Ultrasound-guided percutaneous aspiration of adventitial cysts in the occluded popliteal artery – clinical results and MR findings at 5-year follow-up

Cystic adventitial disease is a rare disorder that occurs in peripheral arteries. Calf claudica­tion caused by compression of the popliteal artery is a typical presentation of this disease. This is a report of two cases of occluded popliteal artery decompression by percutaneous ultrasound-guided cyst aspiration. In both cases, decompression of the artery was achieved with a significant decrease in the size of adventitial cysts and restoration of flow. Both pa­tients reported complete resolution of symptoms and no calf pain 5 years after the proce­dure. MR findings and resolution of symptoms in these two patients show the efficacy of percutaneous adventitial cyst aspiration in a 5-year follow-up

Correlation between findings of multislice helical computed tomography (CT), endoscopic examinations, endovascular procedures, and surgery in patients with symptoms of acute gastrointestinal bleeding

Background: Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. Material/Methods: The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. Results: The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. Conclusions: CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding

Hybrid surgery of a patient with B aortic dissection and renal ischemia

Rozwarstwienie aorty jest ciężką, potencjalnie śmiertelną chorobą występującą z częstością > 2000 nowych przypadków rocznie. Istotą choroby jest uszkodzenie błony wewnętrznej aorty, które prowadzi do powstania w jej obrębie dwóch kanałów przepływu krwi: prawdziwego i rzekomego. Jedną z metod leczenia, poza postępowaniem farmakologicznym, jest wewnątrznaczyniowa implantacja stentgraftu, która ma na celu utrzymanie drożności kanału prawdziwego aorty oraz zapobieganie powiększaniu się jej wymiaru poprzecznego. Częstym skutkiem takiego postępowania jest również zakrzepnięcie kanału rzekomego. Metoda ta może implikować powikłania kliniczne, których częstość występowania ocenia się w sumie na około 14% przypadków. Wśród nich istotny problem stanowi niedokrwienie narządów jamy brzusznej, w tym nerek. U pacjentów, u których dobra perfuzja narządowa jest uwarunkowana drożnością kanału rzekomego, należy rozważyć leczenie operacyjne z zastosowaniem przeszczepów naczyniowych.Aortic dissection is a serious, potentially lethal disease which is estimated to occur > 2000 new cases per year. The essence of the disease is the damage of aorta intima which results in separating of the aorta walls and leads to forming two blood flows: in a true and a false lumen. One of the treatment methods, apart from pharmacological one, is an endovascular stent-graft placement in order to maintain proper patency of aorta true lumen and protecting from increasing the diameter of aorta. One of the most common result of this kind of treatment is the thrombosis of false lumen. This method can implicate clinical complication occurring in approximately 14% patients. Abdominal organs ischemia, including kidneys, is one of the most significant problem. Surgical treatment with vascular grafts should be considered in cases when the proper organ perfusion depends on the false lumen patency

An X-ray lead screen may be used to reduce an interventional radiologist's radiation exposure during CT-guided procedures

Purpose: The exposure of both patient and operator to radiation is one of the limitations of computed tomography (CT)-guided interventions, and it should be kept as low as reasonably possible. The purpose of the study was to evaluate the efficacy of a lead screen in reducing the radiation dose to an operator in the course of CT-guided interventions. Material and methods: This prospective study analysed data collected from 72 consecutive CT-guided procedures, all of which were performed with an X-ray protective lead screen placed between the scanner and the operator. Five dosimeters were placed in the CT scanning room, and accumulated radiation doses were measured for each dosimeter. Results: The dosimeter placed on the gantry side of the lead screen revealed highest levels of radiation (11.33 ± 1.93 mSv), which were significantly higher than those at all other dosimeters. The radiation dose behind the lead screen was almost the same when measured by dosimeters on the CT scanner gantry side and 3 metres away from it. The presence of the screen caused no discomfort for operators. Conclusions: A lead screen reduces an operator's radiation exposure significantly, while not posing any obstacles or causing any discomfort while CT-guided procedures are carried out

Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysmsand dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen moreoften, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison toclassic open surgery, endovascular treatment is also associated with complications. One of the rarer and usuallyfatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complicationwas AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increasedinflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-oldwoman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatorymarkers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performedin patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect inthe aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy(EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enablesto confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammationin patients with the history of TEVAR should always suggest the presence of AEF

Microwave ablation of colorectal cancer lung metastases — the first experience in Poland

Introduction. This study aimed to present the results of the first experiences in thermal ablation of colorectal cancer lung metastases in Poland.  Material and methods. Seven patients with colorectal cancer lung metastases were treated with CT-guided microwave ablation. One of them was lost to follow-up, so 6 patients with 7 metastatic foci were included in this study. The mean diameter of lesions was 15 mm (10–20 mm). The patients were disqualified from surgical treatment due to comorbidities.  Results. The mean duration of follow-up was 15 months (range: 6–29). No mortality was noted during that period. Local progression was not reported, while distant progression was found in two patients. Two patients presented with pneumothorax just after the ablation, and one of them required chest tube drainage. No complications were noted.  Conclusions. Patients with a few small colorectal cancer lung metastases can benefit from thermal ablation. The method is safe and should be available for medically inoperable patients with pulmonary oligometastatic disease

