Aneurysmal bone cyst: Its pathogenesis based on angiographic, immunohistochemical and electron microscopic studies

Based on angiographic, immunohistochemical as well as electron microscopic findings, authors outline a hypothesis for the etiopathogenesis of aneurysmal bone cysts. No changes were found at the arterial site in 16 studied aneurysmal bone cysts, with no signs of an arteriovenous shunt. In certain cases, however, dilated and tortous efferent veins became visible in the late venous phase. Due to the impedance of venous flow, the intracystic pressure increases and the small veins become dilated causing formation of aneurysmal slits. This is supported by the immunohistochemical finding that S-actin shows concentric arrangement around the aneurysmal cavities. Endothelial lining and basal membrane remnants were detectable in places, though the aneurysmal slits were devoid of continuous endothelial lining and basal membrane. We suggested that the aneurysmal bone cyst corresponds to a hemodynamic disturbance and is due to primary or secondary venous malformation of the bones.     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

Cranial dural arteriovenous malformation and fistula. Radiological diagnosis and management. Review of thirty four patients.

The clinical features, imaging and angiographic findings of thirty four patients with cranial dural arteriovenous malformations and fistulae are presented in four groups. Group 1 – Seven patients with anterior cavernous malformations, predominant superior ophthalmic vein drainage, and symptoms and signs of carotico-cavernous fistula. Group 2 – Twelve patients with malformations of the superior petrosal, transverse and sigmoid sinus regions, presenting predominantly with bruit. Group 3 – Seven patients with malformations of the basal sinuses and prominent cortical venous drainage, presenting with intracranial haemorrhage, headache and impaired cortical function. Intracranial haemorrhage never occured in the absence of cortical venous drainage. Group 4 – Eight patients with infrequent manifestations. Group 1 and 2 patients are readily recognized and diagnosed. Group 3 and 4 patients are often misdiagnosed. Treatment modalities comprised embolisation therapy, surgical excision, and carotid compression. Twenty patients were treated by one or more of these modalities with a successful outcome in thirteen patients. Group 1 patients are the most amenable to trans-arterial embolisation. Carotid compression as the sole modality of treatment was successful in four patients. Unless the fistula is successfully closed, Group 3 patients and patients who present with cervical or thoracic myelopathy carry a grave prognosis. There is need for greater radiologist awareness of Group 3 and the rarer presentations, particularly myelopathy. With the exception of one patient, the morphological features of our cases are consistent with the now-accepted view that these lesions are acquired arterio-venous fistulae and not congential malformations.     

Cerebral Venous Malformations

Cerebral venous malformations (CVM) are increasingly being recognised with the widespread use of CT scanning. Five cases are presented which demonstrate typical angiographic features and CT findings. These lesions when located in the cerebral hemispheres are benign and have been distinguished from the better known arteriovenous malformations on the basis of their characteristic angiographic features. CT findings have been considered nonspecific but our early post contrast CT scans demonstrate characteristic features suggesting that in many cases the diagnosis of cerebral venous malformations may be made on the CT scan alone.     

肝脏局灶性结节增生的螺旋CT平扫及三期增强扫描

目的 分析肝脏局灶性结节增生（FNH）的螺旋CT平扫及三期增强扫描表现,以提高对FNH的诊断准确率。方法对21例21个经手术病理证实的FNH进行螺旋CT平扫及增强的动脉期、门脉期、延迟期扫描。其中2例行肝动脉血管造影。结果 21个FNH,平扫16个为低密度,5个为等密度,其中12个病灶中央有点状、条状、放射状低密度影。动脉期21个FNH除中央疤痕外,均明显均匀强化,9例见明显增粗的供血动脉;门脉期病灶密度下降,但均高于或略高于肝实质;延迟期病灶呈等密度或略低于肝实质,3例见包膜强化。血管造影可见粗大的供血动脉及引流静脉。结论 FNH在螺旋CT平扫及三期增强扫描中的特征性表现,对FNH的确诊及治疗方案的选择有重要价值。     

Three‐dimensional gadolinium‐enhanced magnetic resonance angiography of pulmonary arteriovenous malformation

Pulmonary arteriovenous malformations (AVMs) are rare vascular malformations of the lung. Although most patients are asymptomatic, AVMs can bleed and result in haemoptysis and haemothorax. We describes a case of pulmonary AVMs in a patient with Osler–Weber–Rendu syndrome with 3‐D contrast‐enhanced MR angiography. Magnetic resonance angiography provided accurately and non‐invasively the number and size of the feeding arteries and draining veins.     

