Venous thrombosis and segmental hypoperfusion in amebic liver abscess: MDCT demonstration and its implications.

PURPOSE: To report venous thrombosis and associated perfusion defect in amebic liver abscess (ALA) using MDCT. METHOD: MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities. RESULT: The study found 43 (69%) patients with venous thrombosis: portal vein thrombosis (PVT) occurred in 39, hepatic vein thrombosis (HVT) in 37 and inferior vena cava (IVC) thrombosis in 4. Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were confined to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identified in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred significantly more often with combined PVT and HVT than HVT alone (p = 0.05). Arterial phase enhancement occurred in 2 of 13 patients with multiphasic CT. All patients were symptomatic despite medical therapy and therefore required percutaneous drainage. About half of the patients were identified with ruptured abscesses. Segmental atrophy was observed in seven of nine patients who underwent follow-up CT. CONCLUSION: Combined PVT and HVT commonly occur with ALA and often manifests as segmental hypoperfusion in portal venous phase, indicating ischemia. The detection of such events by CT may be indicative of severe disease that requires aggressive management involving percutaneous drainage.

Outcomes of different surgical resection techniques for end-stage hepatic alveolar echinococcosis with inferior vena cava invasion.

BACKGROUND: Hepatic alveolar echinococcosis (HAE) lesions with inferior vena cava (IVC) invasion require combined resection of the liver and IVC. The outcomes of different surgical treatments, including in situ, ante situm and ex vivo resection, remain unclear. METHODS: A total of 71 consecutive HAE patients who underwent hepatectomy with retrohepatic IVC resection were included. The patients were divided into ex vivo liver resection and autotransplantation (ERAT) group (n = 45) and in vivo resection group (n = 26). These techniques were assessed for feasibility and short- and long-term outcomes. RESULTS: There were no significant differences with respect to postoperative complications and mortality between the ERAT and in vivo resection groups. The causes of mortality were liver failure in 3 patients, hemorrhagic shock in 1 patient, intra-abdominal bleeding in 1 patient, and acute cerebral hemorrhage in 1 patient. During a median of 22 months followed-up time, 2 patients developed ascites because of venous outflow stenosis, and 1 patient developed biliary stenosis in the ERAT group. The distant metastasis, local recurrence, and mortality rates were 0%, 1.4%, and 8.5%, respectively. CONCLUSION: Combined liver resection and reconstruction of the IVC can be safely performed in selected patients with in situ, ante situm, and ex vivo resection.

Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation.

BACKGROUND: For end-stage hepatic alveolar echinococcosis, insufficient guidance is available regarding surgical treatment, especially for ex vivo liver resection combined with autotransplantation. The indications for this complex surgery require further discussion. METHOD: We reviewed 50 cases of patients who underwent ex vivo liver resection combined with autotransplantation from January 2014 to February 2018. A newly developed classification was used to describe vascular infiltration in all patients, who were divided into four groups based on anatomic lesion features and surgical patterns. The surgical planning for ex vivo liver resection combined with autotransplantation is then thoroughly discussed according to the gathered information. RESULTS: In all patients, the length of the operation and the anhepatic phase were 735 minutes (range, 540-1,170 minutes) and 309 minutes (range, 122-480 minutes), respectively. The median remnant liver volume-to-standard liver volume ratio was 0.58 (range, 0.32-1.11). The rate of complications classified as Clavien-Dindo grade III or higher was 22% (11/50). A total of 3 postoperative deaths occurred. We identified 4 types with distinguished lesion anatomic features. Type I patients required more frequent unconventional reconstruction of the portal vein and bile duct than the other patients. Of the 6 type IV patients, 4 required modification of the surgical protocol according to intraoperative findings. CONCLUSION: Vascular infiltration-based classification could improve the anatomic comprehension and, thus, facilitate surgical planning for ex vivo liver resection combined with autotransplantation. Through cautious evaluation of operability, liver function, and residual liver volume, together with delicate operative techniques and careful postoperative management, ex vivo liver resection combined with autotransplantation can achieve good results in the treatment of end-stage hepatic alveolar echinococcosis.

Retrospective study of canine heartworm disease with caval syndrome in Grenada, West Indies.

Canine heartworm disease caused by Dirofilaria immitis is an important disease of dogs. The aim of this retrospective study was to estimate the prevalence of canine heartworm disease and evaluate cases of caval syndrome in dogs submitted for necropsy in Grenada. Out of 1617 dogs necropsied over a period of 13 years (2001-2013), 249 were found to be infected with D. immitis; giving an overall prevalence of 15.4% (95% confidence interval, 13.6% to 17.1%). There was no significant difference between male and female dogs with respect to canine heartworm infection (p = 0.3). During this period, the annual prevalence of canine heartworm disease was 22% in 2001 before slightly declining to an average of 18% in 2002-2003 and peaking at 26.8% in 2004-2005. From 2006 onwards, annual prevalence rates have steadily been decreasing; reaching the lowest (9%) in 2013. Among the 249 positive cases, 33 (13.2%) of the dogs had caval syndrome. Caval syndrome cases presented with concurrent clinical signs and were associated with cardio-pulmonary and hepatic gross lesions at necropsy. Aberrant migration of D. immitis was also noted in 2 dogs with caval syndrome. This is the first report which presents the findings of canine heartworm disease with caval syndrome in Grenada.

