Venous contrast extravasation during digital subtraction angiography.

Six episodes of contrast extravasation occurred in 5 patients during intravenous digital subtraction angiography in a period of 9 months. The extravasations were into the mediastinum (3), pericardium (1), and right atrial wall (2). These occurred using a variety of catheters, all the same size (5.0 F--1.67 mm). Three were Katzen catheters, one had a pigtail configuration, and two were straight catheters. We believe that the extravasations are due to three main factors. The first is catheter-related, owing to the small size (5.0 F) creating recoil and marked jet stream effect due to the large volume and pressure that must be delivered through the side holes. The second factor is related to positioning of the catheter in the superior vena cava. Finally, the respiratory phase at the time of injection becomes crucial. Understanding of these factors may help to decrease this potentially serious complication.

Percutaneous transluminal angioplasty of the abdominal aortic bifurcation.

Percutaneous transluminal angioplasty (PTA) of the abdominal aortic bifurcation was performed in three patients with atherosclerotic disease. All three patients had experienced severe claudication on exertion. The dilatations were performed with Gruntzig balloon catheters after determination of a significant pressure gradient (greater than 20 mm Hg) across the stenotic lesions. Follow-up at 9, 12, and 23 months revealed no recurrent symptoms. Balloon dilatation of the distal abdominal aorta is safe and effective and eliminates the risk of impotence that is common after vascular reconstruction.

Type IV total anomalous pulmonary venous connection. Unusual survival and review of the literature.

Total anomalous pulmonary venous connection (TAPVC) is a condition most frequently seen in the pediatric age group. Of those that survive uncorrected into adulthood, type I and type II constitute the great majority. It is most unusual to see a patient with a type IV lesion survive. We report a 34 year old female patient with TAPVC of the right upper lobe and left lung veins into the vertical vein and the right lower lobe vein into the coronary sinus. This patient has the second longest survival of those with type IV lesion of TAPVC, and the second oldest to have successful surgical correction. We attribute her long survival to the normal pulmonary artery pressure, a wide atrial septal defect and no other associated cardiac lesions. a review of the surgical survival in the English literature of patients with type IV TAPVC is presented.

Mediastinal extramedullary plasmacytoma.

An asymptomatic 65-year-old woman was found to have a mediastinal mass on routine chest x-ray examination. The initial diagnosis of aneurysm of the thoracic aorta was excluded by a thoracic aortogram, and a plasmacytoma was discovered at exploratory operation.

Lymphocele: an unusual mass in the right upper quadrant.

A patient with a palpable right upper abdominal mass eight years after cholecystectomy was found to have a subhepatic lymphocele. Although this is an uncommon location, the presence of a sonolucent mass in an area of previous surgery suggests lymphocele.