Advantages of blood pool contrast agents in MR angiography: a pictorial review

Gadofosveset trisodium (Ablavar®, formerly Vasovist®) is the first intravascular contrast agent approved for clinical use in peripheral vascular disease. The purpose of this review is to illustrate the clinical uses of gadofosveset‐enhanced magnetic resonance angiography in patients referred for assessment of arteriovenous disease. Superior T1 shortening enables first pass renal and peripheral arteriography of quality comparable with larger doses of extracellular agents. In applications such as thoracic outlet syndrome, there may be other advantages such as superior venous imaging and need for only one injection. Steady‐state delayed imaging provides high resolution mapping of both arterial and venous systems and imaging of multiple territories. A combination of dynamic and delayed steady‐state imaging can provide detailed anatomy and flow characteristics of vascular malformations and mapping for percutaneous sclerotherapy at one investigation. The ability to image in the steady state can provide minimally invasive imaging of thrombo‐occlusive disease of central veins.     

Klippel-Trenaunay syndrome: Unusual magnetic resonance features

Klippel-Trenaunay syndrome (KTS) is a congenital vascular abnormality consisting of a cutaneous naevus, varicose veins and bone and soft-tissue hypertrophy affecting one or more limbs. A case is presented here with some unusual associated findings seen on MR that, to the best of the authors’knowledge, has not been reported in the literature. Although colour Doppler in addition to venography is frequently used in demonstration of the KT vein, MRI may well have an important role in complete assessment.     

脑肿瘤合并脑血管畸形的高危因素分析

目的：探讨脑肿瘤合并脑血管畸形的危险因素。方法：回顾性分析2011年1月－2013年1月阳新县人民医院的109例脑肿瘤患者,对其中合并脑血管畸形的15例患者影响因素进行分析,并采用 Logostic 多因素进行影响因素分析。结果：高龄、高血压、糖尿病、心脏瓣膜病、高血脂、吸烟饮酒、颈动脉硬化、动脉瘤、硬脑膜动静脉瘘、肥胖、脑血流紊乱、家族遗传史是脑肿瘤合并脑血管畸形的独立危险因素（P 均＜0．05）。结论：脑肿瘤合并脑血管畸形危险因素和脑血管病相近。     

A reasoned approach to a case of suspected arteriovenous fistula

The case of an 82-year-old female patient with severe tricuspid regurgitation come to the authors' observation for suspected arteriovenous fistula, is reported. Color-Doppler US was performed for re-evaluation. It documented the presence of systemic venous and portal pulsatility associated with severe ectasia and varicosity of infracardiac systemic venous system due to systemic venous hypertension. Color-Doppler study allowed a correct diagnostic approach, excluding the presence of an arteriovenous fistula.     

Administration of Chemotherapy by an Arteriovenous Fistula in a Patient with Metastatic Rectal Cancer after Life-Threatening, Port Thrombosis-Associated Cava Superior Syndrome. An Option for Patients without Possibility of Peripheral or Central Venous Access

Background: Patients with solid tumors have an increased risk of venous thromboembolism, potentially related to a venous port system. In case of catheter-related thrombosis despite full anticoagulation, further treatment administration is difficult. Case Report: A 41-year-old female patient with a K-Ras wild-type adenocarcinoma of the rectum was diagnosed with systemic disease in June 2008 after several local recurrences treated with surgery and additive chemotherapy. To administer chemotherapy with FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) and bevacizumab, a venous port system into the vena subclavia was implanted. In April 2009, the computed tomography (CT) scan revealed a portassociated thrombosis with cava superior syndrome, despite treatment with phenprocoumon and an international normalized ratio (INR) of 3.75 at the time of the event. The port system was explanted. According to the possible relationship to bevacizumab, treatment was discontinued, followed by rapid disease progression. Access to peripheral veins became virtually impossible. Therefore, a radiocephalic fistula was established. For 9 months, the patient has been receiving several therapeutic agents with 20 punctures of the fistula, revealing no locoregional events (e.g. arterial, venous or cutaneous). Conclusion: The application of current therapeutic agents by an arteriovenous fistula seems to be a feasible option for patients with restricted peripheral or central vein status and/or medical history of thrombotic events disabling the use of a port system.     

