晚期肝癌伴门脉癌栓介入治疗的体会

目的：回顾分析40例晚期肝癌伴门脉癌栓病人介入治疗疗效和肝动脉栓塞安全性。方法：靶血管内灌注化疗并碘化油乳剂栓塞治疗。结果：经介入治疗后病人存活6个月至18个月不等。较文献报道仅生存平均14周为佳。结论：肝动脉化疗栓塞术对门脉癌栓病人是安全有效的。     

Bronchial arteries to right pulmonary artery anastomoses in right pulmonary vein atresia

A case of right sided pulmonary vein atresia with blood return exclusively through the right pulmonary artery is presented. Plain films revealed no evidence of venous obstruction. Our case emphasizes the potential association of pulmonary hypoplasia with radiographically occult pulmonary vein atresia.     

Treatment of acute embolus of the superior mesenteric artery by topical infusion of streptokinase

Two patients with sudden onset of acute abdominal pain caused by embolic disease of the superior mesenteric artery (SMA) were evaluated angiographically. In one patient, the study was performed soon after the clinical onset of symptoms, and successful treatment with low-dose topical streptokinase infusion produced total lysis of the clot over a period of 30 h. In the second patient, the angiogram was obtained 6 days following the initial episode of pain. Radiographic and clinical findings indicated advanced gastrointestinal ischemia with bleeding which contraindicated the use of fibrinolytic therapy. Surgical resection of infarcted intestine was required. Early angiographic detection of acute mesenteric thrombus or embolus is crucial for the selection of patients for fibrinolytic therapy. Our cases suggest that with early diagnosis, streptokinase infusion is an alternative to surgical management of selected patients with acute mesenteric ischemia.     

Anomalous origin of the right coronary artery from the pulmonary artery

Anomalous origin of the right coronary artery from the pulmonary artery was diagnosed by selective left coronary artery angiography in an asymptomatic five-year-old boy with a continuous murmur. The anomalous coronary artery, along with a cuff of the pulmonary artery, was re-implanted into the aorta. The patient is asymptomatic five years postoperatively.     

Acute pulmonary embolus mimicked on V/Q scan by sarcoidosis

Acute pulmonary embolus is a common problem requiring evaluation in the emergency setting. Following the initial chest radiograph, the most common imaging test requested is the ventilation perfusion lung scan. We describe a patient with sarcoidosis and a false positive ventilation perfusion lung scan caused by bilateral hilar adenopathy compressing the proximal pulmonary arteries. This case illustrates that patients with hilar adenopathy and suspected pulmonary embolus may have unreliable ventilation perfusion scans, and should be referred to arteriography or CT for evaluation, rather than for a ventilation perfusion lung scan.     

Percutaneous retrieval of a right atrioventricular embolus

Percutaneous retrieval of a 12-cm-long serpiginous clot lodged in the right atrium and ventricle is reported. Following bilateral common femoral vein puncture, a Bird’s Nest cava filter was first positioned ready to deploy immediately below the renal veins via the right femoral vein. From the left femoral vein, a Cook intravascular retrieval basket was advanced to the right atrium. Under transthoracic echocardiographic visualization, the basket was used to engage, trap, and gently withdraw the clot in a single long strand below the prepositioned inferior vena cava filter. The filter was immediately deployed, leaving the clot trapped inferior to the renal veins, in the cava and left iliac vein. The patient remained well and asymptomatic at discharge.     

Unusual bullet embolism in the brachial artery: Case report and literature review

Chest cardio-vascular trauma by a gunshot bullet is less common than head trauma in forensic medicine practice, but still an extremely mortal injury. In front of no exit wound, ballistic trajectory could appear unexplained. We present the case of a 43-year-old man who sustained a gunshot wound in his chest. The entrance was facing the sternum and there was no exit wound. An autopsy completed by forensic radiology (CT-scan of the whole body) showed a wound of anterior pericardial, massive bleeding of pericardia, a wound of the anterior ascending thoracic aorta, and then the bullet embolism to the left brachial artery. Without forensic imaging, the bullet was difficult to find. Bullet embolization should be suspected when there is a gunshot injury to the chest without an exit injury and with no projectile in the area, particularly if the projectile is small. Forensic radiology can help to find bullet projectile: by using whole-body radiography or computed tomography.     

