Endovascular retrieval of difficult to remove port-a-caths

Long dwelling central venous lines develop intravenous adhesions or a calcified fibrous sheath causing difficulties in removal. Although such cases are rare, a few cases of endovascular retrieval have been reported in pediatric literature. We report our experience with 6 cases in children with port-a-caths. Transfemoral snare technique was effective in all but 1 patient. The mean age of the in dwelling port-a-caths was 5 years. One patient whose catheter could not be removed has developed no complications after a follow-up of 5 years. Review of literature suggests that while endovascular retrieval is not without risks, leaving a central line in situ has no major disadvantages. Heroic measures to remove such lines should be pursued only when absolutely necessary as in the case of an infected line

Diagnosis and management of the venous malformations of Klippel-Trénaunay syndrome

Objective A dearth of information exists in the literature regarding current practice in the management of Klippel-Trénaunay syndrome (KTS), a rare condition. We review and describe the etiology, diagnosis, and treatment of KTS. Methods Relevant data were synthesized from a Medline review using a combination of the keyterms “Klippel” and “Trénaunay.” The majority of hits described singular case reports and were subsequently excluded. The remaining papers were then reviewed and included on the basis of the quality of evidence and the authors' discretion. Conclusions KTS is characterized by a clinical triad of extremity varicosities, cutaneous vascular malformations, and hypertrophy of soft tissues and long bones. The diagnosis is clinically supplemented with magnetic resonance imaging and computed tomography. Although this syndrome is associated with significant comorbidities, such as pain, edema, ulcerations, and pruritus, it is rarely the cause of death. The backbone of treatment is nonoperative in nature but should be supplemented with minimally invasive, endovascular, and rarely open surgical procedures for refractory cases

Pediatric Interventional RadiologyHandbook of Vascular and Non-Vascular Interventions /

XIV, 418 p. 241 illus., 61 illus. in color.onlin

Diagnosis and Follow-up of Incidental Liver Lesions in Children

ABSTRACT: Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow-up of incidental liver lesions based on review of the literature, use of state-of-the-art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH) and focal fatty lesions, have specific imaging characteristics. Recently, contrast-enhanced ultrasound (CEUS) was FDA-approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and AFP should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and when biopsy is not feasible