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Sample records for biliary-systemic air embolism

  1. "Air embolism during fontan operation"

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    Madan Mohan Maddali

    2014-01-01

    Full Text Available In patients with a right to left intracardiac shunt, air embolism results in an obligatory systemic embolization. Nonembolization of entrained air is described in a child with a single ventricle physiology who had earlier undergone bidirectional Glenn shunt construction and Damus-Kaye-Stansel anastomosis. The air entrainment was detected by intra-operative transesophageal echocardiography. The combined effect of a "diving bell" phenomenon and mild aortic valve regurgitation are suggested as the reasons for the confinement of air into the ventricle preventing catastrophic systemic embolization.

  2. Acute pulmonary embolism following air travel

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    Ledermann, J. A.; Keshavarzian, Ali

    1983-01-01

    Three cases of pulmonary embolism following long air flight are described. There was no previous history of venous disease. The symptoms were transient in one and severe in two. The occurrence of pulmonary embolism immediately after air travel is emphasized.

  3. Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

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    Chen Lin

    2014-01-01

    Full Text Available Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL. Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA branches. She was emergently taken for hyperbaric oxygen therapy (HBOT. Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.

  4. Systemic arterial air embolism after percutaneous lung biopsy

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    Hare, S.S., E-mail: samanjit@btinternet.com [Ottawa Hospital, Ontario (Canada); Gupta, A.; Goncalves, A.T.C.; Souza, C.A.; Matzinger, F.; Seely, J.M. [Ottawa Hospital, Ontario (Canada)

    2011-07-15

    Systemic arterial air embolism is a rarely encountered but much feared complication of percutaneous lung biopsy. We present a comprehensive review of iatrogenic air embolism post-lung biopsy, a complication that is often suboptimally managed. This review was inspired by our own institutional experience and we use this to demonstrate that excellent outcomes from this complication can be seen with prompt treatment using hyperbaric oxygen chamber therapy, after initial patient stabilization has been achieved. Pathophysiology, clinical features, and risk factors are reviewed and misconceptions regards venous versus arterial air embolism are examined. An algorithm is provided for radiologists to ensure suspected patients are appropriately managed with more favourable outcomes.

  5. Air embolism during off-pump coronary artery bypass graft surgery -A case report-

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    Chang, Choo-Hoon; Shin, Young Hee; Cho, Hyun-Sung

    2012-01-01

    There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO2 blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO2 blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass.

  6. Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

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    Natalie Chen

    2012-01-01

    Full Text Available Double balloon enteroscopy (DBE is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

  7. Mesenteric air embolism following enteroscopic small bowel tattooing procedure.

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    Chen, Natalie; Lamba, Ramit; Lee, John; Lall, Chandana

    2012-01-01

    Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT) findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made. PMID:23393642

  8. Iatrogenic systemic air embolism treated with hyperbaric oxygen therapy

    DEFF Research Database (Denmark)

    Jørgensen, Thomas Bech; Sørensen, Allan Martini Ibsen; Jansen, Erik C.

    2008-01-01

    Air embolism is a rare and potentially severe complication of surgical and invasive procedures. Emboli large enough to produce symptoms require immediate treatment because of the risk of 'gas lock' in the right side of the heart and subsequent circulatory failure. If air is transmitted to the art...... to the arterial circulation through a shunt, it may cause cerebral emboli with neurological symptoms. We present two cases with venous air emboli and concurrent cerebral arterial emboli. Both patients were successfully treated with hyperbaric oxygen therapy Udgivelsesdato: 2008/4...

  9. Four Cases of a Cerebral Air Embolism Complicating a Percutaneous Transthoracic Needle Biopsy

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    Um, Soo Jung; Lee, Soo Keol; Yang, Doo Kyung; Son, Choon Hee; Kim, Ki Nam; Lee, Ki Nam [Dong-A University College of Medicine, Busan (Korea, Republic of); Kim, Yun Seong [Busan National University College of Medicine, Busan (Korea, Republic of)

    2009-02-15

    A percutaneous transthoracic needle biopsy is a common procedure in the practice of pulmonology. An air embolism is a rare but potentially fatal complication of a percutaneous transthoracic needle biopsy. We report four cases of a cerebral air embolism that developed after a percutaneous transthoracic needle biopsy. Early diagnosis and the rapid application of hyperbaric oxygen therapy is the mainstay of therapy for an embolism. Prevention is the best course and it is essential that possible risk factors be avoided.

  10. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

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    Ai Hosaka

    2015-01-01

    Full Text Available Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

  11. Plant pneumatics: stem air flow is related to embolism - new perspectives on methods in plant hydraulics.

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    Pereira, Luciano; Bittencourt, Paulo R L; Oliveira, Rafael S; Junior, Mauro B M; Barros, Fernanda V; Ribeiro, Rafael V; Mazzafera, Paulo

    2016-07-01

    Wood contains a large amount of air, even in functional xylem. Air embolisms in the xylem affect water transport and can determine plant growth and survival. Embolisms are usually estimated with laborious hydraulic methods, which can be prone to several artefacts. Here, we describe a new method for estimating embolisms that is based on air flow measurements of entire branches. To calculate the amount of air flowing out of the branch, a vacuum was applied to the cut bases of branches under different water potentials. We first investigated the source of air by determining whether it came from inside or outside the branch. Second, we compared embolism curves according to air flow or hydraulic measurements in 15 vessel- and tracheid-bearing species to test the hypothesis that the air flow is related to embolism. Air flow came almost exclusively from air inside the branch during the 2.5-min measurements and was strongly related to embolism. We propose a new embolism measurement method that is simple, effective, rapid and inexpensive, and that allows several measurements on the same branch, thus opening up new possibilities for studying plant hydraulics.

  12. Fatal Cerebral Air Embolism: A Case Series and Literature Review

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    Reddy, Pavithra; Khaja, Misbahuddin

    2016-01-01

    Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale. PMID:27635266

  13. Normal diffusion-weighted imaging in cerebral air embolism complicating angiography

    International Nuclear Information System (INIS)

    We report a case of cerebral air embolism resulting from accidental air infection during cerebral angiography. A 60-year-old man was accidentally injected with air via the left subclavian artery. Angiography demonstrated air within the basilar artery. The patient showed signs of posterior circulation ischaemia (confusion, blindness, gaze palsy and hemiparesis). However, MRI, including diffusion-weighted imaging, showed no abnormality 4 h later. The patient was treated with hyperbaric oxygen within 5 h of the embolism. All symptoms and signs resolved completely within a week. (orig.)

  14. Normal diffusion-weighted imaging in cerebral air embolism complicating angiography

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    Sayama, T.; Inamura, T.; Fukui, M. [Dept. of Neurosurgery, Kyushu University Hospital, Fukuoka (Japan); Mitani, M.; Yagi, H. [Dept. of Neurosurgery, Yagi Hospital, Fukuoka (Japan)

    2000-03-01

    We report a case of cerebral air embolism resulting from accidental air infection during cerebral angiography. A 60-year-old man was accidentally injected with air via the left subclavian artery. Angiography demonstrated air within the basilar artery. The patient showed signs of posterior circulation ischaemia (confusion, blindness, gaze palsy and hemiparesis). However, MRI, including diffusion-weighted imaging, showed no abnormality 4 h later. The patient was treated with hyperbaric oxygen within 5 h of the embolism. All symptoms and signs resolved completely within a week. (orig.)

  15. Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

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    S. Gursoy

    2012-01-01

    Full Text Available Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism.

  16. Cerebral air embolism as a complication of peptic ulcer in the gastric tube: case report

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    Suzuki Takahisa

    2011-12-01

    Full Text Available Abstract Background The reported incidence of ulcer formation in the gastric tube in esophageal replacement is rare. Case Presentation This is the first report of a case of cerebral air embolism as a result of spontaneous perforation of an ulcer in the constructed gastric tube into the pulmonary vein during post-operative follow-up in a patient with esophageal cancer. Conclusions Cerebral air embolism is a rare complication of penetrating gastric ulcer, but should be considered in patients with a history of esophagectomy with gastric conduit that present with acute neurologic findings.

  17. Air embolism as a cause of the systemic inflammatory response syndrome: a case report

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    Kapoor, Tarun; Gutierrez, Guillermo

    2003-01-01

    We describe a case of systemic inflammatory response syndrome associated with air embolism following the removal of a central line catheter, coupled with a deep inspiratory maneuver. The presence of a patent foramen ovale allowed the passage of a clinically significant amount of air from the venous circulation to the systemic circulation. The interaction of air with the systemic arterial endothelium may have triggered the release of endothelium-derived cytokines, resulting in the physiologic ...

  18. A Cerebral Air Embolism That Developed Following Defecation in a Patient with Extensive Pulmonary Tuberculosis: A Case Report

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    Oh, Ji Young; Park, Dong Woo; Hahm, Chang Kok; Park, Choong Ki; Lee, Seung Ro; Lee, Young Jun [Hanyang University College of Medicine, Guri Hospital, Guri (Korea, Republic of)

    2010-08-15

    Cerebral air embolisms generally result from invasive procedures such as a percutaneous needle biopsy, chest tube insertion, central venous catheter access or removal, operations and so on. Likewise, they are mostly iatrogenically induced and present various degrees of severity depending on the number of air bubbles. With the exception of divers, the occurrence of a cerebral air embolism in the absence of invasive procedures is very rare. We report a case of a cerebral air embolism that developed following defecation and was detected by CT in a patient with extensive pulmonary tuberculosis

  19. Vascular air embolism after contrast administration on 64 row multiple detector computed tomography: A prospective analysis

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    Kushaljit S Sodhi

    2015-01-01

    Full Text Available Background: Vascular air embolism is being progressively reported as a nonfatal event with increase in use of computed tomography (CT as a diagnostic modality. This study was undertaken to study the frequency and site of vascular air embolism in patients undergoing contrast-enhanced CT (CECT and analyze CT parameters that influence its prevalence and final outcome. Materials and Methods: This was a prospective study approved by departmental ethics committee. Presence and location of air emboli in 200 patients who underwent CT scan of chest on a 64 detector scanner was recorded. We analyzed the role of various factors that could influence the prevalence of air embolism after injection of contrast in CECT scans. These factors included the amount of contrast injected, rate of flow of injection of contrast, site of injection of contrast, and size of intravenous access line. Results: Iatrogenic vascular air emboli were seen in 14 patients (7% of total. The locations of air emboli were main pulmonary artery in 12 (6% of total, left brachiocephalic vein in 3 (1.5% of total, right atrial appendage in 4 (2% of total, and superior vena cava (SVC in 1 (0.5% patient. There was no association between volume of contrast, flow rate, site and size of intravenous access, and presence of air emboli. Conclusion: Radiologists as well as referring physicians should be aware of vascular air embolism, which can occur after contrast injection in patients undergoing CT scan. Age, volume of contrast, flow rate of pressure injector, and site and size of venous cannula do not influence the likelihood or incidence of detection of venous air emboli on CT scans.

  20. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist.

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    Marchesi, Matteo; Battistini, Alessio; Pellegrinelli, Moira; Gentile, Guendalina; Zoja, Riccardo

    2016-01-01

    Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis.

  1. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist.

    Science.gov (United States)

    Marchesi, Matteo; Battistini, Alessio; Pellegrinelli, Moira; Gentile, Guendalina; Zoja, Riccardo

    2016-01-01

    Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis. PMID:26209631

  2. Patient safety and quality improvement: Iatrogenic venous air embolism in diagnostic imaging

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    Lockwood, P; Breen, W.

    2013-01-01

    The Medicines and Healthcare products Regulatory Agency (MHRA), the executive agency for the Department of Health (DoH) in England, ensures medicines and medical devices work and are safe. An incidence of fatal arterial embolism (AE) was reported, in which air was inadvertently injected into a patient rather than contrast media during a Computer Tomography (CT) examination with a contrast power injector pump. Instigating the issuing of safety notification MDA_SN_96261 however this was withdra...

  3. [Air embolism during lumbar discal hernia repair. Retroperioneal vessels lesions have to be suspected].

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    Lieutaud, T; Terrier, A; Linne, M; Farhat, F; Tahon, F

    2006-03-01

    Occurrence of deep PETCO(2) drop during surgical lumbar disk repair is rare but dramatic. This case report leads to the diagnosis of retroperitoneal vessels lesions. We review the different diagnosis related to the drop of the PETCO(2) during surgery in the genupectoral position. We recommend that the diagnosis of retroperitoneal vessels lesion have to be suspected early if air embolism occurs during lumbar disk surgery. PMID:16481144

  4. AIR LEAK SYNDROME AND A RARE CASES PRESENTATION OF PNEUMOPERICARDIUM ASSOCIATED WITH AIR EMBOLISM IN TTN BABY

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    Dinakara

    2014-04-01

    Full Text Available : Air leak syndromes are a group of clinically recognizable disorders produced by alveolar rupture and subsequent escape of air in to the tissue in which air is not normally present. All the clinical types of air leak syndrome originate in over distended alveoli, which ultimately rupture. Over distention is because of spontaneous vigorous respirations (usually larger term babies at birth, increased pressure of mechanical ventilator (PEEP, PIP vigorous Cardio Pulmonary resuscitation, air trapping in the presence of a ball valve mechanism, most of this air leaks occur spontaneously, but incidence increases with ventilator support, in some cases of collagen vascular diseases and associated renal problems.1 But in our study spontaneous pneumopericardium with air embolism a rare presentation and spontaneously recovered and followed up to one year. Timely radiological investigations including x-rays, USG chest, and ultra sound guided drainage of pneumopericardium with help of radiologist, play an important role in the management preventing morbidity and mortality.

  5. Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

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    Gursoy, S.; Duger, C.; Kaygusuz, K.; Ozdemir Kol, I.; Gurelik, B.; Mimaroglu, C.

    2012-01-01

    Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air...

  6. Functional analysis of embolism induced by air injection in Acer rubrum and Salix nigra

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    Peter Jegsen Melcher; Maciej Andrzej Zwieniecki

    2013-01-01

    The goal of this study was to assess the effect of induced embolism with air injection treatments on the function of xylem in Acer rubrum L. and Salix nigra Marsh. Measurements made on mature trees of A. rubrum showed that pneumatic pressurization treatments that created a pressure gradient of 5.5 MPa across pit membranes (DPpit) had no effect on stomatal conductance or on branch-level sap flow. The same air injection treatments made on three year old potted A. rubrum plants also had no eff...

  7. Significant air embolism: A possibility even with collapsible intravenous fluid containers when used with rapid infuser system

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    Deepanjali Pant

    2010-01-01

    Full Text Available Significant venous air embolism may develop acutely during the perioperative period due to a number of causes such as during head and neck surgery, spinal surgery, improper central venous and haemodialysis catheter handling, etc. The current trend of using self collapsible intravenous (IV infusion bags instead of the conventional glass or plastic bottles has several advantages, one of thaem being protection against air embolism. We present a 56-year-old man undergoing kidney transplantation, who developed a near fatal venous air embolism during volume resuscitation with normal saline in collapsible IV bags used with rapid infuser system. To our knowledge, this problem with collapsible infusion bags has not been reported earlier.

  8. When Coughing Can Cause Stroke - A Case-Based Update on Cerebral Air Embolism Complicating Biopsy of the Lung

    International Nuclear Information System (INIS)

    Introducing gas to the circulation is a largely iatrogenic problem which can result in serious morbidity and even death. We report a case of CT-guided needle biopsy of a pulmonary lesion complicated by acute stroke. The English literature on cerebral air embolism is reviewed, including an update of current opinions on its pathomechanism, diagnostic findings, therapeutic strategies, and means of prevention.

  9. In vivo microvascular mosaics show air embolism reduction after perfluorocarbon emulsion treatment.

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    Torres Filho, Ivo P; Torres, Luciana N; Spiess, Bruce D

    2012-11-01

    Massive arteriolar gas embolism (AGE) has never been evaluated in vivo using intravital microscopy and previous perfluorocarbon (PFC) emulsions were only effective in AGE when administered before AGE. We implemented a new system for quantitative studies of massive AGE using brightfield microscopy and tested a treatment with a third-generation PFC emulsion after massive AGE. We studied bubble dynamics in cremaster muscles from anesthetized rats after AGE was induced by direct air injection into the femoral artery ipsilateral to the studied muscle. Using a motorized microscope stage and a color camera, in vivo microvascular mosaics were produced on-line from over 2000 digital images to evaluate multiple networks in order to investigate the distribution, lodging, breaking, reduction and moving of 105 air bubbles in microvessels. Thirty minutes after PFC treatment, there was a reduction of 80% in bubble volume while untreated and saline-treated rats showed significantly smaller decreases of 33% and 40%, respectively (pbubbles also dissolved into a larger number of smaller bubbles after PFC treatment. The proposed methodology may prove useful for rapid in vivo data acquisition from large networks. Since large air bubbles broke-up, decreased in length and volume, and moved toward smaller microvessels, the study provides quantitative data to support a mechanism by which PFC may improve tissue blood flow following massive AGE. The findings suggest that this new generation of PFC emulsions administered after severe AGE may reach compromised microvascular networks and provide help to alleviate microvascular obstruction by increasing air bubble reabsorption.

  10. [Thoracoabdominal CT scan: a useful tool for the diagnosis of air embolism during an endoscopic retrograde cholangiopancreatography].

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    Tan, B K; Saunier, C-F; Cotton, F; Gueugniaud, P-Y; Piriou, V

    2008-03-01

    We report the case of an 82-year-old woman treated with biliary stents for an ampulloma of Vater's papilla, with recurrent stenosis of the common bile duct. She was hospitalized with a cholestasis. An endoscopic retrograde cholangiopancreatography (ERCP) was scheduled to change the biliary stent for a metallic one, under general anaesthesia, with oral intubation. The ERCP was performed initially without any complication, but as the metallic biliary stent was placed, an air embolism occurred and a cardiac arrest happened immediately. The etiologic diagnosis was quickly confirmed by an injected multislice body-scan, which showed liver, right heart and brain gas embolism. Cardiopulmonary resuscitation allowed a complete haemodynamic recovery but a poor neurological recovery. The patient was transferred in intensive care unit, were she died 12 days after, despite hyperbaric oxygen therapy and the disappearance of the air embolism on the following computed tomography scan. This case may be useful to recall the utility of a body-scan for the diagnosis, treatment and follow-up of an air embolism during ERCP. PMID:18313255

  11. On the mechanical behavior of the human biliary system

    Institute of Scientific and Technical Information of China (English)

    Xiaoyu Luo; Wenguang Li; Nigel Bird; Swee Boon Chin; NA Hill; Alan G Johnson

    2007-01-01

    This paper reviews the progress made in understanding the mechanical behaviour of the biliary system.Gallstones and diseases of the biliary tract affect more than 10% of the adult population. The complications of gallstones, i.e. acute pancreatitis and obstructive jandice, can be lethal, and patients with acalculous gallbladder pain often pose diagnostic difficulties and undergo repeated ultrasound scans and oral cholecystograms. Moreover, surgery to remove the gallbladder in these patients, in an attempt to relieve the symptoms, gives variable results. Extensive research has been carried out to understand the physiological and pathological functions of the biliary system, but the mechanism of the pathogenesis of gallstones and pain production still remain poorly understood. It is believed that the mechanical factors play an essential role in the mechanisms of the gallstone formation and biliary diseases. However, despite the extensive literature in clinical studies, only limited work has been carried out to study the biliary system from the mechanical point of view. In this paper, we discuss the state of art knowledge of the fluid dynamics of bile flow in the biliary tract, the solid mechanics of the gallbladder and bile ducts, recent mathematical and numerical modelling of the system,and finally the future challenges in the area.

  12. Venous air embolism in consecutive balloon kyphoplasties visualised on CT imaging

    International Nuclear Information System (INIS)

    We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken. Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position. Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16-3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system. Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered. (orig.)

  13. Venous air embolism in consecutive balloon kyphoplasties visualised on CT imaging

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    Tins, Bernhard J.; Cassar-Pullicino, Victor N.; Lalam, Radhesh; Haddaway, Mike [Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)

    2012-09-15

    We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken. Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position. Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16-3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system. Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered. (orig.)

  14. Body position does not affect the hemodynamic response to venous air embolism in dogs

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    Mehlhorn, U.; Burke, E. J.; Butler, B. D.; Davis, K. L.; Katz, J.; Melamed, E.; Morris, W. P.; Allen, S. J.

    1994-01-01

    Current therapy for massive venous air embolism (VAE) includes the use of the left lateral recumbent (LLR) position. This recommendation is based on animal studies, conducted 50 yr ago, which looked primarily at survival. Little is known, however, about the concomitant hemodynamic response after VAE in various body positions. The purpose of this study was to investigate the hemodynamic and cardiovascular changes in various body positions after VAE. Twenty-two mechanically ventilated supine mongrel dogs received a venous air infusion of 2.5 mL/kg at a rate of 5 mL/s. One minute after the infusion, 100% oxygen ventilation was commenced and the body position of the dogs was changed to either the LLR (n = 6), the LLR with the head 10 degrees down (LLR-10 degrees; n = 6) or the right lateral recumbent (RLR; n = 5) position. Five dogs were maintained in the supine position (SUP; n = 5). One dog died in every group except in the SUP group, where all the dogs recovered. There were no significant differences among the various body positions in terms of heart rate, mean arterial pressure, pulmonary artery pressure, central venous pressure, left ventricular end-diastolic pressure, or cardiac output. The acute hemodynamic changes occurring during the first 5-15 min after VAE recovered to 80% of control within 60 min. Our data suggest that body repositioning does not influence the cardiovascular response to VAE. Specifically, our data do not support the recommendation of repositioning into the LLR position for the treatment of VAE.

  15. An abrupt reduction in end-tidal carbon-dioxide during neurosurgery is not always due to venous air embolism: a capnograph artefact.

    Science.gov (United States)

    Vinay, Byrappa; Sriganesh, Kamath; Gopala Krishna, Kadarapura Nanjundaiah

    2014-04-01

    Venous air embolism (VAE) is a well recognized complication during neurosurgery. Pre-cordial doppler and trans-esophageal echocardiography are sensitive monitors for the detection of VAE. A sudden, abrupt reduction in the end-tidal carbondioxide (ETCO2) pressure with associated hypotension during neurosurgery might suggest VAE, when more sensitive monitors are not available. We describe an unusual cause for sudden reduction in ETCO2 during neurosurgery and discuss the mechanism for such presentation. PMID:23996497

  16. Cavernous sinus thrombosis and air embolism following surgery for acoustic neurinoma : a case report.

    Directory of Open Access Journals (Sweden)

    Nadkarni T

    2002-04-01

    Full Text Available A 55 year old male patient was operated on for a massive and vascular acoustic neurinoma in a sitting position. The tumor was completely excised. Post-operatively, the patient developed irritability and clinical features suggestive of contralateral cavernous sinus thrombosis. CT scan showed air within the dural walls of the cavernous sinus on the side of surgery. However, there was no radiological evidence of cavernous sinus thrombosis on the contralateral side. Cavernous sinus thrombosis as a post-surgery complication has not been reported. Air within the dural confines of the cavernous sinus has also not been observed or radiologically recorded in the literature.

  17. Treating Biliary System Postoperational Complications by Syndrome Differentiation Using Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ The operation of the biliary system is usually employed for liver,gallbladder or pancreatic diseases.Most benign cases are cholelithiasisinduced cholecystitis and choledochitis,while malignant ones mainly include gallbladder cancers,cholangiocarcinoma or carcinoma of the head of the pancreas.

  18. Influenceable and Avoidable Risk Factors for Systemic Air Embolism due to Percutaneous CT-Guided Lung Biopsy: Patient Positioning and Coaxial Biopsy Technique—Case Report, Systematic Literature Review, and a Technical Note

    Directory of Open Access Journals (Sweden)

    Gernot Rott

    2014-01-01

    Full Text Available Following the first case of a systemic air embolism due to percutaneous CT-guided lung biopsy in our clinic we analysed the literature regarding this matter in view of influenceable or avoidable risk factors. A systematic review of literature reporting cases of systemic air embolism due to CT-guided lung biopsy was performed to find out whether prone positioning might be a risk factor regarding this issue. In addition, a technical note concerning coaxial biopsy practice is presented. Prone position seems to have relevance for the development and/or clinical manifestation of air embolism due to CT-guided lung biopsy and should be considered a risk factor, at least as far as lesions in the lower parts of the lung are concerned. Biopsies of small or cavitary lesions in coaxial technique should be performed using a hemostatic valve.

  19. Influenceable and Avoidable Risk Factors for Systemic Air Embolism due to Percutaneous CT-Guided Lung Biopsy: Patient Positioning and Coaxial Biopsy Technique-Case Report, Systematic Literature Review, and a Technical Note.

    Science.gov (United States)

    Rott, Gernot; Boecker, Frieder

    2014-01-01

    Following the first case of a systemic air embolism due to percutaneous CT-guided lung biopsy in our clinic we analysed the literature regarding this matter in view of influenceable or avoidable risk factors. A systematic review of literature reporting cases of systemic air embolism due to CT-guided lung biopsy was performed to find out whether prone positioning might be a risk factor regarding this issue. In addition, a technical note concerning coaxial biopsy practice is presented. Prone position seems to have relevance for the development and/or clinical manifestation of air embolism due to CT-guided lung biopsy and should be considered a risk factor, at least as far as lesions in the lower parts of the lung are concerned. Biopsies of small or cavitary lesions in coaxial technique should be performed using a hemostatic valve. PMID:25431666

  20. [Diagnostic methods of gallstones--plain radiogram and contrast examination of biliary system].

    Science.gov (United States)

    Mizuno, T

    1993-07-01

    There is a wide spectrum of diagnostic imaging modalities to evaluate the biliary system, such as plain radiogram, echogram (US), oral cholecystogram (OCG), intravenous cholangiogram (DIC), CT, MRI, and RI scintigram. Since the late 1970's US, non-invasive and easily available, is the first choice of examination when gallstones are suspected because of achievement of detailed resolution. OCG or DIC is rarely performed for gallstones. However, it was not until the advent of various measures of treatment for gallstones, other than cholecystectomy, such as dissolution therapy or extracorporal shock wave lithotripsy of gallstones, that contrast examination of the biliary system has been re-utilized to evaluate the characteristics, number and size of gallstones, and patency of cystic duct, which are important data. The indications and significance of plain and contrast examinations for gallstone disease is discussed. PMID:8366591

  1. Catheter Embolization

    Science.gov (United States)

    ... Comment: E-mail: Area code: Phone no: Images × Image Gallery Radiologist and patient consultation. View full size with caption Related Articles and Media Computed Tomography (CT) - Body Magnetic Resonance Imaging (MRI) - Body Uterine Fibroid Embolization ( ...

  2. Rating and limitations of ultrasonic examination of the biliary system with contrast radiography

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Distelmaier, W.

    1981-07-01

    The rating of sonography compared with contrast roentgenography is examined for the biliary system. A high quota of accuracy equivalent or superior to contrast radiography is achieved by sonography, as demonstrated by a comparison of oral cholecystography with sonography (accuracy 69% to 95.5%), IV cholangiocholecystography (accuracy 86.5% to 88.9%) and ERCP (accuracy 69.9% to 67.3%).

  3. Pulmonary embolism

    International Nuclear Information System (INIS)

    Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. 84 references

  4. Influence of Fasciola Hepatica on Serum Biochemical Parameters and Vascular and Biliary System of Sheep Liver

    Directory of Open Access Journals (Sweden)

    A Hodžić

    2013-03-01

    Full Text Available Background: The aim of this study was to evaluate the functional capacity of the liver based on the activity of specific enzymes and bilirubin in serum and also to investigate the influence of mechanical and toxic effects of Fasciola hepatica on the structures of the blood vessels and biliary tract in the sheep liver.Methods: Blood samples and liver of 63 indigenous sheep of Pramenka breed, slaughtered in the period from March to December 2009 were used. Based on parasitological findings in the liver, all animals were divided into two groups: control (n=34 and infected group (n=29. For investigation and description of pathological changes in sheep liver, naturally infected with F. hepatica, corrosion cast technique was used.Results: Biochemical analysis of tested parameters showed a significant elevation (P≤0.05 of serum gamma-glutamyl transferase (GGT, total bilirubin (TBIL and direct bilirubin (DBIL in infected sheep group comparing with the control group. No significant differences were observed for activity of aspartate aminotranferase (AST between groups. Vascular and biliary systems of the liver were found to be affected.Conclusion: Results of biochemical analysis are consistent with pathological findings and measuring of tested parameters could be used in early diagnosis of sheep fasciolosis and to test the effectiveness of anthelmintic therapy. Corrosion cast technique is very useful for investigation of pathological changes and neoangiogenesis of vascular and biliary system in sheep liver, caused by mechanical and toxic effects of F. hepatica.

  5. [Pulmonary embolism].

    Science.gov (United States)

    Söffker, Gerold; Kluge, Stefan

    2015-01-01

    Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed. In the high-risk group the immediate diagnosis is usually done by multidetector spiral computed tomography (MDCT) and primarily the medical therapy of right ventricular dysfunction and thrombolysis is recommended.In the non-high-risk group, this is subdivided into an intermediate-risk group and low-risk group, the diagnosis algorithm based on the PE-pretest probability--determined by validated scores. Moreover, the diagnosis is usually secured by MDCT--the new gold standard in the PE-diagnosis, scores, or it can be primarily ruled out due to the high negative predictive value of D-dimer determination. To improve the prognostic risk stratification in non-high-risk group patients the additional detection of right ventricular dysfunction (MDCT, echocardiography), cardiac biomarkers (troponin, NT proBNP) and validated scores (e.g. Pulmonary Embolism Severity Index) is recommended. Therefore, the intermediate-risk group can be further subdivided. For treatment of non-high-risk group patients, the initial anticoagulation (except those with severe renal insufficiency) using low molecular weight heparin/fondaparinux and conversion to vitamin-K antagonists or alternatively with direct oral anticoagulants (DOAK) is recommended. Hemodynamically stable patients with right ventricular dysfunction and myocardial ischemia (Intermediate-high-risk group patients) but with clinically progressive hemodynamic

  6. Hepcidin is an antibacterial, stress-inducible peptide of the biliary system.

    Directory of Open Access Journals (Sweden)

    Pavel Strnad

    Full Text Available BACKGROUND/AIMS: Hepcidin (gene name HAMP, an IL-6-inducible acute phase peptide with antimicrobial properties, is the key negative regulator of iron metabolism. Liver is the primary source of HAMP synthesis, but it is also produced by other tissues such as kidney or heart and is found in body fluids such as urine or cerebrospinal fluid. While the role of hepcidin in biliary system is unknown, a recent study demonstrated that conditional gp130-knockout mice display diminished hepcidin levels and increased rate of biliary infections. METHODS: Expression and localization of HAMP in biliary system was analyzed by real time RT-PCR, in-situ hybridization, immunostaining and -blotting, while prohepcidin levels in human bile were determined by ELISA. RESULTS: Hepcidin was detected in mouse/human gallbladder and bile duct epithelia. Biliary HAMP is stress-inducible, in that it is increased in biliary cell lines upon IL-6 stimulation and in gallbladder mucosa of patients with acute cholecystitis. Hepcidin is also present in the bile and elevated prohepcidin levels were observed in bile of primary sclerosing cholangitis (PSC patients with concurrent bacterial cholangitis compared to PSC subjects without bacterial infection (median values 22.3 vs. 8.9; p = 0.03. In PSC-cholangitis subjects, bile prohepcidin levels positively correlated with C-reactive protein and bilirubin levels (r = 0.48 and r = 0.71, respectively. In vitro, hepcidin enhanced the antimicrobial capacity of human bile (p<0.05. CONCLUSION: Hepcidin is a stress-inducible peptide of the biliary epithelia and a potential marker of biliary stress. In the bile, hepcidin may serve local functions such as protection from bacterial infections.

