Percutaneous thrombin injection under contrast-enhanced ultrasound guidance to control active extravasation not associated with pseudoaneurysm

The technique of percutaneous thrombin injection (PTI) under contrast-enhanced ultrasound (CEUS) guidance for control of acute hemorrhage-active extravasation not associated with pseudoaneurysm is demonstrated in three cases: 1) Massive spontaneous retroperitoneal hematoma in a patient with multiple comorbidities. Contrast-enhanced computed tomography (CT) showed extensive active extravasation, which was only partially controlled by transarterial embolization. CEUS was performed in the angiography suite. Contrary to unenhanced US and colour Doppler US (CDUS), CEUS confirmed persistent extravasation; CEUS-guided PTI was performed immediately thereafter. 2) Large rectus sheath hematoma in a patient on anticoagulant therapy. Contrast-enhanced CT and unenhanced US/CD could not definitely diagnose extravasation. CEUS clearly showed extravasation and was used for guidance of PTI. 3) Chest wall hematoma complicating central venous catheter placement in a patient with coronavirus on anticoagulant therapy. CDUS was inconclusive. CEUS was performed at the bedside, clearly showed active extravasation, and was used for guidance of PTI. In all three cases, post-PTI CEUS confirmed the absence of residual enhancement of the hematomas, and the hemodynamic status of the patients improved. PTI appears to be effective in selected cases of hematomas associated with active extravasation. In this context, CEUS may be the most suitable modality for guidance and for an immediate evaluation of the treatment effect

mRECIST criteria and contrast-enhanced US for the assessment of the response of hepatocellular carcinoma to transarterial chemoembolization

PURPOSEWe aimed to evaluate the combination of the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and contrast-enhanced ultrasonography (CEUS) as a tool for the assessment of hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODSForty-seven hepatocellular carcinoma patients (80 target tumors suitable for mRECIST measurements) were studied. They were treated with scheduled transarterial chemoembolization with doxorubicin-eluting microspheres every 5–7 weeks. Imaging follow-up (performed one month after each transarterial chemoembolization) included a standard, contrast-enhanced modality (computed tomography [CT] in 12 patients or magnetic resonance imaging [MRI] in 35 patients) and CEUS. The study focused on response evaluation after the third transarterial chemoembolization. CEUS required a bolus injection of an echo-enhancer and imaging with a dedicated, low mechanical index technique. The longest diameters of the enhancing target tumors were measured on the CEUS or CT/MRI, and mRECIST criteria were applied. Radiologic responses were correlated with overall survival and time to progression. RESULTSThe measurements of longest diameters of the enhancing target tumors were easily performed in all patients. According to mRECIST-CEUS and mRECIST-CT/MRI, complete response was recorded in five and six patients, partial response in 22 and 21 patients, stable disease in 16 and 14 patients, and progressive disease in four and six patients, respectively. There was a high degree of concordance between CEUS and CT/MRI (kappa coefficient=0.84, P < 0.001). Responders (complete+partial response) according to mRECIST-CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders (37.1 vs. 11.0 months, P < 0.001 and 24.6 vs. 10.9 months, P = 0.007, respectively). CONCLUSIONThe mRECIST-CEUS combination is feasible and has prognostic value in the assessment of hepatocellular carcinoma following transarterial chemoembolization

The value of contrast-enhanced ultrasonography in detection of prostatic infarction after prostatic artery embolization for the treatment of symptomatic benign prostatic hyperplasia

PURPOSEWe aimed to assess the clinical and predictive role of contrast-enhanced ultrasonography (CEUS) as the primary method for imaging evaluation of prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH).METHODSThirty-one patients with symptomatic BPH, treated with PAE from October 2016 until February 2018, were enrolled in this prospective, single-center study. Microspheres (100–700 µm) were utilized for PAE. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow (Qmax), prostatic volume (PV) and post void residual volume (PVR) were measured at baseline and at 1, 3, and 6 months post PAE. Unenhanced transabdominal US was utilized for PV and PVR measurements; prostatic enhancement was studied with transabdominal CEUS at baseline, during the procedure, 1 day and 1, 3, and 6 months post PAE. Technical success was defined as embolization of the PA of at least one pelvic side. Clinical success was based on the improvement of IPSS and QoL, with no need for any additional treatment. Follow-up time ranged from 6 to 18 months (mean, 9.7±4.3 months). Clinical success rates were calculated and changes in prostatic enhancement were correlated with the outcome parameters.RESULTSTechnical success rate was 90.3%. Clinical success rates at 3, 6, and 12 months post PAE were 85.7%, 85.7%, and 79.1% respectively. Improvement of outcome parameters (baseline vs. 6-month values) was statistically significant, with 12.4 points mean reduction of IPSS (50.4%, P = 0.003), 2.0 points mean reduction of QoL (45.4%, P 10%.CONCLUSIONCEUS appears to be a practical method for the study of the local ischemic effect of PAE, with potential predictive value

Intraprocedural and postprocedural ceus of drug-eluting beads chemoembolization: criteria of prognosis and response

