Editor:This report was granted exemption from institutional review board approval. The authors report a case of endovascular recanalization and stent placement in the right hepatic vein (HV) by using a collateral loop-guided approach through a caudate-lobe patent accessory HV.A 9-year-old boy presented with a 2-month history of abdominal distension, left thigh pain, and claudication. Blood tests revealed erithrocytosis, γ-glutamyl transpeptidase level of 143 U/L, and lactate level of 2,30 mmol/L. Coagulation, thrombophilia studies, and copper levels were normal. Autoantibody screens were negative, and autoimmune lymphoproliferative syndrome was excluded by flow cytometry. Genetic analysis showed a nonspecific JAK2 gene polymorphism.Doppler ultrasound (US) demonstrated narrowed HVs with decreased flow (10 cm/s), and thrombosis of the confluence of the right, middle, and left HVs (Fig 1). A tortuous caudate lobe vein was identified. The portal vein had antegrade flow with normal velocity (33 cm/s). The hepatic artery had normal resistive indices. Hepatomegaly (liver length at the midclavicular line of 15 cm) and ascites were noted. Computed tomographic (CT) angiography confirmed the HV obstruction and demonstrated caudate lobe hypertrophy with retrohepatic vena cava compression (3 mm). The caudatelobe accessory HV draining into the inferior vena cava (IVC) was identified (Fig 2).The patient was referred to our institution for angiographic evaluation and, if possible, retrograde recanalization of the HVs. The venography and endovascular treatment were performed through a right transjugular approach. A 6-F, 11-cm-long sheath introducer (Boston Scientific, Natick, Massachusetts) was inserted into the right jugular vein, through which a 65-cm-long, 5-F multipurpose 0.038-inch catheter (Cordis, Warren, New Jersey) was advanced into the abdominal IVC. It was impossible to selectively cannulate the main HVs because of the confluence obstruction. The accessory HV draining the caudate lobe directly into the IVC was cannulated. A venous shunt between the accessory caudate lobe vein and the right HV was found. A roadmap image of this shunt was obtained (Fig 3). A 180-cm-long, 0.035-inch nitinol guide wire (Terumo, Tokyo, Japan) was advanced through the shunt into the right HV. Venography at this time revealed a 4-cm obstruction of the right HV. It was possible to cross the obstructing clot and reach the IVC with the Terumo guide wire. The 6-F introducer was replaced by an 11-cm-long, 8-F sheath introducer (Boston Scientific), which allowed a loop fashioned from a 300-cm-long, 0.014-inch Cougar LS Nitinol guide wire (Meditronic, Figure 1. US scan shows echoic material (between calipers) at the confluence of the left and middle HVs, suggestive of obstructing clot. (Available in color online at www.jvir.org.) Figure 2. Postcontrast coronal CT image shows unenhacing caudate-lobe HV communicating with the unopacified main HV through an intrahepatic collateral vessel (arrows). Note the presence of ascites (asterisk).None of the au...
Emphysematous vaginitis represents a rare and self‐limited condition, which presents with vaginal discharge. Despite its benignity, it has some worrisome imaging features, which should be recognized in order to avoid unnecessary invasive procedures.
Urachal pathologies are rare and can mimic numerous abdominal and pelvic diseases. Differential diagnosis of urachal anomalies can be narrowed down by proper assessment of lesion location, morphology, imaging findings, patient demographics, and clinical history. We report a case of a 60-year-old male, with a history of unintentional weight loss without associated symptoms, who was diagnosed with locally invasive urachal adenocarcinoma. With this article, we pretend to emphasize urachal adenocarcinoma clinical features along with its key imaging findings with radiologic-pathologic correlation.
Celiac axis stenosis may lead to severe liver ischaemia and mortality after pancreatic cephalic resection. 5 % of patients submitted to pancreaticoduodenectomy may have celiac axis stenosis. Atherosclerosis and arcuate ligament syndrome are the most frequent aetiologies. When preoperative radiologic assessment and intraoperative hepatic blood flow assessment suggest celiac axis stenosis, surgical revascularization or, nowadays, endovascular approach is needed before pancreatic head resection.We present the case of a middle-aged male with an ERCP and cytology diagnosis of peri-ampullary tumor. Review of CT images by the pancreatic surgeons and radiologists in multidisciplinary meeting raises the suspicious of celiac axis stenosis, not previously described. Endovascular approach was attempted although it showed to be technically unfeasible. An aorto-hepatic bypass graft was performed followed by a pancreaticoduodenectomy. Presently, two months after surgery, the patient is under adjuvant chemotherapy. Systematic preoperative assessment by dedicated experts in a multidisciplinary setting leads to a patient specific surgical algorithm strategy which will guide the surgical approach according to the intraoperative findings, minimizing the risk of mortality and morbidity associated to complex surgical procedures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.