Liver hydatid cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case.

Hydatid disease (HD) is a worldwide parasitic disease. Echinococcosis may involve many organs but affect most commonly liver and lungs. The location of echinococcal cysts inside pulmonary artery is extremely rare. Radiologic findings range from purely cystic lesions to a completely solid appearance. Hydatid cysts (HC) can be solitary or multiple and varies size. Pulmonary artery embolism of HC can be symptomatic or asymptomatic. When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.

Management and outcome of cardiac and endovascular cystic echinococcosis.

BACKGROUND: Cystic echinococcosis (CE) can affect the heart and the vena cava but few cases are reported. METHODS: A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009) is reported. RESULTS: Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months). One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE) and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications. CONCLUSIONS: Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.

[Multiple pulmonary hydatid disease with cardiovascular localisation]. / Hydatidose pulmonaire multiple avec localisation cardiovasculaire.

Multiple thoracic hydatid disease is rare. Cardiovascular localisation is exceptional. Clinical, radiological and even electrocardiographic signs are not specific. The diagnosis is often difficult. We report a case of multiple pulmonary hydatid disease associated to a hydatid cyst of the infundibulum of the pulmonary artery. This is presented in a young man, aged 21 years, in good physical health, with recurrent minimal haemoptysis dating back two years ago. The authors emphasise, throughout this case history, the difficulties of diagnosis and treatment of multiple hydatid cysts especially with cardiovascular localisation.

Hepatic and inferior vena caval thrombosis: vascular complication of amebic liver abscess.

Although amebic liver abscess is a common disease, it is a rare cause of venous thrombosis. Computed tomography (CT) scan is an ideal tool for diagnosing the various complications associated with liver abscess. We describe a case of amebic liver abscess in a patient who developed a rare vascular complication of hepatic vein and inferior vena cava thrombosis.

Combined resection of the liver and the inferior vena cava for hydatid disease.

Hydatid disease can result in cystic liver disease. If a conservative treatment fails, these cysts require resection. Involvement of the inferior vena cava requiring resection for hydatid disease is unusual. We present a case of hydatid disease with complete caval obstruction and resultant portal hypertension that required combined liver resection and inferior vena cava replacement.

Hydatid cyst of the pulmonary artery secondary to hepatic hydatid cyst embolism.

A cystic lesion of the liver extending into the inferior vena cava was discovered in a 33-year old female patient suffering from dyspnea, pain and swelling in the legs. Plain chest X-ray was normal. CT and MRI of the thorax showed a cystic lesion within the right pulmonary artery. The liver lesion was treated by a partial cystectomy and omentoplasty, inferior vena cava and bile ducts repair. Through a right thoracotomy, a hydatid cyst was found in the pulmonary artery and enucleated. Although very rare, pulmonary artery hydatidosis may be the cause of an unexplained dyspnea in patients with hydatidosis of the liver.

Alveolar hydatid disease causing total occlusion of the inferior vena cava.

Alveolar hydatid disease is a malignancy-like parasitic disease. It is invasive, metastatic, and almost always lethal if left untreated. A case of alveolar hyatid disease presenting with total of the inferior vena cava is reported. This 28-year-old man was referred for elevation of obstructive jaundice. He was a lama and had recently arrived in Taiwan after touring temples in Nepal, India, and Singapore. Computed tomography showed calcified mass which occupied the right hepatic lobe with extension to the left hepatic lobe. The inferior vena cava was occluded and stricture of biliary tree and portal vein at the hilum was also noted. The patient was treated successfully with palliative resection combined with postoperative albendazole. With increasing travel and immigration, clinicians will be more likely to encounter this rare disease, and thus should be able to recognize its symptoms.

Evaluation of the retrievability of the OptEase IVC filter in an animal model.