Computed tomography evaluation of patent paraumbilical vein and its aneurysm in relation to other portosystemic collateral channels in patients with liver cirrhosis and portal hypertension

Purpose: The aim of the study was to evaluate the relationship between the diameter and aneurysmal dilatation of the paraumbilical vein (PUV) and the presence of portosystemic collateral shunts and their relationship with age and portal vein diameter. Material and methods: The retrospective analysis, performed in the II Department of Radiology, Medical University Hospital in Warsaw, included 126 patients (77 males and 49 females) with patent umbilical vein and signs of portal hypertension due to liver cirrhosis. All patients underwent contrast enhanced abdominal CT. The average age was 54.7 ±12.98. We analysed the number and type of portosystemic collateral channels in respect of age, sex, presence of oesophageal varices, and the diameter of the paraumbilical vein and the portal vein. Results: Our results disclosed statistically significant negative correlation between patient age and diameter of paraumbilical vein, number of portosystemic collateral channels and diameter of portal vein and positive correlation between diameter of paraumbilical vein and diameter of portal vein. A statistically significant difference in diameter of portal vein and number of collateral channels was found in groups with and without oesophageal varices. No significant difference in age and portal vein diameter was found in these groups. Conclusions: Our study showed that younger patients with liver cirrhosis are characterised by wider paraumbilical veins and higher number of portosystemic collateral channels. The presence of oesophageal varices does not correlate with age, sex, diameter of paraumbilical vein, and number of collateral portosystemic channels

Validation of exophthalmos magnetic resonance imaging measurements in patients with Graves’ orbitopathy, compared to ophthalmometry results

Purpose: Although assessment of the orbital structures using magnetic resonance imaging (MRI) is well described in the literature, there is no consensus as to which measurement method is the most useful in exophthalmos assessment. The aim of the study was to correlate 2 MRI methods of exophthalmos measurement with exophthalmometry results and to determine a proper technique of exophthalmos measurement. Material and methods: Fifty-four patients (108 orbits) with exophthalmos in the course of Graves’ orbitopathy were enrolled in the study. Two measurements on axial T2W orbital MRI images were performed by 2 independent radiologists: the distance from the interzygomatic line to the anterior surface of the globe (AD) and the distance from the interzygomatic line to the posterior sclera (PD). Within 4 weeks, an exophthalmometry was performed by an ophthalmologist using a Hertel exophthalmometer. The inter-observer variation was assessed using the Pearson correlation coefficient. Values were presented as mean and standard deviation, and the differences in values were explored with Student’s t-test. Results: The mean AD measured on MRI by the first observer was 20.6 ± 3 mm, and 20.6 ± 2.9 mm by the second observer. PD values were 2.9 ± 2.8 mm and 3.4 ± 2.8 mm, respectively. The mean exophthalmometry result was 21 ± 3.3 mm. The correlation was very high between observers for AD measurements (r = 0.98, p = 0.01) and high for PD measurements (r = 0.95, p = 0.01). AD measurements on MRI and exophthalmometry results were strongly correlated (r = 0.9, p = 0.01). Conclusions: The AD measurement has better reproducibility and is directly correlated with Hertel exophthalmometry. This method could be sufficient in routine practice

Computed tomography evaluation of patent paraumbilical vein and its aneurysm in relation to other portosystemic collateral channels in patients with liver cirrhosis and portal hypertension

Purpose: The aim of the study was to evaluate the relationship between the diameter and aneurysmal dilatation of the paraumbilical vein (PUV) and the presence of portosystemic collateral shunts and their relationship with age and portal vein diameter. Material and methods: The retrospective analysis, performed in the II Department of Radiology, Medical University Hospital in Warsaw, included 126 patients (77 males and 49 females) with patent umbilical vein and signs of portal hypertension due to liver cirrhosis. All patients underwent contrast enhanced abdominal CT. The average age was 54.7 ±12.98. We analysed the number and type of portosystemic collateral channels in respect of age, sex, presence of oesophageal varices, and the diameter of the paraumbilical vein and the portal vein. Results: Our results disclosed statistically significant negative correlation between patient age and diameter of paraumbilical vein, number of portosystemic collateral channels and diameter of portal vein and positive correlation between diameter of paraumbilical vein and diameter of portal vein. A statistically significant difference in diameter of portal vein and number of collateral channels was found in groups with and without oesophageal varices. No significant difference in age and portal vein diameter was found in these groups. Conclusions: Our study showed that younger patients with liver cirrhosis are characterised by wider paraumbilical veins and higher number of portosystemic collateral channels. The presence of oesophageal varices does not correlate with age, sex, diameter of paraumbilical vein, and number of collateral portosystemic channels