Radiofrequency Ablation of Functioning Adrenal Adenomas: Preliminary Clinical and Laboratory Findings.

PURPOSE: To evaluate clinical and laboratory findings in patients undergoing radiofrequency (RF) ablation for functioning adrenal adenomas. MATERIALS AND METHODS: Eleven adult patients, nine with Conn syndrome and two with Cushing syndrome, underwent percutaneous computed tomography-guided RF ablation for benign adrenal neoplasms. Systolic, diastolic, and mean blood pressure and the number of classes of antihypertensive drugs used by each patient were analyzed before and 1, 4, and 12 weeks after the procedure. Serum hormone levels were analyzed within 30 days before and 12 weeks after the procedure. RESULTS: Of the nine patients with Conn syndrome, eight showed normal serum aldosterone levels after the procedure and one patient had a nodule located very close to the inferior vena cava, resulting in incomplete ablation. The two patients with Cushing syndrome had normal serum and salivary cortisol levels after the procedure. Mean aldosterone concentration at baseline was 63.3 ng/dL ± 28.0 and decreased to 13.3 ng/dL ± 13.5 at 12 weeks postoperatively (P = .008). Systolic, diastolic, and mean blood pressures decreased significantly in the first week after the procedure (P < .001) and remained stable during further follow-up. CONCLUSIONS: In patients with Conn syndrome or Cushing syndrome, percutaneous RF ablation of functioning adrenal adenomas may result in normalization of hormone secretion, improvement in blood pressure, and reduced need for antihypertensive drugs.

Percutaneous ablation of functioning adrenal adenoma: a report on 11 cases and a review of the literature.

PURPOSE: Percutaneous ablation of functioning adrenal adenomas has been an alternative to videolaparoscopic treatment. This study aimed to evaluate the feasibility, safety and efficacy of radiofrequency ablation (RFA) in the treatment of functioning adrenal tumors using a computed tomography (CT)-guided percutaneous technique as demonstrated by our experience and the literature. METHODS: Eleven adult patients (mean age 46 years) with a diagnosis of functioning adrenal adenoma underwent CT-guided RFA between October 2011 and August 2012. All RFA procedures were performed using a needle electrode with a single lateral filament and the RITA(®) 1500X radiofrequency generator. The RFA protocol consisted of two cycles of 5 min each with 1-min interval, with no additional ablation cycles. Contrast-enhanced CT scans were obtained and analyzed for immediate treatment success and possible complications. RESULTS: Maximum tumor dimension ranged from 1.2 to 3.4 cm. The mean procedure time was 74 min, and length of hospital stay ranged from 0.9 to 3.2 days (mean 1.8 days). One patient had residual pneumothorax and one patient had neuritis involving the T10 dermatome. Of 11 patients, 10 recovered from their condition. Only one patient remained with hyperaldosteronism, but with reduced anti-hypertensive medication. CONCLUSIONS: CT-guided percutaneous RFA was a safe and effective treatment for functioning adrenal adenomas, with short hospital length of stay and low complication rate.

Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic.

Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.

Endobiliary biopsy.

The differential diagnosis between benign and malignant biliary strictures is challenging and requires a multidisciplinary approach with the use of serum biomarkers, imaging techniques, and several modalities of endoscopic or percutaneous tissue sampling. The diagnosis of biliary strictures consists of laboratory markers, and invasive and non-invasive imaging examinations such as computed tomography (CT), contrast-enhanced magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (EUS). Nevertheless, invasive imaging modalities combined with tissue sampling are usually required to confirm the diagnosis of suspected malignant biliary strictures, while pathological diagnosis is mandatory to decide the optimal therapeutic strategy. Although EUS-guided fine-needle aspiration biopsy is currently the standard procedure for tissue sampling of solid pancreatic mass lesions, its diagnostic value in intraductal infiltrating type of cholangiocarcinoma remains limited. Moreover, the "endobiliary approach" using novel slim biopsy forceps, transpapillary and percutaneous cholangioscopy, and intraductal ultrasound-guided biopsy, is gaining ground on traditional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography endobiliary forceps biopsy. This review focuses on the available endobiliary techniques currently used to perform biliary strictures biopsy, comparing the diagnostic performance of endoscopic and percutaneous approaches.