螺旋CT双期增强扫描对门静脉癌栓的诊断价值

目的探讨螺旋CT双期增强扫描对门静脉癌栓的诊断价值。方法对21例门静脉癌栓患者行螺旋CT双期增强扫描,观察门静脉癌栓在CT上的表现,并与常规CT表现进行比较。结果所有21例门静脉显示满意,均显示了癌栓所在部位门脉阻塞征象,13例显示了肝门部侧支血管。结论螺旋CT双期增强扫描是诊断门静脉癌栓的有效方法,尤其在显示侧支循环方面有很大优越性。     

Unusual migration of a foreign body from the gut to a vertebral body

We report a unique case in which a needle was accidentally swallowed and migrated into the vertebral body. Plain films and CT of the spine revealed fragmented, linear, metallic-density material in the L3 vertebral body. The possible mechanisms of the migration are discussed. Received: 6 October 1997 Accepted: 26 February 1998     

Peripheral vascular gunshot bullet embolus migration to the cerebral circulation

Summary Bullet embolization to intracranial branches of the major cerebral arteries is a rare complication of gunshot wounds. A review of the literature on cerebral vascular bullet embolization from peripheral sources revealed a number of single case reports that included 12 cases involving the anterior cerebral circulation, and one which involved the posterior circulation. This communication details two additional subjects who were treated at our institution.     

Penetrating axillary trauma in a survivor of the World Trade Center disaster

Penetrating axillary trauma is classically associated with gunshot wounds or stab wounds, and it is a cause for concern because of the high risk of vascular injury. We report a case of penetrating axillary trauma to a victim of the World Trade Center disaster. In this case report, we discuss the CT and angiographic findings of both blunt and penetrating axillary injury, and present a diagnostic algorithm. Electronic Publication     

Delayed migration of a catheter fragment from the left to the right pulmonary artery

A 45-year-old woman is described in whom an intrapulmonary venous access catheter fragment, originally left in place when discovered 1 year after port removal, migrated from one side to the other 2 years later. The patient underwent uncomplicated percutaneous removal of the fragment via the right internal jugular vein. The observed fragment mobility adds further argument for removing all intravenous catheter fragments, even if they have embolized to the pulmonary artery.     

Prevention of embolization of a catheter fragment to the lower extremity by compression of the femoral artery

Distal embolization of a catheter fragment into the lower leg during attempted retrieval was prevented by compression of the common femoral artery to retain the fragment above the inguinal ligament, where it was retrieved successfully. This maneuver should be employed when it is suspected that a fragment may dislodge or is difficult to grasp. This will prevent embolization occurring distally, where surgical retrieval will most likely be required.     

Sonography of the right upper quadrant

Sonography of the right upper quadrant generates a wealth of information for the clinician. Color Doppler has added value to the examination. Endoscopic sonography has further expanded the possibilities, especially in pancreatic imaging. The use of contrast agents and intraoperative applications further the applicability of sonography. As resolution improves and transducer development proceeds, with three-dimensional imaging on the horizon, ultrasound will continue to be the mainstay of imaging in the right upper quadrant.     

Shotgun pellet embolization to the intracranial internal carotid artery: Report of a case and review of the literature

We report a patient with the angiographic diagnosis of embolization of a shotgun pellet from its presumed left internal carotid artery entry site to the ipsilateral intracranial internal carotid artery. Subsequently, a left middle cerebral artery territory infarct developed. Review of the literature reveals 30 previous reports of intracranial embolization of metallic missile fragments. Observations of patient demographics, foreign body type, embolization patterns, neurologic deficits and presentations, and patient evaluation and therapy are discussed.     

Anomalous origin of the right pulmonary artery from the ascending aorta: Diagnosis by magnetic resonance imaging

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital anomaly. Magnetic resonance imaging (MRI) was performed on three patients with anomalous origin of the right pulmonary artery from the ascending aorta. ECG-gated, Tlweighted, spin-echo MRIs and cine MRIs were obtained. In one patient, postoperative MRI was also obtained. Echocardiography and cardiac catheterization were performed in three patients and angiocardiography was performed in two. MRI clearly showed anomalous origin of the right pulmonary artery from the posterior aspect of the ascending aorta, as well as combined anomalies including patent ductus arteriosus, aortopulmonary window, and interruption of the aortic arch in all three patients. Echocardiography missed this anomaly in all three. We suggest that MRI is an accurate imaging modality in diagnosing anomalous origin of the right pulmonary artery from the ascending aorta, obviating the need to perform angiocardiography     

A case of an anomalous pulmonary vein of the right middle lobe

A case is reported in which the abnormal course of a pulmonary vein was suggested by computed tomography and confirmed by digital subtraction angiography. The vein drained blood from the right middle lobe into the apical pulmonary vein. This abnormality was probably due to abnormal segmentation of the right lung. Comparable cases have been reported in the literature. It is important to distinguish these benign lesions from more complex malformations because of the therapeutic and prognostic implications. The radiologic findings of this case and a systematic overview of pulmonary vein abnormalities is provided.