Therapeutic lymphangiography with ethiodized oil for the management of lymphoceles and chylous ascites.

PURPOSE: The purpose of this study was to analyze the safety, technical success and clinical outcome of percutaneous intranodal ethiodized oil (Lipiodol®) based lymphangiography (L-LAG) for the management of refractory pelvic lymphoceles or chylous ascites using high doses of ethiodized oil. MATERIALS AND METHODS: Thirty-four patients presenting with symptomatic, refractory postoperative pelvic lymphocele or chylous ascites referred for theranostic, inguinal, intranodal L-LAG treatment between May 2018 and November 2021 were retrospectively included. There were 21 men and 13 women, with a mean age of 62.7 ± 16.2 (standard deviation) years (age range: 9-86 years), who underwent a total of 49 L-LAG for the management of lymphoceles (n = 14), chylous ascites (n = 18) or a combination of lymphocele and chylous ascites (n = 2). Clinical and radiological pre-interventional, procedural and follow-up data up to January 2022 were collected from patients' electronic medical records and imaging files. RESULTS: Technical success was obtained in 48 out of 49 L-LAG (98%). No complications related to L-LAG were noted. After one or more L-LAG, clinical success was obtained in 30 patients (88%) with a mean of 1.4 interventions per patient and mean intranodal injected volume of 29 mL of ethiodized oil per session. The remaining four patients (12%), with one or more failed L-LAG, underwent additional surgical intervention to definitively treat the postoperative lymphatic leakage. CONCLUSION: L-LAG using high doses of ethiodized oil is a minimally invasive, safe and effective treatment of postoperative pelvic lymphocele or chylous ascites. Multiple sessions may be needed to obtain a meaningful clinical result.

Infected Urachal Cyst Mimicking Urachal Carcinoma: A Rare Cause of Lower Abdominal Tenderness.

Teaching Point: Infected urachal cysts are a rare cause of abdominal complaints and can be accurately diagnosed by abdominal ultrasound and computed tomography (CT).

Balloon-assisted transcaval embolization of a type II endoleak associated with an aortocaval fistula after endovascular aortic repair.

Endovascular aortic repair is an accepted treatment option for patients with infrarenal aortic aneurysm. Type II endoleak associated with persistent aneurysmal sac growth is considered an adverse event requiring endoleak occlusion. We describe the case of a patient with type II endoleak after endovascular aortic repair for infrarenal aortic aneurysm associated with aortocaval fistula and persistent aneurysm growth. Type II endoleak embolization was successfully performed with coils and Onyx through a transcaval approach using an occlusion balloon and co-axial microcatheter.

Anatomically based classification of medial clavicle fractures.

Medial clavicle fractures represent less than 5% of all clavicle injuries. The purpose of this study was to evaluate reliability of a new anatomically based (AB) classification system compared to other classification systems and to evaluate the clinical outcome of nonoperative treated fractures. 55 acute medial clavicle fractures (55 patients) were 3D reconstructed and evaluated using the Edinburgh (ED), Throckmorton (TR) and new AB classification. The AB classification classified the fracture as medial (Type 1) or lateral (Type 2) to the costoclavicular ligament and no or minimal displaced (Type A) or displaced (Type B). Next, a consecutive retrospective clinical evaluation of 38 of these patients was performed using the Oxford Shoulder and Constant Score. An anatomically based classification shows the highest inter- and intra-observer reliability. In case the fracture line originate medial to the costoclavicular ligament and is displaced the Constant and Oxford scores are significantly less.

CT colonography interpretation times: effect of reader experience, fatigue, and scan findings in a multi-centre setting.

Our purpose was to assess the effect of reader experience, fatigue, and scan findings on interpretation time for CT colonography. Nine radiologists (experienced in CT colonography); nine radiologists and ten technicians (both groups trained using 50 validated examinations) read 40 cases (50% abnormal) under controlled conditions. Individual interpretation times for each case were recorded, and differences between groups determined. Multi-level linear regression was used to investigate effect of scan category (normal or abnormal) and observer fatigue on interpretation times. Experienced radiologists (mean time 10.9 min, SD 5.2) reported significantly faster than less experienced radiologists and technicians; odds ratios of reporting times 1.4 (CI 1.1, 1.8) and 1.6 (1.3, 2.0), respectively (P

Polyp measurement and size categorisation by CT colonography: effect of observer experience in a multi-centre setting.

The extent measurement error on CT colonography influences polyp categorisation according to established management guidelines is studied using twenty-eight observers of varying experience to classify polyps seen at CT colonography as either 'medium' (maximal diameter 6-9 mm) or 'large' (maximal diameter 10 mm or larger). Comparison was then made with the reference diameter obtained in each patient via colonoscopy. The Bland-Altman method was used to assess agreement between observer measurements and colonoscopy, and differences in measurement and categorisation was assessed using Kruskal-Wallis and Chi-squared test statistics respectively. Observer measurements on average underestimated the diameter of polyps when compared to the reference value, by approximately 2-3 mm, irrespective of observer experience. Ninety-five percent limits of agreement were relatively wide for all observer groups, and had sufficient span to encompass different size categories for polyps. There were 167 polyp observations and 135 (81%) were correctly categorised. Of the 32 observations that were miscategorised, 5 (16%) were overestimations and 27 (84%) were underestimations (i.e. large polyps misclassified as medium). Caution should be exercised for polyps whose colonographic diameter is below but close to the 1-cm boundary threshold in order to avoid potential miscategorisation of advanced adenomas.

CT colonography after fecal tagging with a reduced cathartic cleansing and a reduced volume of barium.

OBJECTIVE: The objective of our study was to assess the efficacy of fecal tagging with a small volume of barium in combination with a reduced cathartic cleansing before CT colonography. MATERIALS AND METHODS: The study consists of a review of 200 patients examined in a clinical setting. Conventional colonoscopy and CT colonography or follow-up were used as the gold standard. All patients prepared for CT colonography the day before the examination with a dedicated low-residue diet. Fecal tagging was performed with 50 mL of barium. The residual feces and fluid were evaluated on a segmental basis. The residual feces was divided in two categories (< 6 mm and > or = 6 mm). The amount of fluid was assessed on the axial slices. The efficacy of tagging was evaluated visually. RESULTS: For the study, 1,200 segments were evaluated. Residual feces was present in 413 segments (34.41%), with feces less than 6 mm in 210 segments (17.5%) and feces 6 mm or greater in 203 segments (16.92%). There was residual fluid in 527 segments (43.91%). Nontagged feces 6 mm or greater was present in 49 segments (4.08%) and nontagged fluid in 178 segments (14.83%). All nontagged feces 6 mm or greater was easy to assess. All fluid redistributed with dual positioning. A total of 65 lesions 6 mm or greater were correctly diagnosed on primary CT colonography. In two patients, two lesions adjacent to each other were misinterpreted as being only one. Another 8-mm lesion was missed. CONCLUSION: In the present study, CT colonography after fecal tagging with 50 mL of barium combined with a reduced cathartic cleansing was feasible.