What the radiologist should know about the role of percutaneous gastrostomy: a pictorial essay.

The image-guided gastrostomy techniques, as transoral and transabdominal, can be performed when there is a failure of the endoscopic procedure or in some specific clinical scenarios. This pictorial essay intends to show the percutaneous gastrostomy techniques, indications, technical approaches, post-procedure care, and complications.

As técnicas de gastrostomia guiadas por imagem, por via transoral e transabdominal podem ser realizadas quando há falha na técnica endoscópica ou em cenários clínicos em que a endoscopia não pode ser realizada. Este ensaio iconográfico pretende mostrar as técnicas de gastrostomia percutânea, suas indicações, aspectos técnicos, cuidados pós-procedimento e complicações.

Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience.

Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication-a small dehiscence of the anastomosis-which extended the catheter dwell time. Minor complications occurred in two cases-one small perihepatic hematoma and one segmental thrombosis of the left portal branch-neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.

Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.

A scoping study of pulmonary paracoccidioidomycosis: severity classification based on radiographic and tomographic evaluation.

The lungs have great importance in patients with paracoccidioidomycosis since they are the portal of entry for the infecting fungi, the site of quiescent foci, and one of the most frequently affected organs. Although they have been the subject of many studies with different approaches, the severity classification of the pulmonary involvement, using imaging procedures, has not been carried out yet. This study aimed to classify the active and the residual pulmonary damage using radiographic and tomographic evaluations, according to the area involved and types of lesions.

Biliary involvement in liver metastases: long-term experience with biliary biopsy from a single center.

OBJECTIVE: To investigate long-term results of biliary biopsy performed with transluminal forceps in the setting of metastatic biliary involvement. MATERIALS AND METHODS: Between September 2014 and June 2019, 25 patients-18 males (72%)-with a mean age of 65 ± 15 years, underwent 26 biliary biopsy procedures with a dedicated forceps system. All patients presented with obstructive jaundice that was suspected of being malignant and underwent pre-procedural magnetic resonance cholangiopancreatography. The biopsies were performed during percutaneous placement of an internal-external biliary drainage catheter, under fluoroscopic guidance. RESULTS: The technical success rate was 96% (corresponding to 25 of the 26 procedures). The histological diagnosis was inflammatory biliary stricture in five cases, pancreatic adenocarcinoma in six, liver metastases from colorectal cancer in eight, and hepatocellular carcinoma in three, the biliary mucosa being categorized as normal in three cases. In one case, the sample was considered insufficient and the procedure was successfully repeated, after which a diagnosis of pancreatic adenocarcinoma was made. Over a follow-up period of 6-48 months, there were five false-negative results: two findings of inflammatory biliary stricture were later identified as liver metastases from breast and gastric cancer, respectively; and all three patients in which the biliary mucosa was categorized as normal were subsequently diagnosed with metastatic hilar lymph nodes. The procedure was found to have a sensitivity of 77%, a specificity of 100%, and an overall accuracy of 80%. The complication rate was 11.5% (mild, transient hemobilia occurring in three cases). CONCLUSION: Percutaneous transluminal forceps biopsy is a safe, effective, minimally invasive procedure for histological characterization in patients presenting with obstructive jaundice due to a non-primary biliary tumor.

