Complications of pancreatitis such as pseudocyst formation and abscess are well known to radiologists. Secondary formation of pseudoaneurysms has not been emphasized in the radiologic literature. The great morbidity and mortality associated with pseudoaneurysms emphasize the importance of early detection. Three patients are described whose angiographically proved pseudoaneurysms were demonstrated on contrast material-enhanced abdominal CT scans obtained for evaluation of pancreatitis. A homogeneously enhancing structure within or adjacent to a pancreatic pseudocyst or contiguous with a vascular structure should be considered highly suspicious for an associated pseudoaneurysm.
Percutaneous transluminal angioplasty (PTA) was used to treat 109 patients with 141 renal artery stenoses, including 58 patients in whom medical management was unsuccessful. The initial success rate was 94%. Fifty-five patients had severe diffuse atherosclerosis and 40 had renal insufficiency. Thus far, 36 patients (50 stenoses) have undergone a total of 52 follow-up angiographic studies. Clinical data, including blood pressure response, were obtained in all cases. Only 7 of the 98 hypertensive patients failed to respond to PTA. Of the 11 patients treated primarily for renal insufficiency, 5 improved. Of the 29 hypertensive patients who also had elevated BUN and creatinine, renal function improved in 13. Altogether, 96 patients (88%) benefited from the procedure. Analysis of long-term results suggests that PTA should be the treatment of choice for fibromuscular dysplasia and short, segmental atherosclerotic lesions and could also prove helpful in improving renal insufficiency.
Percutaneous transluminal angioplasty of lesions located at the bifurcation of vessels, especially the aortic bifurcation, has been considered contraindicated because of possible occlusion or embolization of the contralateral vessel. With the evolution of angioplasty techniques and the development of new balloon catheters, these lesions can now be successfully treated with the kissing balloon technique. This technique was used to dilate 61 atherosclerotic vascular lesions in 32 patients with vascular insufficiency. The procedure was successful in 58 atherosclerotic stenoses in 30 patients. Because of the high blood flow and large size of these vessels, beneficial clinical results can be anticipated following successful dilatation. Follow-up study, extending for as long as 53 months, suggests the durability of the procedure and that the kissing balloon technique should be considered as a viable alternative to surgery in dilatable lesions of the aortic bifurcation.
Extracorporeal shock wave lithotripsy was used for the treatment of 1,252 kidneys and ureters with calculi during a 10-month period at the authors' medical center. Before lithotripsy was performed, excretory urography, radiography, renography, computed tomography, and ultrasound studies were done, when necessary, to locate the calculi. Nine calculi in five kidneys could not be fragmented with lithotripsy. Of 895 patients with calculi less than 2.5 cm in diameter, only 13 (1.5%) required interventional procedures to clear the calculi, whereas of 161 patients with calculi greater than or equal to 2.5 cm, 36 (22.4%) required nephrostomies. A column of calculous debris in the mid and distal portions of the ureter (steinstrasse) was seen in 171 instances (13.6%) after lithotripsy; 62% required interventions. The most common intervention required for successful lithotripsy was retrograde ureteral catheterization. Evaluation and treatment of patients with urolithiasis were largely dependent on radiography and excretory urography.
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