No abstract

A 30-year-old male with cerebral palsy and motor impairment presented with right femur fracture. He had gradually worsening mobility and contractures of all extremities for the preceding 5 years. Evaluation showed multiple vertebral and femoral fractures, severe osteoporosis, a large parathyroid adenoma, and parathormone (PTH) exceeding 2500 pg/mL. Because of poor general health and high anesthetic risk, parathyroidectomy was deemed impractical. Ultrasound-guided radiofrequency ablation (RFA) helped achieve 50% size reduction and PTH levels with better control of hypercalcemia. Later, as calcium and PTH remained elevated, percutaneous ethanol ablation was performed with resultant normalization of PTH and substantial symptomatic improvement. Two years later, he still remains normocalcaemic with normal PTH levels. We propose that RFA and percutaneous ethanol ablation be considered as effective short-term options for surgically difficult cases, which could even help achieve long-term remission. Although not previously reported, our case illustrates that both RFA and percutaneous ethanol ablation could be safely performed successively achieving long-term remission.

Thoracic duct embolization (TDE) is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct.

Background: To compare the outcomes in a group of patients with Budd-Chiari syndrome (BCS) managed by percutaneous recanalization with a group of patients who were managed by medical therapy alone. Methods: We retrieved the hospital records of 37 patients with BCS admitted to our facility between 2004 to 2017 and identified 24 patients (male:female = 10:14; mean age, 32.7 ± 12.5 years) who underwent percutaneous recanalization. Remaining thirteen patients (male:female = 3:10; mean age, 36.77 ± 14.71 years), were managed by medical therapy. Technical and clinical results, complications, and primary patency of percutaneous recanalization were analyzed. Overall and symptom-free survival rates, the frequency of symptom recurrence, and the number of readmissions for recurrent symptoms were analyzed in both interventional treatment and medical therapy groups. Results: Technical success for recanalization of hepatic vein/inferior venecava by angioplasty ± stenting was achieved in 22 patients (22/24, 91.7%). Clinical success was achieved in 19 patients (19/24, 79.2%). Overall survival for patients who underwent percutaneous recanalization at 1 year and five years was 87.0% and 87.0% and for patients with medical therapy was 90.1% and 45.5%, respectively (P = 0.710). Symptom-free survival for patients who underwent percutaneous recanalization at 1 year and five year was 93.3% and 81.7% and for patients with medical therapy was 26.0% and 0%, respectively (P < 0.001). In the intervention group, 4 patients (4/24, 16.7%) were admitted for recurrent symptoms (median number of readmissions 1, range: 1-2) whereas in medically managed patients 9 patients (9/13, 69.2%) were readmitted (median number of readmissions, 2; range, 1-5) (P = 0.003). Conclusion: There was no statistically significant difference in overall survival of patients managed with percutaneous recanalization and medical therapy. Percutaneous recanalization had definite benefit in terms of fewer recurrent symptoms and hospital admissions, hence should be performed whenever technically feasible.

Aim To evaluate whether right inferior phrenic artery (RIPA) is a source of extrahepatic arterial supply to the liver in cirrhotic patients without hepatocellular carcinoma (HCC) using 256 slice computed tomography (CT). Materials and Methods Institutional review board approval was obtained for this retrospective study. A total of 262 consecutive cirrhotic patients (male:female–172:90; mean age 56.45 ± 12.96 years) without HCC and hepatic vascular invasion, and who underwent technically successful multiphase CT, were included in the study. Additionally, 280 noncirrhotic patients (male:female–169:111; mean age 54.56 ± 14.21 years) who underwent abdominal multiphase CT scans for indications other than liver disease and did not have focal liver lesions or hepatic vascular disease were included as a control group. The RIPA and left inferior phrenic artery (LIPA) diameters were measured at the level of the ascending segment of IPA located anterior to the diaphragmatic crus. The relationship between RIPA diameters and Child–Pugh score was assessed. Results The cirrhotic patient group and control group were matched for age (p = 0.11) and gender (p = 0.20). The mean diameter of RIPA in the cirrhotic group (1.93 ± 0.4 mm) was significantly higher than in the control group (1.50 ± 0.5 mm), p < 0.001. The mean diameter of LIPA in the cirrhotic group (1.34 ± 0.5 mm) was not significantly higher than in the control group (1.30 ± 0.5 mm), p = 0.32. We found a statistically linear and moderate degree relationship between RIPA diameter values and Child–Pugh scores (p = 0.002, r = 0.593). Conclusion RIPA is hypertrophied in patients with cirrhosis without HCC. It may be an important contributor to the blood flow to the liver in cirrhotic patients even without HCC, especially with portal hypertension.

Amoebiasis, a common parasitic infection in the tropics is most commonly associated with solitary liver abscess. Multiple hepatic, splenic and renal abscesses are a very rare presentation of extraintestinal amoebiasis in children. The authors report a 6-y-old girl who presented with a febrile illness, hepatosplenomegaly and erythema nodosum and was diagnosed to have multiple amoebic abscesses by imaging and aspiration cytology of a liver abscess. This is also the first case report of the association of erythema nodosum with extraintestinal amoebiasis in children.