• Bedside and fluoroscopy guided techniques are commonly used for PICC placement. • Catheter malposition is the major technical issue with the bedside technique. • Catheter malposition occurred in 53% of patients with the bedside technique.
Purpose To compare estimated future remnant liver (FRL) growth following portal vein embolization or liver venous deprivation (LVD) (combined PVE and right hepatic vein embolization), before surgery for a Klatskin tumor in patients who receive intraoperative biliary drainage or before venous interventional radiology. Material and Method Six patients underwent LVD and six underwent PVE alone before hepatectomy for a Klatskin tumor. Before embolization, the FRL ratio, prothrombin time and bilirubin levels were similar in both groups. The FRL was determined before and 3 weeks after embolization by enhanced CT. PVE was performed with n-butyl-2cyanoacrylate, and the right hepatic vein was embolized with vascular plugs during the same procedure. Biliary drainage was performed percutaneously or by endoscopy. Post-hepatectomy liver function and duration of hospital stay were assessed. Results There were no adverse events. The median FRL ratio was significantly higher following LVD than after PVE 58% (54-71) and 37% (30-44), respectively, p = 0.017. The FRL volume after embolization was 1.6 times higher after LVD than PVE (p = 0.016). Four and five patients were operated in the LVD and PVE groups, respectively. There was a trend toward a shorter median postoperative hospital stay and 90-day mortality in the LVD versus PVE group: 14 versus 44 days, (p = 0.114) and 0 versus two deaths (p = 0.429), respectively. Conclusions LVD associated with biliary drainage is safe and results in a better FRL ratio than biliary drainage associated with PVE alone.
• Intravascular filling-defect lesions are related to both benign conditions and malignant tumours. • Endovascular biopsy is indicated in case of doubt about intravascular lesion nature. • Percutaneous endovascular biopsy is a safe technique. • Endovascular biopsy provides tissue samples leading to correct histopathological analysis. • Percutaneous endovascular biopsy provides early diagnosis of malignant intravascular lesions.
We report the case of a patient presenting with convulsions in the emergency department. A CT examination revealed a mixed solid and cystic frontal peripheral mass. The intra-axial or extra-axial location and the differentiation between primary or secondary origin were not evident so MRI was performed. The most probable diagnosis was cystic meningioma with intratumoural cysts. Based on MRI findings, the neurosurgeon resected the mass together with its cystic components. The histological report verified the diagnosis and the patient had an excellent outcome.
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