A Case of Transcatheter Coil Embolization of Diffuse Pulmonary Arteriovenous Malformation

This is a case report of multiple coil embolization for the diffuse pulmonary arteriovenous malformations(PAVM). PAVMs are direct communications between pulmonary arteries and pulmonary veins, resulting in an anatomic right-to-left shunt that may cause paradoxical embolization to may occur, resulting in neurologic complications such as stroke or cerebral abscess. The treatment of choice for solitary PAVMs was limited to surgical resection or ligation of the PAVM but, multiple PAVMs present a difficult management problem, since surgical resection is not feasible in most instances. The coil embolization is a safe and effective treatment of multiple PAVMs. Our exprience was of a 5-year-old boy who had cyanosis and clubbing of his finger, and was diagnosed with multiple PAVMs by chest CT and pulmonary angiography. The coil embolization was peformed, thirteen vessels were successfully occluded and no complication in placement of coils occured. Embolization therapy should be performed in all cases of PAVMs to prevent neurologic complications.

Hyperechogenicity of Renal Medulla and Urinary Bladder in Normal Neonates: Clinical Significance

PURPOSE: To evaluate the clinical significance of hyperechogenicity of the renal medulla and urinary bladder in normal neonates. MATERIALS AND METHODS: We investigated 31 clinically normal neonates, including one post-term, 16 pre-term, and 14 full-term babies, in whom hyperechogenicity of the renal medulla or urinary bladder was seen on ini-tial sonograms. All neonates underwent sonography while aged between 1 and 21 (mean: 2.5)days. For 14, fol-low-up sonography was performed 2-20 (mean : 6.8) days later. Eighteen neonates also underwent urinalysis, and two underwent a bacteriologic examination. RESULTS: Initial sonograms revealed (hyperechogenicity in the renal medulla (n=28) and urinary bladder (n=12). Twenty-five neonates were aged less than one week, four were aged 1-2 weeks, and two were aged 2-3 weeks. Urinalysis showed that six neonates were erythrocyte-positive (+/-:1, +1:4, +4:1), two were protein-pos-itive (+/-:2), and the others were negative. In all cases the results of bacteriologic study were negative. Follow-up sonography revealed that the hyperechogencity of renal medulla had regressed (n=12) or decreased (2), and that of the urinary bladder had regressed (n=4). CONCLUSION: In clinically normal neonates, hyperechogenicity of the renal medulla and urinary bladder was mostly visualized within the first week of life, and on follow-up sonography was seen to have regressed or decreased.

Superselective Intra-arterial Fibrinolysis for Acute Cerebral Ischemic Infarct: Usefulness of Diffusion Weighted MR Imaging1

PURPOSE: To evaluate the efficacy of superselective intra-arterial fibrinolysis for acute cerebral stroke and the usefulness of pre- and postfibrinolysis diffusion-weighted MRI (DWI). MATERIALS AND METHODS: In 41 patients with acute ischemic stroke whose treatment involved intra-arterial fibri-nolysis, the occlusion site, degree of recanalization, and clinical results were compared. In 12 patients, diffusion weighted MRI was performed before fibrinolysis, and eight of these also underwent diffusion-weighted MRI after fibrinolysis. Using diffusion-weighted MRI, neurological outcomes were compared with signal intensity ratio (SIR, or the average signal intensity within the region of interest divided by that in the contralateral, nonischemic, homologous region). RESULTS: Twenty patients showed complete recanalization, nine partial recanalization, and in twelve there was no recanalization. Fourteen patients (34 %) improved neurologically. No relationship existed between occlusion sites, degree of recanalization, and clinical outcome. Among 12 patients who underwent DWI before fibrinolysis, complete recanalization was noted in eight. Neurological improvement was seen in four patients with low SIR(1.7 ), neurological outcome was poor despite complete recanalization. CONCLUSION: Although superselective intra-arterial fibrinolysis for acute cerebral stroke is a good therapeutic method for recanalization, the clinical outcome can be disappointing. We therefore suggest that in cases of acute cerebral ischemic infaret, SIR-as seen on DWI-might be useful for predicting the benefits of recanalization. In such cases, further investigation of the use of DWI prior to fibrinolysis is therefore needed.

Traumatic Intraventricular Hemorrhage: Classifications and Prognosis According to CT Findings

PURPOSE: To determine clinical outcome in cases of traumatic intraventricular hemorrhage(TIVH) according to the mechanisms and amount of hemorrhage seen on initial CT. MATERIALS AND METHODS: We retrospectively reviewed the initial CT findings of 61 patients with TIVH. The mechanisms of TIVH were analyzed on the basis of the following CT findings: Type I; large intracerebral hematoma extending to adjacent ventricle; Type II: hemorrhagic and/or non-hemorrhagic diffuse axonal injury in the thalamus and basal ganglia; Type III: multiple small hemorrhagic lesions in the septum pellucidum, fornix, corpus callosum, and periventricular region, which may be due to inner cerebral trauma, Type IV: evidence of hypoxic brain injury, and Type V: TIVH with contusion and small subdural or epidural hematomas. The amount of TIVH was classified according to the Graeb score. We analyzed these mechanisms on the basis of CT findings, and for prognosis, correlated these with clinical outcomes and the Glasgow coma score. RESULTS: Prognosis was good in types V and III and poor in type I and II(p=0.001). In patients with a Graeb score of 4 or less, the clinical outcome was better than in those with a Graeb score above 5(p=0.03). Patients with a lower initial Glasgow coma score had poor outcomes(p=0.001). CONCLUSION: The hemorrhage mechanism in patients with TIVH could be important for estimating clinical outcome, especially during the early phase. In patients with type V or III TIVH, clinical outcome was better than in those with type I or II.