Sonography of the radial artery at the wrist

The radial artery as a superficial structure at the wrist is susceptible both to direct penetrating injury and to blunt trauma, with the potential development of both false and true aneurysms. This report summarizes the sonographic features of seven consecutive patients who were referred for evaluation of the radial artery. The diagnoses include two cases of radial artery aneurysm, one tortuous nonaneurysmal artery, two cases of arteriovenous fistulae (one surrounded by fluid and one aneurysmal), a ganglion, and an inflammatory mass of the wrist. Although radial aneurysms are unusual and angiography may be required to define the nature and extent of distal embolization to the hand, the nature of a palpable aneurysm in this region, vascular vs avascular, is easily and quickly assessed with high-resolution sonography.     

Variceal hemorrhage and cystic fibrosis: outcomes and implications for liver transplantation.

Autopsy and imaging studies show that liver involvement is common in cystic fibrosis. However, complications of chronic liver disease including portal hypertension and variceal bleeding are infrequently encountered, and the degree to which variceal hemorrhage affects prognosis in cystic fibrosis is unclear. This uncertainty has lead to debate as to whether liver transplantation is indicated in these patients. We describe a case series of 18 patients and compare their survival with a control group of cystic fibrosis patients without liver disease. The median age at first bleed was 20.0 years (range 9.7-30.9). The median survival after first bleed was 8.4 years, compared to 13.0 years in the control group (P = 0.15). A total of 14 patients have died, 9 from respiratory disease with no discernable contribution from their liver disease. Liver disease contributed to 4 deaths. Only 1 patient suffered a fatal hemorrhage, which may have been either variceal or bronchial in origin. Long-term survival is a frequent occurrence in patients with cystic fibrosis who suffer variceal hemorrhage, and age at death is comparable to the general cystic fibrosis population. In conclusion, this suggests that liver transplantation is not indicated in these patients without additional features of liver decompensation.