operasi yang lebih akurat. Diagnosis dan tatalaksana tumor CPA diharapkan akan semakin baik, seiring dengan berkembangnya teknik imaging, teknik pembedahan mikro dan radiosurgery
Objective: To assess the correlation between the Alpha-fetoprotein (AFP) level and characteristics of liver lesions listed in the abdominal computed tomography (CT) scan scores in hepatocellular carcinoma.Methods: This was a retrospective analytic observational study with a cross-sectional design conducted at Sanglah Hospital in January 2017–January 2021. Subjects were patients diagnosed with hepatocellular carcinoma based on clinical and laboratory features. Samples were taken by consecutive sampling. The results of the abdominal CT scan were read by two radiologists with a predetermined abdominal CT scan scoring system. The AFP level data were taken at a maximum of 5 days before an abdominal CT scan was performed.Results: A total of 64 subjects were included in this study. The mean serum AFP level was 1,000 IU/mL (range 0.54–61830 IU/mL). The mean abdominal CT scan score by examiner one was 10.093±5.59, while the examiner two provided a score of 10.281±5.45. The difference in mean CT scan scores between the two examiners was very low and insignificant (mean difference score -0.188; 95% CI -1.894–1.519). The rho Spearman value was 0.918 (p<0.001) between serum AFP levels and abdominal CT scan scores. In the partial correlation, the value of r=0.678 (p<0.001) was obtained after controlling for body mass index (BMI), age, and sex variables.Conclusions: There is a strong positive correlation between serum AFP levels and abdominal CT scan scores in hepatocellular carcinoma patients. Further research is needed with a prospective design to reduce research bias.
Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and right hydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression.
Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and righthydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression.
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