Epidemiology and diagnosis of pulmonary embolism in lung cancer patients: is there a role for age adjusted D-dimers cutoff?

Our knowledge about the incidence of pulmonary embolism (PE) and the performance of age adjusted D-dimers (Dd) cutoff amongst patients with lung cancer (LC) and suspected PE, remains limited. We retrospectively analyzed all clinically suspected patients who underwent computed tomography pulmonary angiography (CTPA) in a tertiary hospital during a 19 month period. Cancer diagnosis was established using ICD10 code. Eligible for Dd analysis were those tested up to 24 h prior to the scan. We analyzed 2549 patients (54.6% males, median age 68.8 years, IQR 57-78), 15.8% had active LC and 5.4% other cancers (oC), while 70% were scanned in the Emergency Department (ED) and the rest during hospitalization. Overall incidence of PE was 16%. LC, but not oC, increased significantly the risk for PE (OR 1.58, 95% CI 1.21-2.06). LC patients were less likely to have bilateral (aOR 0.16, 95% CI 0.07-0.4) or central PE (aOR 0.2, 95% CI 0.09-0.48). Amongst those diagnosed with PE in the ED, LC increased all-cause inhospital mortality (aOR 6.7, 95% CI 2.64-16.95). When age adjusted instead of conventional Dd cutoff was used for ruling out PE in the ED, specificity for LC patients increased (10.16% vs 3.91%) without false negative tests (negative likelihood ratio-NLR = 0). A higher cutoff of 1.13 mg/l raised specificity to 28.9%, with only one case missed (sensitivity: 97.4%, NLR: 0.09, 95% CI 0.01-0.64). LC increases the risk for PE and adversely affects prognosis. Age adjusted and probably an even higher, "LC adjusted" Dd cutoff, could increase the specificity of the test without compromising its sensitivity.

Ablation techniques in non-small cell lung cancer patients: experience of a single center.

BACKGROUND: Percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established treatments for patients with non-small cell lung cancer (NSCLC). This study assessed the efficacy and safety of RFA and MWA performed on NSCLC patients. MATERIAL AND METHODS: This retrospective study included one hundred twenty-four patients with NSCLC who underwent percutaneous ablation from November 2014 to November 2020 in the Department of Medical Imaging and Interventional Radiology of Sotiria General Hospital for Chest Diseases in Athens, Greece. Forty (stage IA) were treated with RFA, while 84 were treated with MWA (stages IA, IB, and IIA). All procedures were performed using the AMICA GEN radiofrequency and microwave generator. As a follow-up method, computed tomography was performed immediately after the procedure to evaluate the lesion's response and complications and one, three, six, and twelve months after the ablation. RESULTS: All ablations were technically successful. The first-month follow-up revealed stage IIA residual tumors in eight patients. Local recurrence was detected one year after RFA in two of the 40 patients and thirteen of the 84 patients after MWA. Overall survival (OS) rates at one, two, and three years for stage IA NSCLC patients treated with ablation were 94 %, 73 %, 57 % for RFA, and 96 %, 75 %, and 62 % for MWA, respectively. In contrast, the OS for stages IB and IIA patients treated with MWA was 90 %, 66 %, and 51 % for the IB stage and 82 %, 62 %, and 48 % for the IIA stage, respectively. Fifteen percent of patients after RFA and 9.5 % after MWA experienced minor complications. Pneumothorax was documented in three patients after RFA and four after MWA. Post-ablation syndrome occurred in 15 % of RFA patients and 8.3 % of MWA patients. There were no major complications. CONCLUSION: RFA and MWA have comparable efficacy and safety for patients in stage IA. MWA is an effective alternative treatment option for non-resectable IB or IIA stages NSCLC patients. HIPPOKRATIA 2022, 26 (3):105-109.

Spontaneous subarachnoid haemorrhage due to acoustic neurinoma. Case report and review of the literature.

Subarachnoid haemorrhage (SAH) of the posterior fossa in cases of acoustic neurinoma is very rare. The authors present the clinical, neuroradiological and histological findings of an acoustic neurinoma presenting with SAH. The literature regarding this subject is reviewed and the pathogenesis of haemorrhage from neurinoma is discussed.

Percutaneous CT-guided nephrostomy: a safe and quick alternative method in management of obstructive and nonobstructive uropathy.

