Percutaneous spine biopsy: reaching those hard-to-reach places.

Cancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personalised oncology, the need to establish a definitive histopathologic diagnosis to guide management is more important than ever. Percutaneous biopsy has proven to be safe and efficient in establishing a reliable histopathologic diagnosis. The spine, however, can be a challenging site to biopsy, due to the proximity of critical neurovascular, respiratory, and gastrointestinal structures. Successful spine biopsy depends on several factors: suspected diagnosis, size of the lesion, location within the spine, modality for best imaging guidance, operator experience, technical equipment considerations, and desired approach and associated limitations. The specimen must also be obtained with a biopsy route amenable to any future surgical intervention, with surgical input often sought, frequently in a multidisciplinary setting, to confirm procedure-specific goals and expectations. Knowledge of the requisite local anatomy, procedural and patient-specific indications, and contraindications and various approaches that may be used to access different segments of the spine, potential complications, and how to address these are keys to a successful percutaneous spinal biopsy, even in the most challenging of circumstances.

Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors.

Primary and secondary malignant tumors of the spine are relatively uncommon in the pediatric population but are associated with high morbidity and significantly decreased quality of life due to pain. Local management of these tumors is often challenging due to the importance of maintaining vertebral mechanical integrity as well as the spinal growth potential. Typically, surgery and/or radiation therapy have been used in the primary management of these tumors. However, treatment options become more limited when there is relapse or refractory disease, with re-resection or additional radiotherapy often not being viable therapies. Vertebroplasty is a currently underutilized modality that might provide significant pain palliation in cases of relapsed cancer in the spine.

Endovascular pharmacomechanical thrombolysis-a novel treatment for circumaortic left renal vein and inferior vena cava thrombosis in a paediatric patient with relapsing nephrotic syndrome.

While venous thromboembolism (VTE) in children with nephrotic syndrome (NS) remains an uncommon clinical entity, it represents one of the disease's most severe and potentially fatal complications. As such, clinicians and radiologists must maintain a high level of suspicion for VTE and low threshold for performing diagnostic imaging studies in children with NS, thereby ensuring prompt diagnosis and early management initiation. Despite the recent advances and development of image-guided endovascular procedures, there remains a marked paucity of literature describing the use of endovascular intervention for the treatment of acute VTE in NS, and a clear consensus on the gold standard for management has yet to be fully elucidated. Moreover, given the relative rarity of this complication in children as opposed to adults, no prior report has been made in which a paediatric patient has undergone endovascular intervention for acute VTE in the setting of NS. This report will outline the use of endovascular pharmacomechanical thrombolysis and thrombectomy as a novel treatment option for acute circumaortic left renal vein and inferior vena cava thrombosis in a paediatric patient with relapsing NS.

Where did the clot go? An unusual complication of mechanical thrombectomy caused by malignancy related subclavian steal phenomenon in a patient with acute basilar artery occlusion.

Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.

Where did the clot go? An unusual complication of mechanical thrombectomy caused by malignancy related subclavian steal phenomenon in a patient with acute basilar artery occlusion.

Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.

Dynamic arterial and valsalva-augmented venous phase multidetector CT for orbital vascular lesions: a pictorial review*.

PURPOSE: To describe the value and purpose of a new method of dynamic arterial and Valsalva-augmented venous phase CT angiographic assessment of vascular orbital lesions. METHODS: Description of a dynamic arterial and Valsalva-augmented venous phase multidetector CT protocol currently being used at the institution of the authors for investigation of orbital vascular lesions. Research ethics approval was not required by the institution because this is a 1-case report, with a pictorial review of imaging findings in various representative orbital vascular lesions. RESULTS: One case of a distensible venous malformation depicts the clinical application of the imaging protocol. Key features of the malformation were demonstrated by arterial and venous phases of imaging. CONCLUSIONS: This technique is of value in diagnosis and management of vascular malformations of the orbit.

Case report and literature review of a rare diagnosis of ossifying renal tumour of infancy.

One must entertain a broad differential diagnosis for infants presenting with gross hematuria. Initial workup includes urine analysis, serum laboratory values and abdominal ultrasound. We describe an infant presenting with gross hematuria found to have a calcified renal mass upon initial ultrasound and subsequent computed tomography scan. We considered a differential diagnosis of, but not exclusive to, staghorn calculi, nephroblastoma, Wilms' tumour, mesoblastic nephroma and ossifying renal tumour of infancy (ORTI). A nephrectomy was performed, and the pathology report identified the calcified mass as an ORTI.

Percutaneous thrombin embolization of a post-traumatic superficial temporal artery pseudoaneurysm.

Pseudoaneurysm of the superficial temporal artery is rare in children and is frequently a result of direct facial trauma. Conventional management has included surgical ligation and resection and more recently endovascular embolization to prevent complications including local pain, headache, facial disfigurement and bleeding. We report a unique case of a US-guided percutaneous thrombin injection for the treatment of a post-traumatic superficial temporal artery pseudoaneurysm in a child.