Preliminary Experience of Endovascular Embolization Using N-Butyl Cyanoacrylate for Hemoptysis due to Infectious Pulmonary Artery Pseudoaneurysms via Systemic Arterial Approach.

We report 5 patients with hemoptysis due to infectious pulmonary artery pseudoaneurysm (PAP) treated with endovascular embolization using N-butyl cyanoacrylate (NBCA) injected via bronchial and nonbronchial systemic arterial approaches. Infectious diseases included inactive tuberculosis (n = 3), nontuberculous mycobacteriosis (n = 1), and chronic infection of unknown origin (n = 1). Seven PAPs were detected on selective systemic angiography, and injection of NBCA was performed. Disappearance of all PAPs was confirmed on systemic arteriography after the intervention. In all patients, hemoptysis was stopped without major complications, and it did not recur during the follow-up period (mean, 351 d; range, 285-427 d).

Interventional therapeutic strategy for hemoptysis originating from infectious pulmonary artery pseudoaneurysms.

This study reports 6 cases of hemoptysis originating from infectious pulmonary artery pseudoaneurysms (PAPs). Selective pulmonary angiography revealed PAPs in 5 cases, and segmental pulmonary artery embolization was performed using coils and gelatin sponge particles. Systemic arterial embolization also was performed in 5 cases because of inadequate initial control or for shunts from systemic to pulmonary arteries. At a median follow-up time of 9 months (range, 25 d to 25 mo), no recurrence occurred, although 2 patients died of respiratory failure. Segmental artery embolization combined with systemic artery embolization may be useful in patients with hemoptysis secondary to PAPs.

Hepatic arterial infusion chemotherapy with fine-powder cisplatin and iodized-oil suspension in patients with intermediate-stage and advanced-stage (Barcelona Clinic Liver Cancer stage-B or stage-C) hepatocellular carcinoma: multicenter phase-II clinical study.

PURPOSE: This single-arm, multicenter, phase-II trial evaluated the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) using fine-powder cisplatin and iodized-oil suspension in patients with intermediate- and advanced-stage [Barcelona Clinic Liver Cancer (BCLC) stage-B and stage-C] hepatocellular carcinomas (HCCs). METHODS: The Institutional Review Board approved this study and patients provided written informed consent. Thirty-five patients (24 men and 11 women, mean 74 ± 6 years [range 60-87 years]) with BCLC stage-B (57 %, 20/35) or stage-C (43 %, 15/35) HCCs who were not candidates for other locoregional treatments were enrolled. HAIC was performed using a suspension of fine-powder cisplatin with a maximum dose of 65 mg/m(2) and iodized oil on demand. The primary endpoint was the response rate evaluated based on Response Evaluation Criteria in Solid Tumor (RECIST) and modified RECIST (mRECIST). Secondary endpoints were overall survival, progression-free survival, and safety. RESULTS: The initial and best overall response rates at 4 weeks and 3 months, respectively, were 14 and 17 % based on RECIST, and 57 and 23 % based on mRECIST. The median overall and progression-free survival times were 18 and 4 months, respectively. The most frequent grade-3 or grade-4 adverse events were elevation of serum alanine (23 %) and aspartate aminotransferase (20 %), and thrombocytopenia (17 %). CONCLUSION: This HAIC provides promising therapeutic effects with acceptable safety to patients with intermediate-stage and advanced-stage HCCs.

Intravenous Lobular Capillary Hemangioma Occurring after Needle Insertion during Routine Health Checkup.

Surgery was performed on a 53-year-old male patient with a painful mass in front of the elbow. The mass originally occurred after needle insertion during a routine health checkup and grew in size during a 1-year period. Intravenous tumor with arterio-venous fistula was diagnosed, and it was resected. Histopathological diagnosis of intravenous lobular capillary hemangioma was made. Occurrence of this tumor after a routine health checkup is rare. The etiology of this tumor occurring simultaneously with arteriovenous fistula is discussed.

Rapid development of aneurysmal formation after successful endovascular treatment of chronic total occlusion of a persistent sciatic artery.

Persistent sciatic artery (PSA) is a rare congenital anomaly that is frequently complicated by atherosclerotic changes, such as occlusion and aneurysmal formation. This report describes a case of a chronic total occlusion (CTO) of a unilateral, complete-type PSA in the right thigh of a 74-year-old woman that was treated successfully with endovascular angioplasty and stent placement. Within 3 months, however, a PSA aneurysm developed in the gluteal region. This aneurysm was repaired endovascularly through placement of a stent graft. To the authors' knowledge, rapid formation of a PSA aneurysm and successful endovascular treatment of both CTO of a PSA and of a PSA aneurysm have not been reported previously.