OBJETIVO: Investigar os resultados a longo prazo da biópsia endobiliar realizada com um pinça tipo fórceps transluminal no diagnóstico de neoplasia biliar metastática. MATERIAIS E MÉTODOS: Entre setembro de 2014 e junho de 2019, 25 pacientes - 18 homens (72%), com idade média de 65 ± 15 anos) - foram submetidos a 26 procedimentos de biópsia endobiliar com um conjunto dedicado. Todos os pacientes apresentaram icterícia obstrutiva, suspeita de malignidade e colangiorressonância pré-procedimento. Os procedimentos foram realizados durante o posicionamento percutâneo da drenagem biliar interna-externa, sob orientação fluoroscópica. RESULTADOS: A taxa de sucesso técnico foi de 96% (25 casos), com diagnóstico histológico de estenose benigna (inflamatória) em cinco casos, adenocarcinoma pancreático em seis casos, metástases hepáticas retais no cólon em oito casos, carcinoma hepatocelular em três casos e de mucosa biliar normal em três casos. Em um caso a amostra foi considerada insuficiente pelo patologista (um adenocarcinoma pancreático) e o procedimento foi repetido com sucesso. O seguimento de 6 a 48 meses mostrou cinco casos falso-negativos, em particular dois casos de metástases hepáticas retais sem cólon (câncer de mama e gástrico) e três linfonodos hilares metastáticos. A análise estatística revelou sensibilidade de 77%, especificidade de 100% e precisão geral de 80%. A taxa de complicações foi de 11,5% (três casos com hemobilia transitória). CONCLUSÃO: A biópsia biliar transluminal realizada com pinça tipo fórceps é um procedimento minimamente invasivo, seguro e eficaz para caracterização histológica em pacientes que apresentam icterícia obstrutiva no diagnóstico de neoplasia biliar metastática.

New frontiers in endovascular therapies for locally advanced hepatocellular carcinoma.

Hepatocellular carcinoma is the most common primary malignant liver tumour and is a leading cause of death worldwide. Despite the advent of screening programmes, most cases of hepatocellular carcinoma are diagnosed late (in an advanced stage) which precludes curative treatments such as surgery and ablation. Therefore, intra-arterial locoregional treatments now play a central role in the management of advanced hepatocellular carcinoma, such treatments ranging from trans-arterial chemo-embolisation to the more recently developed trans-arterial radio-embolisation technique. In this essay, we discuss the state of the art of intra-arterial treatment for locally advanced hepatocellular carcinoma and the future directions for such treatment.

O carcinoma hepatocelular é o tumor hepático maligno primário mais frequentemente observado, sendo uma das principais causas de mortalidade mundial. Apesar do advento dos programas de triagem, na maioria dos casos o diagnóstico tardio está associado a um estágio avançado da doença que impede o tratamento curativo, como cirurgia ou ablação. Assim, os tratamentos locorregionais intra-arteriais têm agora um papel central no gerenciamento avançado do carcinoma hepatocelular, passando por quimioembolização transarterial e radioembolização. Neste ensaio, discutimos o estado da arte do tratamento intra-arterial atualmente disponível para o carcinoma hepatocelular localmente avançado e suas direções futuras.

Endovascular management of giant common iliac artery pseudoaneurysm after complications in simultaneous pancreas-kidney transplant: a case report.

BACKGROUND: Pancreatic transplantation is a definitive treatment for selected patients with insulin-dependent diabetes. It is a technically challenging surgery, and vascular complications are the most common cause of pancreatic graft failure. Although rare, pancreas transplants present higher rates of pseudoaneurysms at the vascular anastomosis than other visceral transplants. We present a case of a simultaneous pancreas-kidney transplant complicated with graft failure and common iliac artery pseudoaneurysm that was successfully treated through endovascular techniques. CASE PRESENTATION: A 34-year-old White woman presented with abdominal pain and a history of type 1 diabetes mellitus, end-stage renal disease, and two previous pancreas transplantation failures. The first was a simultaneous pancreas-kidney transplantation performed 7 months prior that was complicated by pancreas graft thrombosis within 1 month and required graft resection. Five months later, she underwent a second pancreas transplantation with another pancreatic graft thrombosis requiring graft resection. Abdominal angiotomography revealed a pseudoaneurysm in the right common iliac artery at the point of the previous graft anastomosis. The patient was successfully treated endovascularly with a covered stent in the common iliac artery. CONCLUSION: Stent graft implantation for the treatment of common iliac artery pseudoaneurysm as a complication of simultaneous pancreas-kidney transplantation is a safe and feasible procedure.