PURPOSE: To present the indications, technique, complications, and contraindications for CT-guided percutaneous nephrostomy (PCN) as an alternative to standard fluoroscopy-guided puncture that involves no radiation exposure for the radiologist. PATIENTS AND METHODS: Between June 2000 and July 2004, 258 percutaneous CT-guided nephrostomies were performed in 215 patients in our department. Most patients (201; 93%) underwent PCN for obstructive uropathy, while 14 (7%) required the procedure as treatment for nonobstructive bladder trauma. All patients had subsequent insertion of a nephrostomy tube under CT guidance. RESULTS: Percutaneous access was achieved without major complications in all patients. The most common complication was pain at the puncture site. In 50 patients (23%), the nephrostomy catheter remained in place until full decompression of the obstruction. In the 14 patients with bladder trauma, the catheter was removed after trauma repair. In 151 patients (70%), the catheter's placement was permanent. CONCLUSION: Percutaneous CT-guided nephrostomy is a reliable, safe, fast, and highly effective method associated with a low complication rate that involves no radiation for the interventional radiologist.

Unusually located osteoid osteomas.

The files of 12 patients (aged 12-33 years) with an equal number of surgically proven osteoid osteomas (OOs) were reviewed in attempt to find a diagnostic algorithm in cases of unusually located OOs. Plain radiography (PR) and thin collimation computed tomography (CT) had been performed in all patients, while bone scintigraphy (BS) had been performed in eight and magnetic resonance imaging (MRI) in two. The OOs were located at juxta- or intra-articular sites, except for one located at the left neck of the L4 vertebra. The diagnosis based on the MRI examinations was synovitis. BS showed increased accumulation of the radioisotope at the site of the lesions, without the 'double density' sign. PR showed the nidus of OO in only six patients, whereas CT located the nidus in all patients. In conclusion, we believe that when an OO is clinically suspected at an unusual location, CT should be performed in all cases, even when a lesion is depicted by PR and BS, because CT will not only locate the nidus but will also provide a precise anatomy of the area around the nidus and help in therapeutic decision making and surgical planning. MRI can be misleading and must not be used in the initial assessment of a possible osteoid osteoma.

CT portography and post-lipiodol CT in the preinterventional work-up of primary and secondary liver tumors. A single center experience.

BACKGROUND/AIMS: The evaluation of the clinical use of CT portography (CTp) and post-lipiodol CT (CT post-lip) in terms of therapeutic implications in patients with liver malignancies, particularly hepatocellular carcinoma (HCC). METHODOLOGY: We prospectively evaluated 130 patients with CTp and CT post-lip: 109 with HCC and underlying cirrhosis (group I) and 21 with liver metastases considered for surgical resection (group II). All patients also underwent hepatic angiography (hA). Mean lesion size was 4.6 cm and 2.2 cm for group I and II respectively. Previous contrast-enhanced CT studies were available for comparison. RESULTS: Diagnostic CTp examinations resulted in only 84.4% of group I due to enhancement in homogeneities and in all patients from group II. In comparison with the referral CT, additional lesions were seen in 83.6% of the HCC group and in 66.6% of the metastatic group that implicated treatment alterations in 15.21% and in 23.8% of them, respectively. Hepatic angiography revealed hypervascularity in 91.3% of HCC lesions and in 33.3% of metastatic ones. CT post-lip images suitable for evaluation resulted in 104/130 patients (80%). At CT post-lip false negative results were observed in 33.73% patients with HCC and in 30.95% patients with liver metastases. Selective lipiodol retention was seen in only 50% of the biopsy proved satellites. CONCLUSIONS: CTp reveals additional lesions that have therapeutic implications in at least 15% of HCC patients and in 20% of patients with metastatic disease, and should be routinely included in the preinterventional work-up particularly for cases in which intraarterial or percutaneous treatment is scheduled. By contrast, CT post-lip seems to be of limited value unless it is evaluated in combination with CTp and angiography.

An unusual case of brucellar spondylitis involving both the cervical and lumbar spine.

We report an unusual case of brucellar spondylitis, involving both the cervical and lumbar spine. Diagnosis was established using magnetic resonance imaging (MRI). An initial plain radiograph of the lumbar spine, showing mild degenerative lesions, was misleading. Therefore, institution of a proper treatment was delayed.

Multiple tuberculous abscesses and mediastinal lymphadenitis with no pulmonary involvement in an immunocompetent patient.