Anatomy and pathophysiology of varicose veins

The venous anatomy of the leg is described with special reference to the superficial venous system. The histologic and histochemical differences between varicose and normal veins are presented. The pathophysiology of varicose veins is related to congential or acquired abnormalities of the deep venous system, venous valves, and/or fascial or vein wall weakness. Increased deep venous pressure may be both proximal and distal in etiology, arising from arteriovenous anastomoses, incompetent communicating veins, or venous obstruction. Primary valvular incompetence arises from venous obstruction (thrombosis), thrombophlebitis, or valvular agenesis. Secondary valvular incompetence occurs from deep venous obstruction or increased venous distensibility (usually secondary to circulating estrogens). Finally, fascial weakness of the vein wall or supporting fascia provided a genetic basis for the pathophysiology of varicose veins. Understanding the anatomy and pathophysiology of varicose veins should lead to a more rational and efficacious treatment.     

Iliocaval arteriovenous fistula presenting with multiple organ failure

Iliac arteriovenous fistulas are an uncommon condition, which may be spontaneous or traumatic in nature. Such fistulas classically present with a triad of high‐output cardiac failure, pulsatile abdominal mass with a bruit and unilateral leg ischaemia or venous congestion. We describe a case of an iliocaval fistula secondary to rupture of a common iliac artery aneurysm, with an unusual presentation of multiple organ failure, masquerading as sepsis. We describe the CT findings of iliocaval fistula, which was the means of diagnosis in this study.     

肝癌合并肝动-静脉瘘DSA表现及其与门脉高压间的关系

目的：研究肝癌中肝动-静脉瘘的发病率、分型、发生部位以及与肝癌类型、肿瘤血供和门脉高压之间的关系。方法：110例选自我科1989—1999年间收治的经临床和影像资料证实的583例肝癌患者。均采用Seldinger技术行DSA检查证实为肝动-静脉瘘。其中男102例,女8例,年龄27—70岁,平均48．5岁。原发性肝癌103例,转移性肝癌7例（其中原发结肠癌3例,壶腹癌2例,胰腺癌1例,贲门癌1例）;合并腹水58例,上消化道出血31例。行纤维胃镜检查33例,上消化道钡餐检查30例。结果：肝癌中肝动-静脉瘘平均发生率为18．9％。肝动-静脉瘘多发生于多血供、巨块型、原发性肝癌（发生率分别为80．9％、62．7％、93．6％）。肝动-静脉瘘中103例为单纯型,占93．6％,表现为：肝动脉-门静脉瘘97例（88．2％）,肝动脉-肝静脉瘘4例,肝动脉-下腔静脉瘘2例。7例复杂型表现为：同时存在肝动脉-门静脉瘘、肝动脉-下腔静脉瘘3例,肝动脉-下腔静脉瘘、肝动脉-肝静脉瘘1例,先肝动脉-门静脉瘘,后肝动脉-下腔静脉瘘1例,先肝动脉-下腔静脉瘘、后肝动脉-门静脉瘘1例,3处肝动脉-门静脉瘘1例。按肝动-静脉瘘发生部位分型：周围型95例（86．4％）,中央型15例（13．6％）。上消化道钡餐和纤维胃镜对合并腹水和上消道出血病例的检查结果显示：纤维胃镜对食管静脉曲张的阳性检出率明显高于上消化道钡餐检查。结论：肝动-静脉瘘在肝癌中的发生率较高。其中原发性肝癌明显高于转移性肝癌。肝动-静脉瘘多发于巨块型、多血供肝癌,常提示病变的严重程度;肝动-门静脉瘘可能是中晚期肝癌顽固性门脉高压的重要原因之一。肝动-静脉瘘引起的门脉高压中,临床表现腹水为主,出血次之。纤维胃镜对食管静脉曲张的阳性检出率明显高于上消化道钡餐检查。DSA应做为合并门脉高压肝癌患者的常规检查。肝动脉栓塞可阻断肝动-静脉瘘,缓解门脉高压所致腹水和上消化道出血,并减少通过静脉分流引起的远处转移。     

Primary small-cell carcinoma of the oesophagus with spontaneous oesophageal perforation following chemotherapy

The authors describe a 66 year old woman with small-cell carcinoma of the oesophagus who developed a perforation following chemotherapy. Small-cell carcinoma of the oesophagus is a rare neoplasm, varying in appearance from a small mucosal lesion to a larger fungating mass, which in our patient presented as a bulky soft-tissue mass causing stricture. Pleural fluid collections which developed via a spontaneous oesophageal-pleural fistula were subsequently drained using percutaneously placed catheters. Radiologic management of this condition provided a successful and cost-effective means of patient care.     