Early second-trimester diagnosis of body stalk anomaly by fetal magnetic resonance imaging.

We report a case of body stalk anomaly detected prenatally by fetal magnetic resonance imaging (MRI) at 14 weeks' gestation. A 29-year-old woman was followed during her first pregnancy. At 11-12 weeks' gestation, our sonographic images showed multiple fetal deformities. An abdominal wall defect was suspected. The exteriorized abdominal contents and the lower limb appeared within the extraembryonic celom with an intact amniotic membrane. Fetal MRI at 14 weeks' gestation confirmed a large anterior wall defect with herniation of the liver and bowel. In addition, abnormally rotated lower limb and scoliosis could be demonstrated. The fetus was prenatally diagnosed with body stalk anomaly, expected to be lethal in nature. The parents decided to terminate the pregnancy at 15 weeks' gestation. Prenatal diagnosis of body stalk anomaly is usually based on sonographic findings. As far as we are aware, this is the first case report of body stalk anomaly satisfactorily diagnosed by fetal MRI in the early second trimester. Fetal MRI scans should provide ground for a precise antenatal diagnosis of body stalk anomaly from early gestation.

Ectopic cervical thymoma located in the carotid triangle.

Ectopic cervical thymoma is an extremely rare tumor thought to arise from ectopic thymic tissue caused by the aberrant migration of the embryonic thymus. We present the case of a 44-year-old woman with an ectopic cervical thymoma located in the carotid triangle. A computed tomography (CT) scan detected a mass in her right carotid triangle. On an unenhanced scan, the tumor showed homogeneous isodensity compared with muscles, and neither fat nor calcification was detected. A contrast-enhanced CT image obtained during the arterial phase showed intratumoral septa, while an image obtained during the parenchymal phase showed cystic changes within the mass. The patient underwent a surgical resection. A histological study enabled a diagnosis of type AB thymoma in which foci with the features of type A thymoma are admixed with foci rich in lymphocytes. This subtype is a benign tumor with a good prognosis. Ectopic cervical thymoma should be included in the differential diagnosis of solid masses located in the carotid triangle when the CT findings are typical of a thymoma.

Dieulafoy lesion in the ileum of a child: a case report.

A 14-year-old girl had massive bleeding from a Dieulafoy lesion of the ileum. A preoperative dynamic computed tomography scan detected the point of bleeding. Selective arteriography with embolization using microcoils could not stop the bleeding, but the microcoils were useful as markers of the location of the bleeding point. The position of the microcoils was confirmed by intraoperative fluoroscopy. A partial resection of the ileum that included the lesion was performed. The pathologic finding was Dieulafoy lesion of the ileum. Dieulafoy lesion is a rare condition that usually presents in the stomach. Dieulafoy lesion of the ileum is extraordinarily rare, and to our knowledge, this is only the second case report of an ileal lesion in a child.

Can selective CT angiography reduce the incidence of severe complications during transcatheter arterial embolization or infusion chemotherapy for thoracic diseases?

PURPOSE: To evaluate the usefulness of selective computed tomography (CT) angiography in preventing severe complications, such as spinal cord injury and broncho- esophageal fistula, during the transcatheter arterial embolization or infusion chemotherapy for thoracic diseases. MATERIALS AND METHODS: Data from 28 patients with thoracic diseases were retrospectively analyzed in terms of selective CT angiography procedures carried out before transcatheter arterial embolization or transcatheter arterial infusion chemotherapy. RESULTS: There were no spinal cord injuries (0/13 and 0/15) or broncho-esophageal fistula developments (0/13 and 0/15) during transcatheter arterial embolization and transcatheter arterial infusion chemotherapy, respectively. CONCLUSION: We conclude that selective CT angiography is potentially useful for reducing the incidence of severe complications during transcatheter arterial embolization or infusion chemotherapy for thoracic diseases.

Reconstructive surgery for segmental arterial mediolysis involving both the internal carotid artery and visceral arteries.

Segmental arterial mediolysis (SAM) is a rare, nonatherosclerotic, noninflammatory arteriopathy. A 52-year-old man with sudden hemiparesis of the right side was found to have an aneurysm of the left internal carotid artery and concomitant multiple aneurysms of the extrahepatic, celiac, and superior mesenteric arteries. Reconstructive operations using autologous vein graft were performed to treat the aneurysms. The histopathology analyses of resected arterial and aneurysmal specimens showed characteristics consistent with SAM. To our knowledge, a successfully treated case of SAM affecting both the carotid artery and visceral arteries has not previously been described.