ABSTRACT
BACKGROUND: Secondary sclerosing cholangitis has clinical features similar to primary sclerosing cholangitis but originates from a known pathological entity. Secondary sclerosing cholangitis has not been investigated in patients with drug-induced liver injury. METHODS: Overall 102 patients diagnosed with drug-induced liver injury were identified and magnetic resonance cholangiopancreatography images of 25 patients were reviewed. RESULTS: Ten patients (all females) out of 102 had confirmed features of secondary sclerosing cholangitis on biliary imaging. Overall 70% of patients with sclerosing cholangitis had jaundice vs. 25% without sclerosing cholangitis (p<0.01). All sclerosing cholangitis patients had cholestatic/mixed type of liver injury and compared with patients with cholestatic/mixed liver injury without confirmed abnormal MRCP (n=52), they also had more frequently jaundice, 70% vs. 23% (p=0.0065), higher peak alkaline phosphatase 551 (352-716) vs. 329 (202-543) (p=0.055) and longer time to resolution of liver injury 152 days (123-353) vs. 62 days (36-91) than patients without confirmed sclerosing cholangitis (p<0.0009). CONCLUSIONS: Our results indicate that drugs can lead to bile duct injury visualized on imaging. This should be a part of the differential diagnoses of secondary sclerosing cholangitis. These patients were more likely to present with jaundice and longer recovery of liver injury than other patients with cholestatic/mixed type of drug-induced liver injury.
Subject(s)
Chemical and Drug Induced Liver Injury/complications , Cholangitis, Sclerosing/etiology , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Magnetic Resonance , Cholangitis, Sclerosing/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
An 83-year-old man with sepsis sustained right common carotid artery injury during attempted central-line placement. A computed tomographic scan showed a large hematoma in the patient's neck and a carotid pseudoaneurysm. His clinical condition was such that transfer to the interventional suite was judged unsafe. Percutaneous thrombin injection was performed at the bedside under ultrasonographic guidance, but without protective temporary balloon occlusion. The procedure was successful, with no neurologic complications. At follow-up ultrasonographic evaluation, there was complete and sustained occlusion of the pseudoaneurysm.Emergent percutaneous treatment of common carotid artery pseudoaneurysm can be performed without temporary balloon occlusion for cerebral protection-in extreme circumstances, and at unknown risk.
Subject(s)
Aneurysm, False/drug therapy , Carotid Artery Injuries/drug therapy , Carotid Artery, Common , Thrombin/administration & dosage , Aged, 80 and over , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Carotid Artery Injuries/diagnosis , Carotid Artery Injuries/etiology , Carotid Artery, Common/diagnostic imaging , Catheterization, Central Venous/adverse effects , Hematoma/etiology , Humans , Injections, Intra-Arterial , Male , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, Color , Ultrasonography, InterventionalABSTRACT
Endovascular therapies have become a mainstream option for treatment of many extracranial vascular disorders and is the preferred management strategy for vascular injury secondary to head and neck malignancy. The interventionalist must be familiar with the clinical trials as basis for the management of extracranial atherosclerotic disease as well as understanding the therapeutic options, risks, and benefits. Nonatherosclerotic injury including trauma, injury due to neoplasm or its treatment, and idiopathic lesions have unique considerations important to the use and deployment of various devices. The diagnostic approaches, treatment strategies, and the role of endovascular techniques in patients with extracranial vascular disease are discussed.
Subject(s)
Carotid Artery Diseases/therapy , Vertebrobasilar Insufficiency/therapy , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/methods , Angioplasty, Balloon/statistics & numerical data , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/pathology , Carotid Artery, Internal, Dissection/diagnostic imaging , Carotid Artery, Internal, Dissection/pathology , Carotid Artery, Internal, Dissection/therapy , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Endarterectomy, Carotid/statistics & numerical data , Head and Neck Neoplasms/blood supply , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/therapy , Humans , Radiography , Vascular Surgical Procedures/methods , Vascular Surgical Procedures/trends , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/pathology , Vertebral Artery Dissection/therapy , Vertebrobasilar Insufficiency/diagnostic imaging , Vertebrobasilar Insufficiency/pathology , Wounds and Injuries/complications , Wounds and Injuries/therapyABSTRACT
Knowledge of the anatomy of the vasculature of the head and neck from the thorax to the skull base is critical to the approach to diagnosis and treatment of cerebrovascular disease. Awareness of the anatomic variations that may be encountered, common and uncommon, is necessary to avoid diagnostic pitfalls and to avert therapeutic disasters. Careful anatomic analysis and understanding of collateral pathways and dangerous anastomoses facilitates cross-sectional and angiographic diagnosis and the development of surgical and endovascular treatment strategies.
Subject(s)
Carotid Artery, Common/anatomy & histology , Head/blood supply , Skull Base/blood supply , Vertebral Artery/anatomy & histology , Carotid Artery, Common/diagnostic imaging , Carotid Artery, External/anatomy & histology , Carotid Artery, External/diagnostic imaging , Carotid Artery, Internal/anatomy & histology , Carotid Artery, Internal/diagnostic imaging , Cerebral Angiography , Humans , Jugular Veins/anatomy & histology , Jugular Veins/diagnostic imaging , Neck/blood supply , Vertebral Artery/diagnostic imagingABSTRACT
Chronic venous insufficiency (CVI) is an exceedingly common and underdiagnosed disorder with a wide range of symptoms and prognosis ranging from cosmetic issues to skin ulceration with tissue loss. Ultrasound plays a pivotal role in the diagnosis, classification, and guidance of percutaneous treatment of CVI. It is therefore of critical importance to the practicing radiologist to have a sound understanding of the pathophysiology, pertinent venous anatomy, and classification of CVI. We review the superficial and deep venous anatomy of the lower extremity, introduce a pattern recognition approach for mapping of varicosities, and review the protocol for ultrasound evaluation for CVI. In addition, we discuss the pathophysiology of CVI and the role of ultrasound in guidance for and follow-up of percutaneous treatment.