Purpose: To evaluate contrast-enhanced ultrasonography (CEUS) as a tool for the intra- and post-procedural assessment of the effectiveness of transarterial chemoembolization with drug-eluting beads (DEB-TACE). To assess the combination of CEUS with standard response and prognostic criteria.Materials and Methods: 63 patients with 109 target tumors (52 patients with hepatocellular carcinoma-HCC, 9 patients with liver metastases from colorectal cancer, and 2 patients with intrahepatic cholangiocarcinomas-ICC) were studied. They were treated with DEB-TACE, every 5-7 weeks. Imaging follow-up included a standard, contrast-enhanced modality (computed tomography-CT or magnetic resonance-MR) and CEUS. RECIST, mRECIST and EASL criteria of response were applied on appropriate CEUS and CT/MR images. Radiologic response was correlated with overall survival (OS) and progression-free survival (PFS). Results: There was a high degree of concordance between post-procedural CEUS and CT/MR in the evaluation of tumor response according to mRECIST (k=0.84, p<0.001). Responders according to mRECIST-CEUS had a significantly longer mean OS and PFS compared to non responders (37.1 vs 11.0 months, p<0.001 and 24.6 vs 10.9 months, p=0.007, respectively). mRECIST had a higher prognostic value than RECIST. Conclusion: In the context of post-DEB-TACE assessment of liver tumors, the combination CEUS with standard response criteria is feasible and of prognostic value.Σκοπός: Να αξιολογηθεί η υπερηχογραφία με ενισχυτές ηχογένειας (contrast-enhanced ultrasonography, CEUS) σαν μέθοδος διεπεμβατικής και μετεπεμβατικής αξιολόγησης του χημειοεμβολισμού με σφαιρίδια εκλύοντα χημειοθεραπευτικό (transarterial chemoembolization with drug-eluting beads, DEB-TACE). Να αξιολογηθεί ο συνδυασμός CEUS με ευρέως αποδεκτά κριτήρια ανταπόκρισης και πρόγνωσης.Υλικό-Μέθοδος: Μελετήθηκαν 63 ασθενείς, με 109 όγκους-στόχους (52 ασθενείς με ηπατοκυτταρικό καρκίνωμα, 9 ασθενείς με ηπατικές μεταστάσεις, 2 ασθενεις με ενδοηπατικό χολαγγειοκαρκίνωμα), οι οποίοι υπεβλήθησαν σε DEB-TACE ανά 5-7 εβδομάδες. Ο απεικονιστικός έλεγχος συμπεριέλαβε μία δυναμική εξέταση αναφοράς (υπολογιστική ή μαγνητική τομογραφία) και CEUS. Επί των απεικονιστικών ευρημάτων εφαρμόστηκαν τα κριτήρια ανταπόκρισης RECIST, mRECIST and EASL. Η απεικονιστική ανταπόκριση συσχετίστηκε με την συνολική επιβίωση (overall survival, OS) και την επιβίωση ελεύθερη προόδου νόσου (progression-free survival, PFS). Αποτελέσματα: Παρατηρήθηκε υψηλού βαθμού συμφωνία μεταξύ της CEUS και της εξέτασης αναφοράς στην αξιολόγηση της ανταπόκρισης κατά mRECIST (k=0.84, p<0.001). Ασθενείς με ανταπόκριση (κατά mRECIST-CEUS), είχαν σημαντικά μεγαλύτερη OS και PFS σε σύγκριση με τους υπόλοιπους (37.1 vs 11.0 μήνες, p<0.001 και 24.6 vs 10.9 μήνες, p=0.007,αντίστοιχα). Τα κριτήρια mRECIST είχαν υψηλότερη προγνωστική αξία από τα RECIST. Συμπέρασμα: Στο πλαίσιο της αξιολόγησης ηπατικών όγκων μετά DEB-TACE, ο συνδυασμός της CEUS με ευρέως αποδεκτά κριτήρια ανταπόκρισης φαίνεται εφικτός και με προγνωστική αξία

A rubber tube in the bladder as a complication of autoerotic stimulation of the urethra

Self-insertion of foreign bodies in the urethra is most commonly associated with sexual or erotic arousal of adolescents with mental health disorders. Rarely it may practiced by healthy adults for masturbation. Migration of foreign bodies used for the abovementioned purpose from the urethra to adjacent organs is a relatively uncommon urologic problem that may cause serious complications which arose tardive. Presentation includes a variety of acute or chronic symptoms that depend of the underlying complications. The method of extraction depends on the shape, size and nature of the object and should be tailored according to the condition of the patient. In the present article we present a case of a rubber tube inserted to the urethra for erotic arousal purposes which migrated to the bladder during masturbation

Prostatic calculi : relationship to chronic prostatitis and treatment options. A critical analysis = Οι ασβεστώσεις του προστάτη, η σχέση τους με την χρόνια προστατίτιδα και η αντιμετώπισή τους. Μια κριτική ανάλυση