  7. Production and Teaching Application of Simulated Pulmonary Air Embolism Demonstration Model%模拟肺动脉空气栓塞演示模型的制作及教学应用

    Institute of Scientific and Technical Information of China (English)

    王波; 余珊; 张大新; 王磊; 刘亚彬; 陶剑; 宁海涛; 贾静

    2014-01-01

    目的:设计制作模拟肺动脉空气栓塞演示模型,解决病理解剖学肺动脉空气栓塞实验教学的难题.方法根据局部血液循环障碍和空气栓塞发生的原理设计制作模型,以本校护理专业学生为研究对象,将223名学生随机分为动物实验对照组及模型教学研究组,比较两组教学效果.结果研究组实验考试成绩高于对照组(<0.05).结论使用模拟肺动脉空气栓塞演示模型教学可以明显提高学生实验考试成绩,并能反复重复使用,激发学生实验学习兴趣,降低教学成本,提高教学质量.%Objective To design simulated pulmonary air embolism demonstration model,so as to solve the problem of pathological anatomy of pulmonary air embolism in experiment teaching. Methods According to the principle of the disturbance of local blood circulation and air embolism, we designed a pulmonary air embolism model. We took 223 school nursing students as the object of this study,and randomly divided them into 2 groups:animal experiment teaching group and model control group,then we compared the teaching effect between the two groups. Result The test scores of students in the animal experiment teaching group were higher than control group (P<0.05) . Conclusion The use of simulated pulmonary air embolism demonstration model teaching can improve the students’experimental test scores,and can be repeatedly used,stimulate students' study interest,reduce the cost of teaching,and improve the teaching quality.

  8. Removal of Gross Air Embolization from Cardiopulmonary Bypass Circuits with Integrated Arterial Line Filters: A Comparison of Circuit Designs.

    Science.gov (United States)

    Reagor, James A; Holt, David W

    2016-03-01

    Advances in technology, the desire to minimize blood product transfusions, and concerns relating to inflammatory mediators have lead many practitioners and manufacturers to minimize cardiopulmonary bypass (CBP) circuit designs. The oxygenator and arterial line filter (ALF) have been integrated into one device as a method of attaining a reduction in prime volume and surface area. The instructions for use of a currently available oxygenator with integrated ALF recommends incorporating a recirculation line distal to the oxygenator. However, according to an unscientific survey, 70% of respondents utilize CPB circuits incorporating integrated ALFs without a path of recirculation distal to the oxygenator outlet. Considering this circuit design, the ability to quickly remove a gross air bolus in the blood path distal to the oxygenator may be compromised. This in vitro study was designed to determine if the time required to remove a gross air bolus from a CPB circuit without a path of recirculation distal to the oxygenator will be significantly longer than that of a circuit with a path of recirculation distal to the oxygenator. A significant difference was found in the mean time required to remove a gross air bolus between the circuit designs (p = .0003). Additionally, There was found to be a statistically significant difference in the mean time required to remove a gross air bolus between Trial 1 and Trials 4 (p = .015) and 5 (p =.014) irrespective of the circuit design. Under the parameters of this study, a recirculation line distal to an oxygenator with an integrated ALF significantly decreases the time it takes to remove an air bolus from the CPB circuit and may be safer for clinical use than the same circuit without a recirculation line.

  9. Massive Systemic Air Embolism during Extracorporeal Membrane Oxygenation Support of a Neonate with Acute Respiratory Distress Syndrome after Cardiac Surgery

    OpenAIRE

    Timpa, Joseph G.; O’Meara, Carlisle; McILwain, R. Britt; Dabal, Robert J; Alten, Jeffrey A.

    2011-01-01

    Extracorporeal membrane oxygenation (ECMO) is universally accepted as a potential lifesaving therapy for neonates suffering severe cardiorespiratory failure, with survival reported as 81% weaning off ECMO and 69% to hospital discharge in this population. Although ECMO may reduce mortality in certain neonatal patients, it is associated with significant complications. Air in the circuit complicates 4.9% of neonatal ECMO runs, and it is crucial that all ECMO caregivers are trained in the prevent...

  10. Fat embolism syndrome

    OpenAIRE

    Jacob George; Reeba George; Dixit, R; Gupta, R C; Gupta, N.

    1997-01-01

    Fat embolism syndrome, an important contributor to the development of acute respiratory distress syndrome, has been associated with both traumatic and nontraumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. Fat emboli can deform and pass through the lungs, resulting in systemic embolization, most commonly to the brain and kidneys. The diagnosis of fat embolism syndrome is based on the patient’s history, supported by clinical signs of pulmonar...

  11. PULMONARY EMBOLISM: DIAGNOSIS BY FOUNDATIONS

    OpenAIRE

    Грабовський, Ю. В.

    2015-01-01

    Pulmonary embolism (PE) – this obstruction pulmonary arterial clot (embolus or) formed in the venous system, the right atrium and right ventricle of the heart, or other material that ended up in the pulmonary circulation (droplets of fat, bone marrow, tumor cells, air, parasites, fragments of catheters etc.), resulting in lung parenchyma preryvayetsya circulation. This leads to the development of hypertension, pulmonary circulation and compensated or decompensated pulmonary heart. This is one...

  12. Acceptable Toxicity After Stereotactic Body Radiation Therapy for Liver Tumors Adjacent to the Central Biliary System

    Energy Technology Data Exchange (ETDEWEB)

    Eriguchi, Takahisa; Takeda, Atsuya; Sanuki, Naoko; Oku, Yohei; Aoki, Yousuke [Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa (Japan); Shigematsu, Naoyuki [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Kunieda, Etsuo, E-mail: kunieda-mi@umin.ac.jp [Department of Radiation Oncology, Tokai University, Kanagawa (Japan)

    2013-03-15

    Purpose: To evaluate biliary toxicity after stereotactic body radiation therapy (SBRT) for liver tumors. Methods and Materials: Among 297 consecutive patients with liver tumors treated with SBRT of 35 to 50 Gy in 5 fractions, patients who were irradiated with >20 Gy to the central biliary system (CBS), including the gallbladder, and had follow-up times >6 months were retrospectively analyzed. Toxicity profiles, such as clinical symptoms and laboratory and radiologic data especially for obstructive jaundice and biliary infection, were investigated in relation to the dose volume and length relationship for each biliary organ. Results: Fifty patients with 55 tumors were irradiated with >20 Gy to the CBS. The median follow-up period was 18.2 months (range, 6.0-80.5 months). In the dose length analysis, 39, 34, 14, and 2 patients were irradiated with >20 Gy, >30 Gy, >40 Gy, and >50 Gy, respectively, to >1 cm of the biliary tract. Seven patients were irradiated with >20 Gy to >20% of the gallbladder. Only 2 patients experienced asymptomatic bile duct stenosis. One patient, metachronously treated twice with SBRT for tumors adjacent to each other, had a transient increase in hepatic and biliary enzymes 12 months after the second treatment. The high-dose area >80 Gy corresponded to the biliary stenosis region. The other patient experienced biliary stenosis 5 months after SBRT and had no laboratory changes. The biliary tract irradiated with >20 Gy was 7 mm and did not correspond to the bile duct stenosis region. No obstructive jaundice or biliary infection was found in any patient. Conclusions: SBRT for liver tumors adjacent to the CBS was feasible with minimal biliary toxicity. Only 1 patient had exceptional radiation-induced bile duct stenosis. For liver tumors adjacent to the CBS without other effective treatment options, SBRT at a dose of 40 Gy in 5 fractions is a safe treatment with regard to biliary toxicity.

  13. Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Masashi; Nakagawa, Hirofumi (National Shikoku Cancer Center Hospital, Ehime (Japan)); Kataoka, Masaaki (and others)

    1992-04-01

    From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer were registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p<0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significant). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system. (author).

  14. Radiation diagnosis of the biliary system before laparascopic cholecystectomy (a review of literature). Part 2: Non-ultrasonic techniques

    International Nuclear Information System (INIS)

    The paper is defined as a review of literature on radiation diagnostic of biliary tract. High-quality intraoperative cholangiogramms securing is actual now. The role of selective cholangiography with laproscopic cholecystectomy, a review of 737 consecutive cases of intraoperative cholangiography in laproscopic cholecystectomy, the abilities of spiral computed tomographic cholangiography before laproscopic cholecystectomy are under consideration. Magneto-resonance cholangiopancreatography as a new method of diagnosis of biliary system diseases is analysed in certain papers. The problem of indications to conducting some diagnostic methods as well as sequences their use (algorithm) touches upon all scientific investigations devoted tactics of medical examinations of patients before laproscopic cholecystectomy

  15. Hydraulic conductivity and embolism in the mangrove tree Laguncularia racemosa.

    Science.gov (United States)

    Ewers, Frank W; Lopez-Portillo, Jórge; Angeles, Guillermo; Fisher, Jack B

    2004-09-01

    We measured xylem pressure potentials, soil osmotic potentials, hydraulic conductivity and percent loss of conductivity (PLC) due to embolism, and made microscopic observations of perfused dye in the white mangrove tree, Laguncularia racemosa (L.) Gaertn. f., (1) to determine its vulnerability to air embolism compared with published results for the highly salt-tolerant red mangrove tree, Rhizophora mangle L., and (2) to identify possible relationships between air embolism, permanent blockage of vessels and stem diameter. Laguncularia racemosa was more vulnerable to embolism than reported for R. mangle, with 50 PLC at -3.4 MPa. Narrow stems (5-mm diameter) had higher PLC than larger stems (8.4- or 14-mm diameter) of the same plants. Basic fuchsin dye indicated that up to 89% of the vessels, especially in the narrow stems, had permanent blockage that could not be reversed by high pressure perfusion. Air embolism could lead to permanent vessel blockage and eventual stem mortality. Such vulnerability to embolism may restrict the growth of L. racemosa and limit its distribution to less salty areas of mangrove communities. PMID:15234903

  16. Pulmonary embolism and impending paradoxical embolism: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHONG You; HE Qing; WANG Xin-yue; CHEN Huan; LI Jing; ZHEN Wen-jun; TONG Hong-feng; WANG Huai-bin; CHEN Qi-hang

    2008-01-01

    @@ Adefinitive diagnosis of paradoxical embolism is based on the evidence that a thrombus crosses through the right-to-left shunting. We report a case of impending paradoxical embolism in a patient with pulmonary embolism diagnosed by echocardiography and proved by operation later.

  17. Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism

    Science.gov (United States)

    Törő, Klára; Pongrácz, Rita; Bartholy, Judit; Váradi-T, Aletta; Marcsa, Boglárka; Szilágyi, Brigitta; Lovas, Attila; Dunay, György; Sótonyi, Péter

    2016-03-01

    The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y( n) = α ṡ n β where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and β > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism.

  18. Influence of the Biliary System on Biliary Bacteria Revealed by Bacterial Communities of the Human Biliary and Upper Digestive Tracts.

    Science.gov (United States)

    Ye, Fuqiang; Shen, Hongzhang; Li, Zhen; Meng, Fei; Li, Lei; Yang, Jianfeng; Chen, Ying; Bo, Xiaochen; Zhang, Xiaofeng; Ni, Ming

    2016-01-01

    Biliary bacteria have been implicated in gallstone pathogenesis, though a clear understanding of their composition and source is lacking. Moreover, the effects of the biliary environment, which is known to be generally hostile to most bacteria, on biliary bacteria are unclear. Here, we investigated the bacterial communities of the biliary tract, duodenum, stomach, and oral cavity from six gallstone patients by using 16S rRNA amplicon sequencing. We found that all observed biliary bacteria were detectable in the upper digestive tract. The biliary microbiota had a comparatively higher similarity with the duodenal microbiota, versus those of the other regions, but with a reduced diversity. Although the majority of identified bacteria were greatly diminished in bile samples, three Enterobacteriaceae genera (Escherichia, Klebsiella, and an unclassified genus) and Pyramidobacter were abundant in bile. Predictive functional analysis indicated enhanced abilities of environmental information processing and cell motility of biliary bacteria. Our study provides evidence for the potential source of biliary bacteria, and illustrates the influence of the biliary system on biliary bacterial communities.

  19. Diagnosing pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Khosla Rahul

    2006-01-01

    Full Text Available Pulmonary embolism (PE is a common, treatable, highly lethal emergency, which despite advances in diagnostic testing, remains an under diagnosed killer. The mortality rate of diagnosed and treated pulmonary embolism ranges from 3-8%, but increases to about 30% in untreated pulmonary embolism. PE is a part of the spectrum of venousthromboembolic disease and most pulmonary emboli have their origin from clots in the iliac, deep femoral, or popliteal veins. Nonspecific clinical signs and symptoms with low sensitivity and specificity of routine tests such as arterial blood gas, chest roentgenogram and electrocardiogram make the diagnosis of PE very challenging for the clinician. Pulmonary angiography is the gold standard diagnostic test, but this technique is invasive, expensive, not readily available and labor intensive. Diagnostic strategies have revolved around establishing clinical probabilities based on predictive models, then ruling in or ruling out the diagnosis of PE with various tests. The aim of this article was to review the literature and present an evidence- based medicine approach to diagnosis of pulmonary embolism.

  20. Uterine Fibroid Embolization

    Medline Plus

    Full Text Available ... 1,000 uterine fibroid embolizations. Fibroids are common, benign tumors in women. They can range in size from ... they're not causing a problem. These are benign tumors. They're non-cancerous tumors. So if you ...

  1. Induction of embolism in xylem conduits of pre-defined diameter

    NARCIS (Netherlands)

    Ieperen, van W.; Nijsse, J.; Keijzer, C.J.; Meeteren, van U.

    2001-01-01

    A new method is presented that enables the induction of embolisms in a fraction of all xylem vessels, based on diameter, at one cut end of a stem segment. The method is based on the different capillary characteristic of xylem vessels of different cross-sectional size. To verify the method, air embol

  2. Partial Splenic Artery Embolization

    Directory of Open Access Journals (Sweden)

    Gh. Shadmani

    2010-05-01

    Full Text Available Background/Objective: Hypersplenism often accompanies chronic liver disease and splenomegaly is one of the four cardinal signs of hypersplenism, the other three being cytopenia, normal or hyperplastic bone marrow and response splenectomy. Surgical splenectomy is the traditional treatment."nIn the recent years, partial splenic embolization has been widely used in patients with hypersplenism and cirrhosis.This study was conducted to assess the safety and efficacy of partial splenic embolization using PVA (poly vinyl alcohol and steel coil in the management of hypersplenism."nPatients and Methods: Between Aban 1387 and Aban 1388, ten patients with hypersplenism related hematologic abnormalities (leukopenia, thrombocytopenia, variceal hemorrhage or other sequels underwent partial splenic embolization with PVA and coil. A comparison between pre-procedure and post-procedure lab data, endoscopy and splenic volumetery was done."nResults: All patients showed dramatic improvement in platelet and leukocyte counts. Platelet and leukocyte counts remained at an appropriate level during the follow up period. In one patient after one year progressive decline in the platelet count was noted, however the values remained significantly higher than before PSE (70000 vs 15000."nAlmost all patients had problems related to post embolization syndrome. In one patient severe pain was noted that lasted nearly ten days, in the other patients, pain was less severe. No significant complication (splenic abscess, pancreatitis, portal vein thrombosis developed in this study."nConclusion: The efficacy of PSE observed in our study confirms the results of previous studies in pa-tients with hypersplenism. This safe, fast method can be used bridging therapy for cirrhotic patients waiting for liver transplantation. Hematological response is related to the extension of embolization.

  3. Pulmonary fat embolism induced intravenous injection of autologous bone marrow in rabbit: CT and pathologic correlation

    International Nuclear Information System (INIS)

    To evaluate the correlation between CT and pathologic findings of pulmonary fat embolism in rabbits. In 16 rabbits, pulmonary fat embolism was induced by intravenous injection of autologous bone marrow(mean 3.3 mL). Chest CT scans were obtained immediately(within 1 hour), and 1, 3, and 7 days after embolization. The rabbits were divided into four groups. Group 1 underwent CT scanning immediately after embolization, group 2 immediately and 1 day after embolization, group 3 immediately, 1 day and 3 days after embolization, group 4 immediately, 1 day, 3 days and 7 days after embolization. Pathologic specimens were obtained immediately after the last CT scan. The earliest CT findings of pulmonary fat embolism in rabbits were peripheral lung lucency(16/16, 100%), perivascular ground-glass(12/16, 75.0%) and enlargement of the central pulmonary artery(11/16, 68.8%). Pathologically, perivascular ground-glass opacity correlated with extensive perivascular alveolar congestion and enlargement of the central pulmonary artery correlated with perivascular connective tissue edema and reactive pulmonary arterial engorgement. Peripheral lung lucency was probably caused by embolic occlusion of the pulmonary artery and decreased perfusion and air trapping induced by arterial and bronchial spasm associated with hypoxia. CT scans obtained 1 and 3 days after embolization showed nodules and patchy ground-glass opacity and consolidation. Aggregation of nodules resulted in patch opacities. Pathologically, pulmonary nodules correlated with focal inflammation surrounding an artery and parenchymal opacity correlated with parenchymal consolidation and hemorrhagic edema. CT scans and pathologic specimens obtained 7 days after embolization showed improvement of parenchymal lung abnormalities. Pulmonary fat embolism in rabbits show CT and pathologic findings which vary with dynamic change. Typical earliest findings of pulmonary fat embolism were peripheral lung lucency, perivascular ground

  4. An interesting septic embolism

    Directory of Open Access Journals (Sweden)

    Funda Uluorman

    2014-01-01

    Full Text Available Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

  5. Cerebral fat embolism

    International Nuclear Information System (INIS)

    A case of cerebral fat embolism is reported. A 18-year-old patient with multiple bone fractures was in semiconma immediately after an injury. Brain CT showed no brain swelling or intracranial hematoma. Hypoxemia and alcoholemia were noted on admission, which returned to normal without improvement of consciousness level. In addition, respiratory symptoms with positive radiographic changes, tachycardia, pyrexia, sudden drop in hemoglobin level, and sudden thrombocytopenia developed. These symptoms were compatible with Gurd's criteria of systemic fat embolism. Eight days after injury, multiple low density areas appeared on CT and disappeared within the subsequent two weeks, and subdural effusion with cerebral atrophy developed. These CT findings were not considered due to cerebral trauma. Diagnosis of cerebral fat embolism was made. The subdural effusion was drained. Neurologic and pulmonary recoveries took place slowly and one month following the injury the patient became alert and exhibited fully coordinated limb movement. The CT scans of the present case well corresponded with hitherto reported pathological findings. Petechiae in the white matter must have developed on the day of injury, which could not be detected by CT examination. It is suggested that some petechial regions fused to purpuras and then gradually resolved when they were detected as multiple low density areas on CT. CT in the purpuras phase would have shown these lesions as high density areas. These lesions must have healed with formation of tiny scars and blood pigment which were demonstrated as the disappearance of multiple low density areas by CT examination. Cerebral atrophy and subsequent subdural effusion developed as a result of demyelination. The patient took the typical clinical course of cerebral fat embolism and serial CT scans served for its assessment. (author)

  6. Uterine Fibroid Embolization

    Directory of Open Access Journals (Sweden)

    "R. Malek

    2003-06-01

    Full Text Available Uterine fibroids are commonly asymptomatic. They often cause pelvic pain, abnormal and increased vaginal bleeding, etc. Traditional treatment of symptomatic uterine fibroids was trans-abdominal hysterectomy. Nowadays, uterine artery embolization (UAE, also called uterine fibroid embolization, is considered as a safe and highly-effective nonsurgical treatment for women with symptomatic uterine fibroid tumors. Advantages of UAE over conventional hormonal suppression and surgical procedures include avoidance of the side effects of drug therapy and surgery-related physical and psychological trauma. These patients commonly resume their normal activities within a week after the procedure; weeks earlier than that for trans-abdominal hysterectomy. Over the past 30 years, interventional radiologists have done UAE for treatment of emergency uterine bleeding. Since 1995, interventional radiologists have turned their attention to treatment of uterine fibroids with a similar procedure. The first fibroid embolization in Iran was done approximately three years ago. So far, more than 100 cases have been treated by this method and it is going to be quickly accepted as a safe alternate for surgery.

  7. Amniotic fluid embolism.

    Science.gov (United States)

    Kaur, Kiranpreet; Bhardwaj, Mamta; Kumar, Prashant; Singhal, Suresh; Singh, Tarandeep; Hooda, Sarla

    2016-01-01

    Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%. PMID:27275041

  8. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis.

    Science.gov (United States)

    Kirschen, Matthew P; Dori, Yoav; Itkin, Maxim; Licht, Daniel J; Ichord, Rebecca; Vossough, Arastoo

    2016-09-01

    An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures. PMID:27297208

  9. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    2006243 Sequential hemodynamic changes in pre-cancerous lesions of hepatocellular carcinoma:experimental study with MR perfusion. GUAN Sheng (管生),et al. Dept Radiol ,Zhongshan Hosp ,Fudan Univ , Shanghai 200032. Chin J Radiol 2006;40(40(3):231-234. Objective: To determine the hemodynamic changes in precancerous lesions of HCC using MR perfusion(MRP). Methods: During the period of carcinogenesis (12-20

  10. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009457 The relationship between macrophage migration inhibitory factor and chronic hepatitis B and hepatitis B virus-related cirrhosis.ZHANG Ka,et al.Dept Infect Dis,3rd Affil Hosp,Sun Yat-sen Univ,Guangzhou 510630. Chin J Infect Dis 2009;27

  11. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    11.1 Liver function2004244 Comparison of the biological Features be-tweenhuman fetal hepatocyte and immortalized L-02 hepatocyte in vitro. KONG Weiwei (孔炜炜), et al. Dept Radiolt Zhongda Hosp, Southeast Univ, Nanjing 210009. Chin J Radiol 2004;38(2):119-123. Objective: To evaluate the feasibilities of the po-

  12. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008546 Effects of gene-transfected bone marrow-derived liver stem cell transplantation on accumulation of extracellular matrix in rats with liver fibrosis.SUN Chao(孙超),et al.Dept Gastroenterol,Xinhua Hosp,Shanghai Jiaotong Univ,Shanghai 200092.Natl Med J China 2008;88(38):2685-2689. Objective To explore the effects of urokinase-type plasminogen activator(uPA)gene modified bone marrow-derived stem cell(BDLSC)

  13. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010440 Analysis of the T lymphocyte receptor beta chain complementarity determining region 3 spectra-typing in the peripheral blood and hepatic tissue of patients with chronic hepatitis B.WU Shaoqiang(伍绍强), et al.Dept Infect Dis, Affil Hosp, Zunyi Med Coll, Zunyi 563003.Chin J

  14. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    12.1 Liver function2003091 Treatment of acute hepatic failure by transplantation of microencapsulated xenogenic hepatocyte.ZHANG Weijie(张伟杰), et al. Instit Organ Transplant, Tongji Hosp, Huazhong Univ Sci & Technol, Wuhan 430030. World Chin J Digestol 2002; 10 (12): 1396-1398.

  15. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    9.1 Liver Function2007108 Blood pressure changes post liver transplantation in 206 recipients. LIU Hai(刘海),et al. 1st People′s Hosp, Shanghai Jiaotong Univ, Shanghai 200080. Chin J Cardiol 2006;34(10):902-904. Objective To study the blood pressure (BP)changes in the liver transplant recipients.

  16. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    2011220 Value of liver biopsy in diagnosis of chronic hepatitis B. YANG Fang(杨方) ,et al. 2nd Ward, Shenyang 6th People’s Hosp,Shenyang 110006. Chin J Infect Dis 2011; 29(2):99-103. Objective To explore the value of liver biopsy in diagnosis of the severity of chronic hepatitis

  17. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    11.1 Liver cirrhosis and fatty liver2003230 The relevance of fatty liver and insulin resistance. LIU Jun(刘军), et al. Dept Endocrinol, Zhong-shan Hosp, Fudan Univ, Shanghai 200032, Shanghai Med J 2003; 16(1): 14-17

  18. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    9.1.Liver cirrhosis and fatty liver2005376 The role of ribosomal S6 kinase in thepathogenesis of rat hepatic fibrosis.YANG Miaofang(杨妙芳),et al.Dept Gastroenterol,Changzheng Hosp,2nd Milit Med Univ,Shanghai 200003.Chin J Dig 2005;25(2):98-100.

  19. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    9.1 Liver cirrhosis and fatty liver2003335 The effects of weight reduction in reversing fatty liver changes in overweight and obese patients.ZHU Huijuan(朱惠娟), et al.Dept Endocrinol, PUMC Hosp,CAMS & PUMC, Beijing 100730. Chin J Intern Med 2003:42(2):98-102.Objective:To study the effects of weight loss on non-

  20. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    2004513 The influence of HBV on interferon gamma receptor 1 expression and its signal paghway.CHEN Gongying (陈公英), et al. Instit Infect Dis, 1st Affili Hosp, Med Coll, Zhejiang Univ, Hangzhou 310003. Chin J Infect Dis 2004; (4):250-254.Objective: To investigate whether hepatitis B virus will influence interferon gamma receptor expression

  1. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009090 Clinical observation of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma XU Li(徐立),et al.State Oncol Lab, Dept Hepatobili Surg, Cancer Center, Sun Yat-sen Univ, Guangzhou 510060, Chin J Oncol 2009;31(1):58-61. Objective To observe the efficacy and safety of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma (HCC). Methods Thirty-eight patients with advanced HCC of Child-Pugh status A or B were included in this study. Patients received orally administered sorafenib at a dose of 400 mg twice a day on a continuous schedule.

  2. Thrombolytic therapy in pulmonary embolism.

    LENUS (Irish Health Repository)

    Nagi, D

    2010-01-01

    Massive pulmonary embolism carries a high mortality. Potential treatment includes anticoagulation, thrombolytic therapy and embolectomy. We report a case of deep vein thrombosis leading to progressive massive pulmonary embolism despite appropriate anticoagulation, where thrombolysis with IVC filter placement resulted in a successful outcome.

  3. Fat embolism syndrome.

    Science.gov (United States)

    Williams, A G; Mettler, F A; Christie, J H; Gordon, R E

    1986-07-01

    The fat embolism syndrome is clinically evident in approximately 0.5-2.0% of patients with long bone fractures. The clinical signs and symptoms are evident in 60% of patients within 24 hours and 85% of patients within 48 hours after trauma. A patient is reported who complained of dyspnea and hemoptysis approximately 72 hours after sustaining a fracture to the distal tibia and fibula. Radionuclide ventilation/perfusion imaging was obtained to rule out pulmonary thromboemboli. Perfusion imaging demonstrated the characteristic diffuse, subsegmental ("mottled") appearance of fatty emboli to the lung. PMID:3731649

  4. Corticosteroids for fat embolism after multiple fractures

    Institute of Scientific and Technical Information of China (English)

    CHEN Huai-sheng; ZHANG Qing-mei; WEN Jun-min; WEN Shun-kang; YI Jing; ZHOU Zhi-qiang; WU Sheng-nan

    2007-01-01

    @@ Fat embolism is a common complication of multiple fractures. Corticosteroids are usually prescribed in prophylactic and treatment of fat embolism. A case of fat embolism followed multiple fractures was hospitalized, and we searched best evidences about corticosteroids for fat embolism so as to provide best therapeutics for the patient.

  5. [Posttraumatic fat embolism].

    Science.gov (United States)

    Bouffard, Y; Guillaume, C; Perrot, D; Delafosse, B; Motin, J

    1984-01-01

    Between 1977 and 1982, fifty cases of post-traumatic fat embolism were treated in a general intensive care unit. Average age of patients was 25.5 +/- 13 years; there was no male majority. Mean free interval was 39 +/- 27 h. 12 cases (24%) had single fractures and 38 (76%) multiple fractures. Forty-four patients had a fractured femur. Thirty-two patients presented the complete clinical syndrome with general, respiratory, neurological and cutaneous signs. Thrombocytopaenia and hypocholesterolaemia were the biological signs most often seen. In forty-four patients, orthopaedic treatment consisted of immediate immobilization, usually with traction. Twenty-six patients were reoperated on: intramedullary nail for twenty patients, plate for the other six. Fat embolism appeared in spite of surgery in six cases; it worsened after surgery in six others. Seven patients had per- or postanaesthetic problems. Fourteen per cent of patients died. The decrease in mortality was mainly due to an improvement in mechanical ventilation techniques. Early surgical fixation remained the rule if there was no serious respiratory distress or haemodynamic instability, although it did not seem to change the mortality rate in this group of patients. PMID:6497076

  6. Fat Embolism Syndrome

    Directory of Open Access Journals (Sweden)

    Gabdullin М.М.

    2012-03-01

    Full Text Available The characteristics of fat embolism syndrome (FES, and the complications occurring in fractures of long bones or pelvic bones are considered. Clinical picture classically develops after “lucid space“, then appear pulmonary and neurological manifestations combined with petechial hemorrhage. Basic theories of FES pathophysiology are analyzed. Early signs are likely to be caused by mechanic vascular occlusion by fat globules. Vascular occlusions in FES are frequently temporary or partial as fat globules block capillary blood flow incompletely due to their flowability and deformity. The diagnosis is made based on clinical presentations using A.R. Gurd’s criteria (1970. Laboratory and instrumental methods are used for clinical diagnosis confirmation or therapy monitoring. The treatment is aimed mainly at supporting respiratory function and hemodynamics stabilization. Prevention, early diagnosis and adequate symptomatic treatment are of primary importance.

  7. Embolization for gastrointestinal hemorrhages

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J. [Dept. of Diagnostic Radiology, University of Ulm (Germany); Siech, M. [Dept. of Abdominal Surgery, University of Ulm (Germany)

    2000-05-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  8. Indocyanine green labeled with /sup 123/I for dynamic studies of the hepato-biliary system. [/sup 131/I, /sup 125/I

    Energy Technology Data Exchange (ETDEWEB)

    Lambrecht, R.M.; Ansari, A.N.; Wolf, A.P.; Atkins, H.L.

    1975-01-01

    This report summarizes the results to develop an iodine-123 labeled agent for dynamic studies of the hepato-biliary system. Iodine-123 is an ideal nuclide for radiopharmaceuticals, because of its short half-life (T/sub /sup 1///sub 2// = 13.3 hr); its decay with a high abundance (83%) of 159 keV photons; and the reduced patient radiation exposure (a factor of 100 less than iodine-131). Indocyanine green, a tricarbanocyanine dye, was introduced by Heseltine and co-workers in 1956, has several characteristics which suggested that iodine-123 labeled ICG might be potentially useful for hepatic functional evaluation. The plasma clearance and biliary excretion kinetics of /sup 123/I-ICG (in dogs) will be compared to /sup 131/I-rose bengal and bromosulphalein labeled with iodine-125.

