RESUMEN
Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and studies meeting the inclusion criteria were reviewed for patient outcomes. Results: A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. Infertility was the main indication for investigation and all studies used US as the surveillance modality. A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. Conclusions: Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking. This approach could be considered in patients with incidental, impalpable testicular masses of ≤5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Dimetilsulfóxido/administración & dosificación , Embolización Terapéutica , Endofuga/terapia , Vértebras Lumbares/irrigación sanguínea , Polivinilos/administración & dosificación , Tantalio/administración & dosificación , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Endofuga/diagnóstico por imagen , Endofuga/etiología , Femenino , Humanos , Inyecciones Intraarteriales , Stents , Resultado del TratamientoRESUMEN
An 86-year-old woman presented to hospital with melaena. This was her third presentation with the same symptom. There was no obvious source of bleeding on her oesophagogastroduodenoscopy; however, it did show a previously clipped Dieulafoy lesion. CT angiography showed an aneurysm arising from the hepatic artery. Selective coeliac artery angiogram showed aneurysmal dilatation of the distal part of the coeliac trunk and confirmed the presence of the common hepatic artery aneurysm. The aneurysm was coiled by the interventional radiologist. Final angiogram showed good flow through the hepatic artery with obliteration of the inferior patch. The procedure was uncomplicated and the patient was discharged shortly afterwards.
Asunto(s)
Aneurisma/diagnóstico por imagen , Embolización Terapéutica/instrumentación , Hemorragia Gastrointestinal/diagnóstico , Arteria Hepática/patología , Hígado/irrigación sanguínea , Hígado/patología , Anciano de 80 o más Años , Aneurisma/cirugía , Angiografía por Tomografía Computarizada/métodos , Diagnóstico Diferencial , Embolización Terapéutica/métodos , Servicio de Urgencia en Hospital , Femenino , Hemorragia Gastrointestinal/etiología , Arteria Hepática/anomalías , Humanos , Resultado del TratamientoRESUMEN
We report our experience and the midterm results of a modern technique for endovascular management of isolated iliac artery aneurysms (IAAs) with unfavorable neck anatomy, which involves the inversion of an iliac leg of a Zenith stent graft. Patients who underwent endovascular IAA repair from 2002 to 2010 were reviewed. A total of 12 patients, with a mean age of 77.6 years, underwent endovascular repair of 13 IAAs. Mean size of the aneurysms was 54.6 mm (range 34-133 mm). Mean proximal neck diameter was 18 mm (range 15-22 mm). In 7 patients, the length of the proximal neck was <15 mm (10-14 mm). Only 1 patient developed thrombosis of the stent graft immediately after the operation. Patients were followed up for a mean of 31.5 months (range 18-72 months). Our midterm results demonstrate the durability of this technique in the management of iliac aneurysms with unfavorable anatomy.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Aneurisma Ilíaco/cirugía , Stents , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Femenino , Oclusión de Injerto Vascular/etiología , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Londres , Masculino , Diseño de Prótesis , Estudios Retrospectivos , Trombosis/etiología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Increasing evidence supports a role for contrast-enhanced ultrasound in the assessment of blunt abdominal trauma. Accurate definition of organ injury can be demonstrated, as well as extension to solid organ capsule and even vascular injury. Low-dose contrast is needed for renal imaging, to avoid obscuration of deeper structures from intense cortical enhancement. The liver should be evaluated in the arterial phase for active bleeding and in the late phase for lacerations. The spleen is best assessed in the delayed phase, thereby limiting misinterpretation of early heterogeneous contrast uptake. Typical sonographic features of traumatic injuries of the solid abdominal organs are described. Although contrast-enhanced computed tomography is the gold standard modality for imaging abdominal organ traumatic injury, contrast-enhanced ultrasound has developed a role in the emergency setting, particularly in low-energy injuries and in follow-up of traumatic injuries.
Asunto(s)
Traumatismos Abdominales/diagnóstico por imagen , Medios de Contraste , Ultrasonografía/métodos , Heridas y Lesiones/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagen , Traumatismos Abdominales/patología , Humanos , Hígado/diagnóstico por imagen , Hígado/lesiones , Hígado/patología , Bazo/diagnóstico por imagen , Bazo/lesiones , Bazo/patología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ultrasonografía/instrumentación , Heridas y Lesiones/patología , Heridas no Penetrantes/patologíaRESUMEN
Renal artery embolization is the treatment of choice for massive hemorrhage after percutaneous nephrolithotomy. Late coil migration is a known complication after embolization. We report an unusual case of early coil migration causing ureteric obstruction and postulate on risk factors for this phenomenon.
Asunto(s)
Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Migración de Cuerpo Extraño/terapia , Cálculos Renales/terapia , Nefrostomía Percutánea/efectos adversos , Hemorragia Posoperatoria/terapia , Obstrucción Ureteral/terapia , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Angiografía , Angiografía de Substracción Digital , Aortografía , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/terapia , Cálculos Renales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/diagnóstico por imagen , Arteria Renal/diagnóstico por imagen , Arteria Renal/lesiones , Tomografía Computarizada por Rayos X , Obstrucción Ureteral/diagnóstico por imagen , UreteroscopíaRESUMEN
Endovascular treatments are limited in cases of thoracic aortic aneurysms extending up or proximal to the origin of the left subclavian artery (LSCA). In such cases, the LSCA is usually either occluded or revascularised. We report our first experience of four patients who underwent thoracic aneursym treatment with new custom-made grafts with a scallop in situ for the LSCA. The graft is tailor made per case, and a re-enforced scallop is positioned proximally allowing for the stent to be deployed beyond the origin of the LSCA; the origin of the LSCA remains patent, thus negating the need for revascularisation of the head and neck vessels on the left. The stent contains markers for identifying the scallop and are located along the midline to ensure correct alignment. All of the patients who underwent this procedure had technical success with flow through the LSCA both immediately after stent deployment and on follow-up imaging. This new stent has further expanded endovascular treatment options for patients with thoracic aneurysms extending up to and beyond the LSCA, which can play a part in improving outcome and decreasing mortality rates because surgery for revascularization will not be needed.
Asunto(s)
Aleaciones , Angioplastia/métodos , Aorta Torácica , Aneurisma de la Aorta Torácica/terapia , Aortografía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Diseño de Prótesis , Stents , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Femenino , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Ajuste de Prótesis , Arteria Subclavia/diagnóstico por imagenRESUMEN
OBJECTIVE: The technique of embolization of pulmonary arteriovenous malformations (PAVMs) with the Amplatzer vascular plug (AVP) has been reported, but no large series has evaluated the effectiveness of this relatively new embolic device. The purpose of this study is to assess the role of AVPs in the treatment of PAVMs. MATERIALS AND METHODS: Sixty-nine consecutive patients underwent embolization of pulmonary arteriovenous malformations between September 2006 and December 2008. Clinical, procedural, and physiological data were reviewed retrospectively. RESULTS: Of 161 PAVMs, 120 (75%) were successfully embolized with Amplatzer vascular plugs alone. Complete and rapid occlusion of feeding vessels was easily achieved at the site of arteriovenous communication without complication. Particularly small or tortuous feeding arteries supplying 27 complex and 14 simple PAVMs were occluded with coils. There have been no documented instances of recanalization on follow-up. CONCLUSION: Amplatzer vascular plugs allow the rapid and safe distal occlusion of the majority of PAVMs.