RESUMO
A 70-year-old woman with a history of hypertension developed acute onset of severe tightness headache accompanied by vomiting. Patient reported having right diplopia and occasional and temporary right peripheral facial paralysis for two weeks. Neurological examination revealed only a right squint. Cerebral multi-detector computed tomographic angiography (MD-CTA) and Magnetic Resonance Imaging (MRI) revealed a giant right internal carotid aneurysm (2.7 cm) at the cavenous segment (Figure 1A, 1B). No abnormalities were noted in subarachnoid spaces and white - grey matter. A selective digital subtraction angiography (DSA) of the right internal carotid artery confirmed the giant aneurysm at the cavenous segment (Figure 2A, 2B). Subsequently endovascular flow-diverting stent was deployed at the cavernous segment of the right internal carotid artery to treat over time the giant aneurysm. Her clinical course has no neurological symptoms and she was discharged after two days with established over time clinical and imaging follow-up. Giant intracranial aneurysms and vascular anomalies of the internal carotid are rare, and are defined "giant" those greater than 2.5 cm in diameter (1-4). Conservative treatment of giant intracranial aneurysms have a mortality rates of 65-100% in 2-5 years (4). Clinical presentation of internal carotid aneurysms at the petrous segment can manifest from no-symptom to headache, cranial nerve disturbs and epistaxis (1- 4). MD-CTA and MRI are the two gold standard methods for diagnosis in patients with suspected internal carotid artery and intracranial artery aneurysm (1,5). Internal carotid aneurysms at the cavenous segment are located in a surgically difficult accessible area, therefore endovascular percutaneous techniques are considered the first lines treatments (6).
Assuntos
Doenças das Artérias Carótidas , Aneurisma Intracraniano , Malformações Vasculares , Humanos , Feminino , Idoso , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia DigitalRESUMO
A 77-year-old woman with a 1 years history of Multiple Myeloma (MM) presented with headache, fatigue, and bone pain. She underwent whole body multi-detector computed tomographic (MD-CT) to evaluate possible lytic bone lesions. MD-CT showed small, multiple osteolytic lesions, particularly at the skull level (Figure 1, 2). MM is a plasma cell disorder. It is characterized by the monoclonal proliferation of malignant plasma cells (1,2). These cells, among their various characteristics, determine an infiltrate haemopoietic locations (1). Pathogenesis of MM related bone disease is the uncoupling of the bone remodelling process. There is an increased activity of osteoclastogenesis with the suppressed osteoblastic one, resulting in bone loss (1- 3). This process creates lytic lesions without reactive bone formation (2). Bone disease could be from single lytic lesion to multiple lytic lesions affecting any part of skeleton, preferably skull, spine and long bones (3). MD-CT, with dedicated low-dose protocols, is able to provide whole body skeletal volume information with a greater sensitivity than conventional X-ray studies in MM patients (3). Whole body CT with lowdose protocols can detect lesions with less than 5% trabecular bone destruction, and it is the first-line diagnostic imaging procedure for the diagnosis of lytic bone disease in patients affected by MM (4). When skull is involved, its most common MD-CT presentation is by numerous, well-circumscribed and punched-out lytic bone lesions, without reactive bone formation and diffuse osteopenia (1-5), as in the case presented.
Assuntos
Doenças Ósseas , Mieloma Múltiplo , Idoso , Feminino , Humanos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Crânio/diagnóstico por imagemRESUMO
Facial ArterioVenous Malformations (AVM) are rare lesions and present great difficulty in their diagnosis and treatment. We report a case of a 24-year-old male who has been diagnosed a right facial AVM that underwent endovascular embolization with a liquid embolic device and consequently surgical resection. The type of liquid embolic device used has given advantage for both treatment techniques.
Assuntos
Artérias , Embolização Terapêutica , Humanos , Malformações Arteriovenosas Intracranianas , Masculino , Adulto JovemRESUMO
Interventional radiology provides local management of bone metastases (BM) with a palliative intent in most cases, or with a curative intent in selected patients. Its role has rapidly expanded in the last decade, offering new treatment solutions often in combination with surgery, radiation therapy and medical treatments. The aim of the present paper is to increase awareness, acceptance and adoption of interventional radiology procedures for the treatment of BM; and to present the joint position of the Italian College of Musculoskeletal Radiology and the Italian College of Interventional Radiology.
Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Radiologia Intervencionista/normas , Humanos , ItáliaRESUMO
ation. No significant past medical history except for pharmacologically controlled mild hypertension. During the neurological examination the patient appeared alert, oriented and showed no deficit of strength, sensitivity and coordination. An expressive temporary aphasia was confirmed and Transient Ischemic Attacks (TIA) was suspected. Cranial Computed Tomography Angiography (CTA) showed hypoplasia of left Internal Carotid Artery (ICA) with a focal duplication in the intracavernous segment (Figure 1, arrowhead). Circle of Willis appears to be regular, with the left middle cerebral artery supported by the vertebrobasilar system through the left posterior communicating artery of increased caliber, and by the contralateral ICA via anterior communicating artery. Consequently, patient underwent Digital Subtraction Angiography (DSA) lateral view that confirmed the segmental duplication of the left intracavernous ICA (Figure 2, arrowhead). Vessels had a lightly winding course within the cavernous sinus and the intracranial branches downstream of their confluence presented a slight delay in visualization. After few hours her symptoms completely regressed and, in agreement with clinical and imaging data, diagnosis of TIA was made. The transient ischemic event was, in fact, most likely caused by low flow to the left cerebral hemisphere due to hypoplasia of the ICA and aforementioned abnormalities of its intracavernous tract that caused alteration and reduction of intracranial flow distribution. Medical treatment with anti-platelet drugs was started and patient was discharged with a clinical, laboratory and imaging follow-up program. Duplications of ICA in the intracranial tract are very rare(1,2). Most of the cases are localized in the supraclinoid segment. To our knowledge this is the first case described in literature of true duplication of ICA in the intracavernous tract. Patients with congenital variants or acquired pathology of ICA are mostly asymptomatic, but when symptoms appear, patients must be investigated(1-3). CTA is considered the first line non-invasive diagnostic method for intracranial vascular anatomy. At present, medical treatment remains the choice in patients with no-complicated duplications of ICA in the intracranial tract.
Assuntos
Artéria Carótida Interna , Angiografia Digital , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , HumanosRESUMO
A 77-year-old woman with a history of hypertension developed acute onset of aphasia and right hemiplegia and hemisensory loss. She was urgently referred to emergency department. Cerebral multidetector computed tomographic angiography (MD-CTA) revealed an acute ischemic stroke due to the occlusion of the left middle cerebral artery (Figure 1). Since the symptoms started three hours previously, the patient was candidate for mechanical thrombectomy. The patient then performed a selective digital subtraction angiography (DSA) of the left internal carotid artery that confirmed occlusion of the ipsilateral middle cerebral artery (Figure 2) and subsequently successfully performed the endovascular mechanical thrombectomy (Figure 2). Her clinical course has shown neurological symptoms improvement over time. Acute ischemic stroke can be caused by several factors, but the main ones are arterial and cardiac embolism, arterial wall disease or variants(1-4). The National Institutes of Health Stroke Scale (NIHSS) score, is widely used as clinical assessment for neurological deficits related to ischemic stroke(1). MDCTA and Magnetic Resonance Imaging are the two gold standard methods for diagnosis in acute ischemic stroke patients(1-5). Thrombolytic therapy of this pathological state began in the fifties, while the endovascular mechanical thrombectomy was defined as a new standard of care in 2015(1,5,6). This recent technique have added tissue window" to the existing "time window" (5,6). So, nowadays patients with small ischemic core, large penumbra, and good collaterals vessel may benefit from endovascular mechanical thrombectomy(1,5,6); even if they arrive within 6-24 h of stroke onset(5.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Trombectomia , Terapia Trombolítica , Resultado do TratamentoAssuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Tumor de Klatskin/diagnóstico por imagem , Idoso , Ductos Biliares Intra-Hepáticos/patologia , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
OBJECTIVES: To present the results of our experience with cyanoacrylic glue percutaneous injection to treat post-surgical non-healing enteric fistulae after failure of standard treatments. METHODS: Eighteen patients (14 males; age range 33-84, mean 69 years) were treated for a non-healing post-surgical enteric fistula after failure of standard treatments. Under computed tomography and/or fluoroscopic guidance, a mixture of cyanoacrylic glue (Glubran 2, GEM, Viareggio, Italy) and ethiodized oil was injected at the site of the fistula. Fistula was considered healed when no material was drained by the percutaneous drainage and a subsequent computed tomography confirmed the disappearance of any fluid collection. RESULTS: In all cases, it was possible to reach the site of the fistula using a percutaneous access. A median of 1 injection (range 1-5) was performed. Fistula healing was achieved in 16/18 (89 %) patients. One patient died for other reasons before fistula healing. Median time for fistula healing was 0 days (mean 8, range 0-58 days). No complications occurred. Reoperation was needed in one patient. CONCLUSIONS: Percutaneous injection of cyanoacrylic glue is feasible, safe, and effective to treat non-healing post-surgical enteric fistulae. It may represent a further option to avoid surgical reoperation in frail patients.