  9. Progress of chemoradiotherapy in management of extrahepatic biliary system cancer%肝外胆道系统肿瘤放化综合治疗进展

    Institute of Scientific and Technical Information of China (English)

    李金銮

    2008-01-01

    肝外胆道系统肿瘤是一种少见且预后差的疾病,诊断时多为晚期,丧失了根治手术切除的机会,放化综合治疗成为其主要治疗手段.近年来,放化综合治疗在可切除和不可切除的肝外胆道系统肿瘤治疗上取得了一定进展.%Extrahepatic biliary system cancer(EBSC)is an uncommon disease with a poor prognosis. There is no change to making radical resection in most patients because most of the diseases are diagnosed at late stage.Chemoradiotherapy has been a major therapeutic modality of EBSC.In recent year,the progress of chemoradiotherapy has been made in management of resectable and unresectable EBSC.

  10. Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients.

    Science.gov (United States)

    Hsieh, Jennifer; Thosani, Amar; Grunwald, Matthew; Nagula, Satish; Bucobo, Juan Carlos; Buscaglia, Jonathan M

    2015-10-01

    Controversy exists over the need for unilateral versus bilateral stent placement in patients with malignant obstruction at the biliary hilum. Placement of bilateral uncovered self-expanding metal stent (UCSEMS) at this location is technically challenging, and generally associated with lower rates of procedural success. Serial insertion of side-by-side UCSEMS may be especially difficult when simultaneous deployment is not possible using larger stent delivery catheters. In this single-center, retrospective case series of all patients who underwent bilateral placement of uncovered Wallflex(TM) biliary stents between July 2008 and July 2014, we evaluate the feasibility, technical success, and safety of patients undergoing serial insertion of bilateral UCSEMS using the 8 Fr Wallflex(TM) biliary system for malignant hilar obstruction. A total of 17 patients were included. Primary cholangiocarcinoma, Bismuth IV, was the most common diagnosis. Mean procedure time was 54.4 minutes. Overall procedural technical success was achieved in 17/17 patients. Stricture dilation was necessary prior to Wallflex(TM) insertion in 8/17 patients (47.1%). Transpapillary extension of two stents was performed in all patients. There were no cases of stent deployment malfunction, or inability to insert or deploy the 2(nd) stent. Nine of 17 patients (52.9%) required inpatient hospitalization following ERCP; the most common indications were abdominal pain and need for IV antibiotics. There was one case of ERCP-related cholangitis otherwise; there were no other major complications. Bilateral, serial insertion of UCSEMS using the 8 Fr Wallflex(TM) biliary system in malignant hilar obstruction is feasible with an excellent technical success profile. Using this device for side-by-side deployment of UCSEMS appears to be safe in the majority of patients. PMID:26605283

  11. An Unusual Case of Swab Embolism

    Directory of Open Access Journals (Sweden)

    N. G. Naidoo

    2014-01-01

    Full Text Available Intravascular foreign body embolism is an exceptionally uncommon problem. We report on an unusual case of a surgical swab embolism which occurred during a thoracic surgical procedure.

  12. Amniotic fluid embolism

    Directory of Open Access Journals (Sweden)

    Rudra A

    2009-01-01

    Full Text Available The disastrous entry of amniotic fluid into the maternal circulation leads to dramatic sequelae of clinical events, characteristically referred to as Amniotic fluid embolism (AFE. The underlying mechanism for AFE is still poorly understood. Unfortunately, this situation has very grave maternal and fetal consequences. AFE can occur during labor, caesarean section, dilatation and evacuation or in the immediate postpartum period. The pathophysiology is believed to be immune mediated which affects the respiratory, cardiovascular, neurological and hematological systems. Undetected and untreated it culminates into fulminant pulmonary edema, intractable convulsions, disseminated intravascular coagulation (DIC, malignant arrhythmias and cardiac arrest. Definite diagnosis can be confirmed by identification of lanugo, fetal hair and fetal squamous cells (squames in blood aspirated from the right ventricle. Usually the diagnosis is made clinically and by exclusion of other causes. The cornerstone of management is a multidisciplinary approach with supportive treatment of failing organs systems. Despite improved modalities for diagnosing AFE, and better intensive care support facilities, the mortality is still high.

  13. Pulmonary embolism in adolescents

    Institute of Scientific and Technical Information of China (English)

    MA Qing-bian; YAO Wan-zhen; CHEN Jian-ming; GE Hong-xia; LI Shu; ZHENG Ya-an

    2012-01-01

    Background Pulmonary embolism (PE) is rare and seldom considered in adolescent patients; however it occurs with a greater frequency than is generally recognized,and it is a potentially fatal condition.The aim of the current study was to understand its epidemiology,clinical features and the cause of delay of its diagnosis in adolescents.Methods A retrospective analysis of nine adolescents with acute PE admitted to the Peking University Third Hospital over the past 16-year period was performed.The epidemiology,clinical features and risk factors of the adolescents were described and compared with those of adults and elderly patients.The time to diagnosis and misdiagnosed diseases were analyzed.Pretest probability of PE was assessed retrospectively by the Wells score and revised Geneva score.Results The incidence of PE was 43.6 per 100 000 hospitalized adolescents in our hospital.The incidence of PE in adolescents was much lower than that in adults and PE is diagnosed in about 1/50 of elderly people.The clinical features in adolescents were similar to those in adults.But fever and chest pain were more common in adolescents (P<0.05).The major risk factors included surgery,systemic lupus erythematosus (SLE),thrombocytopenia,long-term oral glucocorticoids and trauma.The mean diagnostic time was (7.8±8.4) days.Six cases had a delayed diagnosis.The mean delay time from symptom onset to diagnosis was (11.0±8.8) days.The time of presentation to diagnosis in patients initially admitted to the emergency department was less than one day,and was much shorter than the time in outpatients,(9.4±7.5) days.Most of the patients were initially misdiagnosed with a respiratory tract infection.Most patients' values of Wells score or revised Geneva score were in the moderate or high clinical probability categories; 88% by Well score vs.100% by revised Geneva score.Conclusions PE was seldom considered in the adolescent patients by physicians,especially outpatient physicians,so the

  14. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    Energy Technology Data Exchange (ETDEWEB)

    Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K. [University of California San Francisco, Department of Radiology (United States); Klimov, Alexander; Bloom, Allan I. [Hadassah Hospital, Department of Radiology (Israel)

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  15. Patient management of pulmonary embolism

    International Nuclear Information System (INIS)

    This is the first article in a four-part continuing education series addressing patient care and the clinical management of disease. This series is not directed at nuclear medicine procedures themselves, but focuses on topics related to patients referred for nuclear medicine studies. After reading this article, the reader should be able to: 1) discuss the diagnosis of pulmonary embolism; and 2) discuss conventional versus thrombolytic approaches to therapy

  16. Clinical update on pulmonary embolism

    OpenAIRE

    Duru, Serap; Keleşoğlu, Arif; Ardıç, Sadık

    2013-01-01

    Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, compute...

  17. Pulmonary embolism, part II: Management

    OpenAIRE

    Bĕlohlávek, Jan; Dytrych, Vladimír; Linhart, Aleš

    2013-01-01

    Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the...

  18. Fat embolism syndrome and pulmonary microvascular cytology.

    Science.gov (United States)

    Castella, X; Vallés, J; Cabezuelo, M A; Fernandez, R; Artigas, A

    1992-06-01

    Pulmonary microvascular cytology consists of analysis of capillary blood sampled while a Swan-Ganz catheter is in the wedge position. This technique has proved to be useful in the diagnosis of lymphangitic spread of carcinoma in the lungs and there are case reports of their use in amniotic fluid embolism. Its usefulness in diagnosing fat embolism syndrome has been shown only rarely. We report a new case in which pulmonary microvascular cytologic study allowed a definite diagnosis of fat embolism syndrome. We suggest obtaining routinely samples of capillary blood when a pulmonary catheter is in place and fat embolism is suspected on a clinical basis.

  19. An unusual case of pulmonary embolism.

    Science.gov (United States)

    Khakural, Prabhat; Shrestha, Kajan R; Sapkota, Ranjan; Shrestha, Uttam K

    2015-01-01

    Pulmonary embolism carries a significant morbidity and mortality. Metastatic choriocarcinoma presenting as pulmonary embolism is a rare event. Here, we report a case of a 25-year-lady with a history of worsening shortness of breath for 4 months who was treated as a case of pneumonia and tuberculosis. Owing to the worsening condition, she had a contrast enhanced computed tomography (CECT) chest done and was diagnosed to have pulmonary embolism. She underwent pulmonary embolectomy. The histopathological examination of the embolus revealed it to be metastatic choriocarcinoma. She showed a good response to chemotherapy. Metastatic choriocarcinoma should be considered as a differential diagnosis in females presenting with pulmonary embolism. PMID:25687445

  20. Air

    Science.gov (United States)

    ... house) Industrial emissions (like smoke and chemicals from factories) Household cleaners (spray cleaners, air fresheners) Car emissions (like carbon monoxide) *All of these things make up “particle pollution.” They mostly come from cars, trucks, buses, and ...

  1. The influence of weather and environment on pulmonary embolism: pollutants and fossil fuels.

    Science.gov (United States)

    Clauss, Ralf; Mayes, Julian; Hilton, Paul; Lawrenson, Ross

    2005-01-01

    Previous publications have highlighted seasonal variations in the incidence of thrombosis and pulmonary embolism, and that weather patterns can influence these. While medical risk factors for pulmonary thrombo-embolism such as age, obesity, hypercoagulable states, cancer, previous thrombo-embolism, immobility, limb paralysis, surgery, major illness, trauma, hypotension, tachypnoea and right ventricular hypokinesis are not directly implicated regarding environmental factors such as weather, they could be influenced indirectly by these. This would be especially relevant in polluted areas that are associated with a higher pulmonary embolism risk. Routine nuclear medicine lung ventilation/perfusion studies (V/Q scans) of 2071 adult patients referred to the nuclear medicine department of the Royal Surrey County Hospital in Guildford, UK, between January 1998 and October 2002 were reviewed and 316 of these patients were classified as positive for pulmonary embolism with high probability scan on PIOPED criteria. The occurrence of positive scans was compared to environmental factors such as temperature, humidity, vapour pressure, air pressure and rainfall. Multiple linear regression was used to establish the significance of these relations. The incidence of pulmonary embolism was positively related to vapour pressure and rainfall. The most significant relation was to vapour pressure (p=0.010) while rainfall was less significant (p=0.017). There was no significant relation between pulmonary embolism and air pressure, humidity or temperature. It is postulated that rainfall and water vapour may be contributary factors in thrombosis and pulmonary embolism by way of pollutants that are carried as condensation nuclei in micro-droplets of water. In particular, fossil fuel pollutants are implicated as these condensation nuclei. Pollutants may be inhaled by populations exposed to windborne vapour droplets in cities or airports. Polluted vapour droplets may be absorbed by the lung

  2. METABOLIC DISORDERS AND PULMONARY EMBOLISM

    Directory of Open Access Journals (Sweden)

    O. Ya. Vasiltseva

    2015-12-01

    Full Text Available The purpose of the study. To examine the contribution of diabetes and obesity in the development of pulmonary embolism on the based data of the Register of new hospital of pulmonary embolism (PE in hospitals inTomsk(2003–2012. Material and Methods. The medical history and records of autopsies of patients treated in hospitals in the city ofTomsk, 2003–2012, and anatomopathological and/or instrumental examination revealed pulmonary embolism have been subjected to studies. We used the classification of diabetes mellitus proposed by the WHO in1999 inour work, because the register including data (2003–2012. The degree of obesity was assessed according to WHO classification (1997. Statistical analysis of the results was carried out with the help of software for computer Statistica for Windows, version 8.0. The Shapiro–Wilk and Kolmogorov–Smirnov tests was used to determine the nature of the distribution of the data. The ho mogeneity of the population variance was assessed using Fisher's exact test andLeuventest. The Mann– Whitney test was used when comparing two independent samples to determine the significance of differences. The analysis was conducted by means of qualitative characteristics contingency tables using Pearson χ 2 . The odds ratio was calculated to assess the association between a specific outcome and the risk. Data are presented as M ± SD factor. The significance level of p for all procedures used by the statistical analysis was taken to be 0.05. It was considered statistically significant level of p < 0.05. The results of the study. In intermediate urbanized city ofWestern Siberia,Tomsk, established register of hospital pulmonary embolism (2003–2012. The register included 751patients whose in vivo and / or postmortem revealed pulmonary embolism (PE. The data histories and autopsy reports was analyze. The type 2diabetes was diagnosed in 205 patients. The type 2 diabetes moderate had 29%. Diabetes severe suffer 82

  3. Air

    International Nuclear Information System (INIS)

    In recent years several regulations and standards for air quality and limits for air pollution were issued or are in preparation by the European Union, which have severe influence on the environmental monitoring and legislation in Austria. This chapter of the environmental control report of Austria gives an overview about the legal situation of air pollution control in the European Union and in specific the legal situation in Austria. It gives a comprehensive inventory of air pollution measurements for the whole area of Austria of total suspended particulates, ozone, volatile organic compounds, nitrogen oxides, sulfur dioxide, carbon monoxide, heavy metals, benzene, dioxin, polycyclic aromatic hydrocarbons and eutrophication. For each of these pollutants the measured emission values throughout Austria are given in tables and geographical charts, the environmental impact is discussed, statistical data and time series of the emission sources are given and legal regulations and measures for an effective environmental pollution control are discussed. In particular the impact of fossil-fuel power plants on the air pollution is analyzed. (a.n.)

  4. 胆道系统CT扫描的三维重建研究%Human biliary system three-dimensional model on perfused cadaveric liver by Computed Tomography

    Institute of Scientific and Technical Information of China (English)

    范立新; 刘建滨; 任家武; 周小兵; 李严斌

    2009-01-01

    目的:通过CT扫描获取胆道系统容积数据,确立人体胆道系统三维重建的方法.方法:7例正常成人新鲜尸肝,以羧甲基纤维素(carboxymethylcellulose,CMC)/氧化铅(leadoxide,LO)混合物、牙托粉和明胶分别对应经胆道、门静脉和肝静脉灌注显影和固形,16排CT机扫描获取断层数据,在工作站用Mimics软件处理,建立胆系三维图像并进行评估.结果:7例标本6例灌注满意;6例满意者胆管连续、光滑、无伪影,空间感强烈、可任意度旋转;肝脏Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ各段胆管显示级数分别为5.8±0.75,10.1±1.05,10.2±0.98,7.8±0.75,11.8±0.75,11.7±0.82,13.2±0.75,11.7±1.63,相应各肝段胆管三维图像质量平均优秀率依次为98.14、97.78、97.82、98.68、97.05、96.22、95.02和95.31%;6例肝胆道图像平均优秀率(97.01±1.35%).结论:本法建立的人体胆道系统三三维模型胆道连续性好、图像空间感强烈,胆管显示级数多,图像质量高,是一种优秀的胆系=三维重建方法.%Objective: To investigate a three-dimensional modeling method of human biliary system on perfused cadaveric liver by Computed Tomography. Methods: 7 isolated livers,which were selectively filled the bile duets with mixtures of carboxymethylcellulose and lead oxide for visualization,the portal vein with dental base acrylic resin powder and the hepatic vein with gelatin for keeping shape of livers,were scanned to obtain respective volumetric dataset of biliary tract by Medical System Brilliance CT. The three-dimensional images of human biliary system obtained by applying Mimics software with the data above and assessed in self-designed standard for image quality analysis. Resluts: 6 of 7 cases were peffused satisfactively. Established images were of great continuity,smooth and glossy,and intense perception of space without defect. The stage numbers of bile duct representing in Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅶ,Ⅷ liver segments were

  5. Dynamics of freeze-thaw embolism in Smilax rotundifolia (Smilacaceae).

    Science.gov (United States)

    Cobb, Alexander R; Choat, Brendan; Holbrook, N Michele

    2007-04-01

    Freeze-thaw cycles pose a major physiological challenge for all temperate perennial plants, but monocotyledonous vines face a still greater risk because their few large vessels are especially susceptible to embolism and are not replaced by secondary growth. The genus Smilax is particularly remarkable because it is widespread in the tropics but includes species that survive the hard frosts of New England winters. Smilax rotundifolia was monitored for a year for evidence of stem xylem freeze-thaw cavitation and refilling. Embolism of metaxylem was complete by late November and was completely reversed by late April, when root pressures rose as high as 100 kPa. Protoxylem remained full of sap throughout the year in cryogenic scanning electron micrographs. Three methods were used to quantify embolism: percent loss conductivity (PLC), gravimetric air fraction (GAF: mass of water in stem xylem relative to capacity), and cryogenic scanning electron microscopy (cryo-SEM). The three methods corroborated one another well and gave quantitatively similar results. Osmolality of xylem sap extracted from exuding stems was 64 mol/kg (±7.0, N = 8), consistent with the root pressures observed. Strong root pressure can account for Smilax's survival in temperate regions with severe frosts, where few monocots with persistent aboveground organs are found. PMID:21636432

  6. Embolizing Papillary Fibroelastoma of the Mitral Valve

    OpenAIRE

    Mazzucco, Alessandro; Faggian, Giuseppe; Bortolotti, Uberto; Bonato, Raffaele; Pittarello, Demetrio; Centonze, Giuseppe; Thiene, Gaetano

    1991-01-01

    We report a case of myocardial infarction secondary to coronary embolization of a papillary fibroelastoma of the anterior mitral leaflet. The patient underwent successful operation. The English literature describes only 9 other surgically excised papillary fibroelastomas of the mitral valve. In 5 of these cases, the patient presented with signs of cerebral or coronary embolization.

  7. Preoperative endovascular embolization of a cerebellar hemangioblastoma

    OpenAIRE

    Almeida-Pérez Rafael; Espinosa Héctor; Romero-Ramírez Haroldo; Alcalá-Cerra Gabriel; Orozco-Gómez Fernando; De la Rosa-Manjarréz Ginna

    2013-01-01

    Introduction: hemangioblastomas are benign tumors located in the cerebellum, whichaffect young adults predominantly. These injuries are recognized by its abundant vascularizationwhich makes difficult its resection.Clinical case: The experience in the endovascular treatment of a patient with a cerebellarhemangioblastoma is exposed, emphasizing in the technical considerations andnecessary materials to achieve a successful embolization.Conclusion: Endovascular embolization of tumour vessels faci...

  8. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  9. Embolization Therapy for Traumatic Splenic Lacerations

    International Nuclear Information System (INIS)

    Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16–80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

  10. Embolization Therapy for Traumatic Splenic Lacerations

    Energy Technology Data Exchange (ETDEWEB)

    Dasgupta, Niloy; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F. [University of Virginia Health System, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2012-08-15

    Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

  11. A Microfluidic Pump/Valve Inspired by Xylem Embolism and Transpiration in Plants

    OpenAIRE

    Li Jingmin; Liu Chong; Xu Zheng; Zhang Kaiping; Ke Xue; Wang Liding

    2012-01-01

    In plants, transpiration draws the water upward from the roots to the leaves. However, this flow can be blocked by air bubbles in the xylem conduits, which is called xylem embolism. In this research, we present the design of a biomimetic microfluidic pump/valve based on water transpiration and xylem embolism. This micropump/valve is mainly composed of three parts: the first is a silicon sheet with an array of slit-like micropores to mimic the stomata in a plant leaf; the second is a piece of ...

  12. 13.LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    13.2.Liver cirrhosis and fatty liver930691 Experimental observation of high portal ve-nous resistance in dogs.WANG Weimin,etal.Dept Surg,1st Teach Hosp,Beijing Med Univ,Beijing,100034 Natl Med J China 1993;73(6):349—351.To study the relationship between portal resistanceand formation of portal hypertension,we designed a

  13. Pulmonary Artery Cement Embolism after a Vertebroplasty

    Directory of Open Access Journals (Sweden)

    Anas Nooh

    2015-01-01

    Full Text Available Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism.

  14. The serpentine mitral valve and cerebral embolism

    Directory of Open Access Journals (Sweden)

    Ker James

    2011-02-01

    Full Text Available Abstract Valvular strands, well-delineated filiform masses, attached to cardiac valve edges are associated with cerebral embolism and stroke. Strokes, caused by emboli from valvular strands, tend to occur among younger persons. In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis. It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.

  15. Takotsubo Syndrome and Embolic Events.

    Science.gov (United States)

    El-Battrawy, Ibrahim; Borggrefe, Martin; Akin, Ibrahim

    2016-10-01

    Takotsubo cardiomyopathy (TTC), initially defined as a benign disease, is associated with several complications. One of them is a thromboembolism, which is clinically presented by events such as stroke, ventricular thrombi, and peripheral embolization, and can be present at index event of TCC as well as at any time in disease course. Patients with elevated C-reactive protein levels, markedly elevated D-dimers and severely impaired left ventricular function seem to be at higher risk of developing thrombemboli. Treatment strategies prescribed in the management of thombembolic complications in patients with acute myocardial infarction includes a short course of anticoagulation. A similar analogy could also be considered for patients with TTC presenting with this complications. Nevertheless, an individualized close-follow-up is of utmost importance to avoid any relapse and not to oversee any impeding complications in light of dynamic processes in myocardial stunning. PMID:27638024

  16. Pulmonary imaging in fat embolism syndrome.

    Science.gov (United States)

    Park, H M; Ducret, R P; Brindley, D C

    1986-07-01

    Ventilation/perfusion lung scanning can be used to effectively detect fat embolism following skeletal trauma. Typical ventilation/perfusion findings may be present when the chest radiograph is normal, and clinical findings are equivocal. PMID:3731656

  17. Emission Tomography in Embolic Lung Disease

    OpenAIRE

    Donaldson, Robert M.; Khan, Omar; Bennett, J. Graeme; Ell, Peter J

    1982-01-01

    Ventilation-perfusion lung scans and emission tomography studies were performed in 84 patients with suspected embolic lung disease. Concordant data were obtained in 72 patients (57 positive, 15 negative); results were discordant in ten patients and indeterminate in two.

  18. Mortality and Embolic Potential of Cardiac Tumors

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2014-07-01

    Full Text Available Background: Cardiac tumors are rare, mostly benign with high embolic potential. Objectives: To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods: Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years. In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%. The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results: Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%, followed by fibromas (6.9%, thrombi (6.4% and sarcomas (6.4%. Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm 37 (19.8% patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001. The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002 and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006, but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months, there were 2 deaths (1.1% and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion: Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

  19. Mortality and Embolic Potential of Cardiac Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Dias, Ricardo Ribeiro, E-mail: ricardo.dias@incor.usp.br; Fernandes, Fábio; Ramires, Félix José Alvarez; Mady, Charles; Albuquerque, Cícero Piva; Jatene, Fábio Biscegli [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-07-15

    Cardiac tumors are rare, mostly benign with high embolic potential. To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

  20. Sympathetic hyperactivity syndrome following cerebral fat embolization

    OpenAIRE

    2013-01-01

    To date, there have been no reports of paroxysmal sympathetic hyperactivity syndrome (PSHS) associated with cerebral fat embolization. We describe the case of a young male who developed acute brain injury and acute hypoxemic respiratory failure secondary to significant fat embolization following a traumatic femur injury. Our patient demonstrated episodes of significant hypertension, tachycardia, fever and extensor posturing. Extensive evaluation lead to the diagnosis and appropriate ...

  1. Pathophysiology of spontaneous venous gas embolism

    Science.gov (United States)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  2. The diagnostic management of suspected pulmonary embolism

    OpenAIRE

    Nijkeuter, Mathilde

    2007-01-01

    Pulmonary embolism is a potentially fatal disease in which early recognition and institution of anticoagulant treatment can prevent mortality. The diagnostic tools available to establish whether a patient has a pulmonary embolism were limited to pulmonary angiography and ventilation-perfusion scintigraphy. Both tests have considerable limitations. Helical CT evolved as a new technique in diagnosing PE and gained widespread interest but has been implemented rapidly, without appropriate assessm...

  3. Mortality and Embolic Potential of Cardiac Tumors

    OpenAIRE

    Ricardo Ribeiro Dias; Fábio Fernandes; Félix José Alvarez Ramires; Charles Mady; Cícero Piva de Albuquerque; Fábio Biscegli Jatene

    2014-01-01

    Background: Cardiac tumors are rare, mostly benign with high embolic potential. Objectives: To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods: Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% wer...

  4. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments.

    Science.gov (United States)

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-01-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice. PMID:27561915

  5. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments

    Science.gov (United States)

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-08-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice.

  6. Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism

    Directory of Open Access Journals (Sweden)

    J.H.T. Ferreira

    2006-09-01

    Full Text Available The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 ± 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 ± 8.64 to 39.14 ± 6.77 mmHg and alveolar air (from 92.97 ± 2.14 to 63.91 ± 8.27 mmHg. The effective alveolar ventilation exhibited a significant reduction (from 199.62 ± 42.01 to 84.34 ± 44.13 consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio also presented a significant reduction after embolization (from 0.96 ± 0.34 to 0.33 ± 0.17 fraction. The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 ± 1.71 to 60.76 ± 6.62 mmHg, but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 ± 1.22 to 23.15 ± 8.24 mmHg. Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 ± 1.36 to 37.61 ± 12.79 mmHg, as also did the calculated alveolar (from 56.38 ± 22.47 to 178.09 ± 37.46 mL and physiological (from 0.37 ± 0.05 to 0.75 ± 0.10 fraction dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution

  7. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Tabitha Schrufer-Poland

    2015-04-01

    Full Text Available Introduction - Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description - A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion - Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality.

  8. Dermatomyositis masquerading as pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Mroz RM

    2009-12-01

    Full Text Available Abstract A 61-year-old Caucasian was admitted to Department of Chest Diseases and Tuberculosis, Medical University of Bialystok, Poland for progressive muscle weakness and weight loss. Eighteen months prior to admission, the patient had been diagnosed with pulmonary embolism. At that point he was started on Enoxaparin QD. Past medical history was unremarkable. In the interim, the patient developed fever, myalgia and progressive dyspnea. Physical examination on admission revealed a rash on his upper torso and back, and the extensor surfaces of all four extremities. Laboratory values included CPK 8229, MB fraction 219, LDH 981. Chest X-ray and CT scan revealed bilateral patchy consolidations and ground-glass opacities. EMG was consistent with myositis. The patient was started on solumedrol 40 mg i.v., b.i.d., and then switched to prednisone 40 mg b.i.d. His symptoms and muscle strength improved remarkably. The patient was discharged with prednisone with an outpatient follow up.

  9. Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Nate P Painter

    2014-01-01

    Full Text Available A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations.

  10. Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography.

    Science.gov (United States)

    Painter, Nate P; Kumar, Priya A; Arora, Harendra

    2014-01-01

    A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP) for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE) demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations. PMID:24732617

  11. Uterine artery embolization to treat uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Machan, L.; Martin, M. [Univ. of British Columbia Hospital, Dept. of Radiology, Vancouver, BC (Canada)

    2001-06-01

    The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

  12. Transcatheter hepatic artery embolization of liver cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Yoo, Hyung Sik; Suh, Jung Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Yun, Heun Yung [Indiana University Hospital, Bloomington (United States)

    1985-12-15

    From March 1985 to September 1985, transcatheter hepatic arterial embolization was performed in 17 primary hepatoma and 8 metastasis of liver in Department of Radiology, Yonsei University College of Medicine. Metastasis cancers of liver were one nasopharyngeal cancer, one small bowel leiomyosarcoma, one gall bladder cancer and 5 colon cancers. The used embolization materials were the followings: Gelfoam particles for one primary hepatoma, 95% absolute ethanol for 4 patients, lvalon (250-590 {mu} m) for 19 patients and autologous blood clots for one metastasis. The results were summarized as the follows: 1. The devascularization of tumor vessels in post-embolization hepatic angiogram was complete in 6 primary hepatoma and one metastasis and partial in 11 primary hepatoma and 7 metastasis. 2. In the follow-up CT evaluation 3 to 4 weeks after embolization, well necrotic density was revealed in 8 primary hepatoma and one metastasis. 3. The complications were fever with higher than 38 .deg. C (92%), abdominal pain (72%) and nausea or vomiting (40%). They were subsided within one to 7 days after embolization. 4. In liver function study, sGOT and sGPT were elevated in 96% of total cases and retuned to normal within 3 to 7 days. Alkaline phosphatase was elevated in 80% of total cases and retuned to normal within 15 to 30 days. LDH was variable. In 4 cases of absolute ethanol infusion, above liver enzymes were markedly elevated as 10 times or more as normal range.

  13. Permanent Cortical Blindness After Bronchial Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Doorn, Colette S. van, E-mail: cvandoorn@gmail.com; De Boo, Diederick W., E-mail: d.w.deboo@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: e.j.m.weersink@amc.uva.nl [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail: o.m.vandelden@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Lienden, Krijn P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands)

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  14. Neural Hypernetwork Approach for Pulmonary Embolism diagnosis

    CERN Document Server

    Rucco, Matteo; Merelli, Emanuela; Johnson, Jeffrey H; Falsetti, Lorenzo; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    This work introduces an integrative approach based on Q-analysis with machine learning. The new approach, called Neural Hypernetwork, has been applied to a case study of pulmonary embolism diagnosis. The objective of the application of neural hyper-network to pulmonary embolism (PE) is to improve diagnose for reducing the number of CT-angiography needed. Hypernetworks, based on topological simplicial complex, generalize the concept of two-relation to many-body relation. Furthermore, Hypernetworks provide a significant generalization of network theory, enabling the integration of relational structure, logic and analytic dynamics. Another important results is that Q-analysis stays close to the data, while other approaches manipulate data, projecting them into metric spaces or applying some filtering functions to highlight the intrinsic relations. A pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches, frequently fatal. Our study uses data on 28 diagnostic features of 1,427...

  15. Permanent Cortical Blindness After Bronchial Artery Embolization

    International Nuclear Information System (INIS)

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent

  16. The fat embolism syndrome. A review.

    Science.gov (United States)

    Levy, D

    1990-12-01

    While fat embolism occurs in most (more than 90%) patients with traumatic injury, the fat embolism syndrome (FES) occurs in only 3%-4% of patients with long-bone fractures. FES involves multiple organ systems and can cause a devastating clinical deterioration within hours. The major clinical features of FES include hypoxia, pulmonary edema, central nervous system depression, and axillary or subconjunctive petechiae. Improvements have been made in supporting the respiratory compromise and adult respiratory distress syndrome that these patients develop. Aggressive measures to improve the pulmonary function, i.e., positive pressure ventilation and effective fluid management, are important and expedite fixation of bone fractures. PMID:2245559

  17. Embolic renal infarction mimicking renal colic

    OpenAIRE

    Mahamid M; Francis A.; Abid A; Awawde M; Abu-Elhija O

    2014-01-01

    Mahmud Mahamid,1,3 Adi Francis,2 Ali Abid,1 Mohammed Awawde,1 Omar Abu-Elhija11Department of Internal Medicine, 2Cardiac Care Unit, Holy Family Hospital, Bar-Ilan University, Nazareth, Israel; 3Digestive Disease Institute, Liver Unit, Shaare Zedek Medical Center, Jerusalem, IsraelAbstract: Atrial fibrillation is a major health problem with risk of systemic arterial embolism. Acute embolic renal infarction is a rare condition with symptoms that are often nonspecific. We present a 36-year-old p...

