Transcatheter Embolization in Patients with Massive Upper Gastrointestinal Hemorrhage

Angiography and transcatheter embolization were performed in 12 patients with massive UGI bleeding from March 1990 to Feburuary 1996. These patients were all men of a mean age of 46 years (range, 33~76 years). Causes of bleeding were duodenal ulcer(5 cases), pseudoaneurysm(3 cases) due to chronic pancreatitis, hemobilia(2 cases) due to trauma, gastric mucosal injury(1 case) due to drug ingestion. Celiac arteriography and superior mesenteric arteriography were performed. Embolization was done in 12 patients. Embolic agents were steel coils. Eleven patients show an extravasaton of contrast media on angiography. In one patient who shows no extravasation, an pseudoaneurysm in gastroduodenal artery was found. Sources of bleeding were gastroduodenal artery(8), right hepatic artery(2), left hepatic artery(1), and left gastric artery(1). Bleeding was successfully controlled in all 12 patients. Two patients, however, rebled and an operation was performed. In one patient with pseudoaneurysm, bleeding recurred 13 days after embolization. This patient underwent second embolotherapy and operation 14 days later. There were no complication related to the procedure. Angiographic localization and transcatheter embolization can be an safe and effective treatment for massive UGI hemorrhage, especially in patients considered poor candidate for operation.

Evaluation of the Lesions of Synovial-lined Clefts in the infrapatellar Hoffa's Fat Pad with MR imaging

PURPOSE: Within Hoffa's infrapatellar fat pad there are two synovial clefts, horizontal and vertical, whichcommunicate with the intra-articular space. Intra-articular lesions can also occur in these clefts, and are oftendifficult to differentiate from extra-articular lesions. The purpose of this study is to evaluate, using MRimaging, the lesions occurring in these synovial lined clefts, as well as associated abnormalities. MATERIALS AND METHODS: Thirty-one knees of 31 patients with lesions in horizontal and vertical clefts in Hoffa's infrapatellarfat pad were retrospectively evaluated. Using a 1.5T MR imager, axial, sagittal, and coronal MR images of kneeswere obtained. Lesions in clefts, degree of joint effusion and associated knee abnormalities were analyzed. RESULTS: Horizontal cleft lesions were noted in 21 cases ; there were 17 cystic dilatations, two loose bodies,one synovial chondroma, and one case of pigmented villonodular synovitis(PVNS). Vertical cleft lesions were notedin 15 cases ; these comprised 11 cystic dilatations, two loose bodies, one synovial osteochondromatosis, and onePVNS. Among all cases, three cystic dilatations, one loose body, and one PVNS occurred in both horizontal andvertical clefts. Among 25 knees with cystic dilatations of clefts, five showed grade I joint effusion, ten gradeII, and ten grade III. Associated abnormalities were meniscal tear in 16 cases, osteoarthritis in 13, cruciateligament tear in five, osteochondritis dissecans in three, osteochondral fracture in two, osteonecrosis in one,loose body in one, and synovitis in one. CONCLUSION: Among synovial-lined clefts in Hoffa's fat pad, the mostcommon lesion was cystic dilatation ; there were various associated abnormalities and a close relationship tojoint effusion. An awareness of the types of lesions found in clefts is helpful for narrowing the differentialdiagnosis of lesions occurring in the area of Hoffa's fat pad.