Large Bore Portal Vein Thrombectomy: An Inari FlowTriever Case Series.

PURPOSE: Portal vein thrombus (PVT) can worsen portal hypertension and hepatic decompensation in patients with cirrhosis and impact liver transplant outcomes. This retrospective case series describes large bore mechanical thrombectomy of PVT with the Inari FlowTriever device during, or remotely after, transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Ten patients with PVT were treated with large bore thrombectomy. All patients had underlying cirrhosis, complicated by portal hypertension with acute/subacute PVT. Thrombectomy was performed either with TIPS placement, or via a previously placed thrombosed shunt. Median time from TIPS placement to thrombectomy was 3 years. RESULTS: Thrombectomy was technically successful in all patients with a majority achieving complete resolution of PVT in a single session. During mean follow-up of 13.3 months, all patients achieved complete resolution of PVT without recurrence. CONCLUSION: Large bore mechanical thrombectomy together with TIPS is a feasible and effective treatment of acute/subacute PVT in cirrhotic patients with portal hypertension, often with complete resolution in a single session.

Gastric lipomas: a case series and review of a rare tumor.

The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between -80 and -120. A single lipoma measuring -50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.

Dependent layering of venous refluxed contrast: A sign of critically low cardiac output.

Mortality associated with cardiogenic shock can reach 80%. Although most often diagnosed clinically, the hemodynamics of cardiogenic shock may manifest on contrast-enhanced computed tomography as dependent layering of contrast within the inferior vena cava (IVC), a finding referred to as the "IVC level sign." Herein we present 2 cases of the IVC level sign. Swift recognition of the IVC level sign and awareness of its dire prognostic implications is essential for achieving the best patient outcomes.