  18. Pulmonary Embolism with Vertebral Augmentation Procedures

    Directory of Open Access Journals (Sweden)

    Swetha Bopparaju

    2013-01-01

    Full Text Available With the prevalence of an aging American population on the rise, osteoporotic vertebral fractures are becoming a common occurrence, resulting in an increase in vertebral augmentation procedures and associated complications such as cement leakage, vertebral compressions, and pulmonary embolism. We describe a patient who presented with respiratory distress three years following kyphoplasty of the lumbar vertebra. Computed tomography (CT angiogram of the chest confirmed the presence of polymethylmethacrylate (PMMA cement in the lung fields and pulmonary vessels. We conducted a systematic review of the published literature identifying effective management strategies for the treatment of vertebroplasty-associated pulmonary embolism.

  19. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Chun Xiang; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Chowdhury, Shahryar M. [Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Fox, Mary A. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations. (orig.)

  20. Cardiac arrest caused by multiple recurrent pulmonary embolism

    DEFF Research Database (Denmark)

    Hannig, Kjartan Eskjaer; Husted, Steen Elkjaer; Grove, Erik Lerkevang

    2011-01-01

    Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1) The ...... and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism.......) The importance of optimal anticoagulant treatment in the prevention of pulmonary embolism reoccurrence. (2) The benefit of immediate accessibility to echocardiography in the handling of haemodynamically unstable patients with an unknown underlying cause. (3) Thrombolytic treatment should always be considered...

  1. Acute pulmonary embolism in helical computed tomography

    International Nuclear Information System (INIS)

    Pulmonary embolism is a common condition in which diagnostic and therapeutic delays contribute to substantial morbidity and mortality. Clinical diagnosis is difficult because the signs and symptoms re unspecific, and a differential diagnosis is extensive, including pneumonia or bronchitis, asthma, myocardial infraction, pulmonary edema, anxiety, dissection of the aorta, pericardial tamponade, lung cancer, primary pulmonary hypertension, rib fracture, and pneumothorax. The purpose of the study was to present the use of CT in diagnosing acute pulmonary embolism. A group of 23 patients with clinically suspected pulmonary embolism underwent CT examination with a helical CT scanner (Somatom Emotion, Siemens) before and after administration of 150 ml of Ultravist. Pulmonary embolism was found in the CT examinations of 13 patients. In two of these it was a central filling defect. Amputation of the artery was found in one. Parietal filling defect in three patients formed an acute angle with the vessel walls. Saddle emboli appearing as filling defects in the contrast column that hung over vessel bifurcations was found in two patients. In five patients,emboli were found in small segmental arteries. CT provides information not only on the pulmonary arteries, but also on the lung parenchyma, hila, mediastinum, and the heart. Alternative findings may be identified by CT chest examination, stablishing alternative diagnoses, including pulmonary disorders (such as pneumonia or fibrosis), pleural abnormalities, and cardiovascular disease (such as aortic dissection or pericardial tamponade). Another advantage of the CT is its widespread availability.(author)

  2. Partial splenic artery embolization in cirrhotic patients

    OpenAIRE

    Hadduck, Tyson A; McWilliams, Justin P.

    2014-01-01

    Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increase...

  3. Acute Thrombo-embolic Renal Infarction

    Directory of Open Access Journals (Sweden)

    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  4. Acute Thrombo-embolic Renal Infarction.

    Science.gov (United States)

    Zhou, Haijiang; Yan, Yong; Li, Chunsheng; Guo, Shubin

    2016-07-01

    A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA).

  5. Arterial embolization in patients with renal carcinoma

    DEFF Research Database (Denmark)

    Christensen, S W; Berg, J; Brynitz, S;

    1989-01-01

    The literature concerning embolization of the renal artery in patients with renal cell carcinoma is reviewed. Based on this review it is concluded that the method is useful in this patient group as it will facilitate the surgical procedure if nephrectomy is performed afterwards. Used as a...

  6. Clinical Application of Partial Splenic Embolization

    Directory of Open Access Journals (Sweden)

    Yong-Song Guan

    2014-01-01

    Full Text Available Partial splenic embolization (PSE is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

  7. Clinical application of partial splenic embolization.

    Science.gov (United States)

    Guan, Yong-Song; Hu, Ying

    2014-01-01

    Partial splenic embolization (PSE) is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

  8. Bronchial Artery Aneurysm Embolization with NBCA

    International Nuclear Information System (INIS)

    We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not

  9. Endovascular embolization of pulmonary arteriovenous malformations

    Institute of Scientific and Technical Information of China (English)

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; DUAN Feng; WANG Zhi-jun; SONG Peng

    2010-01-01

    Background The major consequence of pulmonary arteriovenous malformations (PAVMs) is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients (n=23) with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases.Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from (78.04±8.22)% to (95.13±3.67)% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization (fe=9.101, P <0.001). Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who

  10. COMPLICATION ANALYSIS OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH CONTROLLABLE COILS

    Institute of Scientific and Technical Information of China (English)

    王大明; 凌锋; 王安顺

    2004-01-01

    Objective To explore the causes, prevention, and management of the complications during intracranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC). Methods Retrospective review of 120 cases with 125 intracranial aneurysms embolized with controllable coils from March 1995 to July 1999 was conducted. The 20 accidents (in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed. Results Among the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolizationrelated mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33% (4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization. Conclusion Skilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

  11. Acute paraplegia following embolization of spinal dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    HUANG Cheng-guang; QI Xiang-qian; CHEN Huai-rui; L(U) Li-quan; WU Xiao-jun; BAI Ru-lin; LU Yi-cheng

    2011-01-01

    Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

  12. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  13. Acute tumor lysis syndrome after proximal splenic artery embolization

    OpenAIRE

    Jason T. Salsamendi; Mehul H. Doshi; Francisco J. Gortes; Levi, Joe U; Govindarajan Narayanan

    2016-01-01

    Preoperative splenic artery embolization for massive splenomegaly has been shown to reduce intraoperative hemorrhage during splenectomy. We describe a case of tumor lysis syndrome after proximal splenic artery embolization in a patient with advanced mantle cell lymphoma and splenic involvement. The patient presented initially with hyperkalemia two days after embolization that worsened during splenectomy. He was stabilized, but developed laboratory tumor lysis syndrome with renal failure and e...

  14. Plasma cross linked fibrin degradation products in pulmonary embolism.

    OpenAIRE

    Rowbotham, B J; Egerton-Vernon, J; Whitaker, A. N.; Elms, M J; Bunce, I H

    1990-01-01

    Plasma concentrations of cross linked fibrin degradation products, a marker of intravascular thrombosis and fibrinolysis, were measured in 495 patients with suspected pulmonary embolism referred for ventilation-perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis. Lung scans were described as normal (n = 66) or as showing a low (n = 292), indeterminate (n = 58), or high probability (n = 79) of pulmonary embolism. ...

  15. Deep vein thrombosis and pulmonary embolism in the Chinese population

    OpenAIRE

    Nandi, PL; Li, WS; Leung, R.; Chan, HT; Chan, J

    1998-01-01

    Deep vein thrombosis and pulmonary embolism is a well-recognised major health problem in the West. There is a deep-rooted belief among clinicians that deep vein thrombosis is rare in Asians, particularly in the Chinese population. However, it appears that the incidence of venous thrombosis and pulmonary embolism is increasing in Chinese patients. Prophylaxis reduces the incidence of venous thrombosis by 66% and of pulmonary embolism by 50%Ը? prophylaxis should therefore be considered for Chin...

  16. Complex Coil Assisted Single Coil Embolization for Small Intracranial Aneurysm

    OpenAIRE

    Yang, Ming-Shiang; Yang, Tzu-Hsien; Ou, Chang-Hsien; Chan, Si-Wa; Chen, Tai-I; Yang, Chia-Jung; Chiang, Chia-Ming; Huang, Wen-Chien

    2013-01-01

    The purpose of the technical note is to introduce the complex coil assisted coil embolization method in the treatment of intracranial small aneurysm, in order to enhance the safety of the procedure. The first microcatheter was navigated into the aneurysm sac and the ultrasoft coil was used as the embolization coil. If the embolizations coil could not stay within the aneurysm sac smoothly, such as coil herniation into parent artery during the delivery process. The second microcatheter would be...

  17. Therapeutic aspects of fat embolism syndrome.

    Science.gov (United States)

    Habashi, Nader M; Andrews, Penny L; Scalea, Thomas M

    2006-10-01

    Signs and symptoms of clinical fat embolism syndrome (FES) usually begin within 24-48 hours after trauma. The classic triad involves pulmonary changes, cerebral dysfunction, and petechial rash. Clinical diagnosis is key because laboratory and radiographic diagnosis is not specific and can be inconsistent. The duration of FES is difficult to predict because it is often subclinical or may be overshadowed by other illnesses or injuries. Medical care is prophylactic or supportive, including early fixation and general ICU management to ensure adequate oxygenation and ventilation, hemodynamic stability, prophylaxis of deep venous thrombosis, stress-related gastrointestinal bleeding, and nutrition. Studies support early fracture fixation as a method to reduce recurrent fat embolism and FES. The main therapeutic interventions once FES has been clinically diagnosed are directed towards support of pulmonary and neurological manifestations and management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). PMID:16990063

  18. Uterine artery embolization for cervical ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Qiao Zhou, MD

    2015-12-01

    Full Text Available A 36-year-old woman with 3 prior C-sections is diagnosed with a caesarean scar ectopic pregnancy. Despite receiving intramuscular and transvaginal methotrexate injection 2 months before presentation, the beta human chorionic gonadotropin was recorded to be 73 mIU/mL at the time of encounter. The patient complained of vaginal bleeding with a significant drop in hematocrit from 40% to 33%. Transvaginal ultrasound confirmed retroplacental hemorrhage and because of the patient's desire to retain fertility, interventional radiology was consulted to perform an uterine artery embolization. The uterine artery embolization was successful in achieving hemostasis and resulted in a decrease of betaHCG to 46 on postprocedure day 1 to <1 mIU/mL by postoperative week 3.

  19. Acute pulmonary embolism: the clinical conundrum

    Institute of Scientific and Technical Information of China (English)

    WANG Zeng-li

    2012-01-01

    Despite important advances in the diagnosis and treatment of acute pulmonary embolism (APE),assessment of risk and appropriate management of patients remains a difficult task in clinical practice.In addition to hemodynamic instability and critically clinical condition,acute right ventricular dysfunction (RVD) is a major determinant of in-hospital outcomes.The purpose of this review is to discuss the results of these recent developments.Some outcome evaluation,clinical assessment,and therapeutic implications are also included.

  20. Radiologic findings of cerebral septic embolism

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jee Young; Kim, Sang Joon; Kim Tae Hoon; Kim, Seung Chul; Kim, Jae Seung; Pai, Hyun Joo [Dankook Univ., Seoul (Korea, Republic of). Coll. of Medicine; Kim, Dong Ik [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine; Chang, Kee Hyun [Seoul National Univ. (Korea, Republic of). Coll. of Medicine; Choi, Woo Suk [Kyung Hee Univ., Seoul (Korea, Republic of). Coll. of Medicine

    1998-01-01

    To determine the MR and CT findings which differentiate cerebral septic embolism from thrombotic infarction. Cerebral septic embolism was confirmed by blood culture in six patients and autopsy in two. The number, size, distribution, contrast enhancement, and hemorrhage of the lesions, as seen on MR and CT, were retrospectively analyzed, and four patients were followed up for between one week and seven months. In a total of eight patients, infective endocarditis (n=5) and sepsis (n=3) caused cerebral septic embolism. The number, of lesions was 3 {approx} 7 in six patients, over 10 in one, and innumerable in one: these varied in size from punctate to 6 cm and were distributed in various areas of the brain. Gyral infarction was noted in five patients: non-enhancing patchy lesions involving the basal ganglia or white matter were found in five, tiny isolated nodular or ring-enhancing small lesions involving the cortex and white matter in three, peripheral rim-enhancing large lesions in one, and numerous enhancing nodules disseminated in the cortex in one. Hemorrhage had occurred in six. follow-up studies in four patients showed that initial lesions had enlarged in two and regressed in two: new lesions had appeared in two. Multiple lesions of different sizes and various patterns which include gyral infarction, patchy or nodular lesion in the cortex, white mater of basal ganglia, and isolated small ring-like or nodular enhancement or frequent hemorrhage are findings which could be helpful in the radiologic diagnosis of cerebral septic embolism. (author). 8 refs., 5 figs.

  1. Lung cancer mimicking massive pulmonary embolism

    OpenAIRE

    Kaier, Thomas Edward; Madani, Yasser

    2012-01-01

    Pulmonary embolism (PE) is a common finding in patients with underlying malignancy and is the commonest cause of acute cor pulmonale. A 65-year-old woman with a background of non-small-cell lung cancer presented to the emergency department with nausea and vomiting after starting erlotinib; she was pyrexial and had raised C-reactive protein. Despite aggressive fluid resuscitation and antibiotics the patient remained tachycardic, hypotensive, profoundly hypoxic and had a persistent raised jugul...

  2. Neural Hypernetwork Approach for Pulmonary Embolism diagnosis

    OpenAIRE

    Rucco, Matteo; Sousa-Rodriges, David; Merelli, Emanuela; Johnson, Jeffrey H.; Falsetti, Lorenzo; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    Background Hypernetworks are based on topological simplicial complexes and generalize the concept of two-body relation to many-body relation. Furthermore, Hypernetworks provide a significant generalization of network theory, enabling the integration of relational structure, logic and analytic dynamics. A pulmonary embolism is a blockage of the main artery of the lung or one of its branches, frequently fatal. Results Our study uses data on 28 diagnostic features of 1427 people consid...

  3. Acute tumor lysis syndrome after proximal splenic artery embolization

    Directory of Open Access Journals (Sweden)

    Jason T. Salsamendi

    2016-06-01

    Full Text Available Preoperative splenic artery embolization for massive splenomegaly has been shown to reduce intraoperative hemorrhage during splenectomy. We describe a case of tumor lysis syndrome after proximal splenic artery embolization in a patient with advanced mantle cell lymphoma and splenic involvement. The patient presented initially with hyperkalemia two days after embolization that worsened during splenectomy. He was stabilized, but developed laboratory tumor lysis syndrome with renal failure and expired. High clinical suspicion of tumor lysis syndrome in this setting is advised. Treatment must be started early to avoid serious renal injury and death. Lastly, same day splenectomy and embolization should be considered to decrease the likelihood of developing tumor lysis syndrome.

  4. Acute tumor lysis syndrome after proximal splenic artery embolization.

    Science.gov (United States)

    Salsamendi, Jason T; Doshi, Mehul H; Gortes, Francisco J; Levi, Joe U; Narayanan, Govindarajan

    2016-06-01

    Preoperative splenic artery embolization for massive splenomegaly has been shown to reduce intraoperative hemorrhage during splenectomy. We describe a case of tumor lysis syndrome after proximal splenic artery embolization in a patient with advanced mantle cell lymphoma and splenic involvement. The patient presented initially with hyperkalemia two days after embolization that worsened during splenectomy. He was stabilized, but developed laboratory tumor lysis syndrome with renal failure and expired. High clinical suspicion of tumor lysis syndrome in this setting is advised. Treatment must be started early to avoid serious renal injury and death. Lastly, same day splenectomy and embolization should be considered to decrease the likelihood of developing tumor lysis syndrome. PMID:27257458

  5. Radionuclide venography of the lower limbs in pulmonary embolism

    International Nuclear Information System (INIS)

    In 62 unselected patients affected by pulmonary embolism, radionuclide venography of the lower limbs was performed in order to detect the source of the emboli. Vascular obstruction were found in the deep veins in 13 cases, in the superficial veins in another 13, while in 3 patients both veneous systems were affected. These results suggest that a relationship between superficial vein thrombosis and pulmonary embolism exists. Radionuclide venography allowed us to detect venous obstruction in 6 out of 15 patients with pulmonary embolism but without both anamnesic and clinical evidence of venous thrombosis; hence, this technique may be useful in all cases of pulmonary embolism of unknown origin

  6. Pneumatic compression for embolic protection during upper extremity endovascular intervention.

    Science.gov (United States)

    Cassar, Andrew; Barsness, Gregory W; Wysokinski, Waldemar E; Gifford, Shaun M; Bower, Thomas C; Edwards, William D; Gulati, Rajiv

    2014-01-01

    Embolic protection devices are occasionally employed during endovascular interventions to prevent complications caused by embolic debris. However, these devices have imperfect efficacy, confer risk of endovascular trauma, and are expensive. We report a patient with giant cell arteritis and symptomatic axillary artery stenosis, with a perceived elevated risk of distal embolization during endovascular intervention. We describe a straightforward embolic protection technique of brachial pressure cuff inflation during endovascular intervention and aspiration of displaced thrombotic material from the static column of blood. This novel, effective, and cost-free technique could also be employed in other vascular beds during endovascular intervention.

  7. Portal vein embolization induces compensatory hypertrophy of remnant liver

    Institute of Scientific and Technical Information of China (English)

    Jing-Yao Huang; Wei-Zhu Yang; Jian-Jun Li; Na Jiang; Qu-Bin Zheng

    2006-01-01

    AIM: To evaluate the effectiveness and safety of different portal vein branch embolization agents in inducing compensatory hypertrophy of the remnant liver and to offer a theoretic basis for clinical portal vein branch embolization.METHODS: Forty-one adult dogs were included in the experiment and divided into four groups. Five dogs served as a control group, 12 as a gelfoam group, 12as a coil-gelfoam group and 12 as an absolute ethanol group. Left portal vein embolization was performed in each group. The results from the embolization in each group using different embolic agents were compared.The safety of portal vein embolization (PVE) was evaluated by liver function test, computed tomography (CT) and digital subtraction angiography (DSA) of liver and portal veins. Statistical test of variance was performed to analyze the results.RESULTS: Gelfoam used for PVE was inefficient in recanalization of portal vein branch 4 wk after the procedure. The liver volume in groups of coil-gelfoam and absolute ethanol increased 25.1% and 33.18%,respectively. There was no evidence of recanalization of embolized portal vein, hepatic dysfunction, and portal hypertension in coil-gelfoam group and absolute ethanol group.CONCOUSION: Portal vein branch embolization using absolute ethanol and coil-gelfoam could induce atrophy of the embolized lobes and compensatory hypertrophy of the remnant liver. Gelfoam is an inefficient agent.

  8. Renal artery embolization in severe nephrotic syndrome.

    Science.gov (United States)

    Solak, Yalcin; Koc, Osman; Ucar, Ramazan; Ozbek, Orhan; Ergenc, Hasan; Gaipov, Abduzhappar; Turk, Suleyman

    2016-07-01

    Introduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients. PMID:26833695

  9. Partial splenic artery embolization in cirrhotic patients

    Science.gov (United States)

    Hadduck, Tyson A; McWilliams, Justin P

    2014-01-01

    Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. PMID:24876920

  10. [Pulmonary circulation in embolic pulmonary edema].

    Science.gov (United States)

    Sanotskaia, N V; Polikarpov, V V; Matsievskiĭ, D D

    1989-02-01

    The ultrasonic method was used in acute experiments on cats with open chest under artificial lung ventilation to obtain blood flow in low-lobar pulmonary artery and vein, the blood pressure in pulmonary artery, as well as the left atrial pressure in fat (olive oil) and mechanical (Lycopodium spores) pulmonary embolism. It is shown that pulmonary embolism produces the decrease in the blood flow in pulmonary artery and vein, the increase of the pressure in pulmonary artery and left atria, the increase of lung vessels resistance. The decrease is observed of systemic arterial pressure, bradycardia, and extrasystole. After 5-10 min the restoration of arterial pressure and heart rhythm occur and partial restoration of blood flow in pulmonary artery and vein. In many experiments the blood flow in vein outdoes that in the artery--it allows to suppose the increase of the blood flow in bronchial artery. After 60-90 min there occur sudden decrease of systemic arterial pressure, the decrease of the blood flow in pulmonary artery and vein. The pressure in pulmonary artery and resistance of pulmonary vessels remain high. Pulmonary edema developed in all animals. The death occurs in 60-100 min after the beginning of embolism. PMID:2923969

  11. Percutaneous N-Butyl cyanoacrylate embolization of a pancreatic pseudoaneurysm after failed attempts of transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ri Hyeon; Yoo, Roh Eul; Kim, Hyo Cheol [Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-10-15

    One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

  12. Water-Borne Endovascular Embolics Inspired by the Undersea Adhesive of Marine Sandcastle Worms.

    Science.gov (United States)

    Jones, Joshua P; Sima, Monika; O'Hara, Ryan G; Stewart, Russell J

    2016-04-01

    Transcatheter embolization is used to treat vascular malformations and defects, to control bleeding, and to selectively block blood supply to tissues. Liquid embolics are used for small vessel embolization that require distal penetration. Current liquid embolic agents have serious drawbacks, mostly centered around poor handling characteristics and toxicity. In this work, a water-borne in situ setting liquid embolic agent is described that is based on electrostatically condensed, oppositely charged polyelectrolytes-complex coacervates. At high ionic strengths, the embolic coacervates are injectable fluids that can be delivered through long narrow microcatheters. At physiological ionic strength, the embolic coacervates transition into a nonflowing solid morphology. Transcatheter embolization of rabbit renal arteries demonstrated capillary level penetration, homogeneous occlusion, and 100% devascularization of the kidney, without the embolic crossing into venous circulation. The benign water-borne composition and setting mechanism avoids many of the problems of current liquid embolics, and provides precise temporal and spatial control during endovascular embolization. PMID:26806763

  13. A microfluidic pump/valve inspired by xylem embolism and transpiration in plants.

    Directory of Open Access Journals (Sweden)

    Li Jingmin

    Full Text Available In plants, transpiration draws the water upward from the roots to the leaves. However, this flow can be blocked by air bubbles in the xylem conduits, which is called xylem embolism. In this research, we present the design of a biomimetic microfluidic pump/valve based on water transpiration and xylem embolism. This micropump/valve is mainly composed of three parts: the first is a silicon sheet with an array of slit-like micropores to mimic the stomata in a plant leaf; the second is a piece of agarose gel to mimic the mesophyll cells in the sub-cavities of a stoma; the third is a micro-heater which is used to mimic the xylem embolism and its self-repairing. The solution in the microchannels of a microfluidic chip can be driven by the biomimetic "leaf" composed of the silicon sheet and the agarose gel. The halting and flowing of the solution is controlled by the micro-heater. Results have shown that a steady flow rate of 1.12 µl/min can be obtained by using this micropump/valve. The time interval between the turning on/off of the micro-heater and the halt (or flow of the fluid is only 2∼3 s. This micropump/valve can be used as a "plug and play" fluid-driven unit. It has the potential to be used in many application fields.

  14. A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ou, Ming-Ching; Chuang, Ming-Tsung [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Lin, Xi-Zhang [Department of Internal Medicine, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Tsai, Hong-Ming; Chen, Shu-Yuan [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Liu, Yi-Sheng, E-mail: taicheng100704@yahoo.com.tw [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China)

    2013-08-15

    Purpose: To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches. Materials and methods: A total of 43 liver cirrhosis patients (mean age, 62.19 ± 9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE. Results: PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81 ± 1.69 × 10{sup 3}/mm{sup 3} before PSE to 8.56 ± 3.14 × 10{sup 3}/mm{sup 3} at 1 week after PSE (P < 0.001). Mean platelet count significantly increased from 62.00 ± 22.62 × 10{sup 3}/mm{sup 3} before PSE to 95.40 ± 46.29 × 10{sup 3}/mm{sup 3} 1 week after PSE (P < 0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ] = 0.687, P < 0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16 ± 8.96%. Conclusions: The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ = 0.687.

  15. An experimentally induced fat embolism in the rabbit lung; high-resolution CT and pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong-Ho; Lee, Ki-Nam; Jeong, Jin Sook [Donga Univ. College of Medicine, Pusan (Korea, Republic of)

    2001-02-01

    To assess the high-resolution CT and pathologic findings of fat embolism experimentally induced in rabbit lung. Twelve rabbits were divided into four groups, namely control, 2-hour, 24-hour, and 72-hour, with three rabbits in each, and closed tibiofibular fractures were induced. After the rabbits were sacrificed, high-resolution CT scanning of the artificially inflated lungs was performed, and the CT findings were analyzed by two radiologists. They determined the presence or absence of ground glass opacity or consolidation, the extent of the lesions (using a 10% grading scale), and their distribution, reaching a consensus. The pathologic findings were analyzed using the specimens prepared by H and E and Oil-red O staining. Although the high-resolution CT findings of pulmonary fat embolism were nonspecific, bilateral patchy ground glass opacity (100%), and focal air-space consolidation surrounding the bronchovascular bundle (89%) were most common. In all groups, the occlusion of vessels by fat globules was confirmed by Oil-red O staining. The microscopic findings included focal pulmonary hemorrhage, edema, alveolar collapse, and extensive infiltration of inflammatory cells in the lung parenchyma. The 24-hour group showed more extensive change in high-resolution CT and pathologic findings than did the others. Fat embolism in rabbit lung may occur after closed tibio-fibular fracture. The extent of the lesion revealed by high-resolution CT correlated closely with the pathologic findings. High-resolution CT may thus be helpful for the detection of pulmonary fat embolism and evaluation of its extent.

  16. An experimentally induced fat embolism in the rabbit lung; high-resolution CT and pathologic findings

    International Nuclear Information System (INIS)

    To assess the high-resolution CT and pathologic findings of fat embolism experimentally induced in rabbit lung. Twelve rabbits were divided into four groups, namely control, 2-hour, 24-hour, and 72-hour, with three rabbits in each, and closed tibiofibular fractures were induced. After the rabbits were sacrificed, high-resolution CT scanning of the artificially inflated lungs was performed, and the CT findings were analyzed by two radiologists. They determined the presence or absence of ground glass opacity or consolidation, the extent of the lesions (using a 10% grading scale), and their distribution, reaching a consensus. The pathologic findings were analyzed using the specimens prepared by H and E and Oil-red O staining. Although the high-resolution CT findings of pulmonary fat embolism were nonspecific, bilateral patchy ground glass opacity (100%), and focal air-space consolidation surrounding the bronchovascular bundle (89%) were most common. In all groups, the occlusion of vessels by fat globules was confirmed by Oil-red O staining. The microscopic findings included focal pulmonary hemorrhage, edema, alveolar collapse, and extensive infiltration of inflammatory cells in the lung parenchyma. The 24-hour group showed more extensive change in high-resolution CT and pathologic findings than did the others. Fat embolism in rabbit lung may occur after closed tibio-fibular fracture. The extent of the lesion revealed by high-resolution CT correlated closely with the pathologic findings. High-resolution CT may thus be helpful for the detection of pulmonary fat embolism and evaluation of its extent

  17. Two different embolic agents in the treatment of uterine arterial embolization for symptomatic fibroids

    International Nuclear Information System (INIS)

    Objective: To compare the efficacy and safety of dextran microspheres and polyvinyl alcohol particles in the uterine arterial embolization (UAE)for symptomatic uterine leiomyomata. Methods: Forty women (mean aged 38.5 years, ranged 28-44 years)with symptomatic myomas were randomly divided into two groups with 20 patients in each, PVA (polyvinyl alcohol particles, 355-500 μm)was used as embolic agents in group A and dextran microspheres(Sephadex G-50, 100-300 μm)in group B. The mean diameter of fibroids was 6.5 cm (range, 3-12 cm)with symptoms of menorrahgia, bulk-related symptoms, dysmenorrhea and infertility. Analgesics, anti-infection and rehydration treatments were used after the procedure. The hospital stay, post-embolization syndromes, follow-up materials were reviewed and compared. Results: The hospital stay and the post embolization pain showed no obvious difference between the two groups, simultaneously with no serious complications. The average follow-up duration was 9 months (range, 6-24 months). The average volumes of uterus and fibroid in group A and B decreased gradually during follow-up: 53.4%, 55% and 48.6%, 40.9%, respectively. Conclusion: Dextran microspheres is as the same effective and safe as PVA particles for UAE, but rather cheaper than latter. Further prospective study is warranted. (authors)

  18. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  19. Prognostic factors in bronchial arterial embolization for hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eui Jong; Yoon, Yup; Oh, Joo Hyeong; Lim, Joo Won; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-07-15

    To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. Medical records, angiographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the angiographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). Rebleeding occurred in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non- recurred cases showed severe neovascularity. More than three angiographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non- recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non- recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. The history of repeated hemoptysis, severe neovascularity, variable angiographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions.

  20. Embolization with the Amplatzer Vascular Plug in TIPS patients

    NARCIS (Netherlands)

    P.M.T. Pattynama (Peter); A. Wils (Alexandra); E. van der Linden (Edwin); L.C. van Dijk (Lukas)

    2007-01-01

    textabstractVessel embolization can be a valuable adjunct procedure in transjugular intrahepatic portosystemic shunt (TIPS). During the creation of a TIPS, embolization of portal vein collaterals supplying esophageal varices may lower the risk of secondary rebleeding. And after creation of a TIPS, c

  1. Embolization to treat pelvic congestion syndrome and vulval varicose veins.

    NARCIS (Netherlands)

    Vleuten, C.J.M. van der; Kempen, J.A.L. van; Schultze Kool, L.J.

    2012-01-01

    OBJECTIVE: To evaluate the efficacy of embolization for treating the symptoms of pelvic congestion syndrome (PCS). METHODS: Twenty-one women with PCS who were treated with embolization at Radboud University Nijmegen Medical Centre between 2003 and 2008 were sent a questionnaire about their symptoms

  2. Maternal death due to non-traumatic fat embolism.

    Science.gov (United States)

    Karayel, Ferah; Arican, Nadir; Kavas, Gamze; Turan, Arzu Akcay; Pakis, Isil

    2005-09-01

    The aim of this report is to document a case of non-traumatic fat embolism (NTFE) and to address the need for considerition of fat embolism in suspicious deaths resulting from respiratory distress in the postpartum period. A 28-years-old woman autopsied at the Morgue Department of the Council of Forensic Medicine is included to the study. This female became unconscious and developed respiratory distress 4 h after delivery, and this was followed by respiratory arrest. External examination revealed resuscitation marks and normal postmortem changes. Light microscopy revealed massive fat embolization involving most of the alveolar capillaries on several sections. Only in one particular area was a bone marrow embolus. Pathological diagnosis of the lung was diffuse pulmonary fat embolism. There was no evidence of other organ involvement with emboli. Other visceral organs showed no striking findings other than mild congestion. The cause of death was considered to be respiratory insufficiency resulting from severe fat embolism of the lungs.

  3. Vulnerability of Protoxylem and Metaxylem Vessels to Embolisms and Radial Refilling in a Vascular Bundle of Maize Leaves.

