Pinch-Off Syndrome, a Rare Complication of Totally Implantable Venous Access Device Implantation: A Case Series and Literature Review

Background: Pinch-off syndrome (POS) is a rare complication after totally implantable venous access device (TIVAD) implantation. In cancer patients, it is important to prevent this rare complication and to recognize it early if it does occur. We present a case series of POS after TIVAD implantation and the results of a literature search about this complication. Methods: From July 2006 to December 2015, 924 permanent implantable central venous catheter implantation procedures were performed. The most common indication was vascular access for chemotherapy. Results: POS occurred in 5 patients in our clinic. Two patients experienced POS within 2 weeks, and the other 3 patients were admitted to department of surgery, Istanbul Faculty of Medicine at 6 to 14 months following implantation. The catheters were found to be occluded during medication administration, and all patients complained of serious pain. The transected fragments of the catheters had migrated to the heart. They were successfully removed under angiography with a single-loop snare. Conclusion: POS is a serious complication after TIVAD implantation. It is important to be aware of this possibility and to make an early diagnosis in order to prevent complications such as drug extravasation and occlusion events

Comparison of fdg-pet/ct and mr with diffusion- weighted ımaging for assessing peritoneal ımplants in patients with gynecologic neoplasms

Amaç: Jinekolojik maligniteli hastalarda peritoneal imp- lant saptamada rutin abdominal MRG, diffüzyon ağırlıklı görüntüler (DAG) ve PET-BT tetkiklerinin duyarlılıklarını saptamak ve birbirleri ile karşılaştırmaktır. Gereç ve Yöntemler: Jinekolojik tümör nedeniyle takip edi- len 21 hasta çalışmamıza dâhil edildi. Hastalara PET-BT, tüm batın MRG ve b 0-500-1000 s/mm2 değeri kullanılarak batına yönelik diffüzyon ağırlıklı (DAG) çekimler yapıldı. PET-BT incelemesi nükleer tıp uzmanı tarafından, MRG ve DAG ise radyoloji uzmanı tarafından değerlendirildi. Batın içi implantlar, lezyon sayılarına göre standart referansla karşılaştırılıp değerlendirildi. Bulgular: PET-BT incelemesinde toplam 40 lezyon izle- nirken, MRG’de 49, MRG ve DAG birlikte değerlendiril- diğinde 65 lezyon raporlandı. Tüm görüntüleme metodla- rı ile toplam 8 hastada lezyon izlenmedi. İki hastamızda MRG+DAG’te lezyon izlenirken, MRG ve PET-BT’de iz- lenmedi. Bir hastada ise MRG ve MRG+DAG’de lezyon izlenirken PET-BT’de lezyon izlenmedi. MRG+DAG’de iz- lenen lezyon sayısı, PET-BT ile karşılaştırıldığında anlamlı derecede fark izlendi. Sonuç: Biz bu çalışmada kontrastlı MRG ve MRG+DAG ile PET-BT’ye göre daha fazla lezyon bulduk. PET-BT’ye alternatif olabilecek diffüzyon ağırlıklı görüntüleme, kon- vansiyonel MRG’e eklenerek peritoneal implant taramada daha duyarlı sonuçlar elde edilebilir.Objective: Our aim was to determine the sensitivity and comparison of abdominal MRI, diffusion weighted MRI (DWI), PET-CT in detecting peritoneal implants in patients with gynecologic neoplasms. Material and Methods: Twenty-one patients with gyneco- logical malignant tumors were enrolled in this retrospective study. Twenty-one oncology patients underwent abdominal and pelvic MRI, diffusion weighted MRI with a b value of 0-500-1000 s/mm2 and whole body PET-CT for follow-up. All MRI images were evaluated by a radiologists and PET- CT images were reviewed by a nuclear medicine physici- an. The results were compared with surgery or laparotomy exploratis, follow-up MRI or CT at a varying time between 2 and 12 months from the initial MRI, and moreover they were also evaluated with laboratory values and clinical outcomes at the 12 to 36th month from the initial MRI. Results: Forty lesions were identified with PET-CT, forty- nine lesions with MRI and 65 lesions with MRI+DWI. In 8 patients there were no implants with all imaging modalities. Although PET-CT and MRI were negative for two patients, MRI+DWI was positive for them. And also PET-CT was negative for one patient whereas MRI and MRI+DWI was positive. On a lesion-based analysis, overall lesion num- bers for PET-CT and MRI+DWI were significantly different (p<0,05). Conclusion: In our study we found with MRI and MRI+DWI more implants than PET-CT. DWI which may be an alter- native to PET-CT with conventional MRI can improve the sensitivity in depicting peritoneal implants