Unilateral adrenal hyperplasia: a rare cause of primary aldosteronism

A 73-year-old gentleman with a background history of long-standing hypertension and hyperlipidaemia presented with one-year history of persistent asymptomatic hypokalaemia associated with metabolic alkalosis. Within a few months, the hypertension worsened, needing increasing dose of anti-hypertensive agents. Biochemical test showed an elevated aldosterone-renin ratio but the computerized tomography (CT) scan of adrenal did not show any adrenal mass. Arterial stimulation venous sampling (ASVS) lateralized the lesion to the left side. A left retroperitoneal adrenalectomy was performed with immediate reversal of hypokalaemia and improvement of blood pressure control to only single anti-hypertensive agent

Endovascular Treatment of Intracranial Aneurysms: Diversity in Treatment Techniques of Varying Anatomical Presentations

We discuss and illustrate various endovascular treatment options for intracranial aneurysms, to reflect common technique used in endovascular treatment of brain aneurysm. We select five cases of various aneurysm types to show assortments of endovascular treatment (EVT) are performed. Selective catheterization of the intracranial aneurysms and endovascular treatments are technically feasible, offering a viable alternative to the surgical approach. We discuss the radiographic features, clinical presentation, and strategies of endovascular treatment of intracranial aneurysms. Key words: endovascular treatment, intracranial aneurysm, intracranial stent, balloon assisted

Tackling iatrogenic post-percutaneous access femoral artery pseudoaneurysm – a case series of multiple closure techniques

Femoral artery pseudoaneurysm is an important post-procedural complication following percutaneous access/intervention. Whilst it is uncommon, it causes significant anxiety among clinicians including interventionists as it exposes the clinician to litigation concerns. The management of post-percutaneous access pseudoaneurysm can divided into several broad categories; namely conservative, endovascular or surgical managements. With rapid advancements of endovascular techniques, interventional radiologists has been at the forefront of managing this issue. We aim to highlight; with the aid of a cases series, the various weaponries at the disposal of an interventional radiologist to deal with post-percutaneous access femoral artery pseudoaneurysm

Percutaneous Catheter-Based Rheolytic Thrombectomy for Massive Pulmonary Embolism: A Case Report

Pulmonary thromboembolism is a life-threatening cardiovascular condition. The mortality rate is high in its current management. Besides supportive treatments, systemic thrombolysis and surgical thrombectomy play important roles in the comprehensive management of pulmonary embolism (PE). The percutaneous catheter-based rheolytic thrombectomy is a promising alternative for management of massive pulmonary emboli, particularly, when patients have contraindication with systemic thrombolysis or are not suitable for surgery. We present the case of a 36-year-old Somalian man who came to our center for a total knee replacement (TKR). Three days after TKR, he developed sudden shortness of breath and decreased oxygen saturation. Computed tomography of pulmonary arteriogram showed extensive thrombi within the main pulmonary trunk, right and left pulmonary arteries, bilateral ascending and bilateral descending pulmonary arteries in keeping with massive PE. Because the patient was contraindicated for systemic thrombolysis, percutaneous, catheter-based rheolytic thrombectomy was chosen as the alternative treatment. His clinical symptoms improved immediately post-treatment. In conclusion, catheter-based rheolytic thrombectomy can serve as an alternative treatment for massive PE with a good clinical outcome

Mesenchymal Chondrosarcoma: A Case Report

Mesenchymal chondrosarcoma is a rare disease with poor prognosis. Treatment including wide or radical excision is very important. Radiotherapy and chemotherapy are additional treatment options, but no conclusive results for their efficacy have been shown until date. Imaging modalities can give important clues for diagnosis and management planning. Angioembolization before surgery could be useful as prophylaxis to control intraoperative bleeding, increasing the likelihood of complete resection

Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre’s-Like Syndrome

Lemierre’s syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum ; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS

Carotid intima-media thickness in kidney transplant recipients

Background/Purpose: Cardiovascular disease is the leading cause of mortality among kidney transplant recipients. Carotid intima-media thickness (CIMT) of the common carotid artery is a surrogate marker for early atherosclerosis. We wanted to compare the prevalence of increased CIMT among kidney transplant recipients with matched controls and its association with clinical and laboratory parameters. Methods: A comparative cross-sectional study involving kidney transplant recipients and controls matched for age, sex, chronic kidney disease staging, and cardiovascular risks was used. CIMT measurements were done using carotid ultrasound and considered increased if >75th percentile matched for age- and sex-matched normal controls. Standard laboratory investigations, high sensitivity C-reactive protein, and asymmetric diamethylarginine were analyzed. Results: Thirty-six kidney transplant recipients (25 men, 11 women) with a median age of 41 years [interquartile range (IQR), 38–52 years] and 36 matched controls with a median age of 44 years (IQR, 37–53 years) were enrolled. There were no demographic differences between the two groups. Kidney transplant recipients had a significantly increased CIMT, 0.8 mm (IQR, 0.6–0.9) compared to matched-controls 0.55 mm (IQR, 0.5–0.7, p = 0.001). Two thirds of kidney transplant recipients had increased CIMT, which was associated with a higher low density lipoprotein (LDL) (p = 0.022) and higher hemoglobin (p = 0.006). Smoking status (p = 0.058) and male sex (p = 0.073) had a trend towards significance to increased CIMT. Multiple linear stepwise regression demonstrated both age and hemoglobin were independent predictors of CIMT (p < 0.001). We found no relationship between high sensitivity C-reactive protein and asymmetric diamethylarginine with CIMT. Conclusion: CIMT among our kidney transplant recipients was significantly higher compared to controls thereby increasing their cardiovascular risk. 背景: 心血管疾病是腎臟移植接受者的主要死因,總頸動脈的內膜中膜厚度 (CIMT) 則是早期動脈粥樣硬化的替代性指標。在本研究中,我們比較了 CIMT 增厚於腎臟移植接受者與匹配對照組之間的盛行率,並調查了 CIMT 與臨床及實驗室參數之間的關聯。 方法: 這是一項橫斷式比較性研究,涉及的對象包括腎臟移植接受者、及與其匹配 (年齡、性別、慢性腎病分期及心血管風險) 的對照者。CIMT 以頸動脈超音波測量,增厚的定義為對應年齡性別匹配正常對照組之 > 75th 百分位數。其他測量項目除了標準實驗室參數外,亦包括高敏感度 C-reactive protein (hs-CRP) 及 asymmetric diamethylarginine (ADMA)。 結果: 分析對象包括 36 位年齡中位數 41 歲 (38,52) 之腎臟移植接受者 (25 男、11 女) 及 36 位年齡中位數 44 歲 (37,53) 之匹配對照者,兩組間的人口學特徵並無不同。腎臟移植接受者之 CIMT 為0.8 mm (0.6,0.9 mm),明顯高於匹配對照者之 0.55 mm (0.5,0.7 mm) (p = 0.001)。腎臟移植接受者之間,3 分之 2 呈現 CIMT 增厚的情形,較厚的 CIMT 與較高的低密度脂蛋白 (p = 0.022) 及較高的血色素 (p = 0.006) 有關。吸煙狀況 (p = 0.058) 及男性性別 (p = 0.073) 亦有傾向與 CIMT 增厚有關。多變項線性逐步迴歸分析顯示,年齡及血色素均是CIMT的獨立預測因子 (p < 0.001)。對於 CIMT 與 hs-CRP 或 ADMA 數值之間,我們並未發現明顯的關係。 結論: 在本研究的腎臟移植接受者中,CIMT 明顯高於對照組,因此具較高的心血管風險

The Vanishing Veins: Difficult Venous Access in a Patient Requiring Translumbar, Transhepatic, and Transcollateral Central Catheter Insertion

Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management

The Vanishing Veins: Difficult Venous Access in a Patient Requiring Translumbar, Transhepatic, and Transcollateral Central Catheter Insertion

Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management