HighlightsWe present a very rare case of acute Acute acalculous cholecystitis (AAC).Hepatitis C virus infection has not been documented as a cause of Cholecystitis.Management of AAC mostly conservative, rarely need surgical intervention.Understanding pathophysiology of AAC in crucial for the management.

The aim of this study was to determine the rate of complications in percutaneous nephrostomy (PCN) and nephrolithotomy (PCNL) performed through the 11th and 10th intercostal spaces using our monitoring technique and to discuss the safety of the procedure. Out of 398 PCNs and PCNLs carried out during a 3-year period, 56 patients had 57 such procedures performed using an intercostal approach. The 11th intercostal route was used in 42 and the 10th in 15 cases. One patient had two separate nephrostomies performed through the 10th and 11th intercostal spaces. The technique utilizes bi-planar fluoroscopy with a combination of a conventional angiographic machine to provide anterior-posterior fluoroscopy and a C-arm mobile fluoroscopy machine to give a lateral view, displayed on two separate monitors. None of the patients had clinically significant thoracic or abdominal complications. Two patients had minor chest complications. Only one developed changes (plate atelectasis, elevation of the hemi-diaphragm) directly related to the nephrostomy (2%). The second patient had bilateral plate atelectasis and unilateral congestive lung changes after PCNL. These changes were not necessarily related to the procedure but rather to general anesthesia during nephrolithotomy. The authors consider PCN or PCNL through the intercostal approach a safe procedure with a negligible complication rate, provided that it is performed under bi-planar fluoroscopy, which allows determination of the skin entry point just below the level of pleural reflection and provides three-dimensional monitoring of advancement of the puncturing needle toward the target entry point.

HighlightsHepatic hemorrhage is a life-threatening situation in which a rapid access to hepatic arteries is vital to achieve transarterial hemostasis.The celiac axis should be considered first to gain access to hepatic arteries in such situations.Pancreaticoduodenal arcade is a salvage alternative route for emergency transarterial embolization in case of massive liver hemorrhage in patient with celiac axis extensive stenosis or occlusion.

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Highlights This is the first study in the Asian region and one of the very few that established DRLs based on clinical indication for CT. Standardized CI nomenclature must be established as there are no guidelines for accurate comparison between studies on CT patient exposure. The established clinical DRL values for CT will further facilitate patient dose optimization and quality improvement process HMC in Qatar.