While prostatic calculi are a common ultrasound finding, their exact prevalence of is not known. It has been reported to vary widely, from 7% to 70% with greater incidences occurring in chronic prostatitis patients. However, pathophysiology, clinical relevance and association of prostatic calculi with prostatic diseases remain unclear. Traditionally they considered to be a random finding of no clinical significance probably associated with chronic infection of the prostate. In fact most cases are found incidentally and they are not accompanied by symptoms. However, prostatic calculi associated with chronic prostatitis may be accompanied by chronic pelvic pain and they have been linked with poorer treatment outcome. The relative literature is limited, while knowledge about their treatment is poor. Therefore, it is necessary for specialists to become familiar with this entity Treatment options include monitoring, medication, and surgery if necessary.Ενώ οι ασβεστώσεις του προστάτη είναι ένα κοινό υπερηχογραφικό εύρημα, η ακριβής συχνότητα τους στο γενικό πληθυσμό δεν είναι γνωστή. Έχει αναφερθεί ότι ποικίλλει ευρέως, από 7% έως 70%, με τις μεγαλύτερες συχνότητες εμφάνισης να παρατηρούνται σε ασθενείς με χρόνια προστατίτιδα. Παρόλα αυτά, η παθοφυσιολογία, η κλινική σημασία και η συσχέτιση τους με τα νοσήματα του προστάτη αδένα παραμένουν ασαφείς. Παραδοσιακά θεωρούνται ως ένα τυχαίο εύρημα που δεν έχει κλινική σημασία και που πιθανώς σχετίζεται με ιστορικό λοίμωξης του προστάτη. Στην πραγματικότητα, οι περισσότερες περιπτώσεις εντοπίζονται παρεμπιπτόντως και δεν συνοδεύονται από συμπτώματα. Αντίθετα, οι ασβεστώσεις του προστάτη που σχετίζονται με τη χρόνια προστατίτιδα μπορεί να συνοδεύονται από χρόνιο πυελικό άλγος και έχουν συνδεθεί με φτωχότερα θεραπευτικά αποτελέσματα. Η σχετική βιβλιογραφία είναι περιορισμένη ενώ οι γνώσεις γύρω από την αναγκαιότητα της θεραπείας τους και τις τυχόν θεραπευτικές επιλογές είναι πτωχή. Ωστόσο η παρουσία τους σε ασθενείς με χρόνια προστατίτιδα -ανεξαρτήτως της αιτιολογικής διασύνδεσής τους-καθιστά αναγκαία την εξοικείωση με αυτές. Οι θεραπευτικές επιλογές περιλαμβάνουν την απλή παρακολούθηση και -όποτε αυτές χρειάζονται-φαρμακευτική ή χειρουργική θεραπεία

Οι ασβεστώσεις του προστάτη, η σχέση τους με την χρόνια προστατίτιδα και η αντιμετώπισή τους. Μια κριτική ανάλυση

While prostatic calculi are a common ultrasound finding, their exact prevalence of is not known. It has been reported to vary widely, from 7% to 70% with greater incidences occurring in chronic prostatitis patients. However, pathophysiology, clinical relevance and association of prostatic calculi with prostatic diseases remain unclear. Traditionally they considered to be a random finding of no clinical significance probably associated with chronic infection of the prostate. In fact most cases are found incidentally and they are not accompanied by symptoms. However, prostatic calculi associated with chronic prostatitis may be accompanied by chronic pelvic pain and they have been linked with poorer treatment outcome. The relative literature is limited, while knowledge about their treatment is poor. Therefore, it is necessary for specialists to become familiar with this entity Treatment options include monitoring, medication, and surgery if necessary

Sonographic evaluation of prostatic artery embolization: Far beyond size measurements

Prostatic artery embolization (PAE) has gained acceptance as a minimally invasive, safe and effective treatment of symptomatic benign prostatic hyperplasia. Radiologic imaging is an indispensable part of post-interventional evaluation of PAE and serves both clinical and investigational purposes. In this context, ultrasonography (US) has a central and multifaceted role. Gray-scale US is routinely utilized for measurement of significant outcome parameters (prostatic volume, intra-vesical prostatic protrusion and post-void residual volume) before and after PAE. Improvement of these parameters may become more obvious one-month post-PAE, or later. Contrast-enhanced US (CEUS) with intravenous administration of a second-generation echo-enhancer can demonstrate prostatic infarcts (as enhancement defects) immediately post-PAE and monitor their resolution over time. The volume of prostatic infarcts can also be measured and compared to prostatic volume. Prostatic infarction is a definite sign of the local efficacy of PAE and a predictor of prostate shrinkage and (at least in some patients) of clinical success. CEUS can also be performed intraoperatively in the angio-suite, for on-site evaluation of the ischemic effect; a variation of this technique, with intraarterial (instead of intravenous) administration of diluted echo enhancer, can also be applied intraoperatively, to map the embolized territory and to prevent non-target embolization. Initial experience with US-elastographic techniques (shear-wave and strain elastography) has shown that they can detect and quantify the improvement of tissue elasticity post-PAE, thus providing new insights into the therapeutic mechanisms of this treatment. With utilization of high-end equipment, experience and standardized imaging protocols, US could be the primary modality for imaging evaluation of PAE