    Science.gov (United States)

    Hwang, Bae Geun; Ryu, Jeongeun; Lee, Sang Joon

    2016-01-01

    Regulation of water flow in an interconnected xylem vessel network enables plants to survive despite challenging environment changes that can cause xylem embolism. In this study, vulnerability to embolisms of xylem vessels and their water-refilling patterns in vascular bundles of maize leaves were experimentally investigated by employing synchrotron X-ray micro-imaging technique. A vascular bundle in maize consisted of a protoxylem vessel with helical thickenings between two metaxylem vessels with single perforation plates and nonuniformly distributed pits. When embolism was artificially induced in excised maize leaves by exposing them to air, protoxylem vessels became less vulnerable to dehydration compared to metaxylem vessels. After supplying water into the embolized vascular bundles, when water-refilling process stopped at the perforation plates in metaxylem vessels, discontinuous radial water influx occurred surprisingly in the adjacent protoxylem vessels. Alternating water refilling pattern in protoxylem and metaxylem vessels exhibited probable correlation between the incidence location and time of water refilling and the structural properties of xylem vessels. These results imply that the maintenance of water transport and modulation of water refilling are affected by hydrodynamic roles of perforation plates and radial connectivity in a xylem vascular bundle network. PMID:27446168

  4. Preoperative embolization of primary bone tumors: A case control study

    Science.gov (United States)

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand

    2016-01-01

    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  5. Endovascular embolization through pulmonary artery access for refractory massive hemoptysis

    International Nuclear Information System (INIS)

    Objective: To determine the effectiveness of endovascular embolization through pulmonary artery access in patients with refractory massive hemoptysis in whom systemic artery (SA) embolization is ineffective or contraindicated. Methods: A total of 102 patients were treated with SA embolization for hemoptysis. Of the 102 patients,6 patients had severe persistent hemoptysis despite complete SA embolization and 1 patient had severe hemoptysis following complete bronchial artery embolization and other SA embolization was contraindicated. The underlying diseases were chronic cavitary pulmonary tuberculosis (n=3), chronic cavitary pulmonary tuberculosis complicated with aspergilloma (n=1), tuberculous bronchiectasis (n=1), severe necrotizing pneumonia (n=1) and bronchiectasis complicated with pneumatocele (n=1). The findings of SA angiography, main pulmonary angiography and selective pulmonary angiography were analyzed. Endovascular embolization was performed in patients with the detectable pathology in PA and the clinical results were observed. Results: The findings of SA angiography showed bronchopulmonary shunting in all cases, and pseudoaneurysm of PA in 2 cases and hypertrophy of peripheral PA in 2 cases. The main PA angiography demonstrated pseudoaneurysm of PA in 1 case and hypoperfusion of the diseased PA in other case. The selective PA angiography demonstrated pseudoaneurysm of PA in 4 cases (1 case with extravasation of contrast medium) and hypertrophy of peripheral PA in 2 cases. Coil embolization of the pathologic PA were successfully performed and bleeding ceased in all patients. During follow-up, 1 patient had episodic bloody sputum after embolization, and 2 died day 6 and 15 of severe infection and respiratory failure and the remaining patients were all stable, Conclusions: In patients with refractory massive hemoptysis after systemic embolization, the possibility of PA pathology, especially pseudoaneurysm of PA should be considered. Selective pulmonary

  6. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Nishant Sinha

    2015-01-01

    Full Text Available Pulmonary Cement Embolization (PCE is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation.

  7. A rat model for embolic encephalitis

    DEFF Research Database (Denmark)

    Astrup, Lærke Boye; Agerholm, Jørgen Steen; Aalbæk, Bent;

    2011-01-01

    gain access to the brain by the circulation and, no foreign materials other than bacteria are implated in the brain. This ensures high face-validity and high construct-validity of the model for three reasons: 1) Cerebral infarction by thrombosis or disseminated intravascular coagulation is a key......µl thrombin (2.5 IU/ml) in a catheter until coagulated. A sterile fibrin-clot of 5 mm was selected for embolization and injected via the ECA catheter. The common carotid artery was clamped during injection thereby directing the embolus via the internal carotid artery to the brain. The clot...

  8. SPECT/CT and pulmonary embolism

    OpenAIRE

    Mortensen, Jann; Gutte, Henrik

    2013-01-01

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan i...

  9. Cardiogenic embolism producing crescendo transient ischemic attacks.

    Science.gov (United States)

    Geraghty, Patrick J; Oak, Jack; Choi, Eric T

    2005-09-01

    Lateralizing, repetitive transient ischemic attacks are characteristic of symptomatic carotid bifurcation atherosclerotic plaques. We report a case in which a cardiogenic embolus, after lodging at the left carotid bifurcation, produced crescendo episodes of expressive aphasia and mild right upper extremity weakness. Complete neurological recovery was achieved following emergent carotid embolectomy and endarterectomy. This case demonstrates that the laminar nature of internal carotid blood flow may result in the localization of embolic events to a single region of the cerebral vasculature, regardless of the source lesion in the carotid artery. The role of endoluminal techniques in the diagnosis and management of such lesions is discussed.

  10. Hemoptysis and hemoperitoneum due to metastatic gestational choriocarcinma: bronchial artery embolization and superselective splenic artery embolization: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom; Park, Byung Ho; Yoon, Seong Kuk; Kim, Chan Sung; Lee, Jin Hwa; Oh, Jong Young [Donga University School of Medicine, Pusan (Korea, Republic of); Seong, Chang Kyu; Kim, Yong Joo; Kim, Young Hwan [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2003-01-01

    Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesion and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

  11. Preoperative endovascular embolization of a cerebellar hemangioblastoma

    Directory of Open Access Journals (Sweden)

    Almeida-Pérez Rafael

    2013-06-01

    Full Text Available Introduction: hemangioblastomas are benign tumors located in the cerebellum, whichaffect young adults predominantly. These injuries are recognized by its abundant vascularizationwhich makes difficult its resection.Clinical case: The experience in the endovascular treatment of a patient with a cerebellarhemangioblastoma is exposed, emphasizing in the technical considerations andnecessary materials to achieve a successful embolization.Conclusion: Endovascular embolization of tumour vessels facilitates its surgical resectiondue to it decreases the intraoperative hemorrhage and the possibilities of neurovascularinjuries, although its security profile has been questioned due to the risk ofunleashing intratumoral hemorrhage. Rev.cienc.biomed. 2013; 4(1: 170-173RESUMEN:Introducción: los hemangioblastomas son tumores benignos localizados con mayorfrecuencia en el cerebelo, que afectan predominantemente a los adultos jóvenes. Estaslesiones son reconocidas por su abundante vascularización, lo cual dificulta su resección.Caso clínico: se expone la experiencia en el tratamiento endovascular de una pacientecon un hemangioblastoma cerebeloso, destacando las consideraciones técnicas y losmateriales necesarios para lograr una embolización exitosa.Conclusión: la embolización endovascular de los vasos tumorales facilita su resecciónquirúrgica, debido a que disminuye el sangrado intraoperatorio y las probabilidades delesiones neurovasculares, aunque su perfil de seguridad ha sido cuestionado debidoal riesgo de desencadenar hemorragias intratumorales. Rev.cienc.biomed. 2013;4(1: 170-173

  12. Preoperative embolization of thoracolumbal spinal tumors-technical aspects of procedure

    International Nuclear Information System (INIS)

    Preoperative endovascular embolization of hyper vascular spinal tumors is established procedure to reduce intraoperative blood loss. 48 embolization procedures in 43 patient with primary or metastatic tumors in thoracolumbal spine were retrospectively analysed. The purpose of this study was to assess the technical and anatomical aspects, degree of tumor embolization and safety of the embolization procedure. Our results were compared with similar or larger studies. Preoperative embolization of spinal tumors is safe procedure, that contributes to a success of surgical intervention. (author)

  13. Pushable springcoil embolization of pseudoaneurysms caused by gluteal stab injuries

    International Nuclear Information System (INIS)

    Purpose: To retrospectively review the outcomes of 21 patients with stab wounds to the gluteal region who underwent embolization for pseudoaneurysms causing active bleeding. Materials and methods: Between 1997 and 2007, 3 superior gluteal artery, 2 inferior gluteal artery and 16 deep femoral artery muscular branch pseudoaneurysms detected by digital subtraction angiography were selectively catheterized with diagnostic catheters with hydrophilic coating and embolized with pushable springcoils. 17 of the 21 pseudoaneurysms were located in a distal end of an artery where outflow vessels could not be depicted. The other 4 lesions were side wall injuries which required the placement of coils distal and proximal to the injury site. Results: Embolization was successful in controlling the bleeding in all of the patients. 16 patients required 1 or 2 coils, 4 patients required 3 coils and 1 patient required 5 coils. 2 patients had femoral puncture site hematomas which resolved spontaneously. 2 patients required surgical evacuation of large gluteal hematomas following the embolization because of symptoms second to mass effect. There were no procedure related major complications or mortality. Conclusions: Our experience demonstrates that pushable coil embolization is a relatively simple, effective and economic method for the embolization of pseudoaneurysms caused by penetrating gluteal injuries. Experimenting with other embolization materials does not seem to be justified.

  14. Transcatheter arterial embolization massive of haemorrhage in pelvic fracture

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical therapeutic effect of transcatheter arterial embolization (TAE) for treating massive haemorrhage in pelvic fracture (traffic accident 23, fall injury 5, hit trauma 4, crush injury 3). Methods: Thirty five patients with massive haemorrhage of pelvic fracture(traffic accident 23, fall injury 5, hit trauma 4, crush injury 3), also included 18 complicated injury cases. The inguinal region with free of or small hematoma was apt for femoral arterial puncture and followed by transcatheter bilateral iliac arterioangiography in order to confirm the site of haemorrhage. The gelfoam embolization was performed with superselective catheterization, otherwise the trunk of iliac artery would be embolized to slow down the blood flow and then coils with diameter from 5 to 8 mm were used for embolizing the trunk of iliac artery finally. The bilateral iliac arteries were embolized in the case of patients with bilateral or intermediate fracture. Results: Arterial spasm occurred in all patients with different severities and the patchy or linear extravasation of the contrast agent appeared in 29 patients through arteriography. All patients passed a successful embolization with a recovery of normal blood pressure (90-130)/(60-90)mmHg within 24 hours, without serious complications except one person had a minor skin necrosis at the distal part of big toe. Conclusions: The transcatheter arterial embolization is a simple, minimally invasive, safe and effective procedure, for treating the massive haemorrhage of pelvic fracture. (authors)

  15. Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ali Fani

    2013-05-01

    Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

  16. Grapevine petioles are more sensitive to drought induced embolism than stems: evidence from in vivo MRI and microcomputed tomography observations of hydraulic vulnerability segmentation.

    Science.gov (United States)

    Hochberg, Uri; Albuquerque, Caetano; Rachmilevitch, Shimon; Cochard, Herve; David-Schwartz, Rakefet; Brodersen, Craig R; McElrone, Andrew; Windt, Carel W

    2016-09-01

    The 'hydraulic vulnerability segmentation' hypothesis predicts that expendable distal organs are more susceptible to water stress-induced embolism than the main stem of the plant. In the current work, we present the first in vivo visualization of this phenomenon. In two separate experiments, using magnetic resonance imaging or synchrotron-based microcomputed tomography, grapevines (Vitis vinifera) were dehydrated while simultaneously scanning the main stems and petioles for the occurrence of emboli at different xylem pressures (Ψx ). Magnetic resonance imaging revealed that 50% of the conductive xylem area of the petioles was embolized at a Ψx of -1.54 MPa, whereas the stems did not reach similar losses until -1.9 MPa. Microcomputed tomography confirmed these findings, showing that approximately half the vessels in the petioles were embolized at a Ψx of -1.6 MPa, whereas only few were embolized in the stems. Petioles were shown to be more resistant to water stress-induced embolism than previously measured with invasive hydraulic methods. The results provide the first direct evidence for the hydraulic vulnerability segmentation hypothesis and highlight its importance in grapevine responses to severe water stress. Additionally, these data suggest that air entry through the petiole into the stem is unlikely in grapevines during drought.

  17. Grapevine petioles are more sensitive to drought induced embolism than stems: evidence from in vivo MRI and microcomputed tomography observations of hydraulic vulnerability segmentation.

    Science.gov (United States)

    Hochberg, Uri; Albuquerque, Caetano; Rachmilevitch, Shimon; Cochard, Herve; David-Schwartz, Rakefet; Brodersen, Craig R; McElrone, Andrew; Windt, Carel W

    2016-09-01

    The 'hydraulic vulnerability segmentation' hypothesis predicts that expendable distal organs are more susceptible to water stress-induced embolism than the main stem of the plant. In the current work, we present the first in vivo visualization of this phenomenon. In two separate experiments, using magnetic resonance imaging or synchrotron-based microcomputed tomography, grapevines (Vitis vinifera) were dehydrated while simultaneously scanning the main stems and petioles for the occurrence of emboli at different xylem pressures (Ψx ). Magnetic resonance imaging revealed that 50% of the conductive xylem area of the petioles was embolized at a Ψx of -1.54 MPa, whereas the stems did not reach similar losses until -1.9 MPa. Microcomputed tomography confirmed these findings, showing that approximately half the vessels in the petioles were embolized at a Ψx of -1.6 MPa, whereas only few were embolized in the stems. Petioles were shown to be more resistant to water stress-induced embolism than previously measured with invasive hydraulic methods. The results provide the first direct evidence for the hydraulic vulnerability segmentation hypothesis and highlight its importance in grapevine responses to severe water stress. Additionally, these data suggest that air entry through the petiole into the stem is unlikely in grapevines during drought. PMID:26648337

  18. Relationships between xylem embolism and eco-physiological indices in eight woody plants in sltu(Ⅱ):The relationship with photosynthetic eco-physiological indices

    Institute of Scientific and Technical Information of China (English)

    AN Feng; CAI Jing; JIANG Zaimin; ZHANG Yuanying; ZHAO Pingjuan; ZHANG Shuoxin

    2007-01-01

    The relationship between xylem embolism and eco-physiology indices (I.e.photosynthetic available radiation,temperature,relative humidity,photosynthetic rate,transpiration rate,stomatal conductance and water use efficiency) in eight tree species was investigated in situ.The species studied,Robinia pseudoacacia L.,Acer truncatum Bge.,Hippophae rhamnoides L.,Ulmus pumila L.,Pinus tabulaeformis Carr., Pinus bungeana Zucc.ex Endl.,Ligustrum lucidum Ait.,and Salix matsudana Koidz.f.pendula Schneid,grow well on the Xilin campus of Northwest A&F University.Results indicated that photosynthetic available radiation,air temperature and relative humidity can affect xylem embolism by daily adjustment of stomatal conductance,transpiration rate and water relations of a tree.Embolism was a common case in the daily growth of the plants,and there was some correlation between xylem embolism and photosynthetic rate,transpiration rate,stornatal conductance,and water use efficiency.Embolism may thus be an adaptive mechanism by some tree species to water stress.

  19. A Multimodal Approach in Coil Embolization of a Bile Leak Following Cholecystectomy

    International Nuclear Information System (INIS)

    Bile leak is a well-known complication of cholecystectomy. Endoscopic drainage and decompression of the biliary system including temporary insertion of a biliary stent is generally considered the treatment of choice. We report the successful obliteration of a bile leak using fibered platinum coils placed under fluoroscopic guidance after stent treatment had failed

  20. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications.

    Science.gov (United States)

    Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith

    2016-01-01

    There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele. PMID:26658060

  1. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    Directory of Open Access Journals (Sweden)

    Joshua Halpern

    2016-01-01

    Full Text Available There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.

  2. Renoduodenal Fistula After Transcatheter Embolization of Renal Angiomyolipoma

    Energy Technology Data Exchange (ETDEWEB)

    Sheth, Rahul A. [Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology (United States); Feldman, Adam S. [Massachusetts General Hospital, Division of Urology, Department of Surgery (United States); Walker, T. Gregory, E-mail: tgwalker@partners.org [Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology (United States)

    2015-02-15

    Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.

  3. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach

    International Nuclear Information System (INIS)

    Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.

  4. Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism.

    LENUS (Irish Health Repository)

    Awad, I T

    2012-02-03

    A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.

  5. Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.

    Science.gov (United States)

    Reig, Adam S; Simon, Scott; Mericle, Robert A

    2009-11-01

    Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

  6. Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions

    Energy Technology Data Exchange (ETDEWEB)

    Rennert, Janine; Herold, T.; Schreyer, A.G.; Jung, E.M.; Mueller-Wille, R.; Zorger, N. [Inst. fuer Roentgendiagnostik, Klinikum der Univ. Regensburg (Germany); Banas, B.; Feuerbach, S. [Medizinische Klinik, Nephrologie, Univ. Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany)

    2009-10-15

    Purpose: to evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. Materials and methods: between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. Results: the overall technical and clinical success rate was 100%. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. Conclusion: Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils. (orig.)

  7. SPECT/CT and pulmonary embolism

    DEFF Research Database (Denmark)

    Mortensen, Jann; Borgwardt, Henrik Gutte

    2014-01-01

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar...... technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had...... the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume...

  8. Amniotic fluid embolism: a comprehensive review

    Directory of Open Access Journals (Sweden)

    Manjusha Viswanathan

    2014-04-01

    Full Text Available Amniotic Fluid Embolism (AFE is an obstetric catastrophe which occurs in 1 in 8000-80000 deliveries.1 It presents with shortness of breath, hypotension, hypoxemia, uterine atony, post-partum hemorrhage, disseminated intravascular coagulation, convulsions, coma and death. Pathophysiology is not clearly understood. It may be due to anaphylactoid like reaction to fetal cells that enter maternal circulation. There are no proven risk factors though a few have been postulated. Treatment is mainly supportive. The corner stone of management is a multi-disciplinary approach with support given to the failing organ systems. The mortality and morbidity due to AFE is very high. Hence prompt diagnosis and effective supportive measures is the key in the management. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 304-309

  9. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

    Gianluca Marrone; Settimo Caruso; Roberto Miraglia; Ilaria Tarantino; Riccardo Volpes; Angelo Luca

    2006-01-01

    Arteroportal fistula is a rare cause of prehepatic portalhypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding.Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the colorDoppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed.Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

  10. Lung ventilation-perfusion scintigraphy in pulmonary embolism

    International Nuclear Information System (INIS)

    In 53 patients with possible pulmonary embolism, pulmonary abnormalities of 133Xe ventilation and 99Tcsup(m) albumin microsphere perfusion scintigraphy were compared with absence or presence of pulmonary emboli documented by concurrent pulmonary angiography. It was found that patients with combined scintigraphy considered as unlikely for pulmonary embolism (ventilation defect larger than perfusion defect) or indicative of pulmonary embolism (ventilation defect smaller than perfusion defect) provide high diagnostic specificity. Patients with equal ventillation-perfusion abnormalities (possible pulmonary embolism) require further evaluation by pulmonary angiography to ascertain diagnosis. Importantly, diagnostic accuracy, using ventilation-perfusion scintigraphy and the quantified method of evaluation delineated, is preserved in patients with severe congestive heart failure. (Auth.)

  11. Pulmonary embolism and cor pulmonale in a cat

    International Nuclear Information System (INIS)

    A 14-year-old male neutered cat experienced pulmonary embolism 15 days following surgical debridement of a recurrent dorsolumbar abscess. Clinical signs were dominated by respiratory distress. Pulmonary embolism was suggested from the lateral thoracic radiograph by the presence of an abruptly attenuated lobar artery and a contiguous oligaemic area in the caudal lung lobe. Pulmonary hypertension was demonstrated on Doppler echocardiography by right pulmonary artery dilation and tricuspid regurgitation raising the pulmonary arterial pressure to 56 mmHg. Chronic pulmonary hypertension, assumed from right ventricular wall hypertrophy, and hypokinesia, indicating chronic cor pulmonale, was suggestive of chronic rather than acute pulmonary embolism. Postmortem histological evidence of pulmonary arteriolar occlusion confirmed the diagnosis of pulmonary embolism

  12. The role of lung imaging in pulmonary embolism

    Science.gov (United States)

    Mishkin, Fred S.; Johnson, Philip M.

    1973-01-01

    The advantages of lung scanning in suspected pulmonary embolism are its diagnostic sensitivity, simplicity and safety. The ability to delineate regional pulmonary ischaemia, to quantitate its extent and to follow its response to therapy provides valuable clinical data available by no other simple means. The negative scan effectively excludes pulmonary embolism but, although certain of its features favour the diagnosis of embolism, the positive scan inherently lacks specificity and requires angiographic confirmation when embolectomy, caval plication or infusion of a thrombolytic agent are contemplated. The addition of simple ventilation imaging techniques with radioxenon overcomes this limitation by providing accurate analog estimation or digital quantitation of regional ventilation: perfusion (V/Q) ratios fundamental to understanding the pathophysiologic consequences of embolism and other diseases of the lung. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7p495-bFig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13 PMID:4602128

  13. Renal aneurysm and arteriovenous fistula; Management with transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M. (Padua Univ. (Italy). Ist. di Radiologia Padua Univ. (Italy). Ist. di Fisioterapia)

    1990-01-01

    Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.).

  14. High frequency jet ventilation in fat embolism syndrome.

    Science.gov (United States)

    Lee, A; Simpson, D

    1986-11-01

    The use of high frequency jet ventilation in the management of a patient with fat embolism syndrome is described. Its principal advantage over conventional intermittent positive pressure ventilation is a reduction in the amount of sedation necessary. PMID:3789371

  15. Establishment of an animal model of dural venous sinus embolism

    Institute of Scientific and Technical Information of China (English)

    Peixian Zhang; Chongzhi Zhang; Yi Qin; Quanrui Ma; Jianying Du; Ying Cai

    2008-01-01

    BACKGROUND: The pathological mechanism of secondary brain lesion following an embolism remains unclear. The establishment of an animal model that imitates the clinical pathophysiological processes is crucial to better study this disease during a certain time window.OBJECTIVE: To establish a new animal model of dural venous sinus embolism that is simple, has a high success rate, and emulates the pathophysiological course of clinical disease.DESIGN, TIME AND SETTING: A randomized block design trial was performed at the Department of Anatomy, Ningxia Medical College between March and December 2007.MATERIALS: Fifty-eight healthy, adult, Sprague Dawley rats were used in the present study. Plastic emboli, with a total length of 0.4cm, were self-made. Each plastic embolus had a conical anterior segment; the largest diameter being 0.12cm. The posterior segment became gradually thin and flat, with a width of 0.2cm and length of 0.1cm.METHODS: The fifty-eight rats were randomly divided into three groups: control (n=6), embolism (n=26), and sham-embolism (n=26) groups. In the embolism group, a solid embolus was slowly inserted and fixed into the posterior part of the superior sagittal sinus against the flow of blood. The posterior segment was detained outside the superior sagittal sinus for fixing. In the sham-embolism group, rats were subjected only to sinus sagittalis superior exposure. In the control group, rats received no treatments. In both the embolism and the sham-embolism groups, the rat brains were resected at 6 hours, 1,3, and 5 days post-surgery.MAIN OUTCOME MEASURES: (1) Brain surface appearance in the embolism and sham-embolism groups. (2) Thrombosis in the embolism group. (3) Cerebrospinal fluid content in the above-mentioned two groups.RESULTS: In the embolism group, the model success rate was 92%(24/26). There was visible thrombosis in the superior sagittal sinus. Cerebral edema was noticeable under a microscope. These changes were visible at 6 hours after

  16. Embolia paradojal inminente Impending paradoxical embolism

    Directory of Open Access Journals (Sweden)

    Miguel A. Veltri

    2006-12-01

    Full Text Available La presencia de un trombo venoso atrapado en un defecto interauricular e insinuándose en las cavidades izquierdas configura una forma extremadamente inusual de enfermedad tromboembólica denominada embolia paradojal inminente. Presentamos el caso de un varón de 71 años, sometido 10 días antes a adenomectomía prostática, que consultó por disnea y mareos. Se le diagnosticó tromboembolismo pulmonar bilateral por tomografía axial computada helicoidal. Se lo anticoaguló con heparina sódica y se le realizó un ecocardiograma transesofágico que mostró un trombo que atravesaba el foramen oval y se alojaba en la aurícula izquierda. No presentaba signos clínicos de embolización sistémica. Se realizó la embolectomía quirúrgica y cierre del defecto auricular. El paciente falleció.An intracardiac thrombus traversing a patent foramen ovale is a very infrequent but potentially catastrophic complication of the thromboembolic disease. It is named "impending paradoxical embolism". We report the case of a 71 year old Caucasian male warded in ten days after a prostatectomy because of bilateral pulmonary embolism. Diagnosis was confirmed by HCT scan and the patient received anticoagulation with heparin. A transesophageal ecocardiogram disclosed a thrombus traversing foramen ovale into the left atrium. Surgical embolectomy was performed, but the patient died shortly after surgery.

  17. Hypertension following Therapeutic Arterial Embolization: A Rare Complication

    Directory of Open Access Journals (Sweden)

    Ghansham Biyani

    2014-05-01

    Full Text Available Accelerated hypertension following therapeutic arterial embolization is a rare phenomenon. A patient of left upper limb chronic lymphedema was posted for shoulder disarticulation under general anaesthesia. Coil embolization of the left subclavian artery was done prior to surgery. Following the intervention, patient’s blood pressure increased by more than 30% of the base line value and was managed with antihypertensives for the next 3 hours to get the blood pressure optimised prior to taking the patient for surgery.

  18. Facial necrosis after endovascular Onyx-18 embolization for epistaxis

    OpenAIRE

    Grandhi, Ramesh; Panczykowski, David; Zwagerman, Nathan T.; Gehris, Robin; Villasenor-Park, Jennifer; Ho, Jonhan; Grandinetti, Lisa; Horowitz, Michael; Lanzino, Giuseppe; Burrows, Anthony M.

    2013-01-01

    Background: Evolution in techniques and equipment has expanded the role, effectiveness, and safety of endovascular transarterial embolization for the treatment of severe epistaxis. Risks from this treatment approach include major ischemic complications. To date, there have been only a few reports of soft tissue necrosis following endovascular embolization for severe epistaxis; none involve the use of Onyx-18. Case Description: We report the case of a 52-year-old woman who presented with epist...

  19. Paradoxical coronary artery embolism - A rare cause of myocardial infarction

    OpenAIRE

    Hakim, Fayaz A.; Kransdorf, Evan P.; Abudiab, Muaz M.; Sweeney, John P.

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirec...

  20. Severe fat embolism in perioperative abdominal liposuction and fat grafting

    OpenAIRE

    Rodrigo de Lima e Souza; Bruno Tavares Apgaua; João Daniel Milhomens; Francisco Tadeu Motta Albuquerque; Luiz Antônio Carneiro; Márcio Henrique Mendes; Tiago Carvalho Garcia; Clerisson Paiva; Felipe Ladeia; Deiler Célio Jeunon

    2016-01-01

    ABSTRACT BACKGROUND AND OBJECTIVES: Fat embolism syndrome may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe fat embolism syndrome after liposuction and fat grafting. CASE REPORT: SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to b...

  1. Fibrinolysis for patients with intermediate-risk pulmonary embolism

    OpenAIRE

    Meyer, Guy; Vicaut, Eric; Danays, Thierry; Agnelli, Giancarlo; Becattini, Cecilia; Beyer-Westendorf, Jan; Bluhmki, Erich; Bouvaist, Helene; Brenner, Benjamin; Couturaud, Francis; Dellas, Claudia; Empen, Klaus; Franca, Ana; Galiè, Nazzareno; Geibel, Annette

    2014-01-01

    BACKGROUND The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial. METHODS In a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism. Eligible patients had right ventricular dysfunction on echocardiography or computed tomography, as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin ...

  2. Cerebral fat embolism: Use of MR spectroscopy for accurate diagnosis

    OpenAIRE

    Laxmi Kokatnur; Mohan Rudrappa; Khasawneh, Khaled R.

    2015-01-01

    Cerebral fat embolism (CFE) is an uncommon but serious complication following orthopedic procedures. It usually presents with altered mental status, and can be a part of fat embolism syndrome (FES) if associated with cutaneous and respiratory manifestations. Because of the presence of other common factors affecting the mental status, particularly in the postoperative period, the diagnosis of CFE can be challenging. Magnetic resonance imaging (MRI) of brain typically shows multiple lesions dis...

  3. Partial thyroid arterial embolization for the treatment of hyperthyroidism

    International Nuclear Information System (INIS)

    Background: Hyperactive thyroid gland in patients that are unable to tolerate or accept standard therapy is a common clinical problem. Aim of the study was to evaluate effectiveness of partial thyroid arterial embolization in patients with hyperthyroidism. Material/methods: From May 2004 to November 2005 partial thyroid gland embolization was performed in 15 patients. Mean thyroid gland volume was 162 ml. Embolization of one to three thyriod arteries was performed with the mixture of Histoacryl and Lipiodol. Selective angiography was performed after embolization to ensure that the targeted arteries were completely occluded. Follow-up study covered 12 patients. Results: The embolization procedure was well tolerated by all patients. Three days after embolization fT3 and fT4 levels were higher than before the procedure. Further laboratory tests showed quick reversal to near-normal or normal levels of thyroid hormones. 12 weeks follow-up showed: normal serum levels of fT3, fT4 and TSH in 9 of 12 patients (75%), hyperthyroidism in 3 of 12 patients (25%), goiter volume reduction of approximately 32% of its original volume (from 13 to 76.3%), mean thyroid gland volume of 94 ml. One year after embolization 7 of 12 patients required thyreostatic drugs. At two and four years follow-up thyreostatics doses were significantly lower and thyroid tissue was fibrotic. Conclusions: Based on our results the treatment of the thyroid gland goiters using arterial thyroid gland partial embolization may be offered as an effective alternative for patients who will not or cannot accept standard therapy.

  4. A Case of Turner Syndrome with Multiple Embolic Infarcts

    Directory of Open Access Journals (Sweden)

    Cindy W. Yoon

    2016-09-01

    Full Text Available Only a few cases of Turner syndrome (TS with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  5. Penile angiography and superselective embolization therapy in arterial priapism

    International Nuclear Information System (INIS)

    Purpose: To report feasibility, benefit and complications of penile angiography and superselective penile embolization in arterial priapism. Materials and Methods: Four consecutive patients (aged 28, 29, 40 and 49 years), who underwent penile angiography for arterial priapism (high-flow priapism) within a four-year period, were identified by a keyword search of our radiology information system. One patient had sustained a direct penile trauma (severe blow to the erected penis) and three patients suffered from recurrent spontaneous priapism. All patients had previously undergone corporeal aspiration and noradrenaline injection to achieve detumescence. Two patients had one or several unsuccessful spongiocavernous shunt procedures. Results: In three of the four patients, superselective pudendal and penile angiography demonstrated pathologic arteriocavernous shunting. In two of the three patients, superselective embolization using a coaxial micro-catheter was attempted. In one of the two patients, the cavernous artery became spastic before embolization material was actually injected, inducing immediate and lasting detumescence. In the other patient, unilateral Gelfoam embolization led to immediate detumescence but the priapism recurred 12 hours after the procedure. A subsequent contralateral Gelfoam embolization was successful. Erectile function was preserved in all cases. No procedure-related complications occurred. Conclusion: Our experience supports the prevailing opinion found in the current literature that superselective coaxial embolization constitutes the treatment of choice in patients with high-flow priapism. Prognosis is good with high probability of preserving the erectile function. (orig.)

