Asunto(s)
Enfermedades de la Aorta/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Isquemia/etiología , Pierna/irrigación sanguínea , Enfermedad Arterial Periférica/etiología , Trombosis/diagnóstico por imagen , Enfermedad Aguda , Adulto , Enfermedades de la Aorta/complicaciones , Humanos , Isquemia/diagnóstico por imagen , Pierna/diagnóstico por imagen , Masculino , Enfermedad Arterial Periférica/diagnóstico por imagen , Trombosis/complicacionesRESUMEN
AIM: To assess if intra-tumoural fat on magnetic resonance imaging (MRI) affects the ultrasonographic (US) visibility of small (≤3 cm) hepatocellular carcinomas (HCC) during radiofrequency ablation (RFA). MATERIALS AND METHODS: Institutional review board approval was obtained. A retrospective review of all patients who underwent image-guided ablation between 1 January 2010 and 31 April 2015 was performed. Patients with HCC who underwent US RFA were included. Inclusion criteria included small tumours (≤3 cm), treatment-naive cases or new focus of HCC in a different and untreated segment, and pre-procedural MRI. The presence of intra-tumoural fat was determined retrospectively via in-and-out-of-phase MRI. Other factors that potentially affect ultrasonographic visibility, such as background fatty liver, presence of cirrhosis, tumour size, and distance from diaphragm, were recorded. RESULTS: Ninety procedures performed on 74 patients (62 men and 12 women; mean age: 67.3 years; range: 39-88 years). Seventy-two tumours were visible on US (hypoechoic n=35, hyperechoic n=28, heterogeneous n=9). Intra-tumoural fat was seen in 23 tumours (25.6%, hyperechoic n=17, hypoechoic n=6). The presence of intra-tumoural fat (p=0.005) and distance from diaphragm (p=0.007) were found to be statistically significant factors affecting tumour visibility on planning US. The presence of background fatty liver (p=0.485), cirrhosis (p=0.48), and tumour size (p=0.15) were not found to be significant. CONCLUSION: The present study shows that the presence of intra-tumoural fat in small HCCs on pre-procedural MRI can accurately predict their visibility on planning US during percutaneous tumour ablation.
Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Ablación por Catéter/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética/métodos , Ultrasonografía Intervencional , Tejido Adiposo/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/patología , Femenino , Humanos , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
Contrast medium extravasation at computed tomography (CT) is an accurate indicator of active haemorrhage in pelvic trauma. When this is present, potentially lifesaving surgical or endovascular treatment should be considered. Identification of the site or territory of haemorrhage is helpful for the interventional radiologist as it allows for focused angiographic evaluation and expedites haemostatic angio-embolisation. Even with thin-section arterial phase CT, tracing the bleeding vessel is not always possible and is often time consuming. We introduce a technique for predicting the bleeding vessel based on knowledge of the cross-sectional anatomical territory of the vessel as an alternative to tracing the vessel's course. Several case examples with digital subtraction angiography (DSA) correlation will be provided.
Asunto(s)
Angiografía de Substracción Digital , Fracturas Óseas/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Pelvis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Heridas y Lesiones/diagnóstico por imagen , Arterias/patología , Medios de Contraste , Toma de Decisiones , Embolización Terapéutica/métodos , Urgencias Médicas , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/terapia , Hemorragia/etiología , Hemorragia/cirugía , Humanos , Masculino , Pelvis/irrigación sanguínea , Pelvis/lesiones , Heridas y Lesiones/complicacionesAsunto(s)
Carcinoma Hepatocelular/terapia , Embolización Terapéutica/efectos adversos , Arteria Hepática/lesiones , Enfermedad Iatrogénica , Neoplasias Hepáticas/terapia , Enfermedad Aguda , Tomografía Computarizada de Haz Cónico/métodos , Medios de Contraste , Embolización Terapéutica/métodos , Estudios de Seguimiento , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/patología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica/métodosAsunto(s)
Conductos Biliares , Migración de Cuerpo Extraño/etiología , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Colangiografía , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/cirugía , Humanos , Prótesis e ImplantesRESUMEN
A liver abscess is a feared and potentially fatal complication following transarterial chemoembolisation (TACE) and radiofrequency ablation (RFA) of liver tumours. Iatrogenic bilio-enteric communications, such as bilio-enteric anastomosis, sphincterotomy and biliary stents, are considered major risk factors and are due to bacterial colonisation of the biliary tree with enteric flora. Naturally occurring spontaneous cholecysto-enteric fistula poses a similar risk as its iatrogenic counterparts but is rarely described in the literature. We present a case where abscess formation complicated a combined TACE and RFA in an unrecognised cholecystocolic fistula.
Asunto(s)
Fístula Biliar/etiología , Ablación por Catéter/efectos adversos , Quimioembolización Terapéutica/efectos adversos , Neoplasias del Colon/patología , Enfermedades de la Vesícula Biliar/etiología , Absceso Hepático/patología , Neoplasias Hepáticas/secundario , Anciano , Fístula Biliar/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Humanos , Absceso Hepático/etiología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Mesenteric desmoid tumour (MDT) is an uncommon neoplasm that typically presents as a solid soft-tissue mass on cross-sectional imaging. MDT manifesting as a fat-containing cystic mass on CT has not been described in the literature. We report such an unusual case with clinicopathological correlation.
