In patients who are poor candidates for surgery, stents can be used to treat focal dissections limited to the main renal artery. After the lesion is directly punctured with a needle, contrast is injected to confirm needle placement and determine the volume necessary to fill the lesion. Once the acute infection and inflammation have resolved, a decision needs to be made as to what the appropriate definitive management should be. Right hydronephrosis with right ureteral calculus. The groins are then closed surgically if femoral cutdown was performed, or they are closed by percutaneous arterial closure devices if the procedure was performed in a completely percutaneous 200 C A S E 1 1 6 Courtesy of Dr.
It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. Over a guidewire, the tract is dilated and a large-bore drainage catheter is placed and attached to negative pressure. Because colonic branches are often easy to catheterize rapidly, embolotherapy can be a fast way of obtaining hemostasis. Reviews in journals and word-of-mouth comments have been uniformly favorable. Transjugular liver biopsy in patients with hematologic malignancy and severe thrombocytopenia.
What treatment options are commonly used for this problem? To compensate for this, hepatic arterial flow increases. The cases integrate diagnostic, procedural, and periprocedural aspects, simulating the oral board examination and adequately preparing residents for the interventional radiology section of the examination. Angiographic features include enlarged feeding arteries, neovascularity, puddling, dense tumor stain, arterioportal shunting, portal vein invasion, and occasionally hepatic vein invasion. Mesenteric arterial occlusive and aneurysmal disease. Study effectively with content that mimics the format of official exams as well as the everyday clinical experience—offering highly effective preparation for certification, recertification, and practice. While no one book could completely cover the ever-expanding field of interventional radiology, these 170 cases are fairly comprehensive without being onerous. Most are benign, although malignancy cannot be excluded on imaging.
Coagulation studies and platelet level should also be obtained. . In these patients, symptoms of ischemia might not appear until occlusion is imminent, and some patients present after the vessel has occluded. Access codes may or may not work. In patients who are not surgical candidates, endoluminal recanalization and stenting of the occluded aorta and iliac arteries can be performed. What is the most likely diagnosis? The vast majority of culprit stenoses occur at the venous anastomosis of the graft, within the graft, within the peripheral or central venous outflow veins, or at the arterial anastomosis. Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia? Patients characteristically have an elevated erythrocyte sedimentation rate, and approximately half exhibit constitutional symptoms in the acute inflammatory stage including myalgias, fatigue, low-grade fever, tachycardia, and pain adjacent to the inflamed arteries.
Lesser forms of trauma, including repetitive microtrauma in typists or pianists, can also lead to digital ischemia. The latest edition also provides more evidence-based data on outcomes of existing and newly developed interventional techniques. After a mature transperitoneal tract has formed around the percutaneous cholecystostomy catheter usually 2-4 weeks , the catheter is removed over a guidewire, the tract is dilated, and a large sheath is placed. What vascular systems are serving as collateral networks? Society of Interventional Radiology: Society of Interventional Radiology position statement. What is the probable etiology? Where should the tip be located? Comment Vascular malformations are congenital lesions that grow periodically, often in relation to trauma, surgery, or hormonal stimulation via puberty, pregnancy, or hormonal therapy. Treatment of acute iliofemoral deep vein thrombosis with use of adjunctive catheter-directed intrathrombus thrombolysis.
Comment The images demonstrate multifocal irregularity, stenoses, and small aneurysms in the small and mediumsized arteries of the hepatic circulation. The images here demonstrate the most common source of extrauterine supply to the uterus: an enlarged ovarian artery. This usually occurs in association with congenital heart disease, although it occurs rarely as an isolated abnormality associated with situs inversus. Name two potential causes of failure of uterine fibroid embolization. Seroma, hematoma, urinoma, abscess, lymphocele. Comment In the case shown, tight stricturing of the right and left central biliary ducts is evident on cholangiography, and the angiogram demonstrates thrombosis of the transplant hepatic artery that was anastomosed to a native replaced right hepatic artery. What procedure has been performed? The aortic arch passes over the right mainstem bronchus and descends to the right of the esophagus and trachea.
Percutaneous transabdominal if a suitable window is present, percutaneous transgastric, endoscopic internal drainage, surgical drainage. Urgent percutaneous nephrostomy tube placement is indicated if the patient is febrile. Catheter-directed thrombolysis followed by iliac vein stent placement. Veteran radiologists who wish to hone their diagnostic skills will also find it to be a valuable resource. From the brachial artery below the elbow joint. Are the indications for aortic stent placement different from those of iliac artery stent placement? Spontaneous pleurodesis can occur in up to 46% of patients, usually within a month of placement.
What is the underlying diagnosis? It is therefore highly recommended for this audience. What is the most common anatomic cause of hemodialysis graft malfunction or occlusion? Extensive arterial dissection, which is likely to limit flow. Part of McGraw-Hill's Radiology Case Review Series, this unique resource challenges you to look at a group of images, determine the diagnosis, answer related questions, and gauge your knowledge by reviewing the answer. Surgical arterial revascularization is commonly performed to help with ulcer healing in these patients. Focal contrast extravasation from a left colon diverticulum. Comment Hepatocellular carcinoma can manifest with a solitary mass, multiple masses, or diffuse hepatic involvement.