ABSTRACT
SUMMARY: Endovascular therapy for hemorrhage after tonsillectomy or adenoidectomy is an important adjunct to the definitive treatment of this life-threatening occurrence. We report two cases of hemorrhage after tonsillectomy and/or adenoidectomy and describe the endovascular management of this complication in children.
Subject(s)
Adenoidectomy , Embolization, Therapeutic , Postoperative Hemorrhage/therapy , Tonsillectomy , Angiography , Child , Child, Preschool , Female , Humans , Palate, Soft/blood supply , Palatine Tonsil/blood supply , Pharynx/blood supply , Postoperative Hemorrhage/diagnostic imagingABSTRACT
OBJECTIVE: The high morbidity and mortality rates associated with dural sinus thrombosis may be heightened by a delay in diagnosis, which necessitates prompt and effective treatment. Traditional treatment consists of the initiation of systemic anticoagulation with heparin and, more recently, regional thrombolysis with direct endovascular infusion of thrombolytic agents. We report our experience in a series of five patients in whom we accomplished mechanical clot lysis with the combination of a rheolytic device and balloon catheters. METHODS: Five patients with dural sinus thrombosis were treated with a combination of pharmacological and mechanical thrombolysis with the 5-French Angiolet rheolytic catheter (Possis Medical, Minneapolis, MN) and balloon catheters. The success of the procedure was determined by resolution of or improvement in the patient's neurological examination results and imaging features. RESULTS: All five patients demonstrated immediate improvement as observed on imaging studies or in terms of neurological status. Three patients required more than one intervention, and all but one patient continued to improve after the final intervention. Two of the five patients continued to experience mild residual neurological deficits, and two patients experienced complete recovery. The fifth patient had a delayed recurrence of thrombosis that required multiple interventions, and the patient has significant neurological deficits. Navigation of the dural sinuses was possible in all patients with the use of a microcatheter and was possible to a variable degree with the rheolytic catheter. Known complications of the procedures included two pseudoaneurysms at the femoral puncture site. CONCLUSION: Mechanical clot lysis is a powerful technique for immediate restoration of antegrade venous flow in dural sinus thrombosis. In most patients, the superior sagittal sinuses and contralateral transverse sinuses could be accessed with the 5-French rheolytic catheter.
Subject(s)
Catheterization/methods , Dura Mater/blood supply , Sinus Thrombosis, Intracranial/therapy , Thrombolytic Therapy/methods , Adult , Aged , Female , Humans , Male , Middle Aged , RheologyABSTRACT
Fibrocartilaginous mesenchymoma of bone is a rare primary neoplasm. Our literature search produced only 12 previously reported cases. Radiographic and computed tomography (CT) findings have been described, but the magnetic resonance imaging (MRI) appearance has not been reported previously. We report a patient with fibrocartilaginous mesenchymoma of the ilium and describe the imaging findings on conventional radiography, bone scan, CT, and MRI.
Subject(s)
Bone Neoplasms/diagnosis , Cartilage , Ilium , Mesenchymoma/diagnosis , Biopsy, Needle , Bone Neoplasms/surgery , Cartilage/diagnostic imaging , Cartilage/pathology , Child , Diagnosis, Differential , Humans , Ilium/diagnostic imaging , Ilium/pathology , Magnetic Resonance Imaging , Male , Mesenchymoma/surgery , Neoplasm Recurrence, Local , Radionuclide Imaging , Tomography, X-Ray ComputedABSTRACT
Thrombosis of the dural venous sinuses is a potentially lethal condition that remains a diagnostic dilemma. Clinical outcome is typically dependent on the timeliness of diagnosis and definitive treatment. We report a case of successful rapid thrombectomy of extensive thrombus within the superior sagittal and transverse sinuses using a rheolytic catheter device. This appears to be a promising treatment option, particularly in those patients who do not respond to other, more established, forms of therapy.