Tubercular cold abscesses secondary to neighbouring bone involvement are a well-known clinical manifestation of extra-pulmonary tuberculosis. However, primary soft tissue tuberculous abscesses with no pulmonary involvement in immuno-competent patients are very uncommon. A rare case of multiple primary intrathoracic and extraperitoneal soft tissue tuberculous abscesses and mediastinal lymph node tuberculosis with no pulmonary involvement is reported. This case demonstrates the need for a high index of suspicion for such rare presentations of extra-pulmonary tuberculosis in patients from endemic areas.

CT-guided percutaneous drainage of lung abscesses: review of 40 cases.

PURPOSE: To evaluate the safety and effectiveness of CT-guided percutaneous drainage of lung abscesses considering success rate versus complications. METHODS: This retrospective study was carried out at Computed Tomography and Interventional Radiology Department of Sotiria Hospital, Athens, Greece, from 1/1/2007 to 1/1/2010. Forty patients with lung abscesses in which antibiotic therapy failed and were managed with CT-guided percutaneous drainage were included in the study. Catheter placement was carried out using Trocar technique in the majority of the cases. RESULTS: Lung abscess completely resolved with no residual cavity in thirty three patients. Seven patients had residual cavity and surgery was performed. Thus, the success rate of radiological drainage of the lung abscesses (33/40) was 83%. Five (13%) patients developed pneumothorax. Three developed moderate pneumothorax and chest-tube needed to be inserted and two patients developed mild pneumothorax which was managed with aspiration. These patients were kept under observation and followed-up by chest X-rays. No other complications and no mortality occurred during the procedure for all the forty patients. CONCLUSION: CT-guided percutaneous catheter drainage is a useful and safe procedure for the treatment of patients with lung abscesses who do not respond to medical therapy and should be considered a valuable alternative to open surgery.

Radiofrequency ablation of subcapsular hepatocellular carcinoma: single center experience.

PURPOSE: To present a single center results, regarding radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty patients with subcapsular HCC were treated with RFA under CT guidance for fifty-two discrete lesions in our institution. Twenty-eight patients underwent ablation of a solitary tumor and twelve patients underwent RFA of two tumors. Six patients had a subcapsular HCC with an exofitic location. All lesions had a diameter of <4 cm. We used two types of generators and electrodes: spiral electrode and expandable electrode. Needle track ablation was performed in all cases. Follow-up consisted of an abdomen computed tomography (CT) scan after contrast administration immediately after each session and then after one, three, six, and twelve months. RESULTS: In forty-eight lesions complete tumor ablation was depicted at the one month CT scan. In four lesions with residual viable tumor, a second session was performed. After the second ablation no residual tumor was observed in any patient. No major complications occurred in any of our patients. Fever with a temperature up to 39 °C was documented during the first days as part of the post-ablation syndrome in thirteen patients (32.2%). Seeding along the needle track was observed in none of our patients. Local tumor progression, was observed in ten lesions (19.25%) and in all cases a second RFA session was performed with optimal results. CONCLUSION: Subcapsular location should not be considered as a contraindication for liver RFA.

CT-guided percutaneous drainage of infected collections due to gastric leak after sleeve gastrectomy for morbid obesity: initial experience.

This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26-52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

Primary malignant fibrous histiocytoma of the lung: a case report.

Primary malignant fibrous histiocytoma (MFH) of the lung is extremely rare although it is among the most common soft tissue sarcomas in adults. Surgery is the primary mode of therapy, with high rates of local and distant recurrence, while radiation therapy appears to be a very useful adjunct, decreasing local relapse. We report a case of primary malignant fibrous histiocytoma of the lung. Fourteen years after surgical resection, the patient is still alive although with multiple metastatic lesions throughout his body.

Tumor-like pulmonary sarcoidosis diagnosed by CT-guided transthoracic lung biopsy.

INTRODUCTION: Most patients referred for lung biopsy have a focal lesion that is likely to be a carcinoma and fine needle aspiration (FNA) is usually sufficient to confirm diagnosis. Percutaneous cutting needle biopsy (CNB) is an important and potential diagnostic technique when non carcinomatous disease is suspected or when the pulmonary disease is unclear, so tissue architecture is very important. CASE PRESENTATION: We present a case of a 24 year old male arrived at our hospital with dyspnea and unusual computed tomography (CT) findings of sarcoidosis. Chest X-ray and CT scan revealed multiple masses in both lungs suggesting lung metastasis. Bronchoscopy and bronchoalveolar lavage did not reveal any malignant cells. None of the laboratory examinations revealed any primary extrapulmonary tumor. The patient underwent CT-guided core needle biopsy. Histopathological examination confirmed the diagnosis of sarcoidosis. CONCLUSION: CT-guided core needle biopsy is a very helpful diagnostic tool in order to determine the benign or malignant nature of a thoracic lesion.

