Jaundice in children is more often due to hepatic disease than obstruction. Differential considerations for obstructive jaundice in children include choledocholithiasis, choledochal cysts and rare neoplasms. Rhabdomyosarcoma, the most common soft tissue sarcoma in pediatric patients, typically involves the head and neck, genitourinary system and extremities. Embryonal rhabdomyosarcoma of the biliary tree is a rare entity. We present a 3-year-old boy with abrupt onset obstructive jaundice. Although initial imaging suggested a dilated biliary system with fusiform common bile duct, sludge, and possible cholelithiasis, endoscopic retrograde cholangiopancreatogram (ERCP) diagnosed a common bile duct embryonal rhabdomyosarcoma and further imaging showed involvement of the cystic duct. This case illustrates the importance of considering malignant etiologies in cases of obstructive jaundice, particularly when imaging is not classic for common causes.
Interventional Radiology residency training programs experienced significant impacts secondary to the COVID-19 pandemic. Prospective resident recruitment and resident education were particularly affected due to limitations on in-person gatherings in effort to curb exposure. Finding ways to mitigate the pandemic's effect on recruitment and education was a challenge faced by residency programs across the nation. This article discusses a single Interventional Radiology program's approach to adapting to the reality of limited interpersonal interaction as well as efforts to maintain engagement for resident recruitment and education in a virtual setting.
Iliocaval thrombosis is a major source of morbidity for patients, with a range of clinical presentations, including recurrent lower extremity deep venous thrombosis and postthrombotic syndrome. Endovascular reconstruction of chronic iliocaval occlusion has been demonstrated to be a technically feasible procedure that provides long-lasting symptom relief in combination with antithrombotic therapy and close clinical monitoring. Herein, we describe the etiologies of iliocaval thrombosis, patient assessment, patient management prior to and after intervention, procedural techniques, and patient outcomes.
Percutaneous intentional extraluminal recanalization (PIER) is an endovascular subintimal crossing technique used to treat chronic total occlusions (CTOs) of the peripheral arteries. Intraluminal revascularization remains the standard over PIER when technically feasible; however, when intraluminal approaches fail, PIER may be preferred prior to pursuit of surgical bypass grafting. The major cause of failure of PIER is inability to reenter the true lumen after crossing the CTO. Therefore, several reentry devices and endovascular techniques have been developed to allow for the operators to safely and quickly access the true lumen distal to the occlusion. Reentry devices currently available on the market include the Pioneer Plus catheter, Outback Elite catheter, OffRoad catheter, Enteer catheter, and GoBack catheter. These devices have unique methods of use and specific advantages with regard to their technical success along with reduced procedural and fluoroscopic time. In addition, there are other endovascular techniques available that may facilitate true lumen reentry and these will also be reviewed.
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