Subgroup analysis of accreta, increta and percreta cases using acoustic radiation force impulse elastography.

OBJECTIVE: To compare acoustic radiation force impulse (ARFI) elastography values and histopathological diagnoses (accreta, increta, percreta) in patients suspected of having abnormal placental invasion (API). MATERIALS AND METHODS: This prospective study included 54 patients in the third trimester with a history of caesarian section (CS) and API based on gray scale and Doppler ultrasonography (USG) and 35 healthy controls. Patients underwent ARFI elastography preoperatively. Elastography measurements of the fetal and maternal sides of the placenta were compared to histopathology. RESULTS: Patients had higher maternal-side, fetal-side and average elastography values (P = 0.001). Intraoperatively, eight patients (14.8%) showed abnormal cervical canal invasion and 46 (85.2%) bladder and/or parametrial invasion. Eight patients underwent CS + placental-bed suture, 11 CS + excision of the lower segment, and 35 caesarean-hysterectomy. Histopathology of lower segment excision/caesarian-hysterectomy patients determined 10 (21.7%) accreta, 10 (21.7%) increta and 26 (56.6%) percreta cases. ARFI values were highest in the percreta subgroup. The increta subgroup showed higher ARFI values than the accreta subgroup but maternal-side, fetal-side and average ARFI values were not significantly different across the subgroups (P > 0.05). The cut-off values for average, peripheral and central elastography were determined as >0.90, >0.76, >0.98 (m/s) with sensitivities of 98, 64, 98% and specificities of 85, 80, 91%, respectively. CONCLUSION: ARFI elastography can detect API. However, it cannot determine invasion depth reliably. More studies with subgroup analyses are warranted to reveal its usefulness for invasion depth.

Radiological findings and outcomes of bronchial artery embolization in cryptogenic hemoptysis.

Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

Endovascular management of vascular complications after percutaneous nephrolithotomy.

BACKGROUND: Bleeding is one of the most common and most important complications of percutaneous nephrolithotomy (PCNL), which is mainly controlled with conservative treatment options. Transcatheter arterial embolization is required in less than 1 % of the patients undergoing PCNL. There are only a few studies about endovascular treatment of vascular complications of PCNL. The purpose of this study was to evaluate renal arterial complications of PCNL and treatment outcomes with endovascular coil embolization. PATIENTS AND METHODS: This retrospective study evaluated 16 patients who underwent endovascular management for complications after PCNL, including diagnostic angiography. We analyzed the angiographic appearances of the vascular lesions that caused hemorrhages, treatment outcomes for endovascular coil embolization, and renal parenchymal loss rate following this treatment. RESULTS: Seven patients had a pseudoaneurysm, two patients had an arteriocaliceal fistula (ACF), five patients had a pseudoaneurysm and an arteriovenous fistula (AVF), and two patients had a pseudoaneurysm and an ACF. Of the 14 patients with pseudoaneurysms, five had more than one pseudoaneurysm. Endovascular coil embolization was successful in all patients, and it was able to stop the bleeding. After embolization, 12 patients had less than 10 % parenchymal loss, and 4 patients had 10-20 % parenchymal loss. Mean hospital stay after embolization was 2.3 ± 0.7 days (range, 1 to 3 days). CONCLUSIONS: The injuries seen in the intrarenal arterial system during the PCNL procedure can result in pseudoaneurysms and/or AVFs and/or ACFs, and more than one artery can be harmed. Arterial complications of PCNL can be treated with endovascular coil embolization while preserving renal function at a maximum level.