Migration of Nonfibered Packing Coils Used to Treat Peripheral Pseudoaneurysms: Report of 3 Cases.

Coil migration is a rare complication of vascular embolization. This report describes 3 cases of peripheral pseudoaneurysm embolization with the use of Penumbra packing coils in which coils migrated into the lumens of adjacent viscera: 2 into the duodenum and 1 into the vagina. The coils passed spontaneously in 2 cases and required endoscopic removal in the third. There were no immediate or delayed bleeding or infectious complications following migration. The majority of previously reported coil migration cases have occurred following treatment of pseudoaneurysms adjacent to air-filled structures, and this observation is an important consideration during pretreatment planning.

Sclerotherapy of Diffuse and Infiltrative Venous Malformations of the Hand and Distal Forearm.

PURPOSE: Venous malformations (VM) involving the hand and forearm often lead to chronic pain and dysfunction, and the threshold for treatment is high due to the risk of nerve and skin damage, functional deterioration and compartment syndrome. The purpose of this study is to demonstrate that sclerotherapy of diffuse and infiltrative VM of the hand is a safe and effective therapy. MATERIALS AND METHODS: A retrospective review of all patients with diffuse and infiltrative VM of the hand and forearm treated with sclerotherapy from 2001 to 2014 was conducted. All VM were diagnosed during the clinical visit by a combination of physical examination and imaging. Sclerotherapy was performed under imaging guidance using ethanol and/or sodium tetradecyl sulfate foam. Clinical notes were reviewed for signs of treatment response and complications, including skin blistering and nerve injury. RESULTS: Seventeen patients underwent a total of 40 sclerotherapy procedures. Patients were treated for pain (76%), swelling (29%) or paresthesias (6%). Treatments utilized ethanol (70%), sodium tetradecyl sulfate foam (22.5%) or a combination of these (7.5%). Twenty-four percent of patients had complete resolution of symptoms, 24% had partial relief of symptoms without need for further intervention, and 35% had some improvement after initial treatment but required additional treatments. Two skin complications were noted, both of which resolved. No motor or sensory loss was reported. CONCLUSION: Sclerotherapy is a safe and effective therapy for VM of the hand with over 83% of patients experiencing relief.

Pediatric nonaccidental abdominal trauma: what the radiologist should know.

Abdominal injury in nonaccidental trauma (NAT) is an increasingly recognized cause of hospitalization in abused children. Abdominal injuries in NAT are often severe and have high rates of surgical intervention. Certain imaging findings in the pediatric abdomen, notably bowel perforation and pancreatic injury, should alert the radiologist to possible abuse and incite close interrogation concerning the reported mechanism of injury. Close inspection of the imaging study is warranted to detect additional injury sites because these injuries rarely occur in isolation. When abdominal injury is suspected in known or speculated NAT, computed tomography (CT) of the abdomen and pelvis with intravenous contrast material is recommended for diagnostic and forensic evaluation. Although the rate of bowel injury is disproportionately high in NAT, solid organs, including the liver, pancreas, and spleen, are most often injured. Adrenal and renal trauma is less frequent in NAT and is generally seen with multiple other injuries. Hypoperfusion complex is a constellation of abdominal CT findings that indicates current or impending decompensated shock and is most often due to severe neurologic impairment in NAT. Although abdominal injuries in NAT are relatively uncommon, knowledge of injury patterns and their imaging appearances is important for patient care and protection.