Bilateral parapelvic cysts that mimic hydronephrosis in two imaging modalities: a case report

Parapelvic cysts are uncommon conditions that are usually found during autopsy. Their ultrasonographic appearance is similar to hydronephrosis. We report the case of a 46-year-old female with a 4-year history of vague flank pain and a previous history of bilateral moderate hydronephrosis. The patient was investigated by ultrasonography and non-enhanced CT scan, and finally diagnosed as bilateral parapelvic cysts by a contrast-enhanced CT scan. For any patient with hydronephrosis detected by sonography, the possibility of parapelvic cysts should be kept in mind, especially if no underlying cause is detected and other routine imaging is inconsistent with hydronephrosis. In such circumstances a CT scan with contrast enhancement should not be refused, and relying on sonographic signs, previously mentioned in literatures, can be misleading

Cerebral Gas Embolism -A Serious Complication of CO 2 Angiography

Abstract Carbon dioxide angiography is routinely used for vascular imaging and endovascular procedures. It is very useful in patients with allergy to iodinated contrast agents or with poor renal function. It is relatively safe to use. We describe first case of cerebral gas embolism leading to multiple bilateral ischemic strokes in a patient receiving carbon dioxide angiography for workup of thrombosed arm arteriovenous fistula

Simultaneous proximal embolic protection and inferior vena cava mechanical thrombectomy using the FlowTriever system

Interventional radiologists have the unique ability to apply their imaging knowledge, wide scope of technical skills, and use of innovative technologies to comprehensively address the percutaneous management of the thromboembolic disease processes. This report illustrates successful management of a thrombosed IVC, while protecting against possible pulmonary embolism. Here, we present a 49-year-old female with stage IIIB ovarian cancer who presented with severe bilateral lower extremity edema and anasarca in setting of occlusive thrombus of IVC. The thrombus was the result of compressionfrom a large hepatic hematoma which gradually developed after radical hysterectomy. A new mechanical thrombectomy device approved for use in pulmonary embolism, Inari FlowTriever catheter, was used off-label to remove the clot. The self-expanding mesh discs in the Inari FlowTriever catheter were utilized to protect against pulmonary embolism while percutaneously draining the hepatic hematoma and alleviating the IVC compression. The IVC was largely patent at the end of the procedure, and the patient experienced complete resolution of her symptoms. This case report demonstrates the successful and safe off-label use of a new mechanical thrombectomy device approved for pulmonary embolism thrombectomy in the IVC and illustrates a novel application of the nitinol mesh discs in the device as proximal embolic protection

Safety and feasibility of single use cholecystoscopy for guiding laser or mechanical cholelithotripsy, and mechanical cholelithotomy

PURPOSEPatients with acute calculus cholecystitis and contraindications to cholecystectomy receive cholecystostomy drainage catheters, many of which remain in place until end of life. This study aims to assess safety, feasibility, and early clinical outcomes of percutaneous cholecystoscopy using the LithoVue endoscope, laser/mechanical cholelithotripsy, and mechanical cholelithotomy for management of symptomatic cholelithiasis.METHODSThis was a single-institute retrospective analysis of 17 patients with acute calculus cholecystitis who had contraindications to cholecystectomy, underwent cholecystostomy catheter placement between 2015 and 2017, and stone removal between 2017 and 2018. The LithoVue 7.7- 9.5 F endoscope was used in combination with laser/mechanical cholelithotripsy, mechanical retrograde, and balloon-assisted anterograde cholelithotomy to remove gallstones and common bile duct stones. Surgical contraindications ranged from cardiopulmonary disease to morbid obesity to neoplastic processes. Timing and number of interventions, as well as technical and clinical successes, were assessed.RESULTSThe median time interval from cholecystostomy catheter placement to cholelithotripsy was 58 days, after an average of 2 tube exchange procedures. Technical and clinical success were achieved in all patients (stone-free gallbladder and cholecystostomy tube removal). On average, three sessions of cholecystoscopy and laser and mechanical cholelithotripsy were required for complete gallstone extraction. The mean interval time between the first cholelithotripsy session and removal of cholecystostomy was 71.8±60.8 days. There were neither major nor minor procedure-related complications.CONCLUSIONPercutaneous cholecystoscopy using the LithoVue endoscope, in combination with laser/ mechanical cholelithotripsy and mechanical cholelithotomy, is feasible, safe, well-tolerated, and was able to remove the cholecystostomy tube in the patients with contraindication to cholecystectomy

MR Imaging Measures of Intracranial Atherosclerosis in a Population-based Study

Our MR imaging protocol characterized individuals at greatest risk for having intracranial atherosclerotic disease lesions and offers a reliable technique for identifying lesions in patients with suspected disease