Necrosis of Hepatocellular Carcinoma Caused by Iatrogenic Hepatic Artery Dissection during Transcatheter Arterial Chemoembolization

Transcatheter arterial chemoembolization (TACE) improves the survival rate in patients with hepatocellular carcinoma (HCC). Despite the low probability, iatrogenic hepatic arterial dissections during interventional procedure are rarely created by the technical difficulties. Direct trauma from the guidewire, the tip of the catheter, or the jet of contrast injection can contribute to iatrogenic hepatic arterial dissections. We report one case of a female who had HCC necrosis caused by iatrogenic hepatic arterial dissection during TACE. Ischemia resulting from iatrogenic hepatic arterial dissection during TACE was smilar to the result of transarterial embolization for HCC on our case. To our knowledge, none of the similar cases was reported in previously published literatures.

Entirely Replaced Left Gastric Artery from the Left Hepatic Artery: A Case Report

Arteries originating from the celiac axis have numerous anatomical variations. When performing interventional and surgical procedures, it is important to be aware of these variations to have better outcomes and to prevent iatrogenic complications. We report on a case of a 62-year-old man who came to our institution to receive transarterial chemoembolization for hepatocellular carcinoma. The computed tomography and angiography revealed a rare anatomic variation: the entire left gastric artery originated from the left hepatic artery with no other accessory feature of the left gastric artery from celiac axis or aorta was seen. To our knowledge, this is the first report on the entirely replaced left gastric artery from the left hepatic artery that was confirmed by utilizing both computed tomographic and angiographic images.

Pyomyoma after Uterine Artery Embolization for Postpartum Hemorrhage Misdiagnosed as Uterine Necrosis

A 34-year-old female patient underwent uterine artery embolization (UAE) to control massive postpartum hemorrhage. The interventional radiologist was not informed of the patient's significant history of uterine myoma. Although no significant signs of complications or “red flags” were observed during the procedure, follow-up computed tomography performed four weeks later revealed evidence of a large, globe-like fluid collection with air bubbles in the uterus. The finding and pathology was initially diagnosed as uterine necrosis, which led not to interventional percutaneous drainage; instead, dilation and curettage with resectoscope was performed. The surgical and pathological diagnosis was “expulsion of pyomyoma in the uterine cavity.” Awareness and precise knowledge of imaging findings of pyomyoma and uterine necrosis are important for early diagnosis and treatment of UAE-related complications.

Angled Cool-Tip Electrode for Radiofrequency Ablation of Small Superficial Subcapsular Tumors in the Liver: A Feasibility Study

OBJECTIVE: To evaluate the feasibility of angled cool-tip electrode for radiofrequency ablation of small superficial subcapsular liver tumors abutting abdominal wall, in order to traverse normal liver parenchyma, and thereby, obtain favorable configuration of ablation margin. MATERIALS AND METHODS: In this study, we retrospectively analyzed 15 small superficial subcapsular liver tumors abutting abdominal wall in 15 patients, treated with radiofrequency ablation from March 2013 to June 2015 using a cool-tip electrode manually modified to create 25-35° angle at the junction between exposed and insulated segments. The tumors were hepatocellular carcinoma (n = 13) and metastases (n = 2: cholangiocellular carcinoma and rectosigmoid cancer), with maximum diameter of 10-26 mm (mean, 15.68 ± 5.29 mm). Under ultrasonographic guidance, the electrode tip was advanced to the depth of the tumors' epicenter about 1 cm from the margin. The tip was re-directed to penetrate the tumor for radiofrequency ablation. Minimal ablation margin was measured at immediate post-treatment CT. Radiological images and medical records were evaluated for success rate, length of minimal ablation margin and complications. RESULTS: Technical success rate of obtaining complete necrosis of the tumors was 100%, with no procedure-related complication. Minimal ablation margin ranged from 3-12 mm (mean, 7.07 ± 2.23 mm). CT/MRI follow-up at 21-1022 days (mean, 519.47 ± 304.51 days) revealed no local recurrence, but distant recurrence in 9 patients. CONCLUSION: Using an angled cool-tip electrode for radiofrequency ablation of small superficial subcapsular tumors abutting abdominal wall may be a feasible technique for obtaining adequate ablation margin and lower complication rate.

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage

OBJECTIVE: To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. MATERIALS AND METHODS: From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. RESULTS: Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. CONCLUSION: PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

Non-mass-forming Lymphoma of the Left Ventricle Mimicking Non-ischemic Cardiomyopathy on MR Imaging: A Case Report

We report a case of cardiac lymphoma in a 40-year-old man, who had a mediastinal mass which was diagnosed as sclerosing mediastinitis pathologically. The mediastinal mass caused right pulmonary arterial stenosis. The patient developed myocardial hypertrophy and echocardiography showed restrictive physiology and severely decreased left ventricle ejection fraction, 6 months later. MRI showed global left ventricular myocardial hypertrophy and diffuse late gadolinium hyperenhancement after administration of contrast material. Thus, non-ischemic cardiomyopathy was suspected on MRI. However, pathology confirmed the myocardial abnormality as lymphoma after myocardial biopsy. Because a basal part of the left ventricle and global subendocardial myocardium were not involved on contrast-enhanced delayed MRI, the MRI abnormalities could be differentiated from amyloidosis and other myocardial diseases. The peculiar non-mass forming diffuse hypertrophy pattern of cardiac lymphoma has not been known in the MRI literature.

High-resolution MR Imaging of Carotid Atherosclerotic Plaques

High-resolution carotid MRI allows visualization of carotid atherosclerotic plaque characteristics. MRI serves as a noninvasive option for the detection of active plaque inflammation and intraplaque hemorrhage. Significant gains in signal-to-noise ratio and contrast-to-noise ratio can be obtained for carotid atheroma imaging at 3T compared with 1.5T. Normalized wall index or wall area on MRI has shown its efficacy in monitoring the response after medical therapy. T(2)* quantification in carotid plaques before and after the administration of ultrasmall superparamagnetic iron oxide particles shows difference in response to treatment according to drug doses. In conclusion, high-resolution MRI is useful in the diagnosis and monitoring of carotid atherosclerotic plaques prone to transient ischemic attack and stroke.