Tetracycline Hydrochloride Sclerotherapy: Renal, Hepatic, Ovarian, and Perivesical cysts

PURPOSE: To assess the efficacy and resulting complications of tetracycline sclerotherapy in renal, hepatic, ovarian, and perivesical cysts. MATERIALS AND METHODS: We retrospectively reviewed 23 cases of benign cysts (16 renal, 4 hepatic, 2 ovarian, and 1 perivesical) in 22 patients in whom the condition was diagnosed or confirmed by either ultrasound, CT, or cytology, and who underwent percutaneous tetracycline sclerotherapy. Using a 21-gauge Chiba needle, the target cyst was punctured under ultrasound guidance. Prior to the injection of 1500 mg of tetracycline diluted in 5 ml of normal saline, almost all the cystic content was aspirated, and at the end of the procedure the tetra-cycline was left in the cyst. During a period of between 3 and 22 months, 18 of the 23 cases were followed up. RESULT: In six of the 18 cases followed up, the cysts either decreased in size by 10%, or collapsed completely. In seven cases a collapse of over 50% was noted, and in the remaining five the cyst recurred. In one of these, complete collapse occurred after retreatment at ten months, and the patient with a perivesical cyst underwent surgery six months after recurrence. Thus, treatment was effective (a collapse of at least 50%) in 13 of 18 cases (72.2%). This total of 13 comprised ten of 12 renal cysts (83.3%), two of two ovarian (100%), and one of three hepatic (33.3%). Percutaneous therapy was unsuccessful in five cases (two hepatic cysts, one renal, one para-pelvic and one perivesical). Complications occurring during the procedure or follow-up period included discomfort or mild pain, vomiting, and transient fever, though these subsided within 24 hours. In one patient with severe pain, this subsided after four days. CONCLUSION: As single-shot injection of tetracycline provides safe and effective treatment for renal and ovarian cysts, but for hepatic cysts is unsuccessful.

CT Findings of Normal Pancreatic Tail: Variety of Morphology and Location

PURPOSE: To determine the morphology and location of normal pancreatic tail, as seen on abdominal CT. MATERIALS AND METHODS: A hundred and one patients without pancreatic disease underwent CT scanning. We thendetermined how to relate the location of the pancreatic tail with the splenic hilum, left kidney, and pancreaticbody. We compared the thickness of the tail with that of the body and analysed of the morphology of the tail. RESULTS: Seventy-seven percent of all pancreatic tails were located below the splenic hilum, with 59% of thisproportion located located 1 to 2 cm below. Fifty percent of tails were located at the level of the uppermostquarter of the left kidney, and a further 27% at the level of the second quarter ; 75% were located in theventrolateral portion of this kidney and 23% in the ventral portion. In 48% of patients, the pancreatic tail andbody were the same thickness, and in a further 48%, the tail was thicker than the body. In 34% of patients, thetail showed focal bulging, and in another 32%, it tapered smoothly. Forty seven percent of tails were locatedbelow the pancreatic body and a further 37% were found at the same level as the body. CONCLUSION: Abdominal CTscans showed differing morphology and location of the pancreatic tail. The recognition of these variations willdiminish speculation as to their true nature.

US-guided Percutaneous Gun Biopsy of the Liver through the Left Lobe :Easy Compression of the Left Lobe for Hemostasis

PURPOSE: To evaluate the usefulness of US-guided percutaneous gun biopsy through the left lobe of the liverwith compression for the diagnosis of diffuse hepatic diseases and prevention of post-biopsy complications. MATERIALS AND METHODS: In 35 patients with diffuse hepatic diseases, we performed US-guided percutaneous biopsy via the left lobe of the liver. After biopsy, we immediately applied an extrinsic hands-on compression maneuver at the biopsy site. The integrity of tissue architecture and numbers of portal triad visible in each specimen were histologically examined and post-biopsy complications were documented. RESULTS: A histopathologic diagnosis could be made in all patients except one(97.1%). Microscopically, no significant crush artifact or fragmentation was demonstrated in these 34 patients. The average number of portal triad per specimen was about 4.1. Although two patients complained of severe pain at the biopsy site, no serious post-biopsy complication was noted. CONCLUSION: US-guided percutaneous gun biopsy through the left lobe of the liver with compression appears to be an effective and safe procedure for the evaluation of diffuse hepatic diseases.