Right internal jugular vein thrombosis caused by aneurysm of right-sided aortic arch.

A right-sided aortic arch is normally asymptomatic. We report the case of an 84-year-old man with right internal jugular vein thrombosis caused by an aneurysm in a right-sided aortic arch. The patient had undergone open repair of an abdominal aortic aneurysm and had an uneventful postoperative course. However, a routine postoperative contrast-enhanced thoracic and abdominal computed tomography scan showed right internal jugular vein thrombosis. The patient had no history of catheter insertion in the right jugular veins and had no hereditary coagulopathy. It was presumed that the cause of this thrombosis was compression of the right brachiocephalic vein by an aneurysm of the right-sided ascending aorta that was considered too small to require surgical repair. The right internal jugular vein thrombosis was successfully treated with edoxaban. .

Hypergalactosemia in early infancy: diagnostic strategy with an emphasis on imaging.

BACKGROUND: Portosystemic shunt is one of the main causes of persistent hypergalactosemia without enzyme deficiency, but the diagnostic imaging strategy has not yet been established. The purpose of the present study was to establish a diagnostic imaging strategy. METHODS: A retrospective investigation of the clinical and imaging findings of 10 children with persistent hypergalactosemia without enzyme deficiency detected by screening was undertaken. RESULTS: Abnormal ultrasonography (US) findings were detected in all eight patients with liver disorders. In three patients with citrin deficiency, the combination of fatty liver on US and laboratory evidence of cholestasis led to the diagnosis. In three patients with portosystemic shunt, US on sedation clearly depicted the shunt vessels. The extent was more easily understood on contrast computed tomography (CT). Per-rectal portal scintigraphy with N-isopropyl-p-I-123 iodoamphetamine and lung perfusion scintigraphy with (99m)Tc macroaggregated albumin were useful for evaluation of portal shunt index and assessment of pulmonary arteriovenous shunt. One patient underwent transarterial coil embolization. In two patients with hepatic tumor, the lesions and its vascularity were clearly demonstrated on US and dynamic CT. In one patient, small shunt index on per-rectal portal scintigraphy suggested no need for treatment. The other patient was treated with a combination of steroid, radiation, and interventional radiology. The etiology remained unknown in two children. CONCLUSIONS: In the assessment of hypergalactosemia, US is the modality of choice. CT is a useful tool for more detailed evaluation of the abnormalities found on US. Per-rectal portal scintigraphy and pulmonary perfusion scintigraphy play an important role in the evaluation of portosystemic shunt. Interventional radiology is sometimes effective.

CT pulmonary angiography and CT venography: factors associated with vessel enhancement.

OBJECTIVE: The objective of our study was to determine factors associated with enhancement on CT pulmonary angiography and CT venography. MATERIALS AND METHODS: Two hundred forty-two cases (83 men and 159 women; mean age, 63 years; age range, 21-92 years) underwent CT pulmonary angiography using a bolus-tracking technique; 189 cases subsequently underwent CT venography 3 minutes after the start of the contrast injection. Two different amounts of nonionic iodine contrast medium were administered: patients weighing > 50 kg who were undergoing both CT pulmonary angiography and CT venography received 450 mg I (group B), whereas all other patients received 300 mg I (group A). The enhancement of vessels was subjectively estimated using a four-point scale, and attenuation values were measured at predetermined levels. Multiple regression analyses were performed with attenuation as the dependent variable and patient age, sex, and weight; amount of contrast medium; scanning delay; and presence of embolism as the independent variables. RESULTS: The scanning delay for CT pulmonary angiography ranged from 10 to 31 seconds (mean, 19 seconds; SD, 3.3). Subjective estimates of enhancement quality on CT venography were significantly better for group B than for group A (p < 0.001). Multiple regression analyses revealed that body weight and age were the only significant and consistent independent variables associated with enhancement of the pulmonary arteries. The amount of contrast medium, body weight, and scanning delay were the independent variables that were consistently associated with enhancement of the deep veins. CONCLUSION: The bolus-tracking technique showed relatively small variations in the scanning delay time. Patient age, body weight, and the amount of contrast medium were the important factors associated with vessel enhancement in combined CT pulmonary angiography and CT venography.

Embolization for a bleeding pelvic fracture in a patient with persistent sciatic artery.

Emergency embolization for a bleeding pelvic fracture was performed in a patient with persistent sciatic artery, a rare anatomic variation in which the internal iliac artery continues to the popliteal artery. Successful hemostasis was achieved without complications by means of selective catheterization into each branch of the internal iliac artery. Awareness of this unusual vascular anatomy is critically important to avoid serious complication of emergency embolization.