Bowel intussusception in adult: Prevalence, diagnostic tools and therapy.

Intussusception is defined as invagination of one segment of the bowel into an immediately adjacent segment. The intussusception refers to the proximal segment that invaginates into the distal segment, or the intussusception (recipient segment). Intussusception, more common occur in the small bowel and rarely involve only the large bowel. In direct contrast to pediatric etiologies, adult intussusception is associated with an identifiable cause in almost all the symptomatic cases while the idiopathic causes are extremely rare. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. In this review, we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adult.

Percutaneous solutions for biliary stent dysfunction: pictorial essay.

Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

Disfunção das próteses biliares plásticas ou metálicas pode ser causada por migração, oclusão, mau posicionamento ou fratura. Uma prótese disfuncional na via biliar pode atuar como nidus causando complicações como colangite recorrente e persistente. Pode ainda causar complicações vasculares como formação de pseudoaneurismas ou sangramento, e além disso, perfurar a cápsula hepática causando biloma ou abscesso, ou raramente, causar obstrução intestinal e/ou perfuração. Demonstramos diferentes técnicas da radiologia intervencionista no tratamento de endopróteses biliares plásticas e metálicas disfuncionais, em pacientes com doença biliar obstrutiva.

Antegrade double-J stenting as an alternative to the retrograde approach: experience of the first 150 cases at a single center in Brazil.

OBJECTIVE: To present our clinical experience with percutaneous antegrade ureteral stenting. MATERIALS AND METHODS: This was a single-center retrospective study in which we reviewed the electronic medical records of patients who underwent percutaneous image-guided antegrade ureteral stenting between January 2016 and August 2020. We evaluated 90 patients (48 men). The mean age was 61.4 ± 15 years (range, 30-94 years). Patients were divided into two main groups: those with malignant neoplasms; and those with non-neoplastic disease. Technical and clinical success of the procedure were defined, respectively, as maintenance of the patency of the urinary tract, with a reduction in the degree of hydronephrosis, and as a reduction in the level of nitrogenous waste. Postprocedural complications were categorized as major or minor according to the CIRSE classification. RESULTS: The study sample comprised 150 antegrade stenting procedures performed in 90 patients, most of whom had previously undergone retrograde stenting that was unsuccessful. The stenting was bilateral in 60 patients and unilateral in 30. Technical success was achieved in 143 (95.3%) of the procedures, whereas seven procedures (4.6%) were unsuccessful. Failed procedures were characterized by inability to place a stent or migration of a stent after its placement. Complications occurred in 12 (8.0%) of the procedures. Of those 12 complications, two were classified as major (bleeding) and 10 were classified as minor (lumbar pain or infection). The most common techniques used were the over-the-wire technique and the modified technique (in 58.0% and 42.0% of the cases, respectively). In seven cases (4.7%), a nephrostomy tube was inserted. CONCLUSION: Percutaneous antegrade ureteral stenting is a safe, effective method for the management of ureteral injuries and obstructions, due to malignant or benign causes, when the retrograde approach has failed.