PURPOSE: A new inferior vena cava filter was evaluated in vivo to determine the percutaneous retrievability after an implantation period of up to 18 days. MATERIALS AND METHODS: The inferior venae cavae of six goats were percutaneously implanted with three filters, and one animal received two filters. To assess filter stability, a plain radiograph was obtained after 7-9 days and on the day of retrieval. After cavography, filter retrieval with an endovascular snare and retrieval catheter was performed in three animals after 12 days and in three others after 14 days. In one animal, retrieval of one filter was performed after 18 days, and one filter was intended to be permanent. Twenty-eight days after filter retrieval, cavography was performed before inferior vena cava removal for gross and histologic examination. RESULTS: All filters (N = 20) were implanted without complications. There was no migration during the implantation period. Preretrieval cavography demonstrated all filters to be patent and centered. Filters intended for retrieval (n = 19) were all successfully extracted at 12 (nine filters), 14 (nine filters), and 18 days (one filter). For the animal with the filter extracted at 18 days, one filter remained in situ intentionally. Postretrieval cavography showed no visible signs of vessel wall anomalies. There were no complications during the 28 days of follow-up after retrieval. Presacrifice cavography showed no evidence of caval wall abnormalities. In all animals, gross examination of the inner wall of the explanted vena cava showed only minimal macroscopic changes. The struts of the filter in situ for 46 days (18 days with 28 days of follow-up) were overgrown with neointima. Histological study of the 19 filter retrieval sites revealed no to moderate intima proliferation, minimal residual signs of hemorrhages, and no or only occasional slight inflammatory reaction. CONCLUSIONS: In this animal model, the new vena cava filter demonstrated event-free retrieval, without postretrieval complications, up to 18 days postimplantation. After implantation of 46 days, the filter showed neointima overgrowth of the struts.

MRI of cerebral alveolar echinococcosis.

Cerebral alveolar echinococcosis is rare. We report a case with multiple intracranial masses which show cauliflower-like contrast enhancement pattern on MRI. The lesions originated from hepatic involvement with invasion of the inferior vena cava.

Use of a modified surgical approach to the right atrium for retrieval of heartworms in a dog.

A 2-year-old 2-kg female Maltese dog was referred for treatment of dirofilariosis and mild caval syndrome characterized by hemolysis and lethargy. Ultrasonography revealed worms within the caudal vena cava, right auricle, right ventricle, and pulmonary artery. Because of the mild clinical signs and small size of the dog, jugular venotomy was not performed, and treatment with sodium caparsolate was instituted. A markedly adverse reaction was noticed on initial injection, characterized by cardiac and respiratory arrest. Further treatment with sodium caparsolate was discontinued. Because of progression of the dog's condition surgical removal of heartworms was elected. A modified surgical approach to the right atrium was performed, using a cannula introduced through a pursestring placed in the wall of the right auricle. This technique allowed almost complete removal of heartworms with minimal blood loss. Postoperative ultrasonography revealed a single heart-worm remaining in the distal portion of the left pulmonary artery, but it was subsequently absorbed.

Comparaçäo do parasitismo da veia central da supra-renal com o de outors tecidos em chagásicos crônicos / Comparison of parasitology of the central vein of the adrenal gland and the other tissues in chronic Chagas disease

Através da análise morfológica e morfométrica de cortes foi estudada a ocorrência de ninhos de T. cruzi na veia central e no parênquima das supra-renais, no miocárdico ventricular esquerdo e na veia cava inferior de chagásicos crônicos. Em 36 casos estudados 50 por cento apresentavam fleboparasitismo supra-renálico (total 29 ninhos); 3,1 por cento apresentavam parasitismo na veia cava (apenas 1 ninho) e em 16,8 por cento dos casos encontramos miocardiócitos parasitados (total 23 ninhos). A densidade de parasitismo, expressa em número de ninhos por 100mm² de tecido examinados, foi de 0,585 para a veia supra-renálica, de 0,001 para a veia cava e 0,01 para o miocárdio . Em 269.103,1mm² de parênquima supra-renálico näo encontrando nenhum ninho. Embora tenha sido a menor área examinada, a veia central apresentou a maior freqüência de ninhos de T. cruzi. Como a diferença básica entre estes tecidos está na riqueza de corticóides no sangue que nutre a veia central, podemos admitir que esta prevalência talves seja devido ao ambiente hormonal, que por seu efeito imunossupressor e anti-inflamatório favoreceria a sobrevida dos parasitas

[Comparison of parasitology of the central vein of the adrenal gland and the other tissues in chronic chagas disease]. / Comparação do parasitismo da veia central da supra-renal com o de outros tecidos em chagásicos crônicos.

By morphological and morphometric analyses of serial sections the occurrence of T. cruzi nests in the central vein and in the parenchyma of adrenal glands, in the left ventricular wall and in the inferior vena cava wall in chronic Chagasic patients was studied. Of 36 cases 50% showed parasites in the adrenal central vein wall (total 29 nests), 3.1% showed parasites in the vena caval wall (only I nest) and 16.8% we found parasites in the myocardiocytes (total 23 nests). The density of parasites measured in the nests for each 100mm2 of the tissue examined, was 0.585 for the adrenal vein, 0.001 for the vena cava and 0.01 for the myocardium. No nest was found in 269103.1mm2 of adrenal parenchyma. Although the central vein area examined was smaller, it showed the largest frequency of T. cruzi nests. Since a basic difference between these tissues is the great quantity of corticoids in the blood of the adrenal central vein, this prevalence may be because of this hormonal ambient, which with its immunosuppressor and anti-inflammatory effects could help T. cruzi survival.