Repeated TACE in HCC after Fontan surgery and situs viscerum inversus: A case report

We describe the case of a 32-year-old man who developed a liver neoplasm due to previous Fontan surgery (FS) for a single ventricle anomaly and situs viscerum inversus. He was admitted to our hospital for suspected hepatocellular carcinoma during an Ultrasound (US) follow up. Computed tomography (CT) showed features of chronic liver disease and 7 cm hepatic nodule with arterial enhancement. Laboratory analyses documented preserved liver function and increased levels of alpha-fetoprotein. Trans-arterial-chemoembolization (TACE) was performed obtaining complete necrosis at 4 weeks of follow up and significant reduction of alpha-fetoprotein. The patient is currently in follow-up, being evaluated for further treatments and/or combined liver-heart transplantation. TACE is a therapeutic option for the treatment of patients with unresectable hepatocellular carcinoma (HCC) and with severe heart disease, like those submitted to FS and with also other vascular abnormalities like those correlated to situs viscerum inversus

Overview on Percutaneous Therapies of Disc Diseases

Low back pain is an extremely common pathology affecting a great share of the population, in particular, young adults. Many structures can be responsible for pain such as intervertebral discs, facet joints, nerve roots, and sacroiliac joints. This review paper focuses on disc pathology and the percutaneous procedures available to date for its treatment. For each option, we will assess the indications, technical aspects, advantages, and complications, as well as outcomes reported in the literature and new emerging trends in the field

Endovascular bail-out mechanical thrombectomy of a post-CEA acute internal carotid occlusion with consensual intracranial occlusion: A challenging case

Acute carotid occlusion is a rare but important complication that can occur after a carotid endoacrterectomy (CEA) procedure. Standard intervention after a re-occlusion is usually surgical. We reported a case of a 78-year old patient with acute internal carotid occlusion after a CEA and sociated intracranial embolization to the posterior communicating artery. Surgical approach was therefore excluded because of the above-mentioned cerebral perfusion deficit. Endovascular treatment allowed to restore the proper ICA vessel caliber and the cerebral blood flow through a thromboaspiration catheter. Moreover, the procedure was performed using devices usually intended for other body district. Endovascular treatment could represent an alternative treatment in post-CEA acute occlusions, especially in patient with associated intracranial perfusion deficit, allowing the operator to resolve both issues and reduce the overall ischemic time

CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts

Background and aim: To evaluate the clinical and radiological outcomes, in terms of safety and efficacy, of a new treatment method for symptomatic lumbar facet synovial cysts (LFSC), based on ozone injection inside the cyst. Methods: We retrospectively reviewed clinical records and imaging studies of 77 patients who underwent CT-guided ozone treatment of symptomatic facet joint synovial cysts in our department over a 5-year span. Clinical outcome was assessed with Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) evaluations, obtained prior to the intervention and at 1-, 3-, 6- and 12-months follow-up. Follow-up MRI imaging at 6 and 12 months were obtained and confronted with the pre-procedural MRI to analyse cyst modification after the intervention. Results: Ozone administration was technically successful in 100% of procedures; no immediate complications occurred. At 1 month evaluation, 92% of the patients referred partial or complete symptomatic response; 86% of patients at 3 months and 84% at 6 months confirmed symptoms improvement; final assessment, at 12 months after intervention, outlined overall significant clinical improvement in 81% of patients. During the 12 months of follow-up only 3 patients had a relapse of the cyst (at 6 months) that were retreated with a 100% success. Conclusions: CT-guided ozone therapy for symptomatic LFSC is a safe and innovative treatment option, with good clinical results at 12 months follow-up in a significative percentage of patients, thus reducing the need for invasive surgical interventions

Simplified pressure cooker technique for the treatment of brain AVMs, dAVFs and facial vascular malformations

In 2014, Chapot et al. introduced the pressure cooker technique (PCT), conceived to control undesired reflux of the embolic agent during the treatment of brain arterio-venous malformations (bAVMs). Since then, this technique increased in popularity and it has been extensively used. We present five consecutive cases in which the original PCT was simplified using nylon coils instead of platinum coils and acrylic glue, hence the name of 'Simplified Pressure Cooker Technique' (sPCT). The aim was to obtain a safer, precise and faster creation of the plug to control cohesive embolic agent reflux during the treatment of brain and facial vascular malformations

Cyst of canal of Nuck in a young woman affected by kniest syndrome: ultrasound and MRI features

Swelling of the inguinal region in a woman is a frequent finding in daily clinical practice. We focused our attention on the possible differential diagnoses, giving emphasis to the less common causes of this frequent female disorder and describing their characteristics in ultrasound and magnetic resonance imaging. The causes of swelling in this region may be multiple and in this paper, we will show a rare case of diagnosis of Nuck's canal cyst in a patient with Kniest Syndrome. Keywords: Cyst, Ultrasound, MRI, Canal of nuc