Wünderlich ist nicht so Wunderbar: Bilateral Angiomyolipomas and Wünderlich Syndrome Requiring Emergency Embolization in a Patient without Tuberous Sclerosis.

Bilateral renal angiomyolipomata are rare and usually associated with tuberous sclerosis. Renal angiomyolipomata can rupture spontaneously giving rise to (potentially catastrophic) retroperitoneal hemorrhage (Wünderlich syndrome). We present a very rare case of bilateral renal angiomyolipomata in an individual without tuberous sclerosis, presenting with life-threatening hemorrhage. The patient had emergency embolization of the bleeding angiomyolipoma and received elective embolization of a contralateral lesion. A follow-up brain magnetic resonance imaging showed no tubers but revealed a pituitary adenoma of uncertain significance.

Missed lung cancers on the scout view: do we look every time?

Scout views are digital radiographs obtained to aid planning of the subsequent computed tomography (CT) examination. Review of these scout views may provide additional information not demonstrated on the axial images, but such reviews may not necessarily be performed routinely, especially in the context of abdominopelvic CT studies. We illustrate the value of the scout images by presenting a series of representative cases of missed pulmonary neoplasms in five patients who originally underwent such examinations.

Technical challenges of coronary CT angiography: today and tomorrow.

Rapid advancements in multidetector row computed tomography (MDCT) are beginning to revolutionise cardiac imaging applications. As a consequence, coronary CT angiography (CTA) is fast emerging as a highly effective, noninvasive imaging technique for the assessment of coronary artery disease (CAD). Technology is improving at a robust pace, which brings with it the benefits of superior spatial and temporal resolution as well as fast volume coverage, achieved through the development of systems with an increased number of detectors and shorter gantry rotation time, as well as the advent of systems equipped with dual-source X-ray tubes. The main power of CTA was thought to lie in its high negative predictive value in excluding coronary disease with a high degree of accuracy in patients with low probability for CAD. However, this rapid progress has meant that we are also adding to the growing list of additional potential applications of CTA that are possible with the technology. The aim of this review is to present an overview of the technical capabilities of cardiac MDCT relating to coronary CTA and other applications, the limitations of current technologies, as well as discuss political perspectives and how to address these in medical practice.

Multifocal severe coronary artery vasospasm mistaken for diffuse atherosclerosis: a case report.

Spontaneous severe multivessel coronary artery vasospasm is a rare but important cause of morbidity. One-third of patients have normal coronary vasculature, and these pose a significant therapeutic dilemma as lack of clinical suspicion might potentially lead to unnecessary revascularization therapies. A patient with resting chest pain and ischaemic electrocardiography demonstrated severe coronary obstruction at catheter angiography. Preangioplasty further information highlighted spasm as the likely cause and the angiographic abnormalities resolved post intracoronary nitrate. This paper emphasises thorough history-taking and judicious use of nitrates during diagnostic coronary angiography in such patients. This may negate the need for more complex cardiac interventions.

The role of interventional radiology in obstetric and gynaecology practice.

Interventional radiology is continuing to reshape current practice in many specialties of clinical care. It is a relatively new and innovative branch of medicine in which physicians treat diseases non-operatively through small catheters guided to the target by fluoroscopic and other imaging modalities. The aim is to provide image-guided, minimally invasive alternatives to traditional surgical and medical procedures in suitable cohorts of patients. Procedures which previously required major surgery can now be performed by interventional radiologists, sometimes on an outpatient basis, with little patient discomfort. In this review, we highlight the importance of interventional radiology in treating a comprehensive range of obstetric and gynaecological pathologies.

Endovascular treatment options in the management of lower limb deep venous thrombosis.

Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report.

INTRODUCTION: Cystic hygroma is a benign congenital neoplasm that mostly presents as a soft-tissue mass in the posterior triangle of the neck. Pure mediastinal lesions are uncommon; the vast majority are asymptomatic and are an incidental finding in adulthood. The diagnosis is often made intra- or postoperatively. Prenatal identification is exceptional and post-natal diagnosis also proves challenging. CASE PRESENTATION: We report one such case that was mistaken for other entities in both the prenatal and immediate post-natal period. Initial and follow-up antenatal ultrasound scans demonstrated a multicystic lesion in the left chest, and the mother was counselled about the possibility of her baby having a congenital diaphragmatic hernia. Initial post-natal chest radiographs were reported as normal. An echocardiogram and thoracic computed tomography scan confirmed a complex multiloculated cystic mediastinal mass. The working diagnoses were of a mediastinal teratoma or congenital cystic adenomatous malformation. At operation, the lesion was compressed by the left lung and was found to be close to the left phrenic nerve, which was carefully identified and preserved. After excision, histopathological examination of the mass confirmed the diagnosis of cystic hygroma. Postoperative dyspnoea was observed secondary to paradoxical movement of the left hemidiaphragm and probable left phrenic neuropraxia. This settled conservatively with excellent recovery. CONCLUSION: Despite the fact that isolated intrathoracic cystic hygroma is a rare entity, it needs to be considered in the differential diagnosis of foetal and neonatal mediastinal masses, particularly for juxtadiaphragmatic lesions. The phrenic nerve is not identifiable on prenatal ultrasound imaging, and it is therefore understandable that a mass close to the diaphragm may be mistaken for a congenital diaphragmatic hernia because of the location, morphology and potential phrenic nerve compression. Post-natal diagnosis may also be misleading as many mediastinal cystic masses have similar appearances on imaging. Therefore, as well as cystic architecture, special consideration needs to be given to the anatomical location and effect on local structures.