Vena cava filter insertion and angiographic diagnosis of pulmonary embolism

Insertion of a vena cava filter is a therapeutic alternative for patients in whom anticoagulation is not effective or appropriate. The Greenfield filter is associated with a 95% long-term patency rate and a low incidence of mortality or recurrent embolization. Although insertion can be done through the femoral or jugular route, the right femoral vein is the easiest, most direct approach to the inferior vena cava (IVC). Pulmonary arteriography remains, the “gold standard” for establishing the diagnosis of pulmonary embolism.     

Obstructive cholangitis secondary to mucus secreted by a solitary papillary bile duct tumor

A middle-aged woman had repeated episodes of common bile duct obstruction and cholangitis caused by profuse secretion of mucus by a solitary papillary tumor in the left hepatic duct. This complication usually occurs only with papillomatosis. The tumor initially appeared to be benign but subsequently was proven to be an invasive adenocarcinoma. Although the tumor recurred after surgical resection, her course remained uneventful without spread of the neoplasm for 3 yr.     

Partial splenic embolization in children with hypersplenism

Partial splenic embolization (PSE) was successfully accomplished in 10 of 11 children, aged 2-9, who had portal hypertension or variceal bleeding. Nine of the 11 children had undergone portoenterostomy (Kasai operation) for biliary atresia, and two had portal vein thrombosis. After embolization these children had a longer period of fever (mean = 23.7 days) and elevated white blood cell (WBC) count (above 10,000, mean = 13.6 days) than adults who have undergone the same procedure. The leukopenia and thrombocytopenia of hypersplenism were corrected by PSE in seven of eight children, and the condition of the eighth child improved. Among ten patients who had experienced episodes of variceal hemorrhage, the frequency of bleeding episodes was reduced from an average of 2.87 per year before PSE to 0.67 per year after PSE. There were no splenic abscesses and no other significant complications of the treatment. Ultrasound (US) evaluation after embolization demonstrated hypoechogenicity of the infarcted areas and tiny, linear echoes scattered throughout the spleen typical of postinfarction intravascular gas. All nine children who underwent follow-up Tc-99m sulfur colloid scanning showed evidence of splenic regeneration, though none has had recurrence of clinical symptoms. Splenic regeneration following PSE may occur more frequently in children than in adults.     

Treatment expectations and patient-reported outcomes of nusinersen therapy in adult spinal muscular atrophy

Journal of Neurology - The antisense-oligonucleotide (ASO) nusinersen has recently been approved as the first genetically modifying therapy for 5q-associated spinal muscular atrophy (SMA) based on...     

Multilocular cystic disease in adults Imitator of renal cell carcinoma

Clinical, radiographic, and surgical findings in a case of multilocular renal cyst are presented. The history, physical examination, and laboratory findings, including excretory urogram, renal scan, nephrotomogram, and arteriogram were compatible with the diagnosis of renal cell carcinoma. The urologist's awareness of this entity may prevent erroneous treatment in children. In adults, it may allow the preservation of uninvolved renal parenchyma, particularly in a solitary kidney.     

Radiographic appearance of diffuse splenic hemangiomatosis

The evaluation of splenomegaly in a patient with a consumptive coagulopathy included a liver-spleen scan, an abdominal sonogram, and an abdominal computed tomographic scan, which demonstrated an enlarged spleen with a diffuse parenchymal textural abnormality. A diffuse hemangiomatous pattern was present on splenic angiography. A splenectomy was performed and splenic hemangiomatosis was confirmed. The radiographic findings in this rare entity are presented and discussed.     

Intracranial neurosarcoidosis.

Neuroradiological findings in two cases of histologically confirmed intracranial sarcoidosis are presented, one with periaqueductal granulomata causing aqueduct obstruction. The granulomatous aggregation was of slightly greater attenuation than normal brain parenchyma and did enhance homogeneously following contrast medium administration. No direct signs of basal arachnoiditis could be found on computed tomography (CT) in the other case in which hydrocephalus was produced by a granulomatous infiltration of the fourth ventricle and cisterna magna. The neuropathological and pertinent clinical and laboratory manifestations of neurosarcoidosis are reviewed as a means of predicting recognizable CT patterns of the entity.     

Technical note: Two balloon technique for disimpaction of intrahepatic biliary stones

Considerable difficulty may be encountered when attempting, via a T-tube tract, to retrieve retained biliary stones situated in the intrahepatic ducts. This case illustrates a double balloon technique which was successfully used to dislodge a stone impacted at an intrahepatic ductal bifurcation.