RESUMO
In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard,could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.
Assuntos
Aneurisma Roto/cirurgia , Aorta/cirurgia , Implante de Prótese Vascular , Artéria Celíaca/cirurgia , Embolização Terapêutica , Endoleak/terapia , Procedimentos Endovasculares , Hemostáticos/administração & dosagem , Trombina/administração & dosagem , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico , Aorta/diagnóstico por imagem , Aortografia , Implante de Prótese Vascular/efeitos adversos , Artéria Celíaca/diagnóstico por imagem , Terapia Combinada , Endoleak/diagnóstico , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
PURPOSE: To compare the results of pathologic and cytologic reports of specimens acquired from focal liver lesions using ultrasound-guided biopsy and to evaluate the necessity of performing both techniques in the same patient. MATERIALS AND METHODS: 21 patients were eligible for enrollment in the study. Specimens for both pathologic and cytologic examination were obtained from 16 lesions using a 17G needle guide in a single puncture attempt. In 2 cases the diagnosis was based on cytologic smears. In 3 cases only histologic sections were acquired. The needle was introduced under continuous ultrasonographic control using a freehand technique. A cytologist was present at all times. RESULTS: The diagnostic sensitivity of cytologic examination was 83.33% and that of histologic examination was 94.74%. Histology diagnosed all cases of benign lesions and was proved inconclusive in 1 patient. The diagnostic sensitivity and accuracy of both methods combined reached 100%. In 94.4% malignancy was immediately diagnosed by cytology. CONCLUSIONS: Combination of both methods should increase the sensitivity and accuracy in diagnosing focal liver lesions performing a safe minimally invasive technique.
Assuntos
Biópsia por Agulha/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Ultrassonografia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
We describe an innovative interventional technique for the repair of a postoperative enterocutaneous fistula (ECF). In the reported case, surgical repair of the ECF was contraindicated, while endoscopic closure was unsuccessful. Correction of this high-outflow fistula was achieved using an Amplatzer septal occluder, which was deployed under simultaneous fluoroscopic and endoscopic guidance. The use of an Amplatzer septal occluder should be taken into consideration when there is a need to treat high-outflow ECF in patients who cannot undergo surgery.