  6. A Case of Turner Syndrome with Multiple Embolic Infarcts

    Science.gov (United States)

    Yoon, Cindy W.; Lee, Eungseok; Yoon, Byung-Nam; Park, Hee-Kwon; Rha, Joung-Ho

    2016-01-01

    Only a few cases of Turner syndrome (TS) with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI) findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  7. Paradoxical air embolus during endoscopic retrograde cholangiopancreatography: an uncommon fatal complication.

    Science.gov (United States)

    Markin, Nicholas W; Montzingo, Candice R

    2015-04-01

    Air embolism during endoscopic retrograde cholangiopancreatography is a rare but potentially fatal complication. A 66-year-old man underwent endoscopic retrograde cholangiopancreatography and remained stable until the end of the procedure, when he was found to have mottling on his right side and became hypoxic and unresponsive. Transesophageal echocardiography showed air within the left ventricle, consistent with systemic air embolism. Mortality resulted from significant cardiac and cerebral ischemia. The literature suggests that capnography is helpful in early diagnosis of air embolus, but it could not be used in this case because the patient's trachea was not intubated. PMID:25827860

  8. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism. Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Fink, C.; Michaely, H.J. [Inst. fuer Klinische Radiologie und Nuklearmedizin, Universitaetsklinikum Mannheim, Univ. Heidelberg (Germany); Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany); Johnson, T.R.; Morhard, D.; Becker, C.; Reiser, M.; Nikolaou, K. [Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany)

    2008-10-15

    To evaluate the feasibility of dual-energy CT angiography (CTA) of the lung in patients with suspected pulmonary embolism (PE). 24 patients with suspected PE were examined with a single-acquisition, dual-energy CTA protocol (A-system: 140 kV/65 mAsref, B-system: 80 kV/190 mAsref) on a dual-source CT system. Lung perfusion was visualized by color-coding voxels containing iodine and air using dedicated dual-energy post-processing software. Perfusion defects were classified by two blinded radiologists as being consistent or non-consistent with PE. Subjective image quality of perfusion maps and CTA was rated using a 5-point scale (1: excellent, 5: poor). The reading of a third independent radiologist served as the standard of reference for the diagnosis of PE. In all patients with PE (n = 4), perfusion defects classified as being consistent with PE were identified in lung areas affected by PE. Both readers did not record perfusion defects classified as being consistent with PE in any of the patients without PE. Thus, on a per patient basis the sensitivity and specificity for the assessment of PE was 100% for both readers. On a per segment basis the sensitivity and specificity ranged between 60 - 66.7% and 99.5 - 99.8%. The interobserver agreement was good (k = 0.81). Perfusion defects rated as non-consistent with PE were most frequently caused by streak artifacts from dense contrast material in the great thoracic vessels. The median score of the image quality of both the perfusion maps and CTA was 2. In conclusion, dual-energy CTA of pulmonary embolism is feasible and allows the assessment of perfusion defects caused by pulmonary embolism. Further optimization of the injection protocol is required to reduce artifacts from dense contrast material. (orig.)

  9. Transcatheter Arterial Embolization of Renal VX-2 Carcinoma: Ethiodol-Ethanol Capillary Embolization Combined with Carboplatin

    Energy Technology Data Exchange (ETDEWEB)

    Konya, Andras; Pelt, Carolyn S. Van; Wright, Kenneth C. [The University of Texas MD Anderson Cancer Center, Hoston (United States); Choi, Byung Gil [The Catholic University of Korea, Seoul (Korea, Republic of)

    2007-04-15

    We wanted to determine whether transcatheter Ethiodol-based capillary embolization in combination with carboplatin could improve the efficiency of a 1:1 Ethiodol-ethanol mixture (EEM) to ablate kidneys that been inoculated with VX-2 carcinoma. The right kidney in 34 New Zealand white rabbits were inoculated with fresh VX-2 tumor fragments. One week later, the kidneys were subjected to transarterial treatment (4-5 rabbits/group): Saline infusion (Group 1); carboplatin infusion (5 or 10 mg, Groups 2A and 2B); carboplatin- Ethiodol (CE) alone (Group 3) and followed by main renal artery occlusion with ethanol (RAO) (Group 4); carboplatin-EEM (C-EEM) followed by RAO (Group 5); carboplatin infusion followed by EEM plus RAO (Group 6); and EEM followed by RAO (Group 7). The animals were followed for up to 3-weeks. The treated kidneys were evaluated angiographically and macroscopically. The kidneys that showed successful embolization macroscopically were entirely cut into serial sections, and these were examined microscopically. Histologically, the kidneys were evaluated on the basis of the residual tumor found in the serial sections. The results obtained with carboplatin infusion alone (Groups 2A and 2B) and CE without RAO (Group 3) were similar to those of the control animals (Group 1). Kidneys from Groups 4-7 demonstrated macroscopically successful embolization with histologically proven complete renal parenchyma infarction; however, some residual tumor was evident in all but one animal. None of the Ethiodol-based modalities combined with locoregional carboplatin were more efficacious for tumor ablation than EEM alone.

  10. Comparative imaging study in experimental acute pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the diagnostic characteristics of radionuclide pulmonary perfusion imaging, enhanced spiral computed tomography, and digital subtraction pulmonary angiography in acute experimental segmental pulmonary embolism (corresponding to human subsegmental pulmonary embolism). Methods: Acute pulmonary embolism model was established in thirteen Chinese small type pigs by injecting glutin embolus (the diameter of the embolus was 3.8 to 4.2 mm) into pulmonary artery via jugular vein, and then radionuclide pulmonary perfusion imaging, enhanced spiral computed tomography and digital subtraction pulmonary angiography were performed. The results of sensitivity and specificity of three kinds of imaging methods were compared with the pathological findings. Results: Out of 195 segmental pulmonary arteries, abnormalities were found in forty-six segmental pulmonary arteries by pathological study. Abnormalities were detected in fifty-one segmental pulmonary arteries by pulmonary perfusion imaging, with sensitivity of 87%, specificity 93%. Filling defect was demonstrated in forty-four segmental pulmonary arteries by enhanced spiral computed tomography, with sensitivity of 63%, specificity 89%. Abnormalities were displayed in forty-seven segmental pulmonary arteries by digital subtraction pulmonary angiography, with sensitivity of 98%, specificity 99%. Pulmonary perfusion imaging was superior to enhanced spiral computed tomography (P0.05). Conclusions: Pulmonary perfusion imaging is a noninvasive technique for diagnosis of pulmonary embolism which is superior to enhanced spiral computed tomography in detecting of experimental acute segmental pulmonary embolism (corresponding to human subsegmental pulmonary embolism), but the localization of embolus is more accurate by enhanced spiral computed tomography. Combination of three kinds of imaging methods may significantly improve the diagnostic accuracy for pulmonary embolism

  11. Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate

    Science.gov (United States)

    Favard, Nicolas; Moulin, Morgan; Fauque, Patricia; Bertaut, Aurélie; Favelier, Sylvain; Estivalet, Louis; Michel, Frédéric; Cormier, Luc; Sagot, Paul

    2015-01-01

    Background To evaluate pain, radiation and recurrence rates in patients undergoing varicocele embolization with three different embolic materials. Methods Retrospective study of 182 consecutive patients who underwent transcatheter retrograde varicocele embolization from July 2011 to May 2015 with glue (Glubran®2) (group 1, n=63), mechanical agents (coils and/or plugs) (group 2, n=53) or a sclerosing agent (polidocanol) (group 3, n=66). Patients were asked by telephone interview to evaluate pain during embolization and at 1, 7 and 30 days using a quantitative pain scale ranging from 0 to 10. Duration of scopy, kinetic energy released per unit mass (kerma) and dose area product (DAP) were assessed as radiation parameters during embolization procedures. Recurrence rates after treatment were also evaluated. Statistical analyses were performed using parametric and non-parametric tests. Results Patients in the three study groups were comparable for age, clinical indication and embolization side. No difference was noted for significant pain (pain score ≥3) during embolization and at 1, 7 and 30 days after treatment. Discomfort (pain score <3) was more frequent in group 1 than in groups 2 and 3 at 7 days after the procedure (P=0.049). No difference in discomfort was noted during embolization or at 1 and 30 days. Duration of scopy was shorter (P<0.0001) and kerma was lower (P=0.0087) in group 1 than in groups 2 and 3. DAP was lower in group 1 than in group 2 (P=0.04) but no difference was noted between groups 1 and 3, and groups 2 and 3. The recurrence rate at a mean follow-up of 24.4 months (range, 2-53 months) was significantly lower in group 1 than in the two other groups (P=0.032). Conclusions The use of Glubran®2 acrylic glue for varicocele embolization is safe and leads to less radiation and lower recurrence rates than is the case for other embolic materials without any more significant pain. PMID:26807362

  12. Perfusion visualization and analysis for pulmonary embolism

    Science.gov (United States)

    Vaz, Michael S.; Kiraly, Atilla P.; Naidich, David P.; Novak, Carol L.

    2005-04-01

    Given the nature of pulmonary embolism (PE), timely and accurate diagnosis is critical. Contrast enhanced high-resolution CT images allow physicians to accurately identify segmental and sub-segmental emboli. However, it is also important to assess the effect of such emboli on the blood flow in the lungs. Expanding upon previous research, we propose a method for 3D visualization of lung perfusion. The proposed method allows users to examine perfusion throughout the entire lung volume at a single glance, with areas of diminished perfusion highlighted so that they are visible independent of the viewing location. This may be particularly valuable for better accuracy in assessing the extent of hemodynamic alterations resulting from pulmonary emboli. The method also facilitates user interaction and may help identify small peripheral sub-segmental emboli otherwise overlooked. 19 patients referred for possible PE were evaluated by CT following the administration of IV contrast media. An experienced thoracic radiologist assessed the 19 datasets with 17 diagnosed as being positive for PE with multiple emboli. Since anomalies in lung perfusion due to PE can alter the distribution of parenchymal densities, we analyzed features collected from histograms of the computed perfusion maps and demonstrate their potential usefulness as a preliminary test to suggest the presence of PE. These histogram features also offer the possibility of distinguishing distinct patterns associated with chronic PE and may even be useful for further characterization of changes in perfusion or overall density resulting from associated conditions such as pneumonia or diffuse lung disease.

  13. SPECT/CT and pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Mortensen, Jann [Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); The Faroese National Hospital, Department of Medicine, Torshavn (Faroe Islands); Gutte, Henrik [Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Herlev Hospital, Copenhagen University Hospital, Department of Radiology, Copenhagen (Denmark); University of Copenhagen, Cluster for Molecular Imaging, Faculty of Health Sciences, Copenhagen (Denmark)

    2014-05-15

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE. (orig.)

  14. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    Directory of Open Access Journals (Sweden)

    Nicole H. Goldhaber

    2014-01-01

    Full Text Available Pulmonary embolism (PE following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis.

  15. SPECT/CT and pulmonary embolism.

    Science.gov (United States)

    Mortensen, Jann; Gutte, Henrik

    2014-05-01

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE. PMID:24213621

  16. Single-perfusion defect and pulmonary embolism

    International Nuclear Information System (INIS)

    One hundred thirty-three ventilation-perfusion scans with angiographic correlation were retrospectively reviewed in a double-blind study to evaluate the frequency of pulmonary embolism (PE) in single perfusion defects (SPDs) regardless of ventilation or chest radiographic abnormalities. Of 28 SPDs, PE was present in 46% (13 cases). Ten of 13 SPDs were located in the basal segments of the right lower lobe, one in the right middle lobe, and two in the left lower lobe, seven of 13 patients had undergone recent surgery. in contrast, in the non-PE group, seven of 15 SPDs were in the right lung and eight in the left lower lobe, only one of 15 patients had undergone recent surgery. In ten of 13 PE and ten of 15 non-PE cases, the ventilation-perfusion and chest radiographic findings showed matching abnormalities. Two of six cases with ventilation-perfusion mismatch had PE and abnormal radiographs. One of two cases with ventilation-perfusion match and normal radiographs had PE

  17. Evaluation of percutaneous transhepatic gastroesophageal varices embolization

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical application of percutaneous transheaptic gastroesophgeal varices embolization (PTVE) for treatment and prevention of acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Methods: 48 patients with cirrhotic portal hypertension and gastroesophageal varices were treated with PTVE for the prevention and control of upper gastrointestinal bleeding. Results: The technical success of PTVE was 97.9% and the rate of hemostasis was 100%. During the procedure, steel coil displacement occurred in 1 case, vagus nerve reflection with blood pressure degression and heart rate decline in 4 cases. After the procedure, 1 patients developed refractory ascites and 1 patients died of abdominal bleeding. 2 cases died of hepatic failure and 2 cases occurred rehaemorrhagia in fore 6 mon. after one year follow-up; 3 cases losed follow-up and 5 cases occurred rehaemorrhagia in the late 6 mon. Conclusion: PTVE is mini-invasive and efficient in treating acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Increase of technical success and decreases of morbidity can be achieved on the condition of' proper maneuver. (authors)

  18. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

    Directory of Open Access Journals (Sweden)

    Deng-Wei Chou

    2015-06-01

    Full Text Available OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K. pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%, nodules with or without cavities (79%, pleural effusions (71%, peripheral wedge-shaped opacities (64%, patchy ground-glass opacities (50%, air bronchograms within a nodule (36%, consolidations (21%, halo signs (14%, and lung abscesses (14%. Nine (64% of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14% patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.

  19. Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.

    Science.gov (United States)

    Sanchez, Olivier; Trinquart, Ludovic; Planquette, Benjamin; Couturaud, Francis; Verschuren, Franck; Caille, Vincent; Meneveau, Nicolas; Pacouret, Gérard; Roy, Pierre-Marie; Righini, Marc; Perrier, Arnaud; Bertoletti, Laurent; Parent, Florence; Lorut, Christine; Meyer, Guy

    2013-09-01

    We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular dilatation. In multivariate analysis, the PESI (class III-IV versus I-II, OR 3.1, 95% CI 1.2-8.3; class V versus I-II, OR 5.5, 95% CI 1.5-25.5 and echocardiography (right ventricular/left ventricular ratio, OR (for an increase of 0.1) 1.3, 95% CI 1.1-1.5) were independent predictors of an adverse outcome. In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI. PMID:23258789

  20. Catheter fracture and embolization from totally implanted venous access ports--case reports.

    Science.gov (United States)

    Vadlamani, P; Dawn, B; Perry, M C

    1998-12-01

    Totally implanted venous access ports are excellent devices for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter fracture and embolization are rare and potentially serious complications of these widely used devices. Retrieval of the embolized fragment is generally indicated but may not be possible. The authors report three cases of catheter embolization in their center over a period of 9 years. Catheter "pinch-off," fracture, embolization, and retrieval are discussed. PMID:9855376

  1. Computed tomography of acute pulmonary embolism: state-of-the-art

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Meinel, Felix G.; McQuiston, Andrew D.; Ravenel, James G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Multidetector computed tomography (CT) plays an important role in the detection, risk stratification and prognosis evaluation of acute pulmonary embolism. This review will discuss the technical improvements for imaging peripheral pulmonary arteries, the methods of assessing pulmonary embolism severity based on CT findings, a multidetector CT technique for pulmonary embolism detection, and lastly, how to avoid overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism. (orig.)

  2. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  3. Prostate embolization: A new acting field of interventional radiology

    International Nuclear Information System (INIS)

    Purposes: To present the initial experience with prostatic embolization as an alternative treatment for benign prostatic hyperplasia (BPH) from a technical perspective to establish the contribution provided by diagnostic imaging. Materials and methods: Sixteen patients with lower urinary tract symptoms due to benign prostatic hyperplasia underwent prostatic embolization. All patients were evaluated with specific questionnaires to determine the severity of symptoms, impact on quality of life and erectile function, ultrasound and MRI of the pelvis, urinary flowmetry and PSA before and 30 days after the procedure. Results: Embolization was successful in all patients; in 10 cases the procedure was performed bilaterally and in six, only one side was embolized. The average time for completion of the procedure was 82 minutes and the average fluoroscopy time was 38.5 minutes. All procedures were performed on an outpatient basis with an average hospital stay of 6.4 hours. The mean contrast medium used was 175 ml. At 30 days there was a mean reduction on prostate volume of 21%. Clinical improvement was characterized by a mean 8-point improvement on IPSS, 2 points on QOL and 4 points on IIEF. The uroflowmetry improved 39% and PSA dropped 26%. No major complications that implied unscheduled hospitalization or performing additional surgical procedures were seen. Minor adverse events were verified in 9 patients. Conclusion: The initial results of prostatic embolization as an alternative treatment for BPH indicate that it is a safe and effective procedure to be consolidated as a new field of action of interventional radiology. (authors)

  4. Uterine arterial embolization for uterine leiomyoma: efficacy and clinical outcome

    International Nuclear Information System (INIS)

    To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas. Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdominal discomfort, backache, urinary frequency, etc.) and one was diagnosed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. Nineteen patients were followed up after embolization. Seventeen (89.5 %)reported satisfactory improvement of symptoms and follow-up sonography three months later showed a 58.5 % reduction in mean myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3 %) and fever (23.8 %). Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, enquired

  5. Uterine arterial embolization for uterine leiomyoma: efficacy and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Seon; Lee, Do Yon; Kim, Yong Tae; Park, Ki Hyun; Park, Yong Won; Cho, Jae Sung; Kim, Myung Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Won, Je Hwan [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Kang, Byung Chul [Ewha Womans Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas. Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdominal discomfort, backache, urinary frequency, etc.) and one was diagnosed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. Nineteen patients were followed up after embolization. Seventeen (89.5 %)reported satisfactory improvement of symptoms and follow-up sonography three months later showed a 58.5 % reduction in mean myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3 %) and fever (23.8 %). Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, enquired.

  6. Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

    International Nuclear Information System (INIS)

    Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery

  7. Palliative embolization of hemorrhages in extensive head and neck tumors

    International Nuclear Information System (INIS)

    A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers

  8. Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

    Energy Technology Data Exchange (ETDEWEB)

    Su, Li-xin, E-mail: sulixin1975@126.com [Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People’s Hospital (China); Jia, Ren-Bing, E-mail: jrb19760517@hotmail.com [Shanghai Jiao Tong University School of Medicine, Department of Ophthalmology, Ninth People’s Hospital (China); Wang, De-Ming, E-mail: wdmdeming@hotmail.com; Lv, Ming-Ming, E-mail: lvmingming001@163.com; Fan, Xin-dong, E-mail: fanxindong@aliyun.com [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ninth People’s Hospital (China)

    2015-06-15

    ObjectiveArteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.MethodsTranscatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.ResultsDuring the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76–99 % in 7 patients, and 50–75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.ConclusionEthanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

  9. Neuro-endovascular Embolic Agent for Treatment of a Renal Arteriovenous Fistula

    Directory of Open Access Journals (Sweden)

    Gurpreet Singh

    2016-01-01

    Full Text Available Renal arteriovenous fistula is a known complication following a renal biopsy, and may require catheter based embolization. Distal location of these fistulas in the renal parenchyma in many a case may necessitate non-traditional embolic materials. Liquid embolic agents that allow a controlled delivery may be suitable in this situation, as demonstrated in this case report.

  10. Pipeline Embolization Device with or without Adjunctive Coil Embolization: Analysis of Complications from the IntrePED Registry.

    Science.gov (United States)

    Park, M S; Kilburg, C; Taussky, P; Albuquerque, F C; Kallmes, D F; Levy, E I; Jabbour, P; Szikora, I; Boccardi, E; Hanel, R A; Bonafé, A; McDougall, C G

    2016-06-01

    Flow diversion to treat cerebral aneurysms has revolutionized neurointerventional surgery. Because the addition of coils potentially increases the time and complexity of endovascular procedures, we sought to determine whether adjunctive coil use is associated with an increase in complications. Patients in the International Retrospective Study of Pipeline Embolization Device registry were divided into those treated with the Pipeline Embolization Device alone (n = 689 patients; n = 797 aneurysms; mean aneurysm size, 10.3 ± 7.6 mm) versus those treated with the Pipeline Embolization Device and concurrent coil embolization (n = 104 patients; n = 109 aneurysms; mean aneurysm size, 13.6 ± 7.8 mm). Patient demographics and aneurysm characteristics were examined. Rates of neurologic morbidity and mortality were compared between groups. The Pipeline Embolization Device with versus without coiling required a significantly longer procedure time (135.8 ± 63.9 versus 96.7 ± 46.2 min; P < .0001) and resulted in higher neurological morbidity (12.5% versus 7.8%; P = .13). These data suggest that either strategy represents an acceptable risk profile in the treatment of complex cerebral aneurysms and warrants further investigation.

  11. Pulmonary embolism and stroke associated with mechanical thrombectomy

    Directory of Open Access Journals (Sweden)

    Paulo Bastianetto

    2014-04-01

    Full Text Available Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy.

  12. Pathogenesis, diagnosis and treatment of cerebral fat embolism

    Institute of Scientific and Technical Information of China (English)

    Yihua Zhou; Ying Yuan; Chahua Huang; Lihua Hu; Xiaoshu Cheng

    2015-01-01

    In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate.In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae.For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc.The early diagnosis and comprehensive treatment can improve prognosis.

  13. Spiral CT in the diagnosis of acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, I.J.C.; Prokop, M. [Univ. Medical Center Utrecht, Utrecht (Netherlands)

    2002-07-01

    The traditional approach in patients with clinically suspected pulmonary embolism includes ventilation-perfusion (V/Q) scintigraphy as the first step. This relatively fast and noninvasive technique allows diagnosis or exclusion of pulmonary embolism in a considerable proportion of patients. However, depending on the patient group and evaluation criteria, the results of the V/Q lung scan are nondiagnostic in 40 to 70% of cases. Further testing is needed because pulmonary embolism will be present in only about a quarter of these patients. In order to find a non-invasive strategy for the diagnostic work-up of PE, several promising developments have been made, e.g. D-dimer analysis and spiral CT angiography. Both techniques are fast, noninvasive, and easy to perform and are now conquering the medical world. In this overview we will focus on Spiral CT: what is its role now and what might be expected in the near future? (orig.)

  14. Percutaneous artherial embolization in the treatment of liver trauma

    International Nuclear Information System (INIS)

    Percutaneous arterial embolization in the treatment of liver trauma. Liver trauma requires emergency therapy. Because it is highly vascular and because of its location, the hemostasis is difficult to achieve. The main causes of death associated to liver trauma are due to prolonged hipovolemia. The current forms of surgical treatment of liver wounds are associated with a high morbidity rate. In some hepatic injuries, hemorrage is so massive that operative control of bleeding is necessary, bu t in most cases, particularly in blunt trauma, an angiographic approach with diagnosis and embolotherapy is preferable. Six patients with blunt or perforating hepatic trauma were managed with percutaneous arterial embolization. Hemostasis was achieved immediately in all of them withoyt recurrence. Surgical intervention with additional trauma was thus avoided, decreasing the morbidity rate. The percutaneous arterial embolization presents an efficient alternative in the management of hemorrage due to liver trauma, being particularly useful in the poor risk patient. (author)

  15. Embolic Doppler ultrasound signal detection via fractional Fourier transform.

    Science.gov (United States)

    Gençer, Merve; Bilgin, Gökhan; Aydın, Nizamettin

    2013-01-01

    Computerized analysis of Doppler ultrasound signals can aid early detection of asymptomatic circulating emboli. For analysis, physicians use informative features extracted from Doppler ultrasound signals. Time -frequency analysis methods are useful tools to exploit the transient like signals such as Embolic signals. Detection of discriminative features would be the first step toward automated analysis of embolic Doppler ultrasound signals. The most problematic part of setting up emboli detection system is to differentiate embolic signals from confusing similar wave-like patterns such as Doppler speckle and artifacts caused by tissue movement, probe tapping, speaking etc. In this study, discrete version of fractional Fourier transform is presented as a solution in the detection of emboli in digitized Doppler ultrasound signals. An accurate set of parameters are extracted using short time Fourier transform and fractional Fourier transform and the results are compared to reveal detection quality. Experimental results prove the efficiency of fractional Fourier transform in which discriminative features becomes more evident.

  16. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  17. Spiral CT in the diagnosis of acute pulmonary embolism

    International Nuclear Information System (INIS)

    The traditional approach in patients with clinically suspected pulmonary embolism includes ventilation-perfusion (V/Q) scintigraphy as the first step. This relatively fast and noninvasive technique allows diagnosis or exclusion of pulmonary embolism in a considerable proportion of patients. However, depending on the patient group and evaluation criteria, the results of the V/Q lung scan are nondiagnostic in 40 to 70% of cases. Further testing is needed because pulmonary embolism will be present in only about a quarter of these patients. In order to find a non-invasive strategy for the diagnostic work-up of PE, several promising developments have been made, e.g. D-dimer analysis and spiral CT angiography. Both techniques are fast, noninvasive, and easy to perform and are now conquering the medical world. In this overview we will focus on Spiral CT: what is its role now and what might be expected in the near future? (orig.)

  18. Direct transcranial puncture for Onyx embolization of a cerebellar hemangioblastoma.

    Science.gov (United States)

    Ding, Dale; Starke, Robert M; Evans, Avery J; Liu, Kenneth C

    2014-06-01

    Intracranial hemangioblastomas are benign but hypervascular tumors, most commonly located in the cerebellum, which are difficult to resect without significant operative blood loss. While preoperative embolization may decrease the amount of operative bleeding, the vascular supply of cerebellar hemangioblastomas frequently precludes safe embolization by an endovascular route due to the risk of thromboembolic vertebrobasilar infarction. Direct puncture embolization overcomes many of the limitations of endovascular embolization but its safety and feasibility for intracranial tumors is unknown. We report a 48-year-old man who was diagnosed with a large cerebellar mass after presenting with headaches and gait ataxia. Based on diagnostic angiography, which demonstrated a highly vascular tumor supplied by the posterior inferior cerebellar and posterior meningeal arteries, we decided to embolize the tumor by a direct transcranial puncture approach. After trephinating the skull in a standard fashion, a catheter-needle construct, composed of an Echelon 10 microcatheter (ev3 Endovascular, Plymouth, MN, USA) placed into a 21-gauge spinal needle, was inserted into the tumor under biplanar angiographic guidance. Using continuous angiographic monitoring, 9cc of Onyx 34 (ev3 Endovascular) was injected through the catheter, resulting in 75% tumor devascularization without evidence of complications. The patient was taken directly to surgery where a gross total resection of the hemangioblastoma was achieved with an acceptable operative blood loss. At his 2 year follow-up, the patient was neurologically intact without neuroimaging evidence of residual tumor. We describe, to our knowledge, the first case of direct transcranial puncture for preoperative embolization of a cerebellar hemangioblastoma. PMID:24370504

  19. Pulmonary embolism: are we there yet?

    International Nuclear Information System (INIS)

    Clinical prediction rules (such as Wells model) are a reliable assessment tool for diagnostic work-up of suspected pulmonary embolism (PE). When used as part of a clinical algorithm and in combination with a D-Dimer, the model can safely exclude PE in low-risk groups and indicate when further investigations are unnecessary. The purpose of this study was to investigate the level of adherence to local diagnostic imaging guidelines for suspected PE and to ascertain the impact of interventions. Retrospective search of all patients referred from the Emergency Department (ED) of Royal Perth Hospital for computed tomography pulmonary angiography (CTPA) or V/Q scan between 11 September 2005 to 10 March 2006 (pre-intervention) and 1 January 2008 to 31 March 2008 (post-intervention) was conducted. The guidelines on ‘Diagnostic Imaging Pathways’ were considered as gold standard. Interventions included orienting ED doctors to guidelines and modified request forms for mandatory completion of Wells score. A prevalence- and bias-adjusted kappa (PABAK) score analysed the level of agreement between documentation on notes (R-score) and stamp (S-score). Thirty-five per cent (n = 187) and 22% (n = 109) deviated from the pathway pre-intervention and post-intervention, respectively (13% absolute reduction; P = 0.017). Stamp compliance was only 55% despite mandatory filling requirement. PABAK for ‘PE as most likely diagnosis’ was 0.25 for V/Q group and – 0.26 for CTPA. In addition, 44/60 (73%) had an intermediate or high S-score, yet only 11 of those 44 had a matched intermediate to high R-Score. Interventions reduced inappropriate practice but did not eliminate it completely. Compliance issues may be managed in the future via the introduction of electronic request linked to decision support.

  20. Negative spiral CT in acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, T.; Olausson, A. [Karolinska Hospital, Stockholm (Sweden). Dept. of Thoracic Radiology; Johnsson, H. [Karolinska Hospital, Stockholm (Sweden). Dept. of Internal Medicine; Nyman, U. [County Hospital, Trelleborg (Sweden). Dept. of Radiology; Aspelin, P. [Huddinge Univ. Hospital (Sweden). Dept. of Radiology

    2002-09-01

    Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3-5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains.

  1. Negative spiral CT in acute pulmonary embolism

    International Nuclear Information System (INIS)

    Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3-5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains

  2. Sonography after splenic embolization: the wedge-shaped acute infarct

    International Nuclear Information System (INIS)

    After undergoing therapeutic transcatheter embolization of the splenic artery for treatment of portal hypertension, 11 consecutive patients were evaluated with sulfur colloid scintigraphy and real-time sonography of the left upper quadrant to determine which method was better for follow-up evaluation of the spleen. Six splenic infarcts were documented by both imaging methods; sonography, however, demonstrated the characteristic wedge shape of the infarct in four of the six cases. There were no cases of splenic abscess formation. Sonography should be the primary method for evaluation of the spleen after transcatheter embolization and can help in planning treatment to avoid abscess formation

  3. Pulmonary embolism following celiac plexus block and neurolysis

    Science.gov (United States)

    Raizada, Miles S.; Kelly, Seth M.

    2016-01-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

  4. Paradoxical coronary artery embolism - a rare cause of myocardial infarction.

    Science.gov (United States)

    Hakim, Fayaz A; Kransdorf, Evan P; Abudiab, Muaz M; Sweeney, John P

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence. PMID:25774255

  5. Paradoxical coronary artery embolism - A rare cause of myocardial infarction

    Directory of Open Access Journals (Sweden)

    Fayaz A Hakim

    2014-01-01

    Full Text Available Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence.

  6. Biliary Ischemia Following Embolization of a Pseudoaneurysm after Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Roger Noun

    2006-07-01

    Full Text Available Aim :To report an uncommon consequence of hepatic artery occlusion in the management of a bleeding pseudoaneurysm following pancreaticoduodenectomy. Imaging :Analysis of a case involving a single patient in which a bleeding pseudoaneurysm of the gastroduodenal arterial stump following pancreaticoduodenectomy was treated by transcatheter arterial embolization. Case report: Effective hemostasis necessitated interruption of the hepatic arterial flow and was complicated by biliary ischemia and intrahepatic biloma. Conclusion :Transarterial embolization of the hepatic artery following ancreaticoduodenectomy can result in biliary ischemia and biloma formation.

