Hepatic rupture caused by peliosis hepatis.

Peliosis hepatis is a rare entity that can affect children and cause fatal hepatic hemorrhage or hepatic failure. Radiographic findings are nonspecific and can resemble other hepatic pathologies such as cysts, abscesses, metastases, and hemangiomatosis. Peliosis hepatis can resolve spontaneously or by withdrawal of inciting medications. Certain cases may require surgical resection of the involved portions of the liver. Recently, fatal liver hemorrhage was reported in 2 pediatric patients with a rare congenital muscle disorder known as myotubular (centronuclear) myopathy. One of these patients was found at autopsy to have peliosis hepatis. The authors report the first successful treatment of life-threatening liver hemorrhage caused by peliosis hepatis in a child with myotubular myopathy. Awareness of this condition may reduce the catastrophic complications seen with peliosis hepatis.

Transjugular renal biopsy in patients with liver disease.

Although transjugular renal biopsy has been used extensively in Europe, experience with its use in the United States has been limited. We report 25 patients who underwent both transjugular liver and renal biopsies in the same sitting and 4 patients who underwent only a transjugular renal biopsy. All 29 patients had both liver disease and renal abnormalities. Each patient was also believed to have a relative or absolute contraindication to a percutaneous renal biopsy (usually in the form of a bleeding abnormality). Transjugular renal biopsy yielded a quantity of tissue sufficient for diagnosis in all but 1 patient. The mean number of glomeruli obtained per biopsy was 19.4 +/- 12.2 (SD). Pathological diagnoses found were tubular injury in 5 patients, membranoproliferative glomerulonephritis in 5 patients, nephrosclerosis in 3 patients, diabetic nephropathy in 2 patients, immunoglobulin A (IgA) nephropathy in 2 patients, minimal change disease in 2 patients, end-stage renal disease in 2 patients, nonspecific changes in 1 patient, early glomerulosclerosis in 1 patient, tubular atrophy only in 1 patient, and normal renal histological characteristics in 4 patients. One patient with suspected IgA nephropathy had no histological diagnosis established because of a lack of glomeruli in the biopsy specimen. There were no instances of major bleeding from the perirenal area; however, a small perirenal hematoma was identified in 3 patients by postbiopsy computed tomography or sonography. Thus, based on our experience, transjugular renal biopsy appears to be a safe and effective procedure for establishing a histological diagnosis and is an attractive alternative biopsy method for patients with advanced liver disease and contraindications to conventional percutaneous renal biopsy.

Traumatic pseudoaneurysm of the brachial artery.

Detection and treatment of vascular injuries in extremity and pelvic trauma can be challenging. Angiography, while no longer routinely used in asymptomatic patients, is still a primary means of diagnosis. Appropriate patient selection based on physical examination, along with other less invasive imaging modalities, can decrease the need for angiography while still detecting the vast majority of clinically significant injuries. Angiography also plays a definitive therapeutic role in most cases of significant hemorrhage in the pelvis through precise identification and selective embolization of bleeding vessels.

Penile arteriography.

Vasculogenic impotence can be due to multiple different causes, many of which can be diagnosed by noninvasive studies. Once an arterial etiology for impotence is suspected, penile arteriography may be necessary to define arterial pathology and to plan potential surgical intervention. The quality of arterial imaging is highly dependent on attention to the technical aspects of the examination, which include a thorough understanding of the arterial anatomy of the pelvis. In addition, patient preparation, arterial catheterization techniques, and pharmacological adjuncts can be helpful to improve image quality. The technique of image acquisition also can affect the quality of the images obtained. This article discusses the technical issues involved in penile arteriography.

Splenosis as a cause of testicular pain: laparoscopic management.

This is a case report of a 37-year-old man with severe testicular pain unresolved after conventional investigative and therapeutic methods. On the basis of his history of abdominal trauma followed by emergency splenectomy and evidence of functioning splenic tissue on a radionuclide scan, the diagnosis of splenosis was established. Laparoscopic exploration was done, and the initial diagnosis confirmed. Splenic tissue located at the right inguinal ring was removed. Testicular pain abated after the procedure.

Limb-threatening lower extremity ischemia successfully treated with intra-arterial infusion--case reports.

The authors present two patients with acute arterial vasospasm of the lower extremities causing marked ischemia. One patient had a history of Raynaud's disease, the second had been taking Cafergot for migraine headaches. Both patients's were given a test dose of intra-arterial tolazoline (50 mg). The patient with Raynaud's disease demonstrated marked improvement diffusely and was successfully treated with overnight infusion of papaverine. The second patient, taking Cafergot, demonstrated no angiographic response to tolazoline. It was speculated that the arteries of this patient were thrombosed. The patient was successfully treated with urokinase and remained free of pain at the 15-month follow-up.

Successful nonoperative management of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

BACKGROUND/AIMS: To report the management of a hepatic artery pseudoaneurysm presenting 35 days following a Whipple procedure. METHODS: The case study of a patient with a bleeding pseudoaneurysm is presented. RESULTS: Computed tomography demonstrated a pseudoaneurysm which was successfully embolized. CONCLUSIONS: Acute gastrointestinal bleeding from a pseudoaneurysm in the hepatic artery following Whipple procedure can be successfully managed with transcatheter embolization.

Gastrostomy button placement through percutaneous gastrostomy tracts created with fluoroscopic guidance: experience in 27 children.

PURPOSE: The authors report their experience with skin level (button) gastrostomy placement through radiologically created gastrostomy tracts. PATIENTS AND METHODS: Fifty-two gastrostomy buttons have been placed in 27 children (average age, 73 months; range, 9-235 months). All buttons were placed through tracts created during earlier fluoroscopically guided percutaneous gastrostomy. Fifteen Bard mushroom-type buttons and 12 MIC-Key balloon-type buttons were initially placed. Patients have been followed up for an average of 13.4 months. RESULTS: Button placement was successful at the initial attempt in 25 of 27 patients (93%). Tract age at button placement averaged 18.5 weeks. The average tract length measured 3.5 cm (1.7-6.0 cm). Tract rupture and peritoneal leakage occurred in three patients; one patient had the button immediately repositioned without sequela, and the remaining two patients underwent replacement of the gastrostomy tube into the stomach and successful button placement approximately 1 week later. There were no major complications. Minor problems (leak, granulation tissue, valve malfunction, balloon breakage) occurred in 19 patients. CONCLUSION: Button gastrostomy is a useful alternative to the traditional gastrostomy tube for the pediatric population. Conversion with use of existing radiologically created tracts is possible and safe. Attention to tract integrity and proper button position is required to avoid complications.

Amyloidosis: CT appearance of calcified, enlarged periaortic lymph nodes.

The radiographic demonstration of lymph node involvement in amyloidosis is rare. We report a case of calcified, enlarged perioartic and mediastinal lymph nodes detected by CT.

Decompression of acute urinary tract obstruction by extravasation into a large simple renal cyst.

We report a case of pelvocaliceal decompression by extravasation into a preexisting simple renal cyst. This is a rare complication of acute urinary obstruction. The findings and the prognostic implications are discussed.