Accidental portal vein catheterization during pleural drainage catheter insertion: a case report.

BACKGROUND: Iatrogenic portal vein (PV) injuries following pleural drainage catheter (PDC) insertion are rare but life-threatening. This case report emphasizes the importance of prompt recognition and effective interventional radiology (IR) management. CASE PRESENTATION: A 38-year-old Asian male, admitted for a non-ST-segment elevation myocardial infarction, suffered a critical PV injury during PDC insertion, leading to rapid clinical deterioration. The IR team conducted a portogram, retrieved the catheter, and successfully executed an embolization procedure. The patient's recovery, confirmed through imaging and improving liver function tests, enabled discharge with follow-up instructions. CONCLUSIONS: This case highlights the clinical significance of promptly recognizing and effectively managing iatrogenic PV injuries during PDC insertion, with the pivotal role of IR. Collaboration between IR and surgical teams is crucial for optimizing patient outcomes.

Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient's clinical details, radiological findings, safety, and efficacy are reported. CASES PRESENTATION: Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. CONCLUSION: PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.

Managing Recurrent Rectal Variceal Bleeding Secondary to Portal Hypertension With Liquid Embolics.

Rectal variceal bleeding is one of the rarer manifestations of portal hypertension caused by chronic liver disease. The management of these varices is very challenging. Our patient had portal vein thrombosis and presented with chronic recurrent rectal bleeding requiring transfusion secondary to rectal varices. The patient was treated from trans-splenic access with liquid embolics (sclerotherapy and glue) without balloon occlusion, leading to the successful cessation of his bleeding. Access hemostasis was achieved using a vascular plug in the access tract. There are no clear guidelines for the management of these patients. If rectal varices cannot be managed by colonoscopy, this approach to embolization with liquid embolic is an excellent minimally invasive alternative.

Superior Rectal Artery Embolisation for Haemorrhoids: What Do We Know So Far?

Haemorrhoids are abnormally enlarged anal cushions within the lower rectum. They are common, and have potential to significantly impact patients' quality of life. Superior rectal artery embolisation is a technique which has been discussed in the literature as far back as 40 years ago. More recently, there has been interest in the role of embolisation in the treatment for haemorrhoids, as an alternative to established minimally invasive and conventional surgical techniques. In this review, we discuss the current literature on the topic, with particular focus on technique, clinical outcomes and complications. Emerging procedural and technical considerations are discussed, with further review of the role of coil vs. particle embolisation.

The Safety of Continuing Therapeutic Anticoagulation During Inferior Vena Cava Filter Retrieval: A 6-Year Retrospective Review from a Tertiary Centre.

PURPOSE: Assess the safety of inferior vena cava (IVC) filter retrieval in patients taking anticoagulation, compared to a non-anticoagulated cohort. MATERIALS AND METHODS: Single-centre retrospective analysis of patients who underwent IVC filter retrieval between January 2012 and February 2018. Information about patient demographics, anticoagulation, tilt, major and minor complications was collected. Major complications were defined as: IVC injury from the filter retrieval, retained fragment of filter, filter fracture and filter embolisation. Minor complications were defined as: neck haematoma and puncture site infection. RESULTS: Total of 357 patients (age 18-95, Male: 231) underwent IVC filter retrieval, comprising of Cook Celect Platinum, Cook Celect, and ALN-branded filters. Of these 182 patients were on anticoagulation and 175 patients were not on anticoagulation, based on the indication for the filter (thrombosis or prophylaxis) and at the discretion of the referring unit who were managing the anticoagulation. IVC filter retrieval was technically successful in 349 patients. Five major complications (1.4% of retrievals) were recorded and no minor complications (0% of retrievals). In the anticoagulation cohort, there were two major complications (1.1% of retrievals) both related to IVC injury. In the non-anticoagulated cohort, there were three major complications (1.7% of retrievals) relating to filter embolisation, IVC injury, and filter fracture. CONCLUSIONS: IVC filter retrieval is a safe procedure with a low complication rate. Being on anticoagulation does not increase the risk of a major complication or change the management of major complication compared with a non-anticoagulated cohort. IVC filter retrieval is safe to perform in patients currently taking prophylactic or therapeutic anticoagulation based on our cohort. LEVEL OF EVIDENCE: Level 3, retrospective cohort study.

Retrieval of an embedded suprarenal inferior vena cava filter using the Hangman technique.

Inferior vena cava filters should be ideally placed in the infrarenal caval segment to maintain renal vein outflow and thereby patency; however, in certain circumstances a suprarenal position may be required. Suprarenal filters are subject to the same risks as for infrarenal filters including tilt. While many advanced techniques have been used for infrarenal filter retrievals, there is a paucity of evidence supporting the use of these retrieval techniques in the suprarenal segment. We show a case of successful retrieval of a suprarenal filter using the Hangman technique.

Radiology training in United Kingdom: current status.

Clinical radiology has always been one of the most competitive specialties in UK. Due to the increasing demand for radiology services the number of training posts in the UK has been increased. Clinical radiology training takes 5 years and requires completion of the Fellowship of Royal College of Radiologists (FRCR) exams, adequate evidence to demonstrate completion of the curriculum and successful appraisals. On completing training and receiving the Certificate for Completion of Training (CCT) a select proportion of trainees choose to embark on a fellowship program. This gives trainees the opportunity to further develop their subspecialty interest generating a high level of confidence in diagnostic and procedural skills.

A comparative analysis of ECG-gated steady state free precession magnetic resonance imaging versus transthoracic echocardiography for evaluation of aortic root dimensions.