  7. Coil compaction after embolization of the superior mesenteric artery pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Hama, Yukihiro; Iwasaki, Yoshie; Kaji, Tatsumi; Kusano, Shoichi [Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 3590042 Saitama (Japan); Hatsuse, Kazuo [Department of Surgery I, National Defense Medical College, 3-2 Namiki, Tokorozawa, 3590042 Saitama (Japan)

    2002-07-01

    A 58-year-old man with an abscess of the psoas muscle was returned to our hospital with hematemesis. Two years earlier, he had undergone coil embolization for a superior mesenteric artery (SMA) pseudoaneurysm secondary to pancreatitis. Based on the physical examination, serum amylase level, and abdominal radiographs, a diagnosis of acute exacerbation of pancreatitis and coil compaction of the SMA pseudoaneurysm was made. The patient underwent re-embolization for the coil compaction using interlocking detachable coils. His condition improved gradually, and he was discharged 3 weeks later. To our knowledge, this is the first report of coil compaction of SMA pseudoaneurysm. (orig.)

  8. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  9. Rising incidence of pulmonary embolism in modern China

    Institute of Scientific and Technical Information of China (English)

    Tsung O.Cheng

    2006-01-01

    @@ To the Editor: Pulmonary embolism (PE) used to be thought to be rare in China.1 Traditional teaching by such authorities as Snapper, who was highly regarded in old China as one of the most astute diagnosticians, was that PE was uncommon in China.2 As a matter of fact, he did not even mention it in his book "Chinese lessons to western medicine",3 published in 1941. The rarity of pulmonary embolism was even more remarkable when one considered the widespread use of birth control pills among the Chinese women of child-bearing age.1

  10. Pulmonary embolism--incidence and prognosis in hospitalized elderly.

    OpenAIRE

    Mangion, D. M.

    1989-01-01

    In a retrospective study of 210 patients with pulmonary embolism diagnosed by ventilation perfusion lung scan or at post-mortem, the incidence of pulmonary embolism was greater in patients over 50 years old (1.4%; P less than 0.05). This was largely due to an increased prevalence of serious associated disease (53%; P less than 0.05). Mortality in elderly patients (70 years and older) diagnosed by ventilation perfusion lung scan was similar to that in younger age groups (P greater than 0.05). ...

  11. Noncompaction and embolic myocardial infarction: the importance of oral anticoagulation.

    Science.gov (United States)

    Pulignano, Giovanni; Tinti, Maria Denitza; Tolone, Stefano; Musto, Carmine; De Lio, Lucia; Pino, Paolo Giuseppe; Minardi, Giovanni; Violini, Roberto; Uguccioni, Massimo

    2015-01-01

    Left ventricular noncompaction (LVNC) is characterized by left ventricular (LV) hypertrabeculations and is associated with heart failure, arrhythmias and embolism. We report the case of a 67-year-old LVNC patient, under oral anticoagulation (OAC) therapy for apical thrombosis. After she discontinued OAC, the thrombus involved almost the whole of the left ventricle; in a few months her condition worsened, requiring hospitalization, and despite heparin infusion she experienced myocardial infarction (MI), caused by embolic occlusion of the left anterior descending artery. Although infrequent as a complication of LVNC, and usually attributable to microvascular dysfunction, in this case MI seems due to coronary thromboembolism from dislodged thrombotic material in the left ventricle.

  12. Preoperative arterial embolization in heterotopic ossification: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Balzer, J. [Dept. of Radiology, University of Frankfurt (Germany); Wolff, J.D. [Dept. of Cardiothoracic Surgery, University of Frankfurt (Germany); Skripitz, R. [Dept. of Orthopaedic Surgery, University of Frankfurt (Germany)

    2001-06-01

    We report a case of preoperative embolization in a 64-year-old patient suffering from total stiffness of the right hip joint due to heterotopic ossification following brain injury and pertrochanteric fracture of the right femur. A previous attempt of operative treatment could not be performed successfully due to bleeding complications. After the embolization of the correlating hypervascularisation, the surgical procedure was redone and finished with good result and minimal bleeding complications during the operation and a tolerable drop of the haemoglobin concentration postoperatively. (orig.)

  13. Acute pulmonary embolism%急性肺栓塞

    Institute of Scientific and Technical Information of China (English)

    Giancarlo Agnelli, M.D.; Cecilia Becattini, M.D., Ph.D.; 傅琳

    2010-01-01

    @@ 急性肺栓塞(acute pulmonary embolism, APE)的临床表现范围从休克(shock)或持续性低血压(sustained hypotension)到轻度呼吸困难(dyspnea).肺栓塞(pulmonary embolism)甚至有可能是无症状的,并且是在基于其他目的而实施的影像学操作中被诊断出来.APE的病死率范围从60%到<1%,取决于临床表现[1].抗凝是肺栓塞治疗的基础.

  14. Recent advances of ventilation-perfusion scintigraphy in clinical diagnosis and interventional treatment of pulmonary embolism

    International Nuclear Information System (INIS)

    Ventilation-perfusion scintigraphy can reflect the pulmonary function of ventilation and perfusion, then, indirectly assess the distribution of embolism. This technique is especially valuable in evaluating hemodynamic stability in patients with suspected pulmonary embolism. Ventilation-perfusion scintigraphy is superior to other imaging means in clinical practice as it is non-invasive and carries high specificity in detecting sub-segmental embolism. Furthermore, the advantages of interventional therapy are of significant clinical value in treating pulmonary embolism. This paper aims to make a comprehensive review for the ventilation-perfusion scintigraphy diagnosis, as well as the interventional treatment, of pulmonary embolism. (authors)

  15. Strategic and Technical Considerations for the Endovascular Embolization of Intracranial Meningiomas.

    Science.gov (United States)

    James, Robert F; Kramer, Daniel R; Page, Paul S; Gaughen, John R; Martin, Lacey B; Mack, William J

    2016-04-01

    Endovascular embolization is a frequently used adjunct to operative resection of meningiomas. Embolization may decrease intraoperative blood loss, operative time, and surgical difficulty associated with resection. The specific clinical applications of this treatment have not been defined clearly. Procedural indications, preferred embolic agent, and latency until tumor resection all differ across operators. It is clear that strategic patient selection, comprehensive anatomic understanding, and sound operative technique are critical to the success of the embolization procedure. This article reviews the management and technical considerations associated with preoperative meningioma embolization. PMID:27012380

  16. Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

    Energy Technology Data Exchange (ETDEWEB)

    Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

    2008-10-15

    Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

  17. Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

    International Nuclear Information System (INIS)

    Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

  18. Transarterial Embolization of Type II Endoleaks after EVAR: The Role of Ethylene Vinyl Alcohol Copolymer (Onyx)

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Wille, Rene, E-mail: rene.mueller-wille@ukr.de; Wohlgemuth, Walter A., E-mail: walter.wohlgemuth@ukr.de; Heiss, Peter, E-mail: peter.heiss@ukr.de; Wiggermann, Philipp, E-mail: philipp.wiggermann@ukr.de; Guentner, Oliver, E-mail: oliverguentner@yahoo.de; Schreyer, Andreas G., E-mail: andreas.schreyer@ukr.de; Hoffstetter, Patrick, E-mail: p.hoffstetter@asklepios.com; Stroszczynski, Christian, E-mail: christian.stros@ukr.de [University Medical Center Regensburg, Department of Radiology (Germany); Zorger, Niels, E-mail: niels.zorger@barmherzige-regensburg.de [Krankenhaus Barmherzige Brueder Regensburg, Department of Radiology (Germany)

    2013-10-15

    Purpose: To determine the feasibility and efficacy of transarterial endoleak embolization using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx). Methods: Over a 7-year period eleven patients (6 women, 5 men; mean age 68 years, range 37-83 years) underwent transarterial embolization of a type II endoleak after endovascular aortic aneurysm repair using the liquid embolic agent Onyx. Two patients (18 %) had a simple type II endoleak with only one artery in communication with the aneurysm sac, whereas 9 patients (82 %) had a complex type II endoleak with multiple communicating vessels. We retrospectively analyzed the technical and clinical success of transarterial type II endoleak embolization with Onyx. Complete embolization of the nidus was defined as technical success. Embolization was considered clinically successful when volume of the aneurysm sac was stable or decreased on follow-up CT scans. Result: Mean follow-up time was 26.0 (range 6-50) months. Clinical success was achieved in 8 of 11 patients (73 %). Transarterial nidus embolization with Onyx was technically successful in 6 of 11 patients (55 %). In three cases the nidus was embolized without direct catheterization from a more distal access through the network of collateral vessels. Conclusion: Onyx is a favorable embolic agent for transarterial endoleak embolization. To achieve the best clinical results, complete occlusion of the nidus is mandatory.

  19. Clinical value of pre-operative double embolization for nasopharyngeal angiofibroma

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical value of pre-operative double embolization for nasopharyngeal angiofibroma. Methods: Digital subtraction angiography (DSA) was carried out in 7 cases of nasopharyngeal angiofibroma. In six cases, the supplying arteries originated from the maxillary artery and the branches arising from internal carotid artery underwent double embolization-direct percutaneous puncture embolization and selective embolization of blood supplying arteries. In another case, the supplying artery originated from maxillary artery was only undertaken selective embolization for the feeding arteries. Results: All the tumor masses reduced in volume obviously or even disappeared on the angiography after embolization. Conclusions: Pre-operative double embolization for nasopharyngeal angiofibroma could be a necessary additional treatment method. (authors)

  20. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)

    International Nuclear Information System (INIS)

    To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1,493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism. Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans. Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings

  1. Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

    International Nuclear Information System (INIS)

    The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible

  2. Complete hepatocellular carcinoma necrosis following sequential porto-arterial embolization

    Institute of Scientific and Technical Information of China (English)

    Stéphane Zalinski; Olivier Scatton; Bruto Randone; Olivier Vignaux; Bertrand Dousset

    2008-01-01

    Most patients with hepatocellular carcinoma (HCC) are not eligible for curative treatment, which is resection or transplantation. Two recent series have emphasized the potential benefits of preoperative arterio-portal embolization prior to surgical resection of such tumours. This preoperative strategy offers a better disease free survival rate and a higher rate of total tumor necrosis. In case of non resectable HCC it is now widely accepted that transarterial chemoembolization (TACE) leads to a better survival when compared to conservative treatment. Thus, the question remains whether combined portal vein embolization (PVE) may enhance the proven efficiency of TACE in patients with unresectable HCC. We herein report the case of a 56-year-old cirrhotic woman with a voluminous HCC unsuitable for surgical resection. Yet, complete tumour necrosis and prolonged survival could be achieved after a combined porto-arterial embolization. This case emphasizes the potential synergistic effect of a combined arterio-portal embolization and the hypothetical survival benefit of such a procedure, in selected patients, with HCC not suitable for surgery or local ablative therapy.

  3. Multiple myeloma with pulmonary embolism: a case report

    Institute of Scientific and Technical Information of China (English)

    YING Ke-jing; ZHOU Yong; JIANG Hao; CHEN En-guo; ZHOU Pan

    2006-01-01

    @@ We report a rare case of a patient who died suddenly, in whom bilateral pulmonary artery thrombosis with multiple myeloma was found at autopsy. An estimate of the incidence of pulmonary embolism in myeloma patients based on postmortem examinations is about 3.2%. Hypercoagulability and decreased fibrinolytic capacity due to multiple myeloma were the probable causes of multiple thromboses.

  4. Superselective embolization with microcoil in acute gastronitestinal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Eun Hye; Kim, Jae Kyu; Jang, Nam Kyu [Medical School, Chonnam University, Kwangju (Korea, Republic of)] [and others

    2000-04-01

    To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointerstinal hemorrhage. We evaluated 11 of 42 patients who had undergone diagnostic angiography and transcatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=3D5), pseudoaneurysm from pancreatitis (n=3D3), and postoperative bleeding (n=3D3). The symptoms were melena, hematemesis, and hematochzia, and the critical signs were cecreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. Bleeding occurred in the gastroduodenal artery (n=3D5), inferior pancreaticoduodenal artery (n=3D2), left gastric artery (n=3D2), right hepatic artery (n=3D1), and ileal branch of the superior mesenteric artery (n=3D1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right hepatic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult resiratory distress syndrome. (author)=20.

  5. Coil embolization of an anastomotic leak after ascending aorta replacement

    DEFF Research Database (Denmark)

    Nørgaard, Anders; Andersen, Lars Ib; Haahr, P.E.;

    2008-01-01

    Surgical treatment of diseases of the thoracic aorta (aneurysms, dissections, and ruptures) may be associated with serious postoperative complications. Endovascular repair of thoracic aorta pathology is less invasive and offers a therapeutic alternative in high-surgical-risk patients, particularl...... accepted--embolization with endovascular coils--successfully resulting in occlusion of the leakage....

  6. Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC). The authors present a case of CLE that occurred after the second hepatic arterial chemoembolization for HCC, and attempt to introduce several plausible mechanisms of CLE, after reporting the clinical and radiological findings and reviewing the medical literature.

  7. 'Low-dose' corticosteroid prophylaxis against fat embolism.

    Science.gov (United States)

    Kallenbach, J; Lewis, M; Zaltzman, M; Feldman, C; Orford, A; Zwi, S

    1987-10-01

    The effect of 'low-dose' corticosteroids (9 mg/kg methylprednisolone), given after skeletal trauma, on the incidence of the fat embolism syndrome and isolated arterial hypoxemia was studied in 42 controls and 40 steroid-treated subjects. Fat embolism occurred in ten controls (23.8%) and one steroid-treated subject (2.5%) (p = 0.01). A further 44 subjects developed isolated hypoxemia. This was severe (PaO2 less than 50 mm Hg) in seven of 32 controls (21.9%) and one of 39 steroid-treated subjects (2.6%) (p = 0.01). The overall incidence of hypoxemia was 67.1%, affecting 33 controls (78.6%) and 22 steroid-treated patients (55%) (p less than 0.05). The degree of hypoxemia was severe (PaO2 less than 50 mm Hg) in 12 controls (28.6%) and two (5%) of the steroid-treated subjects (p = 0.005). No control subject died or required mechanical ventilation. One steroid-treated subject without fat embolism died of a fulminant infection. Although methylprednisolone in a relatively low dose provides protection against fat embolism and pulmonary dysfunction after skeletal trauma, the safety of this therapy requires further evaluation. PMID:3312625

  8. Superselective embolization with microcoil in acute gastronitestinal hemorrhage

    International Nuclear Information System (INIS)

    To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointerstinal hemorrhage. We evaluated 11 of 42 patients who had undergone diagnostic angiography and transcatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=3D5), pseudoaneurysm from pancreatitis (n=3D3), and postoperative bleeding (n=3D3). The symptoms were melena, hematemesis, and hematochzia, and the critical signs were cecreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. Bleeding occurred in the gastroduodenal artery (n=3D5), inferior pancreaticoduodenal artery (n=3D2), left gastric artery (n=3D2), right hepatic artery (n=3D1), and ileal branch of the superior mesenteric artery (n=3D1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right hepatic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult resiratory distress syndrome. (author)=20

  9. Cerebral fat embolism studied with MRI and SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Erdem, E. (Dept. of Neurology, Hacettepe Univ. School of Medicine, Ankara (Turkey)); Namer, I.J. (Inst. of Biophysics, Faculty of Medicine, Louis Pasteur Univ., Strasbourg (France)); Saribas, O. (Dept. of Neurology, Hacettepe Univ. School of Medicine, Ankara (Turkey)); Aras, T. (Dept. of Nuclear Medicine, Hacettepe Univ. School of Medicine Ankara (Turkey)); Tan, E. (Dept. of Neurology, Hacettepe Univ. School of Medicine, Ankara (Turkey)); Bekdik, C. (Dept. of Nuclear Medicine, Hacettepe Univ. School of Medicine Ankara (Turkey)); Zileli, T. (Dept. of Neurology, Hacettepe Univ. School of Medicine, Ankara (Turkey))

    1993-03-01

    In a patient with fat embolism to the brain CT showed no abnormality. MRI performed after recovery from coma, when the patient had aphasia and quadriparesis, demonstrated multiple high signal abnormalities in the white matter on both T1- and T2-weighted images. HMPAO-SPECT showed left-sided hypoperfusion which resolved in parallel with clinical improvement 1 month later. (orig.)

  10. Breathomics as a diagnostic tool for pulmonary embolism

    NARCIS (Netherlands)

    Fens, N.; Douma, Renee; Sterk, P.J.; Kamphuisen, P.W.

    2011-01-01

    Rationale The majority of patients suspected of pulmonary embolism (PE) undergoes imaging tests, but PE will only be confirmed in a minority of patients. Consequently, there is a need for non-invasive, safe assessment aimed to accurately exclude PE. Exhaled breath molecular profiling by electronic n

  11. Acute pulmonary embolism. Part 1: epidemiology and diagnosis

    NARCIS (Netherlands)

    R.A. Douma; P.W. Kamphuisen; H.R. Büller

    2010-01-01

    Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE, both inherited and acquired, have been identified. Adequate diagnosis is mandatory to prevent PE-related morbidity and mortality on the one hand, and unnecessary treatment on the

  12. Acute pulmonary embolism. Part 1: Epidemiology and diagnosis

    NARCIS (Netherlands)

    Douma, Renée A.; Kamphuisen, Pieter W.; Büller, Harry R.

    2010-01-01

    Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE, both inherited and acquired, have been identified. Adequate diagnosis is mandatory to prevent PE-related morbidity and mortality on the one hand, and unnecessary treatment on the

  13. Retrospective Clinical Analysis of 38 Cases of Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    Ruiyun Liang; Wei Zhang; Wei Wu; Shanping Jiang; Zhiqiang Lü

    2007-01-01

    To investigate the clinical feature of acute pulmonary embolism.Methods Retrospective clinical analysis was performed according to the data of 38 cases of pulmonary embolism.Results There were ground diseases and predisposing factors in 36 cases of pulmonary embolism among 38 cases,the ratio was 94.7 %,among the total predisposing factors,tumor,cardiovascular disease,venous thrombosis of lower extremity,smoking and long-term bed were common.There was no specificity in clinical feature,physical sign and rout chest X ray,electrocardiography,and their appearances were diversified.There were specificity and sensitivity in echocardiogram (UCG) and D-dimer to some extent.But,the final diagnosis must depend on some special examinations,such as selective pulmonary arteriography,CTPA,MRA and so on.Conclusions The special examinations must be done to make a definite diagnosis to confirm pulmonary embolism when the high risk factors and ground diseases are existing.It is necessary to some cases when the clinical feature can not be explained by other diseases.

  14. Efficacy and Safety of Trans-Arterial Splenic Embolization

    Directory of Open Access Journals (Sweden)

    Ali Cadili

    2012-02-01

    Conclusions: Trans-arterial splenic embolization is a safe and effective procedure that does not lead to longterm compromise of splenic function. Complications and failures of this procedure, however, cannot be predicted based on either patient or procedure characteristics examined in this study. [Arch Clin Exp Surg 2012; 1(1.000: 22-26

  15. Fatal cerebral arterial gas embolism after endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Rangappa Pradeep

    2009-01-01

    Full Text Available We report the case of a 50-year-old woman undergoing elective endoscopic retrograde cholangiopancreatography, who developed coma and hemiparesis secondary to severe cerebral artery gas embolism. Despite prompt diagnosis and early hyperbaric oxygen therapy (HBO 2 she developed severe cerebral edema and died within 24 h.

  16. Bullet embolism of pulmonary artery: a case report

    Directory of Open Access Journals (Sweden)

    Mauricio Gustavo Ieiri Yamanari

    2014-04-01

    Full Text Available The authors report the case of a patient victim of gunshots, with a very rare complication: venous bullet embolism from the left external iliac vein to the lingular segment of the left pulmonary artery. Diagnosis is made with whole-body radiography or computed tomography. Digital angiography is reserved for supplementary diagnosis or to be used as a therapeutic procedure.

  17. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism

    OpenAIRE

    Büller, Harry R; Prins, Martin H.; Lensing, Anthonie W. A.; Decousus, Hervé; Jacobson, Barry F; Minar, Erich; Chlumsky, Jaromir; Verhamme, Peter; Wells, Phil; Agnelli, Giancarlo; Cohen, Alexander; Berkowitz, Scott D.; Bounameaux, Henri; Davidson, Bruce L; Misselwitz, Frank

    2012-01-01

    A fixed-dose regimen of rivaroxaban, an oral factor Xa inhibitor, has been shown to be as effective as standard anticoagulant therapy for the treatment of deep-vein thrombosis, without the need for laboratory monitoring. This approach may also simplify the treatment of pulmonary embolism.

  18. Selective embolization in the treatment of intractable epistaxis

    DEFF Research Database (Denmark)

    Andersen, Pia Juul; Kjeldsen, Anette Drøhse; Nepper-Rasmussen, Jørgen

    2005-01-01

    procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). MATERIAL AND METHODS: This...

  19. Embolization of a deep orbital varix through endovascular route

    Directory of Open Access Journals (Sweden)

    R Ravi Kumar

    2015-01-01

    Full Text Available We report a case of the primary deep orbital venous varix treated by endovascular coil embolization procedure by transfemoral catheterization. This method of treatment has the advantage of image-guided localization of the pathology, real-time management and confirmation of the success of the procedure in the sitting.

  20. Cerebral gas embolism due to upper gastrointestinal endoscopy

    NARCIS (Netherlands)

    ter Laan, Mark; Totte, Erik; van Hulst, Rob A.; van der Linde, Klaas; van der Kamp, Wim; Pierie, Jean-Pierre E.

    2009-01-01

    Cerebral gas embolism as a result of upper gastrointestinal endoscopy is a rare complication and bares a high morbidity. A patient is presented who underwent an upper endoscopy for evaluation of a gastric-mediastinal fistula after subtotal oesophagectomy and gastric tube reconstruction because of oe

  1. Pseudoaneurysm after pancreatoduodenectomy: diagnosis and embolization on angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Jun Yong [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Lee, Sang Hyun; Kim, Sam Soo; Han, Heon; Chung, Hye Won [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Youn, Byung Jae; Han, Joon Koo; Choi, Byung Ihn; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2002-08-01

    To evaluate the efficacy of angiography in the diagnosis and treatment of pseudoaneurysm manifesting arterial hemorrhage as a significant complication following pancreatoduodenectomy. For 51 months, of a total of 298 patients who had undergone pancreatoduodenectomy, 19 patients (6.4%) developed clinically significant hemorrhage and nine patients proved to have a pseudoaneurysm of angiography. These nine patients (3.0%) were managed by transcatheter arterial embolization. We analyzed clinical feature, angiography findings and hemostatic effect of embolization retrospectively. In nine patients (3.0%), pseudoaneurysm was diagnosed on angiography (common hepatic artery in four, gastroduodenal artery in three, proper hepatic artery in one, and left gastroepoploic artery in on patient). The size ranged from 0.3 cm to 6.5 cm (mean 1.9 cm). And extravasation was noted in five patients (55.6%). The remained ten patients showed no evidence of bleeding on angiography. Those who manifested as early bleeding (within two weeks) or delayed bleeding ( later than two weeks) were five and four patients respectively. Before the onset of major bleeding, among the nine pseudoaneurysm patients, seven patients (77.8%) had experienced percutaneous drainage due to intra-abdominal fluid collection with or without abscess resulting from anastomotic leak, and all nine patients had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseucoaneurysm followed by transcatheter arterial embolization (microcoil in eight patients, gelfoam in one) and achieved complete hemostasis yielding a success rate of 100%. Overall, no patients experienced complications related directly to the transcatheter arterial embolization technique. During the follow-up period (72-1, 336days, mean 640), no recurrence of bleeding was note. Although pseudoaneurysm is a rare complication, it is important as a cause of hemorrhage after pancreatoduodenectomy. Angiography followed by

  2. Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    LENUS (Irish Health Repository)

    McCabe, A

    2013-06-01

    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.

  3. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients

    International Nuclear Information System (INIS)

    ObjectiveThis study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE). The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20–25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE. The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion. The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.

  4. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lv Mingming, E-mail: lvmingming001@163.com; Fan, Xin-dong, E-mail: fanxindong@yahoo.com.cn [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ninth People' s Hospital (China); Su Lixin, E-mail: sulixin1975@126.com [Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial Surgery, Ninth People' s Hospital (China); Chen Dong, E-mail: chenjsun@public8.sta.net.cn [Shanghai Jiao Tong University School of Medicine, Department of Otolaryngology, Ninth People' s Hospital (China)

    2013-02-15

    ObjectiveThis study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE). The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20-25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE. The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion. The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.

  5. Outcome in patients undergoing unilateral uterine artery embolization for symptomatic fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Nicholson, T. E-mail: tonynick@tonynick.demon.co.uk

    2004-02-01

    AIMS: To evaluate patients undergoing uterine artery embolization for symptomatic fibroids who, for technical reasons, underwent unilateral rather than bilateral embolization. PATIENTS: Prospective data were collected on 109 patients undergoing uterine artery embolization for symptomatic fibroids. Of these, six underwent unilateral embolization. They were followed with ultrasound or magnetic resonance imaging (MRI) at 3, 6 and 12 months. Patients' histories were reviewed and patients were asked to evaluate their symptoms at 3, 6 and 12 months on a scoring system, which scored their pre-embolization symptoms as 10. RESULTS: In one case the patient's symptoms did not change in the first 3 months. This patient underwent a second embolization procedure to occlude the non-embolized uterine artery. In four cases the patients' symptoms had begun to resolve at 3 months and by 12 months the patients no longer required any further treatment. In one case the patient passed a 10 cm fibroid per vagina 2 months post uterine artery embolization. After this the patient had a normal uterus on MRI and no further symptoms. CONCLUSION: Where planned bilateral uterine artery embolization is not possible for technical reasons and a unilateral embolization only is performed a conservative approach is indicated.

  6. A case of repeated small bowel perforations in a short period in a patient with cholesterol crystal embolism.

    Science.gov (United States)

    Shinozuka, Eriko; Yamada, Takeshi; Kan, Hayato; Matsumoto, Satoshi; Koizumi, Michihiro; Shinji, Seiichi; Arai, Hiroki; Naito, Zenya; Uchida, Eiji

    2016-05-01

    We report a case of jejunal perforation related to cholesterol crystal embolism (CCE) in a woman in her seventies. The jejunum was partially resected;histological examination of the resected tissue revealed that the perforation was caused by CCE. On postoperative day 12, computed tomography (CT) showed free air in the abdomen. We then performed a second operation to alleviate the anastomotic leakage. Subsequently, 26 days after the second surgery, CT again showed free air in the abdomen. A third operation was performed, and multiple perforations of the jejunum were detected. She died of multiple organ failure 43 days after the first surgery. The prognosis of CCE with gastrointestinal perforation is reported to beextremely poor, and there is a high rate of anastomotic leakage. Partial resection of the intestine and ileostomy might be useful for removing the intestinal perforations caused by a CCE. Steroid administration should be continued, however, because discontinuation may worsen the problem. PMID:27151477

  7. Superselective uterine artery embolization for the control and prevention of obstetric hemorrhage

    International Nuclear Information System (INIS)

    Objectives: To evaluate the efficacy of superselective uterine artery embolization for treatment and prevention of obstetric hemorrhage. Methods: Between April 2004 and December 2007, 47 consecutive patients underwent uterine artery embolization to control or prevent hemorrhage, including 20 patients for preventing hemorrhage before abortion and 27 for controlling obstetric hemorrhage. Results: Bilateral uterine artery embolization was performed in all cases except one for abnormal vascular anatomy receiving unilateral approach. Within 10 days after embolization, curettage abortion or uterine-incision delivery was done without hysterectomy, and hemorrhage during abortion was less with average of 54 ml. Conclusions: The high success rate, effectiveness and possibility of preserving reproductive function have made uterine artery embolization the technique of choice to control obstetric hemorrhage, and prophylactic embolization, can prevent hemorrhage before abortion. (authors)

  8. Embolization of the Vasa Recta in Acute Lower Gastrointestinal Hemorrhage: A Report of Five Cases

    International Nuclear Information System (INIS)

    Purpose: To present our preliminary experience in embolization of the vasa recta in acute gastrointestinal hemorrhage. Methods: In four of five patients with acute gastrointestinal hemorrhage superselective embolization of the vasa recta was performed. In one patient in whom superselective catheterization of the bleeding vas rectum was technically impossible, the origin of this vessel was embolized at the level of the terminal arcade. The following embolization materials were used: microcoils and polyvinyl alcohol particles (355-500 μm), n= 2; microcoils only, n= 2; Gelfoam particles, n1. Results: Bleeding was found in two patients in the small bowel (jejunum and ileum) and in three patients in the colon. Immediate hemostasis was achieved in all patients. No signs of ischemia or infarction were observed after intervention. Conclusions: Superselective embolization of the vasa recta proved efficient and safe in our small patient group. Advantages of this technique are reduction of the embolized area to a minimum and direct control of hemostasis

  9. Juvenile nasopharyngeal angiofibroma with skull base invasion : intratumoral direct puncture embolization

    International Nuclear Information System (INIS)

    The purpose of this study is to demonstrate the utility and efficacy of percutaneous direct glue embolization for juvenile nasopharyngeal angiofibromas with skull base invasion. In nine cases of juvenile nasopharyngeal angiofibromas with invasion of the skull base, embolization under general anethesia was performed. Using an 18G spinal needle, direct puncture were made via the transnasal or mandibular sciatic notch. A glue-lipiodol mixture (1:1 -1:3) was injected slowly for 15 to 30 seconds under fluoroscopic control; the number of post-embolization angiography and the distribution of embolic materials was assessed on CT within 1-3 days. The mass was surgically removed 3 to 7 days after embolization. Direct glue embolization of juvenile angiofibroma with skull base invasion appears to be a simple and safe procedure. The technique could be used for other hypervascular lesions in the base of the skull or parapharyngeal space. (author). 19 refs., 1 tab., 2 figs

  10. The role of lung perfusion and ventilation study in the evaluation of pulmonary embolism

    International Nuclear Information System (INIS)

    The role of lung perfusion and ventilation study (Lung scintigraphy), in the diagnosis of management of patients with clinically suspected pulmonary embolism, will be reviewed. Evidence will be provided,that a normal perfusion scan excludes clinically relevant pulmonary embolism, and that a high probability lung scan, defined as a segmented perfusion defect with locally normal ventilation, sufficiently confirms the presence of pulmonary embolism in the majority of patients carried out in the study

  11. Pulmonary Embolization of Fat and Bone Marrow in Cynomolgus Macaques (Macaca fascicularis)

    OpenAIRE

    Fong, Derek L; Murnane, Robert D; Hotchkiss, Charlotte E; Green, Damian J.; Hukkanen, Renee R.

    2011-01-01

    Fat embolization (FE), the introduction of bone marrow elements into circulation, is a known complication of bone fractures. Although FE has been described in other animal models, this study represents the first reported cases of FE and bone marrow embolism in nonhuman primates. Histopathologic findings from cynomolgus macaques (Macaca fascicularis) indicated that in all 5 cases, fat and bone marrow embolization occurred subsequent to multiple bone marrow biopsies. In the most severe case, ex...

