Laser-assisted permanent greenfield filter removal with ileocaval stent reconstruction following filter thrombosis, a case report.

Emerging literature supports removal of chronic indwelling IVC filters when they are contributing to complications for a patient and are no longer indicated. We present an interesting case of an elderly patient who had a history of DVT and underwent spinal surgery, which required cessation of his anticoagulation and placement of an IVC filter pre-operatively. Approximately 15 years later the patient presented to our institution with chronic occlusion of his IVC at the level of his filter which had never been removed, with bilateral lower extremity DVT and symptoms of phlegmasia cerulea dolens. Despite a previous unsuccessful attempt at DVT thrombectomy at an outside institution, interventional radiology was consulted, and he subsequently underwent successful laser sheath assisted removal of his 15-year-old permanent Greenfield filter with bilateral lower extremity DVT thrombectomy and venous stenting with significant improvement in his presenting symptoms. Clinical presentation, diagnostic workup, case findings, and outcomes are described.

Spontaneous pseudoaneurysm of profunda femoris artery following a musculoskeletal sports injury.

Pseudoaneurysms are relatively common entities encountered in clinical practice; however, pseudoaneurysms of the profunda femoris artery are rarely reported in literature. Due to the nonspecific presentation of pseudoaneurysms, diagnosis can be difficult and delayed. We report a case of a 14-year-old athlete diagnosed with spontaneous pseudoaneurysm of profunda femoris artery following a sports injury. Presentation, diagnostic workup, treatment, and complications are described.

Successful percutaneous embolization of an intraoperative swan ganz catheter-related pulmonary artery injury.

Intraoperative pulmonary artery injury due to Swan Ganz catheterization is a rare but potentially life-threatening injury which demands rapid recognition and treatment. Subsequent pseudoaneurysm formation can occur if not immediately recognized, and percutaneous embolization is a viable option for treatment in most settings. We report a case of a 59-year-old female who underwent coronary artery bypass surgery and suffered an intraoperative Swan Ganz catheter-related injury which led to life threatening hemorrhage with subsequent pulmonary artery pseudoaneurysm formation that was successfully embolized. This case report is pathognomonic for this injury and discusses risk factors, presentation, and treatment options of this rare but serious injury.

Successful thrombectomy and thrombolysis of deep vein thrombosis in a patient with acute phlegmasia cerulea dolens with May-Thurner anatomy.

Phlegmasia cerulea dolens (PCD) is a rare and important diagnosis to consider in the setting of a painful, swollen, and cyanotic lower extremity. We report a 59-year-old female diagnosed with PCD 3 days status post extended head and neck surgery with additional imaging findings concerning for May-Thurner anatomy. This case presentation is pathognomonic for PCD. Risk factors, pathogenesis, and management are described.

Nested stromal epithelial tumor of the liver: A multidisciplinary approach to the treatment of an extremely rare malignancy.

Nested stromal epithelial tumor (NSET) of the liver is an extremely rare and unusual liver neoplasm with limited evidence of best practice for management. We report a 28-year-old male with NSET managed with primary partial hepatectomy with subsequent disease recurrence with follow-up metastectomy and successful radiofrequency ablation (RFA). Management of NSET of the liver requires a multidisciplinary approach. RFA proves beneficial in a patient with disease recurrence following tumor resection. In order to validate the regular use of RFA, more long term studies would be required.

A novel treatment for breast pseudoaneurysm in the anticoagulated patient.

A 74-year-old woman requiring lifetime anticoagulation for antiphospholipid syndrome was noted to develop a pseudoaneurysm (PA) of the breast following core needle biopsy. She was successfully treated via thrombin injection and suffered no complications. In patients requiring anticoagulation, definitive management of PA may be desired. In appropriately selected patients, ultrasound (US)-guided thrombin injection offers superior outcomes to alternative conservative management and obviates the need for surgical intervention.

Transcatheter embolization of anticoagulation related pancreatic pseudocyst hemorrhage: A case report.

Hemorrhage associated with anticoagulation therapy is a feared and relatively common complication. Few cases have been documented of spontaneous pancreatic hemorrhage related to anticoagulation, and fewer yet of ruptured pancreatic pseudocyst secondary to anticoagulation-related bleeding. We describe the case of a 74-year-old female with massive intra- and extraperitoneal hemorrhage secondary to an anticoagulation-related ruptured hemorrhagic pancreatic pseudocyst that was treated successfully with coil embolization. An inferior vena cava filter was placed at the same time as the embolization procedure, as she had a contraindication for anticoagulation in the setting of submassive pulmonary emboli and lower extremity deep venous thrombosis.

Successful percutaneous embolization of refractory chylous ascites following peritoneal lymph node dissection.

