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1.
Radiol Case Rep ; 17(11): 4276-4279, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36124318

RESUMO

The American Association for the Study of Liver Diseases recognizes large volume paracentesis as draining greater than 5 liters of ascites and states there is no limit in the amount of ascites drained with appropriate replacement of albumin. For many practitioners performing safe large volume paracentesis between 5 and 10 liters or even 20 liters is not an uncommon practice. However, drainage of higher volumes outside common practice may raise concerns of patient intolerance and complication. The largest volume paracentesis reported in the literature to date is 41 liters. However, few other reports approach this volume. This case report demonstrates patient tolerance of a 39.5-liter paracentesis performed with close monitoring and hypertonic albumin replacement in a patient with chylous ascites due to high-grade follicular lymphoma.

2.
Abdom Radiol (NY) ; 46(3): 1163-1170, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32940757

RESUMO

In the setting of portal hypertension, intractable bleeding from anorectal varices is a rare occurrence. In this review, clinical presentation and management of this dilemma are presented in a case-based fashion. Bleeding may occur in the absence of prior history of cirrhosis or gastroesophageal varices and measurement of hepatic venous pressure gradient and liver biopsy could help to establish the diagnosis. Successful treatment outcome necessitates tailoring treatment to the patient's anatomy and imaging findings. A multidisciplinary algorithmic approach is also proposed to aid clinicians in this regard.


Assuntos
Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico por imagem , Radiologia Intervencionista , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/terapia
5.
Cardiovasc Diagn Ther ; 6(6): 582-592, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28123978

RESUMO

The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods. We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. The clinical aspects and pathophysiology of Paget-Schroetter syndrome (PSS), nutcracker syndrome, and May-Thurner syndrome are discussed in detail, with particular emphasis on the role that interventionalists can play in minimally invasive treatment.

6.
J Vasc Interv Radiol ; 26(10): 1510-1518.e3, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26233837

RESUMO

PURPOSE: To identify risk factors for strut perforation following Celect inferior vena cava (IVC) filter (IVCF) placement and to use finite element modeling to predict the mechanical impact of long-dwelling filters. MATERIALS AND METHODS: Ninety-one patients with three computed tomography (CT) studies were evaluated following Celect IVCF placement (2007-2013). Three-dimensional finite element models of the Celect IVCF were developed to simulate mechanical deformation of the IVCF encountered in vivo. Simulated forces applied by the primary struts on the IVC wall were measured as a function of luminal area and tilt angle. RESULTS: Although 33 patients (36%) showed primary strut perforation on initial follow-up CT, 60 patients (66%) showed progressive perforation over time (P < .0001), with 72 patients (79%) showing primary strut perforation on the final CT (average, 554 d). Female patients (P = .004) and those with malignancy history (P = .01) had significantly higher perforation rates at a given time. Caval area also decreased after primary filter strut perforation, and we therefore proposed that this was the mechanism for progressive perforation. Consistent with this mechanism, three-dimensional finite element modeling demonstrated increasing strut force with decreasing IVC diameter. CONCLUSIONS: Celect IVCF primary strut perforation is progressive over time and is more common in female patients and those with a history of malignancy. In addition, this progressive perforation may be predicted by three-dimensional finite element modeling. These patient populations may require closer follow-up after IVCF placement to prevent or reduce the risk for filter complication or worsening perforation.


Assuntos
Desenho Assistido por Computador , Lesões do Sistema Vascular/epidemiologia , Filtros de Veia Cava/estatística & dados numéricos , Veia Cava Inferior/lesões , Ferimentos Penetrantes/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Simulação por Computador , Módulo de Elasticidade , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Radiografia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
7.
Semin Intervent Radiol ; 31(2): 187-92, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25049446

RESUMO

The combination of anatomic and metabolic information provided by positron emission tomography (PET)/computed tomography makes it an important imaging modality to be obtained in conjunction with percutaneous ablation of primary and secondary malignancies of the lungs and liver. Advantages include more accurate preprocedural staging to determine appropriate treatment options, intraprocedural guidance to target difficult-to-see lesions, and postprocedural detection of residual or recurrent disease. Future applications of PET include strategies for intraprocedural guidance with real-time determination of incompletely ablated tumor, and combined PET/magnetic resonance imaging before, during, and after ablation for greater sensitivity to detect disease.

9.
J Vasc Interv Radiol ; 24(11): 1723-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24041915

RESUMO

PURPOSE: To evaluate and compare the rates of complications on follow-up computed tomography (CT) studies of patients with Celect, Günther Tulip, and Greenfield inferior vena cava (IVC) filters. MATERIALS AND METHODS: Retrospective review of CT studies obtained 0-1,987 days after infrarenal placement of an IVC filter identified 255 Celect, 160 Tulip, and 50 Greenfield filters. Follow-up CT studies were independently evaluated by two observers for IVC perforation, contact with adjacent organs, and filter fracture. Multivariate analysis was performed to identify factors associated with higher rates of IVC perforation, including age, IVC diameter, sex, and history of malignancy. RESULTS: IVC perforation was observed in 126 of 255 Celect filters (49%) with a mean follow-up of 277 days, 69 of 160 Tulip filters (43%) with a mean follow-up of 437 days, and one of 50 Greenfield filters (2%) with a mean follow-up of 286 days. A significantly higher IVC perforation rate was observed in women (45.5%) compared with men (30.8%; P = .002) and in patients with a history of malignancy (43.7%) compared with patients with no history of malignancy (29.9%; P < .001). Filter fracture was rare, observed in two of 255 Celect filters (0.8%), one of 160 Tulip filters (0.6%), and none of 50 Greenfield filters. CONCLUSIONS: No significant difference was observed in IVC perforation rate between Celect and Tulip filters. Greenfield filters had a significantly lower rate of IVC perforation than Celect and Tulip filters. Higher IVC perforation rates were observed in women and patients with a history of malignancy.


Assuntos
Falha de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Lesões do Sistema Vascular/etiologia , Filtros de Veia Cava , Veia Cava Inferior/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Ohio , Flebografia/métodos , Valor Preditivo dos Testes , Desenho de Prótese , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
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