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Portal vein obstruction in childhood produces portal hypertension and hepatopetal collaterals surrounding the obstructed portal vein; this is the "cavernomatous transformation of the portal vein" which is a well defined angiographic entity. Clinically findings are the various manifestations of Banti's syndrome, especially splenomegaly and gastrointestinal bleeding. Ultrasonic diagnosis is possible on the associated findings of splenomegaly, normal liver, a subhepatic sponge like mass corresponding to the hepatopetal collaterals. These signs must be sought in the ultrasonic differential diagnosis of splenomegaly in pediatrics.

The persistent primitive hypoglossal artery is rare remnant of one of the four embryonal carotid-basilar anastomoses. It is present in 0.02–0.26% of all cerebral angiogram. 14 cases of PHA aneurysms have been reportede in the literature and as far as we know no case in which endovascular embolization was used as a treatment. We present a case with subarachnoid haemorrhage due to aneurysm of persistent primitive hypoglossal artery. The aneurysm was successfully occluded with Guglielmi detachable coils. The SAH resolved and recovery was uneventful.

Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation.

Introduction/PurposeWe report on the histopathology results from a preclinical rabbit study and our early clinical experience with the Separator 3D device, featuring novel 3D chambers for securing and removing thrombus. Compatibility with differently sized catheters provides flexibility to combine with aspiration.Materials and MethodsTo evaluate vascular responses of multiple 3D deployments and resheathings, a rabbit elastase model study examined right and left subclavian arteries from five rabbits 30 days after eight cycles. Vessels were subjected to histopathology analysis. Case experience in six European centers was collected in the first 30 days post-device approval. Fourteen consecutive patients presenting with acute ischemic stroke within 8 h of symptom onset were treated with the 3D device. Five cases involved ICA to MCA (M1 or M2) occlusion; four involved M1 segmental occlusion; two involved M1 to M2 occlusion; one involved basilar to PCA occlusion; two were excluded due to underlying stenosis. In the two cases involving stenosis, use of the 3D device followed by other stent retrievers like Solitaire (Covidien), Trevo (Stryker), and Restore (Reverse Medical) could not achieve revascularization; they were eventually resolved by balloon or stent.ResultsMultiple 3D deployment and resheathing cycles in the rabbit revealed no histopathologic lesions at 500 μm magnification nor evidence of injury or inflammation in the internal elastic lamina. Notably, no intraluminal fibrin or thrombus was found. In a multi-center case review study, the 3D device achieved 92% revascularization to TICI 2B or 3, excluding stenotic cases. In all cases, the 3D was successfully delivered to the occlusion site resulting in successful recanalization with 1.5 average passes. No vessel injury, vasospasm, or embolization of new territory was observed.ConclusionPreliminary results demonstrate that the Penumbra Separator 3D is a safe, effective revascularization device. Early animal and clinical experience with the 3D device appears promising. Absence of vessel injuries or new territory emboli may be aided by intraluminal 3D chambers that engage and remove clot with aspiration applied close to the lesion site. Smooth delivery and easy handling of the 3D was noted even in highly tortuous anatomy. Further case experience is warranted to confirm these promising initial observations.Competing interestsNone.