Asunto(s)
Quistes/diagnóstico por imagen , Fibromatosis Abdominal/diagnóstico por imagen , Quiste Mesentérico/diagnóstico por imagen , Dolor Abdominal/etiología , Quistes/patología , Diagnóstico Diferencial , Femenino , Fibromatosis Abdominal/patología , Humanos , Quiste Mesentérico/patología , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Vómitos/etiologíaRESUMEN
PURPOSE: Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005. METHODS AND MATERIAL: 26 women and 16 men with diabetes between the ages of 45 and 91 years old (mean age, 70.8 years) received PTA in 2005. Presenting symptoms were rest pain (n = 22), pre-existing gangrene (n = 17), non-healing ulcer (n = 16) and cellulitis (n = 2). The aim of the PTA was to achieve straight-line flow from the abdominal aorta down to the patent dorsalis pedis or plantar arch, with limb salvage as the ultimate outcome. Failure of treatment was defined as any amputation above the level of a Syme's amputation or the need for further surgical bypass. Technical success was achieved in 90% (38 out of 42 patients). RESULTS: Limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months, 78% at 1 year, 69% at 2 years and 66% at 3 years. Mortality was 17% (n = 7) at 3 years. Of the 13 patients with failed therapy, 3 underwent bypass, 9 had amputations and 1 had bypass followed by amputation. Four of the cases required further intervention due to worsening gangrene and infection, while the remaining was due to persistent rest pain. The rest of the 32 patients had no lower limb related issues at the end of 3 years, with improvement of the presenting symptoms. Patterns of treated segments were aortoiliac occlusions (n = 3), pure infrapopliteal disease (n = 3), femoropopliteal with at least 1 good infrapopliteal run-off vessel (n = 14) and combined femoropopliteal and infrapopliteal disease (n = 25). CONCLUSION: Involvement of infrapopliteal vessels that needs to be treated is common in Asian diabetics. While early limb salvage rates up to 1 year are similar, the 3 year limb salvage rates in Asian diabetics are lower than the western population.
RESUMEN
Right atrial thrombus formation is a known complication of dialysis catheter placements. We describe the case of a 61-year-old woman with end-stage renal failure who presented with gram-negative septicaemia. A gas-containing filling defect was noted incidentally in the right atrium during a CT scan of the abdomen and pelvis, indicative of a thrombus infected by a gas-forming organism. The finding correlated with a positive blood culture of Klebsiella pneumoniae and the two-dimensional echocardiography finding of an echogenic atrial thrombus.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Cardiopatías/diagnóstico por imagen , Infecciones por Klebsiella/etiología , Klebsiella pneumoniae , Trombosis/diagnóstico por imagen , Catéteres de Permanencia/efectos adversos , Femenino , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/etiología , Humanos , Fallo Renal Crónico/terapia , Infecciones por Klebsiella/diagnóstico por imagen , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Trombosis/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Adenocarcinoma/radioterapia , Hepatopatías/diagnóstico por imagen , Hepatopatías/etiología , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/etiología , Neoplasias Gástricas/radioterapia , Tomografía Computarizada por Rayos X , Adenocarcinoma/cirugía , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Radioterapia Adyuvante/efectos adversos , Neoplasias Gástricas/cirugíaRESUMEN
Thoracic endovascular aortic repair (TEVAR) is a recognized treatment for various diseases involving the thoracic aorta. Patients treated with TEVAR require lifelong surveillance for potential complications, with CT being highly utilized in most centres. Endoleak is the most common complication and can be detected using CT. However, other complications such as stent strut perforations and end organ ischemia can also be detected on CT. The purpose of this pictorial essay is to illustrate the CT appearance of post-TEVAR complications encountered in our institution and to highlight their significance.
Asunto(s)
Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Angiografía/métodos , Aorta Torácica/fisiopatología , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/etiología , Diagnóstico por Imagen/métodos , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Stents/efectos adversos , Procedimientos Quirúrgicos Torácicos/efectos adversosRESUMEN
The spontaneous rupture of a phaeochromocytoma is a rare and potentially fatal complication. Prompt diagnosis, patient stabilisation and adrenectomy are crucial for survival. However, it is known that adrenectomy performed in the emergency setting is associated with a high mortality rate, in contrast to the negligible mortality rate with elective surgery. We describe transcatheter arterial embolisation (TAE) using polyvinyl alcohol particles (PVA) in restoring haemodynamic stability during an acute phaeochromocytoma rupture in a 67-year-old man to avoid the risks of performing an emergency adrenectomy. TAE improves the prognosis significantly by prolonging treatment time for patient optimisation and to enable the possibility of elective adrenectomy. To the best of our knowledge, TAE using PVA in an acute phaeochromocytoma rupture has not been previously reported in the English literature.