Arterio-Biliary Fistula as a Rare Life-Threatening Complication of Transjugular Intrahepatic Portosystemic Shunt: A Case Report

A 46-year-old male with alcoholic liver cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites. On the 9th day after the procedure, he presented with melena and decreasing hemoglobin levels. Hemobilia due to fistula formation between the right intrahepatic bile duct and right hepatic artery was suspected on computed tomography. Angiography revealed a fistula of the small branches of the hepatic segmental arteries, and right intrahepatic bile duct was confirmed; embolization was successfully performed with a coil for the eighth segmental hepatic artery, a glue-lipiodol mixture for the fifth segmental hepatic artery, and gelfoam slurry for the right anterior hepatic artery. However, 2 days after embolization, the patient died owing to aggravated disseminated intravascular coagulopathy. When gastrointestinal bleeding occurs after TIPS, careful evaluation is immediately required, and hemobilia should be considered.

Angiographic Findings of an Isolated Meandering Pulmonary Vein: A Case Report

A meandering pulmonary vein (MPV) is a rare pulmonary vascular anomaly characterized by an abnormal course of the pulmonary vein draining into the left atrium. We report the case of a 55-year-old female who was diagnosed with a right MPV on pulmonary angiography. Enhanced chest CT revealed a vascular structure with an abnormal course that drained into the right superior pulmonary vein in the right upper lobe, which resembled a pulmonary arteriovenous malformation (AVM). Pulmonary angiography performed to discriminate between an MPV and pulmonary AVM showed no feeding artery, normal parenchymal staining, and drainage to the left atrium via the culprit vessel. Thus, the patient was diagnosed with MPV. When an MPV is difficult to differentiate from other vascular anomalies on enhanced chest CT, pulmonary angiography can be helpful. By recognizing the angiographic findings of an MPV, unnecessary treatment can be prevented.

Angiographic Findings of an Isolated Meandering Pulmonary Vein: A Case Report

A meandering pulmonary vein (MPV) is a rare pulmonary vascular anomaly characterized by an abnormal course of the pulmonary vein draining into the left atrium. We report the case of a 55-year-old female who was diagnosed with a right MPV on pulmonary angiography. Enhanced chest CT revealed a vascular structure with an abnormal course that drained into the right superior pulmonary vein in the right upper lobe, which resembled a pulmonary arteriovenous malformation (AVM). Pulmonary angiography performed to discriminate between an MPV and pulmonary AVM showed no feeding artery, normal parenchymal staining, and drainage to the left atrium via the culprit vessel. Thus, the patient was diagnosed with MPV. When an MPV is difficult to differentiate from other vascular anomalies on enhanced chest CT, pulmonary angiography can be helpful. By recognizing the angiographic findings of an MPV, unnecessary treatment can be prevented.

MRI Findings of Intercostal Schwannoma: A Case Report

Intercostal schwannomas are uncommon, encapsulated neoplasms that originate in nerve sheaths of intercostal nerves. They account for less than 10% of primary neural tumors of the chest wall. Herein, we report a pathologically confirmed case of intercostal schwannoma with typical magnetic resonance imaging findings.

Intra-Appendiceal Air at CT: Is It a Useful or a Confusing Sign for the Diagnosis of Acute Appendicitis?

OBJECTIVE: To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. MATERIALS AND METHODS: We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. RESULTS: Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). CONCLUSION: Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.

A Case of a Large, Gastric Intramural Hematoma Caused by Endoscopic Mucosal Resection, and Treated with Transcatheter Arterial Embolization / 대한내과학회지

Only two cases of gastric intramural hematoma (IMH) caused by endoscopic mucosal resection (EMR) have been reported to date. This is the first reported case of gastric IMH caused by EMR, treatment of which required hemoclipping and transcatheter arterial embolization. The patient had a normal coagulation profile and no relevant medical history. About 8 h after completing the EMR, the patient vomited approximately 150 mL fresh blood and complained of abdominal pain. Endoscopy showed a 3 x 7 cm hematoma with active surface bleeding in the gastric antrum. Hemoclipping of the bleeding site on the surface and transcatheter arterial embolization of the left gastric artery were performed. Thereafter, conservative management including administration of a proton pump inhibitor was performed, and the lesion resolved. A review of relevant previous cases and this case suggested vessel damage secondary to the submucosal injection itself to be a reasonable causative mechanism for the gastric IMH.

Disconnection of the Rubber Tip of Arrow-Trerotola Percutaneous Thrombolytic Device

A rubber tip disconnection of Arrow-Trerotola percutaneous thrombolytic device (PTD) may occur occasionally. We experienced 5 cases of a rubber tip disconnection among 453 mechanical thrombectomy sessions with the use of PTD. We present a report about these five cases and suggest possible causes for the occurrences.

Enterobiliary Fistula as a Complication of Eosinophilic Gastroenteritis: a Case Report

Eosinophilic gasteroenteritis is an uncommon disease with variable clinical features characterized by eosinophilic infiltration. Clinical manifestations range from non-specific gastrointestinal complaints such as nausea, vomiting, crampy abdominal pain, and diarrhea to specific findings such as malabsorption, protein loosing enteropathy, luminal obstruction, eosinophilic ascites and effusion. We report here on a case of eosinophilic gastroenteritis causing enterobiliary fistula which is an extremely unusual complication.

Metastatic Hemangiopericytoma of the Liver: A Case Report

A hemangiopericytoma is a rare soft tissue sarcoma that originates from pericytes. This neoplasm can occur in any part of the body but their frequent sites of origin are reported to be the lower extremities, pelvis, retroperitoneum, head, neck and trunk. A hemangiopericytoma may be curable by a surgical resection but its prognosis is poor when it recurs. Distant metastases rarely occur and the most commonly affected organs are the lung and bone. At CT, a hemangiopericytoma is typically depicted as a hypervascular tumor with a delayed fill-in of contrast enhancement from the periphery. We encountered a case of hemangiopericytoma that metastasized to the liver. We describe the radiological findings of the metastatic hemangiopericytoma of the liver.

Angiolipoma in the Cerebellopontine Angle: A Case Report

A 65-year-old female, who suffered with a longstanding headache, was admitted to our hospital. MR imaging and digital subtraction angiography (DSA) demonstrated a vascular fat-containing mass in the right cerebellopontine angle. The lesion was surgically removed and the diagnosis of angiolipoma was established. The symptoms subsided after the operation.