Chylous leaks are an uncommon complication in patients undergoing surgical procedures with the majority of cases responding to conservative therapies. Described is a case of a 23-year-old male who developed debilitating refractory chylous ascites as a complication after retroperitoneal lymph node dissection for testicular cancer. Prior to being evaluated by interventional radiology, he required weekly large-volume paracentesis in addition to standard conservative therapies. The patient underwent a single percutaneous treatment of a localized chylous leak involving a retroperitoneal lymphatic duct by utilizing a combined fenestration and embolization technique. Complete resolution of the patient's condition occurred within 3 weeks. No immediate or delayed complications were observed during the 6-month follow-up period.

Embolization of symptomatic intralobar pulmonary sequestration - A minimally invasive treatment option.

The growing field of interventional radiology provides a number of treatment options alternative to previous relied upon invasive surgeries. Pulmonary sequestration is a condition where the option of interventional radiology is particularly promising. Described is a 41-year-old male who elected alternative treatment for his symptomatic intralobar sequestration in order to avoid associated complications of extensive surgery. Specifically, this case reports a successful cure utilizing minimally invasive embolization with polyvinyl alcohol particles and coil placement.

Malignant Solitary Fibrous Tumor of the Renal Vein Presenting as a Giant Renal Artery Aneurysm: A Case Report and Review of Literature.

OBJECTIVES: To discuss an unusual presentation of solitary fibrous tumor (SFT) as well as the first description of SFT originating from the renal vein. CASE REPORT: In this article, we report the case of a 56-year-old man who presented with nonspecific epigastric pain and was found on computed tomography to have a large 10-cm renal artery aneurysm with evidence of contained rupture, segmental ischemia of the kidney, and suggestion of renal vein thrombosis. This was treated by a multidisciplinary team of urologists, vascular surgeons, and interventional radiologists with both renal artery coil embolization and radical nephrectomy. The thrombosis was found on pathologic review to be a malignant SFT originating from the renal vein with likely erosion into the renal artery. CONCLUSION: This report describes the first case of SFT originating from the renal vein and demonstrates the potential for mimicry as a giant renal artery aneurysm.

Novel approach to uterine artery pseudoaneurysm embolization for delayed post-partum hemorrhage.

Uterine artery pseudoaneurysms (UAP) are a rare cause of post-partum hemorrhage. Conservative management is discouraged due to the risk of spontaneous hemorrhage. Intra-arterial embolization is highly successful (>90%) and offers definitive treatment. We present the case of a 27-year-old woman with significant delayed post-partum hemorrhage after cesarean section who was found to have a UAP on imaging. Her tortuous vascular anatomy and spasmodic aneurysmal neck presented technical challenges to embolization with traditional material, such as gel foam and coils. Intra-arterial thrombin was then employed with good technical and clinical outcome. To our knowledge, this is the first case describing the use of intra-arterial thrombin in the treatment of UAP. Given its success in this case, we argue that intra-arterial thrombin should be considered a viable alternative for embolization of UAP when more traditional techniques fail.

Department of Homeland Security national planning scenarios: a spectrum of imaging findings to educate the radiologists.

Following the events of the September 11th attack, there has been an increasing concern about the possibility of a future attack on our homeland. In response, the United States Department of Homeland Defense has planned for a future attack by formulating multiple scenarios which may occur in the event of such a disaster. Radiology will play a key role in each of these scenarios, assisting with triage, diagnosis, and therapy of the large populations which potentially could be involved. This article describes some of these scenarios as well the response which will be expected of the radiology community in the event of such a disaster.

Malignant priapism secondary to adenocarcinoma of the prostate.

The authors report a case of an older gentleman with a history of metastatic prostate cancer who presented to the emergency department following 3 weeks of progressively intermittent and then continuous priapism. After an initial clinical workup, an MRI was performed of the pelvis for further evaluation of the patient's condition which demonstrated metastatic lesions within his corpora cavernosa. The patient underwent follow-up core-needle biopsy with pathologically proven metastasis.

Multiple focal nodular hyperplasia: atypical imaging characteristics in the setting of hepatic steatosis.

Focal nodular hyperplasia is an uncommon, benign lesion of the liver most often affecting women of childbearing age. It can present clinically with chronic, intermittent right upper quadrant pain and nausea, with associated liver enzyme abnormalities. The presence of characteristic sonographic and computed tomography imaging findings can help to differentiate this entity from other hepatic masses. This article describes an unusual case of multifocal disease that demonstrates atypical imaging findings in the background of hepatic steatosis.

Intervertebral disk cyst: a case report.

This case describes a patient who presented with chronic low back pain which developed over the course of 1 year. Imaging revealed a 1.1-cm cystic lesion at the L4-L5 vertebral level posterior to the intervertebral disk. Following both magnetic resonance and computed tomography imaging, diagnosis of intervertebral disk cyst was confirmed by both imaging modalities. A computed tomography-guided aspiration of the lesion was performed, and the patient was given a course of steroid injections with complete resolution of the lesion.