A complicated postsurgical echinococcal cyst treated with radiofrequency ablation.

Surgery of hydatid cysts is often complicated with intrabiliary rupture (IBR), which if not recognized may lead to biliary fistula with rather high rates of morbidity and mortality. We report our experience with the application of radiofrequency (RF) ablation for the treatment of an operated hepatic echinococcal cyst which was complicated with biliocystic communication and cysteocutaneous fistula with bile leakage. RF ablation was performed under CT guidance into the remaining cyst through the cutaneous fistula. Since ablation of the cyst and the fistula the patient has been asymptomatic.

Radiofrequency ablation of osseous metastases for the palliation of pain.

A number of different methods have been proposed for pain relief in cancer patients with bone metastases, each with different indications, contraindications and complications (systemic analgesics, bisphosphonates, antitumor chemotherapy, radiotherapy, systemic radio-isotopes, local surgery and vertebroplasty). The ideal treatment has to be fast, safe, effective and tolerable for the patient. CT-guided radiofrequency (RF) ablation may fulfill these criteria. Our experience in the treatment of 30 patients (34 lesions) with painful bone metastases using RF ablation was assessed. There was a significant decrease in the mean past-24-h Brief Pain Inventory (BPI) score for worst pain, for average pain and for pain interference during daily life (4.7, 4.8 and 5.3 units respectively) 4 and 8 weeks after treatment. There was a marked decrease (3 out of 30 patients 4 and 8 weeks after treatment) in the use of analgesics. CT-guided RF ablation appears to be effective for treatment of painful bone metastases.

Renal cell carcinoma radiofrequency ablation: evaluation of efficacy based on histological correlation.

Percutaneous image-guided ablation with the use of radiofrequency has recently received much attention as a minimally invasive technique for the treatment of solid malignancies. Renal cell carcinomas (RCCs) were among the first extrahepatic tumours to be targeted with radiofrequency ablation (RFA). The aim of this study is to present the efficacy of RFA in RCC and the factors that have an impact on the attained necrosis with regards to the histological findings.

Chronic invasive sinus aspergillosis in an immunocompetent patient: a case report.

We report the case of an immunocompetent, 39 year old male who presented with diplopia and diffuse headache. The CT scan demonstrated the presence of a sizeable mass that took over the nasal cavity, the right maxillary sinus, the sphenoid and ethmoid sinus, extending to the sellar and suprasellar region, and eroding the adjacent bones. The patient also underwent MRI and endoscopic sinus surgery. Biopsy of the suspected tissue for pathology and culture demonstrated Aspergillus fumigatus.

Long-term outcome of a hepatocellular carcinoma 7(1/2) years after surgery and repeated radiofrequency ablation: case report and review of the literature.

An interesting case is presented of a 78-year-old patient with cirrhosis who was managed with combined treatment (surgery and radiofrequency (RF) ablation) for hepatocellular carcinoma (HCC) and has survived for 7(1/2) years. Elevation of the alpha-FP (alpha-fetoprotein) levels was noted 2 years after surgery. CT demonstrated two lesions: one central at the remaining right liver lobe, and the other at the excision site. Biopsy of the lesions confirmed the diagnosis of HCC for both of them. RF ablation of these two lesions was performed in one session with technical success. Four and a half years after the first RF ablation a new recurrence was demonstrated at the CT follow-up control. RF ablation was again applied successfully. The imaging findings and the therapeutic percutaneous management of this patient along with the natural course of HCC and its recurrence are discussed, and the literature concerning risk factors is reviewed.

Scalp actinomycosis mimicking soft tissue mass.

Actinomycosis is a rare, subacute or chronic bacterial infection, characterized by localized swelling with suppuration, abscess formation, tissue fibrosis, and draining sinuses. It is caused by gram-positive, pleomorphic non-spore-forming, non-acid-fast anaerobic or microaerophilic bacilli of the genus Actinomyces. In humans, actinomyces are often normally found in the oral cavity, the gastrointestinal tract and the female genital tract. Infections of the oral and cervicofacial regions are the most commonly reported cases. We present a case of subcutaneous actinomycosis, localized at the upper segment of the posterior neck space, with scalp involvement.