RESUMO
PURPOSE: To determine access blood flow (ABF) rate using 2D image sequences acquired with digital subtraction angiography (DSA) and fluoroscopy. MATERIALS AND METHODS: A total of 23 patients with known or suspected malfunctioning accesses were imaged using 2 filming modes: DSA at 3 or 6 frames/s (F/s), and fluoroscopy at 10 or 15 pulses/s (P/s). ABF rates were quantified using a bolus tracking method based on cross-correlation algorithm and compared with catheter-based thermal dilution (TD) flow measurements. The indicator-dilution curves were fitted with a gamma-variate (GV) curve fitting model to assess the effect on accuracy. Radiation doses were calculated to examine any increased susceptibility to tissue reactions and stochastic effects. RESULTS: For DSA images, the absolute percent deviations (mean ± standard error of mean) in computed flow vs TD flow measurements at 3 F/s and 6 F/s were 34% ± 4.5% and 20% ± 4.7%, respectively, without curve fitting, and 31% ± 3.3% and 20% ± 4.1%, respectively, with curve fitting. For fluoroscopic images, the deviations at 10 P/s and 15 P/s were 44% ± 7.3% and 68% ± 10.7%, respectively, without curve fitting and 36% ± 6.4% and 48% ± 7.1%, respectively, with curve fitting. The mean peak skin dose and effective dose at 6 F/s were 3.28 mGy and 75 µSv, respectively. CONCLUSIONS: Digital subtraction angiography images obtained at 6 F/s offered the highest accuracy for dialysis access blood flow quantification.
Assuntos
Algoritmos , Angiografia Digital/métodos , Derivação Arteriovenosa Cirúrgica , Falência Renal Crônica/terapia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Diálise Renal , Grau de Desobstrução Vascular , Idoso , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Termodiluição , Fatores de TempoRESUMO
OBJECTIVE: The purpose of this article is to describe a handheld external compression device used to facilitate CT fluoroscopy-guided percutaneous interventions in the abdomen. CONCLUSION: The device was designed with computer-aided design software to modify an existing gastrointestinal fluoroscopy compression device and was constructed by 3D printing. This abdominal compression device facilitates access to interventional targets, and its use minimizes radiation exposure of radiologists. Twenty-one procedures, including biopsies, drainage procedures, and an ablation, were performed with the device. Radiation dosimetry data were collected during two procedures.
Assuntos
Impressão Tridimensional , Radiografia Intervencionista/instrumentação , Tomografia Computadorizada por Raios X/instrumentação , Adulto , Biópsia/métodos , Ablação por Cateter/métodos , Drenagem/métodos , Desenho de Equipamento , Feminino , Fluoroscopia/instrumentação , Humanos , Masculino , Agulhas , Pressão , Radiometria , Estudos Retrospectivos , Resultado do TratamentoRESUMO
UNLABELLED: The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the thoracic duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the thoracic duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of thoracic duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the thoracic duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner. KEY POINTS: ⢠Describe clinical importance, embryologic origin, and typical course of the thoracic duct. ⢠Depict common/lesser-known thoracic duct anatomic variants and discuss their clinical significance. ⢠Outline the common causes of thoracic duct injury and indications for embolization. ⢠Review the thoracic duct embolization procedure including both pedal and intranodal approaches. ⢠Present and illustrate the success rates and complications associated with the procedure.
Assuntos
Embolização Terapêutica/métodos , Doenças Linfáticas/terapia , Linfografia/métodos , Ducto Torácico , Variação Anatômica , Drenagem , Humanos , Ducto Torácico/anatomia & histologia , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/embriologia , Traumatismos Torácicos/complicaçõesRESUMO
OBJECTIVE: NUT midline carcinoma is a rare poorly differentiated aggressive subtype of squamous cell carcinoma. To date, fewer than 100 total cases have been reported. CONCLUSION: Given the rarity of this disease process and lack of pathognomonic imaging findings, a definitive diagnosis based solely on imaging findings alone is untenable. Select cases are used to emphasize the particularly infiltrative and aggressive nature of NUT midline carcinoma, which shows a complete disregard for normal tissue boundaries and rapid progression during brief intervals.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Diagnóstico por Imagem/métodos , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Carcinoma de Células Escamosas/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias , Proteínas Nucleares/genética , Proteínas Oncogênicas/genética , Neoplasias de Tecidos Moles/genética , Adulto JovemRESUMO
Acute necrotizing pancreatitis is a severe form of acute pancreatitis characterized by necrosis in and around the pancreas and is associated with high rates of morbidity and mortality. Although acute interstitial edematous pancreatitis is diagnosed primarily on the basis of signs, symptoms, and laboratory test findings, the diagnosis and severity assessment of acute necrotizing pancreatitis are based in large part on imaging findings. On the basis of the revised Atlanta classification system of 2012, necrotizing pancreatitis is subdivided anatomically into parenchymal, peripancreatic, and combined subtypes, and temporally into clinical early (within 1 week of onset) and late (>1 week after onset) phases. Associated collections are categorized as "acute necrotic" or "walled off" and can be sterile or infected. Imaging, primarily computed tomography and magnetic resonance imaging, plays an essential role in the diagnosis of necrotizing pancreatitis and the identification of complications, including infection, bowel and biliary obstruction, hemorrhage, pseudoaneurysm formation, and venous thrombosis. Imaging is also used to help triage patients and guide both temporizing and definitive management. A "step-up" method for the management of necrotizing pancreatitis that makes use of imaging-guided percutaneous catheter drainage of fluid collections prior to endoscopic or surgical necrosectomy has been shown to improve clinical outcomes. The authors present an algorithmic approach to the care of patients with necrotizing pancreatitis and review the use of imaging and interventional techniques in the diagnosis and management of this pathologic condition.