Assuntos
Cianoacrilatos/administração & dosagem , Fístula Intestinal/terapia , Radiografia Intervencionista , Adesivos Teciduais/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Injeções Intralesionais , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , CicatrizaçãoAssuntos
Corpos Estranhos/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Jejuno , Nozes , Idoso de 80 Anos ou mais , Tratamento Conservador , Corpos Estranhos/complicações , Corpos Estranhos/terapia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Jejuno/diagnóstico por imagem , Masculino , Radiografia AbdominalAssuntos
Tumor Glômico , Neoplasias Gástricas , Gastroscopia , Tumor Glômico/diagnóstico por imagem , Tumor Glômico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Antro Pilórico/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologiaRESUMO
PURPOSE: This study was undertaken to evaluate primary stenting in patients with inferior vena cava torsion after orthotopic liver transplantation performed with modified piggyback technique. MATERIALS AND METHODS: From November 2003 to October 2010, six patients developed clinical, laboratory and imaging findings suggestive of caval stenosis, after a mean period of 21 days from an orthotopic liver transplantation performed with modified piggyback technique. Vena cavography showed stenosis due to torsion of the inferior vena cava at the anastomoses and a significant caval venous pressure gradient. All patients were treated with primary stenting followed by in-stent angioplasty in three cases. RESULTS: In all patients, the stents were successfully positioned at the caval anastomosis and the venous gradient pressure fell from a mean value of 10 to 2 mmHg. Signs and symptoms resolved in all six patients. One patient died 3 months after stent placement due to biliary complications. No evidence of recurrence or complications was noted during the follow-up (mean 49 months). CONCLUSIONS: Primary stenting of inferior vena cava stenosis due to torsion of the anastomoses in patients receiving orthotopic liver transplantation with modified piggyback technique is a safe, effective and durable treatment.
Assuntos
Constrição Patológica/cirurgia , Transplante de Fígado/métodos , Complicações Pós-Operatórias/cirurgia , Stents , Veia Cava Inferior/cirurgia , Adulto , Anastomose Cirúrgica , Constrição Patológica/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Aneurysm of the jejunal artery (JA) is very uncommon with few specific symptoms, but can be a lethal entity. When at risk to rupture, it must be treated expeditiously to avoid mortality. We report a case of a 76-year-old male patient that underwent contrast-enhanced multi-detector computed tomography (MDCT) which incidentally reveals a 12 mm saccular aneurysm of the third JA at the bifurcation of the first arcade. Patient underwent successful endovascular embolization using the isolation technique with the Amplatzer Vascular Plug 4. The patient's recovery was unremarkable and he was discharged on postoperative day 5. Follow-up MDCT reveals total exclusion of the saccular aneurysm of the third jejunal artery with patency of the distal branches.
Assuntos
Aneurisma/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Jejuno/irrigação sanguínea , Idoso , Aneurisma/diagnóstico por imagem , Meios de Contraste , Desenho de Equipamento , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Valor Preditivo dos Testes , Resultado do TratamentoRESUMO
Central venous catheterization is a routine vascular access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to pseudoaneurysm formation. We report a case of a 41-year-old female that developed an iatrogenic left subclavian pseudoaneurysm complicating the attempt of left internal jugular vein cannulation for temporary hemodialysis therapy. The patient underwent urgent endovascular treatment with deployment of covered stent into the left subclavian artery (SCA) after embolization of the origin of the left internal mammary artery with Amplatzer Vascular Plug 4. The patient's recovery was unremarkable. Follow-up till 24 months reveals total exclusion of the pseudoaneurysm of the left SCA with patency of the distal branches.
Assuntos
Falso Aneurisma/terapia , Angioplastia com Balão/instrumentação , Cateterismo Venoso Central/efeitos adversos , Embolização Terapêutica/instrumentação , Doença Iatrogênica , Veias Jugulares , Stents , Artéria Subclávia/lesões , Lesões do Sistema Vascular/terapia , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/fisiopatologia , Feminino , Humanos , Tomografia Computadorizada Multidetectores , Desenho de Prótese , Diálise Renal , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologiaAssuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Idoso , Dissecção Aórtica/tratamento farmacológico , Aneurisma da Aorta Torácica/tratamento farmacológico , Tratamento Conservador , Humanos , Masculino , Valor Preditivo dos TestesRESUMO
Background: The self-locating peritoneal dialysis (PD) catheter, contains a tungsten tip. The effects of magnetic resonance (MR) on the catheter were evaluated, emphasizing its MR signal, artifacts, ferromagnetism, and possible heating production during the MR sequences. Methods: The catheter was studied in an ex vivo model using a 1.5T MR system and placed into a plastic box containing saline solution. Acquisitions on coronal and axial planes were obtained on fast gradient-echo T1-weighted and fast spin-echo T2-weighted. In vivo abdominal MR exams were also carried out. Results: Overall, the catheter had good visibility. In all sequences, an extensive paramagnetic blooming artifact was detected at the level of the tip tungsten ballast, with a circular artifact of 5 cm in diameter. The catheter showed no magnetic deflection, rotation, or movements during all MR sequences. After imaging, the temperature of the saline solution did not change compared to the basal measurement. Patients safely underwent abdominal MR. Conclusions: The results point to the possibility of safely performing MR in PD patients carrying the self-locating catheter. The self-locating PD catheter is stable when subjected to a 1.5T MR system. However, it creates some visual interference, preventing an accurate study of the tissues surrounding the tungsten tip.