OBJETIVO: Apresentar os resultados clínicos de 150 casos de inserção anterógrada de cateter duplo J.Materiais e Métodos: Foram revisados os prontuários eletrônicos de pacientes submetidos a inserção percutânea de cateter duplo J guiada por imagem entre janeiro de 2016 e agosto de 2020. Um total de 90 pacientes (48 homens e 42 mulheres; faixa etária, 30-94 anos; idade média, 61,4 ± 15 anos) foi incluído no estudo. Os pacientes foram classificados em dois grupos principais: neoplasia maligna e doença não neoplásica. O sucesso técnico e clínico do procedimento foi definido como a manutenção da perviedade da via urinária com redução do grau de hidronefrose e redução dos níveis das escórias nitrogenadas. As complicações pós-procedimento foram classificadas em maiores e menores, de acordo com o sistema de classificação CIRSE. RESULTADOS: Foram realizados 150 procedimentos (90 pacientes) no período, sendo bilateral em 60 pacientes e unilateral em 30. Houve sucesso técnico em 143 casos (95,3%) e falhas em sete (4,7%), caracterizadas por migração e não progressão do cateter. Nossas taxas de complicações foram de 8,0% (12 casos), sendo dois maiores (sangramento) e 10 menores (principalmente dor lombar). As técnicas mais utilizadas para a inserção foram over the wire (58,0%) e modificada (42,0%). Em sete pacientes (4,7%) foi realizada nefrostomia percutânea. CONCLUSÃO: A inserção anterógrada do cateter duplo J é um método seguro e eficaz para o tratamento de obstruções uretéricas devidas a causas e lesões malignas e benignas, quando há uma falha na abordagem cistoscópica (retrógrada).

Antegrade insertion of a double J catheter in the treatment of malignant ureteral obstruction: a retrospective analysis of the results obtained with a modified technique at a university hospital.

OBJECTIVE: To analyze the results obtained with a modified antegrade double J catheter insertion (JJ stenting) technique in patients with urinary tract obstruction due to malignancy. MATERIALS AND METHODS: This was a retrospective analysis of data collected from patients undergoing antegrade JJ stenting for malignant ureteral obstruction in the interventional radiology department of our institution between March 1, 2017 and May 31, 2019. RESULTS: Antegrade JJ stenting was performed in 32 patients (20 women and 12 men). The mean age was 66.2 years among the females and 61.5 years among the males. A total of 53 antegrade JJ stenting procedures were performed. The procedure was successful in 50 cases and failed in 3 (due to migration of the double J catheter in 2 and due to technical failure in 1). Complications occurred in 3 patients (low back pain, in 1, subcapsular hematoma, in 1, and pyelonephritis, in 1). The procedure time ranged from 14 min to 55 min. CONCLUSION: In patients with ureteral obstruction due to malignancy, antegrade JJ stenting is safe and effective. The technique selected in our study is easily reproduced and can be performed by a trained professional.

OBJETIVO: Análise retrospectiva dos resultados de uma técnica modificada de inserção anterógrada de cateter duplo J em pacientes com obstrução do trato urinário por causas oncológicas. MATERIAIS E MÉTODOS: Coleta e análise retrospectiva de dados de pacientes submetidos a inserção anterógrada de cateter duplo J por obstruções ureterais neoplásicas no departamento de radiologia intervencionista da instituição, entre 1º de março de 2017 e 31 de maio de 2019. RESULTADOS: No total, 32 pacientes foram submetidos a inserção anterógrada de cateter duplo J, sendo 20 mulheres e 12 homens. A média de idade foi de 66,2 anos para o sexo feminino e 61,5 anos para o sexo masculino. Cinquenta e três inserções anterógradas de cateter duplo J foram realizadas. O número de procedimentos bem sucedidos foi 50 e houve 3 falhas (2 migrações do cateter duplo J e 1 insucesso técnico). As complicações ocorreram em 3 pacientes (1 dor lombar, 1 hematoma subcapsular e 1 pielonefrite). O tempo de procedimento variou entre 14 e 55 minutos. CONCLUSÃO: A inserção anterógrada de cateter duplo J em pacientes com obstrução ureteral por causas malignas é eficaz e segura. A técnica descrita no nosso estudo é de fácil reprodução, podendo ser executada por um profissional capacitado.

Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: A comprehensive review.

