Intrahepatic portal-venous shunts during PVE

Portal venous embolization (PVE) is a well-validated technique to promote contralateral liver lobe hypertrophy prior to hepatic resection. We present a case of a patient with Type IV cholangiocarcinoma undergoing PVE prior to hepatic surgical resection. However, intrahepatic portal-venous shunts were incidentally found during the procedure and were subsequently embolized using embolic coils and N-butyl cyanoacrylate. While most patients with congenital portal-venous shunts remain asymptomatic, an unrecognized shunt during PVE could have resulted in a devastating complication secondary to nontarget embolization through the fistula.To our knowledge, this is the first reported case of a portal-venous shunt being discovered during a PVE. Keywords: Portal venous embolization (PVE), Cholangiocarcinoma, N-butyl cyanoacrylate, Portal-venous shun

Direct percutaneous embolization of intestinal lymphatic trunk for chylous ascites management following liver transplant

Chylous ascites can be caused by infection, trauma, malignancy, or maybe a complication after major abdominal surgery including liver transplantation. We present a case of a patient who developed chylous ascites following his liver transplantation. He was subsequently treated with direct embolization of lymphatic trunk efferent branches with a mixture of N-butyl cyanoacrylate and lipiodol after the identification of a localized leak on a fluoroscopic lymphangiogram. To our knowledge, this is the first reported case of chylous ascites following liver transplantation that was treated with direct embolization of intestinal lymphatic trunk branches. Keywords: Chylous ascites, N-butyl cyanoacrylate, Intestinal lymphatic, Liver transplantatio

Uterine anteversion after uterine fibroid embolization

Uterine fibroid embolization has been proven effective in treating symptomatic uterine fibroids for appropriately selected patients as an alternative option to surgical approaches. The most common adult uterine position is anteverted followed by a retroverted uterus which can be found in roughly 15%-20% of normal adult females. The positioning of the uterus can change from anteversion to retroversion due to the filling of bladder or during pregnancy; however, changing from retroverted to anteverted position without prior pregnancy or endometriosis is rather uncommon. Here, we describe a case of uterine orientation change from retroversion to anteversion presenting 6 months after uterine fibroid embolization. Keywords: Anteverted uterus, Retroverted uterus, Anteversion, UFE, Flipped uterus, Tipped uteru

Impending fibroid expulsion on MRI after uterine fibroid embolization

Uterine fibroids are common benign tumors seen in women and can be managed with a variety of treatment options, including hysterectomy, myomectomy, and uterine fibroid embolization (UFE). UFE is an acceptable alternative to surgical treatment in well-selected cases and offers the added benefit of decreased hospital stay and avoidance of general anesthesia risk. Like any other procedure, UFE carries risks and complications. Post-UFE fibroid expulsion is one of them.We present a case of impending fibroid expulsion pre-emptively identified on magnetic resonance imaging at 6-month follow-up after UFE. While the majority of fibroid expulsions occur spontaneously by 3 months post-UFE, delayed expulsions have been reported as late as 4 years following the procedure. Therefore, a high degree of clinical suspicion is paramount for early diagnosis of this complication in UFE patients. Keywords: Uterine artery embolization, Fibroid expulsion, Submucosa