ABSTRACT
The American Association for the Study of Liver Diseases recognizes large volume paracentesis as draining greater than 5 liters of ascites and states there is no limit in the amount of ascites drained with appropriate replacement of albumin. For many practitioners performing safe large volume paracentesis between 5 and 10 liters or even 20 liters is not an uncommon practice. However, drainage of higher volumes outside common practice may raise concerns of patient intolerance and complication. The largest volume paracentesis reported in the literature to date is 41 liters. However, few other reports approach this volume. This case report demonstrates patient tolerance of a 39.5-liter paracentesis performed with close monitoring and hypertonic albumin replacement in a patient with chylous ascites due to high-grade follicular lymphoma.
Subject(s)
Carcinoma, Renal Cell/surgery , Cryosurgery/standards , Kidney Neoplasms/surgery , Microwaves/therapeutic use , Radiofrequency Ablation/standards , Radiography, Interventional/standards , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/secondary , Clinical Decision-Making , Consensus , Cryosurgery/adverse effects , Humans , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/pathology , Microwaves/adverse effects , Patient Selection , Radiofrequency Ablation/adverse effects , Radiography, Interventional/adverse effects , Risk Assessment , Risk Factors , Treatment Outcome , Tumor BurdenSubject(s)
Anemia, Sickle Cell/complications , Chylothorax/therapy , Endovascular Procedures , Superior Vena Cava Syndrome/therapy , Vena Cava, Superior , Anemia, Sickle Cell/diagnostic imaging , Angiography, Digital Subtraction , Chylothorax/diagnostic imaging , Chylothorax/etiology , Computed Tomography Angiography , Endovascular Procedures/instrumentation , Female , Humans , Middle Aged , Phlebography/methods , Stents , Superior Vena Cava Syndrome/complications , Superior Vena Cava Syndrome/diagnostic imaging , Treatment Outcome , Vena Cava, Superior/diagnostic imagingABSTRACT
The combination of anatomic and metabolic information provided by positron emission tomography (PET)/computed tomography makes it an important imaging modality to be obtained in conjunction with percutaneous ablation of primary and secondary malignancies of the lungs and liver. Advantages include more accurate preprocedural staging to determine appropriate treatment options, intraprocedural guidance to target difficult-to-see lesions, and postprocedural detection of residual or recurrent disease. Future applications of PET include strategies for intraprocedural guidance with real-time determination of incompletely ablated tumor, and combined PET/magnetic resonance imaging before, during, and after ablation for greater sensitivity to detect disease.
ABSTRACT
PURPOSE: To evaluate and compare the rates of complications on follow-up computed tomography (CT) studies of patients with Celect, Günther Tulip, and Greenfield inferior vena cava (IVC) filters. MATERIALS AND METHODS: Retrospective review of CT studies obtained 0-1,987 days after infrarenal placement of an IVC filter identified 255 Celect, 160 Tulip, and 50 Greenfield filters. Follow-up CT studies were independently evaluated by two observers for IVC perforation, contact with adjacent organs, and filter fracture. Multivariate analysis was performed to identify factors associated with higher rates of IVC perforation, including age, IVC diameter, sex, and history of malignancy. RESULTS: IVC perforation was observed in 126 of 255 Celect filters (49%) with a mean follow-up of 277 days, 69 of 160 Tulip filters (43%) with a mean follow-up of 437 days, and one of 50 Greenfield filters (2%) with a mean follow-up of 286 days. A significantly higher IVC perforation rate was observed in women (45.5%) compared with men (30.8%; P = .002) and in patients with a history of malignancy (43.7%) compared with patients with no history of malignancy (29.9%; P < .001). Filter fracture was rare, observed in two of 255 Celect filters (0.8%), one of 160 Tulip filters (0.6%), and none of 50 Greenfield filters. CONCLUSIONS: No significant difference was observed in IVC perforation rate between Celect and Tulip filters. Greenfield filters had a significantly lower rate of IVC perforation than Celect and Tulip filters. Higher IVC perforation rates were observed in women and patients with a history of malignancy.