Budd-Chiari syndrome (BCS) is a relatively rare clinical condition with a wide range of symptomatology, caused by the obstruction of the hepatic venous outflow. If left untreated, it has got an high mortality rate. Its management is based on a step-wise approach, depending on the clinical presentation, and includes different treatment from anticoagulation therapy up to Interventional Radiology techniques, such as transjugular intrahepatic portosystemic shunt (TIPS). TIPS is today considered a safe and highly effective treatment and should be recommended for BCS patients, including those awaiting orthotopic liver transplantation. In this review the pathophysiology, diagnosis and treatment options of BCS are presented, with a special focus on published data regarding the techniques and outcomes of TIPS for the treatment of BCS. Moreover, unresolved issues and future research will be discussed.

Percutaneous access for the diagnosis of urothelial neoplasms: pictorial essay with anatomopathological correlation.

Urothelial carcinoma is a rare malignant neoplasm, accounting for only 5% to 7% of kidney tumors and 5% of urothelial tumors. During the management of urothelial carcinoma, anatomopathological evaluation is used for stratifying the tumors into different prognostic groups to aid in the evaluation of treatment results and to optimize the management of patients. Percutaneous image-guided biopsy is a safe and feasible procedure, with high sensitivity and accuracy rates. Although image-guided percutaneous biopsy of the urinary tract is a relatively uncommon procedure, it can be considered an option in selected cases or when traditional methods, such as the ureteroscopic technique, are not possible.

O carcinoma urotelial é uma neoplasia maligna rara, responsável por apenas 5% a 7% dos tumores renais e 5% dos tumores uroteliais. No manejo do carcinoma urotelial, a determinação anatomopatológica tem por objetivo estratificar os tumores em diferentes grupos prognósticos, para permitir avaliar resultados do tratamento e otimizar o gerenciamento dos pacientes. Biópsia percutânea guiada por imagem é um procedimento seguro e tecnicamente viável, com alta sensibilidade e taxa de precisão. Apesar de as biópsias percutâneas guiadas por imagem do trato urinário serem um procedimento relativamente incomum, podem ser consideradas como opção em casos selecionados ou quando os métodos tradicionais, como o a técnica ureteroscópica, não são possíveis.

Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization.

OBJECTIVE: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. MATERIALS AND METHODS: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). RESULTS: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. CONCLUSION: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

OBJETIVO: Demonstrar as principais complicações hemorrágicas após nefrolitotripsia percutânea, bem como os resultados após o tratamento por embolização arterial transcateter (EAT) em um centro de radiologia intervencionista. MATERIAIS E MÉTODOS: Coleta e análise de dados retrospectivos de pacientes submetidos a EAT por complicações hemorrágicas após nefrolitotripsia percutânea. RESULTADOS: O sintoma mais comum foi hematúria macroscópica, presente em cinco pacientes no momento da readmissão ao pronto-socorro, e nestes pacientes identificamos três pseudoaneurismas isolados, dois casos de combinação de pseudoaneurisma e sangramento ativo (hematoma perirrenal) e um caso de associação de pseudoaneurisma e fístula arteriocalicinal. Fístula arteriovenosa foi diagnosticada em três pacientes, não sendo observada em associação com outras lesões vasculares. Não identificamos fístula arteriocalicinal isolada, somente associada a pseudoaneurisma. Cinco pacientes foram submetidos a embolização por micromolas 6 × 15 mm e 6 × 20 mm. Quatro pacientes foram submetidos a embolização por Histoacryl e Lipiodol. Não observamos complicações pela angiotomografia computadorizada de controle. CONCLUSÃO: A angiotomografia computadorizada apresenta alta acurácia diagnóstica e guarnece o radiologista intervencionista de dados para um planejamento terapêutico individualizado. EAT é um procedimento seguro e eficaz e pode ser utilizado como primeira linha para o tratamento de complicações hemorrágicas resultantes de procedimentos percutâneos renais.