Assuntos
Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/terapia , Algoritmos , Humanos , Imageamento por Ressonância Magnética , Pancreatite Necrosante Aguda/classificação , Pancreatite Necrosante Aguda/complicações , Terminologia como AssuntoRESUMO
Cholecystocolonic fistula is an uncommon potential complication of cholecystitis found intraoperatively in 0.06-0.14 % of patients undergoing cholecystectomy and 0.1-0.5 % of autopsy series. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7.9 % of patients. Failure to preoperatively diagnose cholecystocolonic fistula places surgeons in precarious positions, as they may be forced to convert a seemingly routine cholecystectomy to a more sophisticated procedure coupled with adhesiolysis, colonic suturing, or colonic resection. We report a young patient who presented to the emergency department with complaints indicative of acute cholecystitis; however, preoperative ultrasound was suggestive of a cholecystoenteric fistula. Computed tomography and pathology were pathognomonic with clear visualization of the cholecystocolonic fistulous tract.
Assuntos
Colecistite Aguda/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Diagnóstico Diferencial , Fístula/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Humanos , MasculinoRESUMO
Pancreatic ischemia with necrosis is an extremely rare complication of splenic angioembolization (SAE). A 48-year-old male with a grade IV blunt splenic injury underwent angiography which demonstrated no active bleeding or pseudoaneurysm. Proximal SAE was performed. One week later, he developed severe sepsis. Repeat CT imaging showed nonperfusion of the distal pancreas, and laparotomy found necrosis of approximately 40% of the pancreas. Distal pancreatectomy and splenectomy were performed. He endured a prolonged hospital course with multiple complications. Clinicians should have a high index of suspicion for ischemic complications after SAE when sepsis develops.
Assuntos
Embolização Terapêutica , Pancreatite Necrosante Aguda , Sepse , Ferimentos não Penetrantes , Masculino , Humanos , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/terapia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Baço/diagnóstico por imagem , Baço/lesões , Esplenectomia , Pâncreas , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/lesões , Estudos RetrospectivosRESUMO
Angioembolization in blunt splenic trauma is used to maximize splenic preservation. Superiority of prophylactic embolization over expectant management in patients with a negative splenic angiography (SA) is debated. We hypothesized that embolization in negative SA would be associated with splenic salvage. Of 83 patients undergoing SA, 30 (36%) had a negative SA. Embolization was performed in 23 (77%). Grade of injury, contrast extravasation (CE) on computed tomography (CT) or embolization were not associated with splenectomy. In 20 patients with either a high-grade injury or CE on CT, 17 (85%) underwent embolization with a failure rate of 24%. In the remaining 10 without high-risk features, 6 underwent embolization with a 0% splenectomy rate. Despite embolization, the failure rate of nonoperative management (NOM) remains significant in those with high-grade injury or CE on CT. A low threshold for early splenectomy after prophylactic embolization is needed.
Assuntos
Embolização Terapêutica , Ferimentos não Penetrantes , Humanos , Resultado do Tratamento , Estudos Retrospectivos , Baço/diagnóstico por imagem , Baço/lesões , Esplenectomia , Angiografia/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/complicações , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Embolização Terapêutica/métodos , Escala de Gravidade do FerimentoAssuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Achados Incidentais , Neoplasias Hepáticas/terapia , Neoplasias Císticas, Mucinosas e Serosas/terapia , Neoplasias Primárias Múltiplas , Neoplasias Pancreáticas/terapia , Idoso , Angiografia , Antibióticos Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/virologia , Doxorrubicina/administração & dosagem , Endoscopia do Sistema Digestório , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/virologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico por imagem , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do TratamentoRESUMO
Retroperitoneal (RP) hematoma is a rare complication of total vaginal hysterectomy. A 45-year-old female G4P3013 with a history of abnormal uterine bleeding refractory to treatment by endometrial ablation and stress urinary incontinence underwent total vaginal hysterectomy, bilateral salpingectomy, bilateral uterosacral ligament suspension, anterior colporrhaphy, and cystoscopy. After the hysterectomy the left uterine artery pedicle was hemostatic; however, the patient became hemodynamically unstable and anemic. Laparoscopy revealed a stable zone III RP hematoma. Intraoperative observation revealed no further expansion of the hematoma. Left iliac angiography and aortography revealed there was no extravasation from the uterine arteries and gonadal vessels. Four days post-operative abdominal CT showed a stable hematoma. Hemodynamic instability resolved over the post-operative course. RP hematoma must be included in the differential for the evaluation of acute intraoperative hemodynamic instability with an unclear source.