PURPOSE: Accurate and reproducible measurement of aortic root dimensions is essential to inform clinical decision making. Transthoracic echocardiography (TTE) is the first line test for assessment of the aortic root but has potential limitations due to its limited field of view and restricted acoustic windows. Cardiac magnetic resonance imaging (MRI) is considered the "gold standard" technique for assessment of cardiac morphology and recently MRI reference ranges for aortic root dimensions have been published. The purpose of this study was to retrospectively compare aortic root measurements obtained from TTE with those derived from cardiac MRI. MATERIALS AND METHODS: Sixty-eight patients (40 males, 28 females) who had undergone both cardiac MRI and TTE imaging within a 4-month interval (mean 62 days) were included. Steady-state-free precession MRI cine imaging was performed with an acquisition plane perpendicular to the aortic root and through the true cross sectional aortic valve plane. A cusp-commissure dimension from inside wall to inside wall in end-diastole was recorded and compared with standardized TTE derived Valsalva sinus measurements. Pearson correlation coefficients and a paired t-test were used for statistical analysis. RESULTS: Mean aortic root dimension by TTE was 3.2±0.5 cm and MRI was 3.4±0.4 cm with a Pearson correlation coefficient of >0.7. Mean difference between TTE and MRI was 0.2±0.3 (P<0.001) with MRI producing a consistently higher measure. In four patients with a dilated aortic root by MRI the TTE measurement was within the normal reference range. In patients with a dilated aortic root (n=19) the mean difference was 0.2±0.4 cm (P<0.05) with MRI consistently producing the larger measure. In patients with a non-dilated aortic root t (n=49) the mean difference was 0.2±0.3 cm (P<0.05) with MRI consistently producing the larger measure. CONCLUSIONS: There is a high level of correlation between TTE and MRI derived aortic root measurements at the Valsalva sinus level. MRI consistently measures the aortic root dimension higher than TTE which may under diagnose patients with a mildly dilated aortic root. Further investigation is required to properly integrate MRI into imaging assessment algorithms.

Safety of an i.v. ß-adrenergic blockade protocol for heart rate optimization before coronary CT angiography.

OBJECTIVE: The purpose of this study was to assess the safety of heart rate optimization by use of ß-adrenergic blockade solely by the i.v. route before coronary CT angiography. MATERIALS AND METHODS: The records of 679 patients undergoing CT coronary angiography after receiving i.v. ß-adrenergic blockade were retrospectively analyzed. Health screening was completed before scanning, and heart rate was optimized by administration of i.v. metoprolol titrated to a maximum of 70 mg to achieve a heart rate less than 65 beats/min. RESULTS: The median i.v. dose was 20 mg (range, 5-70 mg). The 679 patients analyzed had a total of 10 complications (1.47%). Major complications, defined as not resolving with observation and analgesia alone, occurred in only three patients (0.44%). These complications included a second-degree atrioventricular block. A total of 299 patients (44.0%) needed more than 20 mg of i.v. metoprolol to achieve target heart rate. Only three patients needed the maximum i.v. dose of 70 mg metoprolol. Target heart rate was reached successfully in 666 patients (98.1%) with doses of less than 70 mg. This study did not show a statistically significant association between increasing complication frequency and increasing dose. CONCLUSION: This study showed that high doses of i.v. metoprolol can be used effectively and with a low rate of major complications to control heart rate before coronary CT angiography in correctly screened patients.

Assessment of right heart dilatation with magnetic resonance imaging and multidetector computed tomography angiography: spectrum of disease findings.

Right heart chamber enlargement can be caused by a diverse and heterogeneous group of conditions with highly varied clinical symptoms and signs. An appreciation of the pathophysiology, causes, and imaging features of right heart enlargement is paramount in recognizing and potentially ameliorating the development of right heart dysfunction or adverse cardiac events. Chest x-ray and transthoracic echocardiography have traditionally been, and still are, the mainstay in initial evaluation of right heart dilatation; however, recent advances in both multidetector computed tomography and cardiovascular magnetic resonance imaging now permit a comprehensive assessment of the causes and consequences of right heart dilatation.

A comparative analysis of noncontrast flow-spoiled versus contrast-enhanced magnetic resonance angiography for evaluation of peripheral arterial disease.

PURPOSE: This feasibility study aimed to obtain initial data to assess the performance of a novel noncontrast spoiled magnetic resonance (MR) angiography technique (fresh-blood imaging [FBI]) compared to gadolinium-enhanced MR (Gd-MR) angiography for evaluation of the aorto-iliac and lower extremity arteries. MATERIALS AND METHODS: Thirteen patients with suspected lower extremity arterial disease that had undergone Gd-MR angiography and FBI at the same session were randomly included in the study. FBI was performed using an ECG-gated ow-spoiled T2-weighted half-Fourier fast spin-echo sequence. For analysis, the aortoiliac and lower limb arteries were divided into 18 anatomical segments. Two blinded readers individually graded image quality of FBI and also assessed the presence and severity of any stenotic lesions. A similar analysis was performed for the Gd-MR angiography images. RESULTS: A total of 385 arterial segments were analyzed; 34 segments were excluded due to degraded image quality (1.3% of Gd- MR vs. 8% of FBI-MR angiography images). FBI-MR angiography had comparable accuracy to Gd-MR angiography for assessment of the above knee vessels with high kappa statistics (large arteries, 0.91; small arteries, 0.86) and high sensitivity (large arteries, 98.1%; small arteries, 88.6%) and specificity (large arteries, 97.2%; small arteries, 97.6%) using Gd-MR angiography as the gold standard. CONCLUSION: Initial results show good agreement between FBI-MR angiography and Gd-MR angiography in the diagnosis of peripheral arterial disease, making FBI a potential alternative in patients with renal impairment. FBI showed highest accuracy in the above knee vessels. Technological refinements are required to improve accuracy for assessing the calf and pedal vessels.