选择性血管造影对小肠平滑肌瘤的诊断价值

目的：分析选择性血管造影中小肠平滑肌瘤的X线表现,探讨小肠血管造影对小肠平滑肌瘤的诊断价值。方法：回顾性分析1995年6月～2005年6月我院应用数字减影机进行选择性血管造影并经手术病理证实的17例小肠平滑肌瘤的造影征象。结果：小肠平滑肌瘤血管造影主要征象为：供血动脉增粗;肿瘤血管丰富,呈“蜘蛛网”状;肿瘤实质显色浓密;引流静脉增粗早显;有血管池,瘤体大者恶性肿瘤可能性大。结论：选择性血管造影对小肠平滑肌瘤的诊断明显优于钡剂造影和内镜检查,可作为诊断小肠平滑肌瘤的首选方法。     

Radiosurgery at the Royal Adelaide Hospital: The first 41/2 years’ clinical experience

Radiosurgery refers to the treatment of small lesions localized by stereotactic technology using highly focused radiation. This review utilizes prospectively gathered data from the Royal Adelaide Hospital Radiosurgery unit to summarize experience with the first 62 patients (65 lesions) treated between November 1993 and May 1998. This experience included acoustic neuromas (23 patients), arteriovenous malformations (18), brain metastases (12), meningiomas (6), and glomus tumour, subependymoma, dural arteriovenous fistula (1 each). Although follow up is relatively short, the outcome in terms of morbidity and tumour control is thus far comparable with results reported in the literature. Radiosurgery provides a viable alternative to neurosurgery and conventional external beam radiotherapy for several benign and malignant intracranial lesions.     

Mediastinal Veins on Computed Tomography: II. Congenital and Acquired Abnormalities

Computed tomographic scans of 7 patients are presented, each showing congenital or acquired anomalies of the mediastinal veins. Embryological development of the mediastinal veins is reviewed. C.T. provides a relatively non-invasive means of evaluating abnormalities of mediastinal contour due to abnormal venous structures. In addition, an incidental finding of an anomalous venous system on C.T. scanning would provide useful knowledge if surgery, transvenous catheterisation or pacemaker insertion were contemplated.     

胃癌合并门静脉癌栓的CT表现

为了提高对胃癌合并门静脉癌栓CT表现的认识,回顾性分析1990年5月23日~2005年9月18日7例经胃镜、手术病理及临床确诊的胃癌合并门静脉癌栓患者的资料。7例患者均行CT平扫加增强检查。CT检查均显示胃病变区胃壁明显不规则增厚,3例患者出现肝转移灶。门脉癌栓栓子发生的部位主要位于门脉主干段(7例),其中2例累及左、右分支;1例累及肠系膜上静脉;1例同时累及肠系膜上静脉和脾静脉。7例患者中有5例癌栓未见明显强化,2例患者增强后癌栓轻度强化。5例患者癌栓的所在门脉主干明显扩张,门脉血流阻断,5例患者扩张的门脉主干周围可见明显强化迂曲的侧枝血管影,其中2例出现大量腹水。研究结果显示,虽然绝大部分门静脉癌栓由原发性肝癌引起,但门静脉癌栓也可以是由进展期胃癌形成,密切结合临床资料,两者鉴别诊断并不困难。     

New SMS Classification of Cochleovestibular Anomalies: Our Experience with 25 Cases of Type I Anomaly

PurposeTo study and analyse the radiological and surgical findings of 25 cochlear implantees with SMS type—I cochleovestibular malformation and to compare their outcomes in terms of hearing and speech gains pre- and post-operatively.MethodsRetrospective analysis of cochlear implanted candidates over a period of 8 year from 3 institutions was undertaken and 25 patients suffering from pre-lingual profound congenital sensori-neural hearing loss along with presence of SMS type I cochleovestibular malformation were studied. Pre-operative radiology, surgical difficulties and complication, and post-operative hearing and speech outcomes upto a period of 2 years, using IT-MAIS scores were noted. Statistical comparison pre- and post-implantation was done using Wilcoxon signed rank test and a p-value of < 0.05 was considered significant.ResultsIn 25 cases, we encountered 2 posterior SCC dysplasia, 15 enlarged vestibular aqueducts (LVA), 2 dilated vestibules, 4 superior SCC dysplasia, 2 cases with both posterior and superior SCC dysplasia and of those 1 had a dilated vestibule also. Intra-operatively, CSF leak was observed in 10 patients. Complete electrode insertion and good electrical response (NRT) was detected in all. No facial nerve anomaly was encountered. IT-MAIS scores increased from a pre-operative mean of 4.32 to 34.56 two years post-operatively and this difference was found to be statistically significant.ConclusionOur experience with SMS Type I malformations show promising and motivating results with less chances of complications, similar to implant candidates with normal anatomy. The outcomes in this group of patients are definitely not affected by any malformations in semicircular canals, vestibule or vestibular aqueduct.