RESUMO
Aspergilloma, also known as mycetoma or fungus ball, is the most common manifestation of pulmonary involvement by Aspergillus species. The fungal ball typically forms within preexisting cavities of the lungs. Diagnosis requires both radiographic evidence along with serologic or microbiologic evidence of Aspergillus species involvement. While clinical features such as hemoptysis, chest pain, shortness of breath, cough, and fever are helpful in diagnosis, they are non-specific symptoms. Surgery is currently the mainstay of treatment for aspergilloma but is associated with considerable mortality and morbidity. Alternative options exist for patients who are poor surgical candidates and for those who prefer a less invasive treatment modality. Systemic treatment with amphotericin B is ineffective and is not recommended as a monotherapy, but systemic azoles is effective in approximately 50-80% of patients. Potential alternatives to surgery include intracavitary instillation or endobronchial administration of antifungal medication, as well as direct transbronchial aspergilloma removal. Bronchial artery embolization and radiotherapy are options to manage hemoptysis until definite eradication of the aspergilloma. More rigorous studies are needed to better establish non-surgical treatment paradigm for inoperable patients.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Azóis/administração & dosagem , Tratamento Conservador/métodos , Aspergilose Pulmonar/terapia , Artérias Brônquicas , Embolização Terapêutica/métodos , Feminino , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Instilação de Medicamentos , Masculino , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/radioterapiaAssuntos
Cesárea , Cicatriz/complicações , Gravidez Ectópica/etiologia , Adulto , Feminino , Humanos , GravidezAssuntos
Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/epidemiologia , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/terapia , Neoplasias Torácicas/patologia , Neoplasias Torácicas/terapiaAssuntos
Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/etiologia , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal , Feminino , Cálculos Biliares/terapia , Obstrução da Saída Gástrica/terapia , Humanos , Litotripsia , Radiografia , SíndromeRESUMO
PURPOSE: Assess the effectiveness of conventional lymphangiography, MR lymphangiography, and lymphatic embolization for the diagnosis and treatment of refractory chylous ascites. MATERIALS AND METHODS: A retrospective review of 31 patients (M/F:16/15, average age 52) who presented for the management of refractory chylous ascites was conducted to assess the diagnostic value of conventional and MR lymphangiography and outcome of lymphatic embolization. RESULTS: Of the total 31 patients, 25 presented with chylous ascites secondary to iatrogenic trauma and six patients with a non-traumatic etiology. All patients underwent conventional lymphangiography and nine underwent MR lymphangiogram. The lymphatic leak was visualized in 17/31 (55%) of the patients (15 of which were traumatic) and in 7/9 MR lymphangiograms (six traumatic and one non-traumatic). Embolization with n-BCA glue and/or coils of the leak was performed in 11 of the 17 patients whose leak was identified (65%) with resolution of chylous ascites in 9/11 (82%) patients. Lymphangiogram alone was curative in 7/20 (35%) patients. Overall, 16/31 patients (52%) had clinical resolution of ascites. Ascites resolved in 13/17 (76%) patients in whom the site of leak could be identified compared to 3/14 (21%) of patients in whom the site of leak could not be identified (p = 0.0038). CONCLUSIONS: Lymphangiography and embolization can be used to treat chylous ascites. Identification of the site of leak is associated with significantly greater rate of clinical success compared to those whose site could not be identified.
Assuntos
Ascite Quilosa/diagnóstico por imagem , Ascite Quilosa/terapia , Embolização Terapêutica/métodos , Linfografia/métodos , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Vasos Linfáticos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Venous malformations are the most common type of congenital vascular malformation. The diagnosis and management of venous malformations may be challenging, as venous malformations may be located anywhere in the body and range from small and superficial to large and extensive lesions. There are many treatment options for venous malformations including systemic targeted drugs, open surgery, sclerotherapy, cryoablation, and laser photocoagulation. This article reviews the natural history, clinical evaluation, imaging diagnosis, and treatment modalities of venous malformations.
Assuntos
Criocirurgia/métodos , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Malformações Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia , Adolescente , Pré-Escolar , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/epidemiologia , Malformações Vasculares/fisiopatologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veias/anormalidades , Veias/diagnóstico por imagem , Veias/fisiopatologiaRESUMO
The purpose of this study was to determine whether auditing an online self-reported interventional radiology quality assurance database improves compliance with record entry or improves the accuracy of adverse event (AE) reporting and grading. Physicians were trained in using the database before the study began. An audit of all database entries for the first 3 months, or the first quarter, was performed, at which point physicians were informed of the audit process; entries for the subsequent 3 months, or the second quarter, were again audited. Results between quarters were compared. Compliance with record entry improved from the first to second quarter, but reminders were necessary to ensure 100% compliance with record entry. Knowledge of the audit process did not significantly improve self-reporting of AE or accuracy of AE grading. However, auditing significantly changed the final AE reporting rates and grades.