Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula.

Symptomatic sacral perineural cysts (Tarlov cysts) accompanied by intra-cyst hemorrhage are rare. The treatment strategies have not been established. We report a 57-year-old woman with severe back pain due to a Tarlov cyst accompanying intracyst hemorrhage. Computed tomography angiography revealed an arteriovenous fistula (AVF) at the area surrounding the cyst. The patient underwent transcatheter arterial embolization for the AVF. Thereafter, the hematoma and cyst decreased in size, and clinical symptoms markedly improved with no additional surgery. Transcatheter arterial embolization may be an effective alternative to surgery for Tarlov cysts with vascular disease, including AVF.

Timing of Uterine Artery Embolization for Leiomyoma during the Menstrual Cycle.

PURPOSE: To investigate differences in outcomes of uterine artery embolization (UAE) for leiomyoma when performed during different phases of the menstrual cycle. MATERIALS AND METHODS: In this single-institution retrospective analysis, 111 premenopausal patients (median [range] age, 44 [33-52] years) undergoing UAE for symptomatic leiomyoma between June 2014 and February 2020 were included. Twenty-one patients underwent UAE in the menstrual phase (the early follicular phase), 27 in the late follicular phase, and 63 in the luteal phase. Baseline characteristics and technical and peri-procedural outcomes were compared among groups. Leiomyoma infarction on contrast-enhanced magnetic resonance imaging 1 week after UAE and 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire scores, the volume reduction rates of the uterus and largest leiomyoma, follicle stimulating hormone values, adverse events, and amenorrhea, were compared among groups. RESULTS: A 4-month follow-up was completed for all patients. No significant differences were observed among groups in baseline characteristics or technical and peri-procedural outcomes. There were no significant differences in the multivariate-adjusted 1-week infarction rates of all leiomyoma volumes (P = .161) or multivariate-adjusted 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire symptoms and total scores (P = .864 and P = .798, respectively), the volume reduction rates of the uterus and the largest leiomyoma (P = .865 and P = .965, respectively), and follicle stimulating hormone values (P = .186) among the groups. No significant differences were noted in the 4-month adverse events (P = .260) or amenorrhea (P = .793) among the groups. CONCLUSIONS: The present study demonstrated no significant differences in the outcomes of UAE for leiomyoma when performed during different phases of the menstrual cycle.

Posterior lumbar subcutaneous edema as the rare sign of IgA vasculitis (Henoch-Schönlein purpura): A case of a child.

Posterior lumbar subcutaneous edema (PLSE) is often found on MRI in adults with obesity or various lumbar conditions. We report a case of a 6-year-old boy with IgA vasculitis (Henoch-Schönlein purpura) along with PSLE observed on CT and MRI. The finding is markedly rare in patients with IgA vasculitis, with only limited cases previously reported in the literature. The edema was symmetrically localized along the erector spine muscle with a smooth margin. These findings differed from the irregularly accumulated edema observed in some adult cases. PLSE should not be overlooked as a nonspecific finding. When symmetrical and circumscribed PLSE is found in children, IgA vasculitis should be added to differential diagnosis in PLSE.