  12. Upper extremity tumor embolization using a transradial artery approach: technical note.

    Science.gov (United States)

    Zaw, Taryar; Ni, Jason C; Park, Jonathan K; Walsworth, Matthew

    2016-09-01

    Transradial access is being used with increasing frequency for interventional radiology procedures and offers several key advantages, including decreased access site complications and increased patient comfort. We report the technique of using transradial access to perform preoperative embolization of a humeral renal cell carcinoma metastasis and pathologic fracture. A transradial approach for performing humeral preoperative tumor embolization has not been previously reported, to our knowledge. In the appropriately selected patient, this approach may be safely used to perform upper extremity embolization. PMID:27594948

  13. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

    OpenAIRE

    Madhusudhan, Kumble Seetharama; Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan

    2016-01-01

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the tr...

  14. Adjustments in the diagnostic work-up, treatment and prognosis of pulmonary embolism

    OpenAIRE

    Middeldorp, S.; Kamphuisen, P.W.; Gerdes, V.E.A.; Douma, R.A.; Es, van, Bert

    2013-01-01

    Pulmonary embolism is a potentially fatal condition, in which an embolus, usually a thrombus originating from one of the deep veins of the legs, blocks one or more pulmonary arteries. This leads to impaired blood flow through the lungs. Pulmonary embolism is the third most common cardiovascular disorder in Western society, affecting 1-2 per 1000 patients per year. The clinical presentation of patients with suspected acute pulmonary embolism varies from only mild symptoms to severe dyspnoea, p...

  15. Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism

    OpenAIRE

    Prediletto, Renato; Miniati, Massimo; Tonelli, Lucia; Formichi, Bruno; Di Ricco, Giorgio; Marini, Carlo; Bauleo, Carolina; Allescia, Germana; Cocci, Franca; Monti, Simonetta; Pistolesi, Massimo; Giuntini, Carlo

    1999-01-01

    Objective: To assess the value of parameters derived from arterial blood gas tests in the diagnosis of pulmonary embolism. Method: We measured alveolar-arterial partial pressure of oxygen [P(A–a)O2] gradient, PaO2 and arterial partial pressure of carbon diaxide (PaCO2) in 773 consecutive patients with suspected pulmonary embolism who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism. Diagnosis: The study design required pulmonary angiography in all patients with...

  16. Disastrous Portal Vein Embolization Turned into a Successful Intervention

    Energy Technology Data Exchange (ETDEWEB)

    Dobrocky, Tomas, E-mail: tomas.dobrocky@insel.ch [University of Bern, Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital (Switzerland); Kettenbach, Joachim, E-mail: joachim.kettenbach@stpoelten.lknoe.at [Universitätsklinikum St. Pölten-Lilienfeld, Institute of Medical Radiology, Diagnostic, Intervention (Austria); Lopez-Benitez, Ruben, E-mail: Ruben.lopez@insel.ch; Kara, Levent, E-mail: levent.kara@insel.ch [University of Bern, Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital (Switzerland)

    2015-10-15

    Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.

  17. Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

    Directory of Open Access Journals (Sweden)

    Youming Long

    2014-01-01

    Full Text Available Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9% patients were women. Fifteen (55.6% patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2, moyamoya disease (n = 1, and neuromyelitis optica (n = 1. We found positive associations between mRS (>3 and female gender (r = 0.873, P10 × 109/L (r = 0.722, P = 0.002, tumour size (r = 0.866, P0.05. Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis.

  18. Current Concepts of Immunology and Diagnosis in Amniotic Fluid Embolism

    Directory of Open Access Journals (Sweden)

    Michael D. Benson

    2012-01-01

    Full Text Available Amniotic fluid embolism (AFE is one of the leading causes of maternal mortality and morbidity in developed countries. Current thinking about pathophysiology has shifted away from embolism toward a maternal immune response to the fetus. Two immunologic mechanisms have been studied to date. Anaphylaxis appears to be doubtful while the available evidence supports a role for complement activation. With the mechanism remaining to be elucidated, AFE remains a clinical diagnosis. It is diagnosed based on one or more of four key signs/symptoms: cardiovascular collapse, respiratory distress, coagulopathy, and/or coma/seizures. The only laboratory test that reliably supports the diagnosis is the finding of fetal material in the maternal pulmonary circulation at autopsy. Perhaps the most compelling mystery surrounding AFE is not why one in 20,000 parturients are afflicted, but rather how the vast majority of women can tolerate the foreign antigenic presence of their fetus both within their uterus and circulation?

  19. Embolization for major lower gastrointestinal haemorrhage: five-year experience

    International Nuclear Information System (INIS)

    The management of major lower gastrointestinal haemorrhage has changed dramatically in the last 15 years. Innovations in coaxial catheter technology have allowed the interventional radiologist to reach the small peripheral mesenteric arteries and perform superselective embolization with a variety of agents. The present large series represents the 5-year experience of this technique at the Alfred Hospital, Melbourne, in a patient cohort with a high number of comorbidities. Technical success was achieved in 96% of cases. The clinical symptoms of mesenteric ischaemia developed in four patients after embolization and were managed conservatively in two. The procedure-related mortality was low when compared with the published complication rates for emergency surgery, in this clinical setting. Copyright (2004) Blackwell Publishing Asia Pty Ltd

  20. Effectiveness of arterial embolization procedure in uterine cancer patients.

    Science.gov (United States)

    Hayashi, M; Murakami, A; Iwasaki, N; Yaoi, Y

    1999-01-01

    Patients with late stage gynecologic malignancies occasionally develop massive pelvic hemorrhage, and management of the hemorrhage is often difficult. Transcatheter arterial embolization with an absorbable gelatin sponge following the Seldinger method was performed to control hemorrhage in five patients with cancer of the uterine cervix. Pelvic arteriograms of five patients showed no further extravasation and their bleeding ceased. No patients died of pelvic hemorrhage, and all of them eventually died as a result of the original disease within two years of the procedure. As for complications of this procedure, slight fever (3/5) and minimal lumbar pain (2/5) were noticed, which were easily controlled by an indomethacin suppository. Based on these findings, this therapeutic embolization method proved to be useful in the management of massive pelvic hemorrhage in patients with cervical cancer. PMID:17312676

  1. Thrombolytic therapy in bilateral embolism of renal arteries branches

    Directory of Open Access Journals (Sweden)

    Cassini Marcelo F.

    2003-01-01

    Full Text Available Bilateral renal artery embolism is rare, but it is a significant cause of arterial hypertension and renal failure, and most often is associated with cardiac arrhythmias. We report a case of bilateral renal artery embolism with a satisfactory outcome following use of thrombolytic therapy. A 42 year-old Caucasian man presented a sudden complaint of intense abdominal pain, in mesogastrium and left flank with dorsal irradiation, 3 days after electrical cardioversion due to cardiac arrhythmia. Laboratory tests revealed slight leukocytosis, hematuria, and creatinine of 1.8 mg/dL. Chest radiography was normal and computerized tomography showed an area of massive ischemia in left kidney, and focal ischemia in right kidney and spleen. The patient was then submitted to systemic venous therapy with 1.5 million units of streptokinase, with an excellent outcome.

  2. Using Topological Data Analysis for diagnosis pulmonary embolism

    CERN Document Server

    Rucco, Matteo; Herman, Damir; Petrossian, Tanya; Merelli, Emanuela; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    Pulmonary Embolism (PE) is a common and potentially lethal condition. Most patients die within the first few hours from the event. Despite diagnostic advances, delays and underdiagnosis in PE are common.To increase the diagnostic performance in PE, current diagnostic work-up of patients with suspected acute pulmonary embolism usually starts with the assessment of clinical pretest probability using plasma d-Dimer measurement and clinical prediction rules. The most validated and widely used clinical decision rules are the Wells and Geneva Revised scores. We aimed to develop a new clinical prediction rule (CPR) for PE based on topological data analysis and artificial neural network. Filter or wrapper methods for features reduction cannot be applied to our dataset: the application of these algorithms can only be performed on datasets without missing data. Instead, we applied Topological data analysis (TDA) to overcome the hurdle of processing datasets with null values missing data. A topological network was devel...

  3. Preoperative embolization in surgical treatment of spinal metastases

    DEFF Research Database (Denmark)

    Clausen, Caroline; Dahl, Benny; Frevert, Susanne Christiansen;

    2015-01-01

    AND METHODS: This single-blind, randomized (1:1), controlled, parallel-group, single-center trial was approved by the Danish National Committee on Biomedical Research Ethics and was conducted from May 2011-March 2013. Participants (N = 45) were scheduled for decompression and posterior thoracic/lumbar spinal...... instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat. RESULTS......: The intention-to-treat analysis included 45 patients. Mean intraoperative blood loss did not differ significantly (P = .270) between the embolization group (618 mL [SD, 282 mL]) and the control group (735 mL [SD, 415 mL]). There was also no significant difference in allogeneic RBC transfusion (P = .243...

  4. Fat Embolism Syndrome After Femur Fracture Fixation: a Case Report

    OpenAIRE

    Akoh, Craig C; Schick, Cameron; Otero, Jesse; Karam, Matthew

    2014-01-01

    Fat embolism syndrome (FES) is a multi-organ disorder with potentially serious sequelae that is commonly seen in the orthopaedic patient population after femur fractures. The major clinical features of FES include hypoxia, pulmonary dysfunction, mental status changes, petechiae, tachycardia, fever, thrombocytopenia, and anemia. Due to technological advances in supportive care and intramedullary reaming techniques, the incidence of FES has been reported as low as 0.5 percent. Here, we present ...

  5. Transarterial embolization for management of severe postcoital bleeding

    Directory of Open Access Journals (Sweden)

    Armen Eskandari

    2016-08-01

    Full Text Available Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.

  6. Post-traumatic pulmonary embolism in the intensive care unit

    OpenAIRE

    Mabrouk Bahloul; Anis Chaari; Hassen Dammak; Fatma Medhioub; Leila Abid; Hichem Ksibi; Sondes Haddar; Hatem Kallel; Hedi Chelly; Chokri Ben Hamida; Mounir Bouaziz

    2011-01-01

    Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients ...

  7. Bronchial artery embolization in the treatment of massive hemoptysis

    International Nuclear Information System (INIS)

    Objective was to evaluate the efficacy of bronchial arteriography and bronchial artery embolization (BAE) in the management of massive hemoptysis in a developing Asian country. A retrospective review was carried out from March 2000 to March 2005 to evaluate the demographics, clinical presentation, radiographic studies, bronchoscopy results, and complications of bronchial arteriography and BAE at a tertiary care hospital in Pakistan. Fourteen patients (9males, 5 females) with a mean age of 49 years underwent bronchial arteriography and BAE for massive hemoptysis. Hemoptysis was caused by bronchiectasis (10 patients), active pulmonary tuberculosis (3 patients), and lung malignancy (one patient). A CT scan of the chest was carried out in 11 patients, which revealed bronchiectasis (8 patients), cavity with infiltrates (3 patients), and mass lesion (one patient). Bronchoscopy was performed in all patients. Bleeding lobe or segment was identified in 12 patients. Bronchial arteriography revealed hypervascularity (13 patients), bronchial artery hypertrophy (5 patients), hypervascularity with shunting (one patient), dense soft tissue staining (7 patients), extravasation of contrast (one patient) pseudoaneurysm (one patient). Bronchial artery embolization was carried out in all patients. Rebleeding occurred within 24 hours in 2 patients who underwent surgery and within one week another 2 patients who were managed with repeat BAE. The complication of embolization occurred in one patient (transverse myelitis). Thirteen patients improved and were discharged home. One patient with terminal lung carcinoma died due to cardiogenic shock secondary to acute myocardial infarction. Bronchial artery embolization is an effective method for management of massive hemoptysis in developing countries and has a low complication rate. (author)

  8. Pulmonary Embolism as the First Manifestation of Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    N. Vallianou

    2013-01-01

    Full Text Available Multiple myeloma is considered a hypercoagulable state due to several mechanisms such as the increased IL-6 and immunoglobulins production, the defective fibrinolytic mechanism, and the acquired resistance to activated protein C that are involved in the pathogenesis and clinical futures of the disease. We describe a case of a female patient who presented to the hospital with pulmonary embolism as the first manifestation of the hypercoagulability of multiple myeloma.

  9. Two Cases of Postmyomectomy Pseudoaneurysm Treated by Transarterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Nobutake, E-mail: nobutake@rad.med.keio.ac.jp [Keio University, School of Medicine, Department of Diagnostic Radiology (Japan); Natimatsu, Yoshiaki; Tsukada, Jitsuro; Sato, Akihiro; Hasegawa, Ichiro [Kawasaki Municipal Hospital, Department of Diagnostic Radiology (Japan); Lin, Bao-Liang [Kawasaki Municipal Hospital, Department of Gynecologic Endoscopy (Japan)

    2013-12-15

    Pseudoaneurysm resulting from hysteroscopic myomectomy is a rare clinical situation, and interventional radiologists are not traditionally involved in the management. To our knowledge, endovascular treatment of a pseudoaneurysm resulting from hysteroscopic myomectomy has not yet been reported in the English-language literature. Here, two such cases are reported, including one of a woman who later became pregnant. The case is unique because little is known about the influence of unilateral coil embolization of the uterine artery on fertility.

  10. Severe fat embolism in perioperative abdominal liposuction and fat grafting

    Directory of Open Access Journals (Sweden)

    Rodrigo de Lima e Souza

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Fat embolism syndrome may occur in patients suffering from multiple trauma (long bone fractures or plastic surgery (liposuction, compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe fat embolism syndrome after liposuction and fat grafting. CASE REPORT: SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45 min of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH = 7.21; PCO2 = 51 mmHg; PO2 = 52 mmHg; BE = -8; HCO3 = 18 mEq L-1, and lactate = 6.0 mmol L-1. Transthoracic echocardiogram showed PASP = 55 mmHg, hypocontractile VD and LVEF = 60%. Diagnosis of pulmonary embolism. After 24 h of intensive treatment, the patient developed anisocoria and coma (Glasgow coma scale = 3. A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72 h of evolution, the patient progressed to brain death. CONCLUSION: Fat embolism syndrome usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction. The multiorgânico involvement indicates a worse prognosis.

  11. Symptomatic subsegmental pulmonary embolism: what is the next step?

    OpenAIRE

    M.; Carrier; Righini, Marc Philip; Le Gal, G

    2012-01-01

    The introduction of computed tomography pulmonary angiography (CTPA) has led to an increase in the incidence of pulmonary embolism (PE) diagnosis. However, the case fatality rate is lower and the mortality rates of PE have remained unchanged, suggesting a lower severity of illness. Specifically, the multiple-detector CTPA increased the rate of subsegmental filling defect reported in patients with suspected PE. Whether these filling defects reported on CTPA would correlate with true subsegment...

  12. Sequential changes in gas exchange following traumatic fat embolism.

    Science.gov (United States)

    Burnstein, R M; Newell, J P; Jones, J G

    1998-04-01

    We present a young man who developed fat embolism syndrome following a fractured femoral shaft. By intermittently measuring oxygen saturation with a pulse oximeter and varying the inspired partial pressure of oxygen we were able to quantify the development of shunt and ventilation/perfusion (V/Q) mismatch over the course of his illness. Shunt and low V/Q gradually improved in the week following admission but deteriorated following general anaesthesia for nailing of the femur. PMID:9613303

  13. The significant value of uterine artery embolization in treating adenomyosis

    International Nuclear Information System (INIS)

    Adenomyosis is a common obstetric and gynecological disease. The main clinical symptoms include menorrhagia, menostaxis and progressive exacerbated dysmenorrhea. The main treatments currently used to deal with this disease are surgery and medication, but both have certain advantages. With the development of interventional radiology and the deepening of clinical researches concerning uterine artery embolization for adenomyosis, interventional therapy has become a major therapeutic method for adenomyosis in clinical practice. (authors)

  14. Fat embolism syndrome in a patient demonstrating only neurologic symptoms

    OpenAIRE

    Bardana, David; Rudan, John; Cervenko, Frank; Smith, Roger

    1998-01-01

    Fat embolism syndrome (FES) is a recognized complication of both long bone fractures and intramedullary orthopedic procedures. The usual presenting features are respiratory failure, neurologic dysfunction and petechiae. In this report, a 25-year-old woman with FES presented with serious neurologic symptoms and signs in the absence of respiratory dysfunction. The diagnosis is essentially a clinical one, but nuclear magnetic resonance imaging of the brain revealed distinctive lesions that may h...

  15. Fat embolism syndrome in a patient demonstrating only neurologic symptoms.

    Science.gov (United States)

    Bardana, D; Rudan, J; Cervenko, F; Smith, R

    1998-10-01

    Fat embolism syndrome (FES) is a recognized complication of both long bone fractures and intramedullary orthopedic procedures. The usual presenting features are respiratory failure, neurologic dysfunction and petechiae. In this report, a 25-year-old woman with FES presented with serious neurologic symptoms and signs in the absence of respiratory dysfunction. The diagnosis is essentially a clinical one, but nuclear magnetic resonance imaging of the brain revealed distinctive lesions that may help future diagnosis of FES. PMID:9793509

  16. Pulmonary embolism in young natives of high altitude

    Directory of Open Access Journals (Sweden)

    Sanjay Singhal

    2016-01-01

    Full Text Available Thrombotic events are relatively common in high altitude areas and known to occur in young soldiers working at high altitude without usual risk factors associated with thrombosis at sea-level. However, till now, cases with thrombotic events were reported only in lowlanders staying at high altitude. These two cases of pulmonary embolism demonstrate that thrombotic events can occur in highlanders after a prolonged stay at the extreme altitude.

  17. MRI of pulmonary embolism; MRT der akuten Lungenembolie

    Energy Technology Data Exchange (ETDEWEB)

    Fink, C.; Schoenberg, S.O. [Universitaetsklinikum Mannheim, Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Institut fuer Klinische Radiologie, Mannheim (Germany); Thieme, S.; Clevert, D.; Reiser, M.F. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Ley, S. [Deutsches Krebsforschungszentrum Heidelberg, Abteilung Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Abteilung Paediatrische Radiologie, Heidelberg (Germany); Kauczor, H.U. [Deutsches Krebsforschungszentrum Heidelberg, Abteilung Radiologie, Heidelberg (Germany)

    2007-08-15

    Recent technical developments have substantially improved the potential of MRI for the diagnosis of pulmonary embolism. On the MR scanner side this includes the development of short magnets and dedicated whole-body MRI systems, which allow a comprehensive evaluation of pulmonary embolism and deep venous thrombosis in a single exam. The introduction of parallel imaging has substantially improved the spatial and temporal resolution of pulmonary MR angiography. By combining time-resolved pulmonary perfusion MRI with high-resolution pulmonary MRA a sensitivity and specificity of over 90% is achievable, which is comparable to the accuracy of CTA. Thus, for certain patient groups, such as patients with contraindications to iodinated contrast media and young women with a low clinical probability for pulmonary embolism, MRI can be considered as a first-line imaging tool for the assessment of pulmonary embolism. (orig.) [German] Technische Weiterentwicklungen der MRT haben deren Moeglichkeiten fuer die Diagnostik der Lungenembolie erheblich verbessert. Hierzu zaehlen auf Geraeteseite kuerzere Magneten sowie dedizierte Ganzkoerper-MRT-Systeme, die einerseits den Patientenzugang beguenstigen und andererseits eine Abklaerung einer potenziell zugrunde liegenden Venenthrombose in einer Untersuchung ermoeglichen. Auf Seite der Sequenztechnik hat die Einfuehrung der parallelen Bildgebung die raeumliche und zeitliche Aufloesung der MR-Angiographie (MRA) der Lunge deutlich verbessert. Durch eine Kombination zeitaufgeloester Messungen der Lungenperfusion und einer raeumlich hochaufgeloesten MRA kann fuer die Diagnostik der Lungenembolie eine Sensitivitaet und Spezifitaet von ueber 90% erzielt werden, was vergleichbar der Genauigkeit der CT-Angiographie (CTA) ist. Daher kann die MRT fuer bestimmte Personen, wie z. B. Patienten mit Kontraindikationen gegen jodhaltige Roentgenkontrastmittel (z. B. Hyperthyreose) oder juengere Frauen mit einer geringen klinischen Wahrscheinlichkeit fuer

  18. AMNIOTIC FLUID EMBOLISM: AN EVIDENCE-BASED REVIEW

    OpenAIRE

    Conde-Agudelo, Agustin; Romero, Roberto

    2009-01-01

    We conducted an evidence-based review of information bout amniotic fluid embolism (AFE). The estimated incidence of AFE is 1:15,200 and 1:53,800 deliveries in North America and Europe, respectively. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. Risk factors associated with an increased risk of AFE include advanced maternal age, placental abnormalities, operative deliveries, eclampsia, polyhydramnios, cervical lacerations, and uterine ru...

  19. Developments in the management and treatment of pulmonary embolism

    OpenAIRE

    Rachel Limbrey; Luke Howard

    2015-01-01

    Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has be...

  20. Ventilation-perfusion scintigraphy in suspected pulmonary embolism

    International Nuclear Information System (INIS)

    This paper defines the frequency of pulmonary embolism (PE) within the various scintigraphic patterns. The results of ventilation/perfusion (V-Q) imagining and pulmonary angiography were retrospectively analyzed in 151 patients with suspected PE. The study population consisted of 65 men and 86 women, aged 19--91 years. All scans were interpreted by an experienced nuclear medicine physician who knew each patient's clinical history. The V/Q studies were interpreted in accordance with the criteria established by previous work

  1. Prominent Crista Terminalis in Patients with Embolic Events

    OpenAIRE

    Na, Jin Oh; Kim, Eung Ju; Mun, Sun Joung; Choi, Eun Hee; Mun, Jin Hee; Lee, Hye Ra; Kim, Yun Kyung; Yong, Hwan Seok

    2011-01-01

    A prominent crista terminalis is a normal anatomic variant which consist of thick muscular bridge within the right atrium. However, it could be often misdiagnosed with an abnormal mass on the transthoracic echocardiography. The case report presented here, describe the findings of transthoracic echocardiography that suggested a right atrial mass in patients with pulmonary embolism. However, subsequent transesophageal echocardiography and cardiac computed tomography/magnetic resonance imaging d...

  2. Interventional radiology in the management of visceral artery pseudoaneurysms: A review of techniques and embolic materials

    Energy Technology Data Exchange (ETDEWEB)

    Madhusudhan, Kumble Seetharama; Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan [All India Institute of Medical Sciences, New Delhi (India)

    2016-06-15

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.

  3. Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach.

    Science.gov (United States)

    Agnelli, Giancarlo; Becattini, Cecilia

    2015-04-01

    The management of patients with acute pulmonary embolism is made challenging by its wide spectrum of clinical presentation and outcome, which is mainly related to patient haemodynamic status and right ventricular overload. Mechanical embolic obstruction and neurohumorally mediated pulmonary vasoconstriction are responsible for right ventricular overload. The pathophysiology of acute pulmonary embolism is the basis for risk stratification of patients as being at high, intermediate and low risk of adverse outcomes. This risk stratification has been advocated to tailor clinical management according to the severity of pulmonary embolism. Anticoagulation is the mainstay of the treatment of acute pulmonary embolism. New direct oral anticoagulants, which are easier to use than conventional anticoagulants, have been compared with conventional anticoagulation in five randomised clinical trials including >11 000 patients with pulmonary embolism. Patients at high risk of pulmonary embolism (those with haemodynamic compromise) were excluded from these studies. Direct oral anticoagulants have been shown to be as effective and at least as safe as conventional anticoagulation in patients with pulmonary embolism without haemodynamic compromise, who are the majority of patients with this disease. Whether these agents are appropriate for the acute-phase treatment of patients at intermediate-high risk pulmonary embolism (those with both right ventricle dysfunction and injury) regardless of any risk stratification remains undefined. PMID:25700388

  4. Transhepatic Preoperative Portal Vein Embolization Using the Amplatzer Vascular Plug: Report of Four Cases

    International Nuclear Information System (INIS)

    The Amplatzer Vascular Plug (AVP) is a device originally intended for arterial and venous embolization in peripheral vessels. From December 2004 to March 2007 we implanted a total of 8 AVPs in the portal venous system in our institution for preoperative portal vein embolization in 4 patients (55-71 years) prior to right hemihepatectomy. AVP implantation was successful in all patients. Total occlusion of the embolized portal vein branches was achieved in all patients. There were no major complications associated with the embolization

  5. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

    Science.gov (United States)

    Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan

    2016-01-01

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks. PMID:27134524

  6. Efficacy and safety of embolization in iatrogenic traumatic uterine vascular malformations

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Z.; Chen, J.; Shi, H.; Zhou, K.; Sun, H. [Department of Radiology, Peking Union Medical College Hospital, Beijing (China); Li, X., E-mail: pumch005@sina.com [Department of Radiology, Peking Union Medical College Hospital, Beijing (China); Pan, J.; Zhang, X.; Liu, W.; Yang, N.; Jin, Z. [Department of Radiology, Peking Union Medical College Hospital, Beijing (China)

    2012-06-15

    Aim: To retrospectively evaluate the efficacy of embolotherapy in patients with iatrogenic traumatic uterine arteriovenous malformations (AVMs). Materials and methods: A retrospective review of all patients who underwent uterine arterial embolization in Peking Union Medical College Hospital between January 2000 and December 2010 was performed. Forty-two patients were diagnosed with a uterine vascular malformation. All patients had obstetric manipulations before. Serial beta-human chorionic gonadotropin ({beta}-HCG) levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of bilateral uterine arteries. The complications, control of haemorrhage, and outcome of subsequent pregnancies were assessed. Results: A total of 49 embolization procedures were performed in 42 patients. Seven patients required repeated embolizations for recurrence of bleeding. The technical success rate of embolization was 100%. Bleeding was controlled in 35 of 42 patients (83%) after the first embolization procedures, and bleeding was controlled in another two patients who underwent repeat embolization at a median follow-up of 29 months (range 3 months to 5 years). The overall clinical success rate was 88% (37/42). Thirteen patients subsequently became pregnant and eight of 13 patients had uneventful intrauterine pregnancies carried to term. Seven patients had post-embolization syndrome and no other complication occurred. Conclusion: Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. Future pregnancy is still possible after embolization.

  7. Intravenous Thrombolysis for Embolic Stroke due to Cardiac Myxoma

    Directory of Open Access Journals (Sweden)

    Mu-Chien Sun

    2011-01-01

    Full Text Available Cardiac myxoma is a rare but curable cause of ischemic stroke. Current guidelines do not address the use of intravenous thrombolysis for embolic stroke caused by cardiac myxoma. The risk of hemorrhage due to occult tumor emboli or microaneurysms is a major concern. We describe a 45-year-old man who had an embolic stroke in the left middle cerebral artery. The initial National Institutes of Health Stroke Scale (NIHSS score was 16. He received intravenous thrombolysis 2 h and 52 min after stroke onset. No intracranial hemorrhage developed. A cardiac mass was found in the left atrium and removed surgically 84 h after stroke. Pathological study showed a myxoma with extensive hemorrhage and thrombus over the surface. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3. Our experience with this patient supports the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.

  8. Ventilation-perfusion studies in suspected pulmonary embolism

    International Nuclear Information System (INIS)

    The results of ventilation-perfusion (V-Q) imaging and pulmonary angiography were retrospectively analyzed in 146 patients with suspected pulmonary embolism (PE) to define the frequency of PE associated with various scintigraphic patterns. When the radionuclide images demonstrated at least two moderate-sized or one large area of V-Q mismatch, the probability of PE was 92%. However, only one of three patients with a single moderate-sized V-Q mismatch had PE, while small V-Q mismatches were not associated with PE in any of 19 patients. Matched V-Q abnormalities in lung regions that were radiographically normal were infrequently due to PE (4.8%). When a perfusion defect was substantially smaller than a corresponding radiograpic abnormality, frequency of PE was low (7.7%). Conversely, when a perfusion defect was substantially larger than the corresponding radiographic abnormality, there was a high probability of PE (87%). Matched perfusion and radiographic abnormalities indicated an intermediate probability of PE (27%). Patients with suspected pulmonary embolism may be classified into groups with low, intermediate, or high probability of pulmonary embolism on the basis of size and number of perfusion defects and a careful comparison of perfusion defects with ventilatory and radiographic findings

  9. Deep venous thrombosis and pulmonary embolism in psychiatric settings

    Directory of Open Access Journals (Sweden)

    Els G. Van Neste

    2009-03-01

    Full Text Available Background and objectives: Deep venous thrombosis and pulmonary embolism are serious, possibly life-threatening events which are often ignored in psychiatric settings. This article investigates which psychiatric patients are at increased risk of developing a venous thromboembolism. To our knowledge we are the first to perform a literature review of clinical studies relating venous thrombosis and pulmonary embolism to psychotropic drugs and mental disorders. Methods: A Medline search for English studies using the appropriate search terms was performed. In addition, cross references of the relevant articles` literature references were considered. We withheld 12 observational studies, 29 case-reports and one review-article. Results: We found evidence that low potency antipsychotic drugs like chlorpromazine and thioridazine, and clozapine for treatment of resistant schizophrenia have an increased risk of venous thromboembolism. There is no evidence that antidepressants, benzodiazepines or mood stabilizers have a similar effect. Also psychiatric conditions like physical restraint, catatonia and neuroleptic malignant syndrome are related to a higher incidence of deep venous thrombosis. Conclusions: Limitations of the studies and hypotheses about underlying biological mechanisms are reviewed. The rationale for prophylactic measures is discussed and recommendations to prevent deep venous thrombosis and pulmonary embolism are given.

  10. [Acute massive pulmonary embolism in a patient using clavis panax].

    Science.gov (United States)

    Yüksel, Isa Oner; Arslan, Sakir; Cağırcı, Göksel; Yılmaz, Akar

    2013-06-01

    In recent years, the use of herbal combinations, plant extracts or food supplements has increased in our country and all over the world. However, there is not enough data to determine the effective doses of these substances in the composition of herbal preparations, or their effects on metabolism and drug interactions. With the widespread use of herbal combinations, life-threatening side effects and clinical manifestations that arise from them have been reported. Herein we present a case with acute massive pulmonary embolism while using an herbal combination in the context of Tribulus terrestris, Avena sativa and Panax ginseng. A 41-year-old man was admitted to the emergency department with the complaint of sudden onset of dyspnea and syncope. As a result of investigations (blood gases, echocardiography, ventilation-perfusion scintigraphy) he was diagnosed with an acute massive pulmonary embolism. The patient's use of panax did not pose as a risk factor for the pulmonary embolism. He was given thrombolytic therapy and shortness of breath improved. At the pre-discharge the patient was informed of the risks associated with the herbal combination, especially panax. Coumadin was started and he was discharged for the INR checks to come. PMID:23760126

  11. Endovascular coil embolization in internal carotid artery bifurcation aneurysms

    International Nuclear Information System (INIS)

    Aim: To present the clinical and radiological results of coil embolization in internal carotid artery (ICA) bifurcation aneurysms (BA). Materials and methods: The records of 65 patients with 66 ICA BA were retrieved from data prospectively accrued between September 1999 and July 2013. Clinical and morphological outcomes of the aneurysms were assessed, including technical aspects of treatment. Results: The aneurysms under study were directed either superiorly (41/66, 62.1%), anteriorly (24/66, 36.4%), or posteriorly (1/66, 1.5%), and all were devoid of perforators. Aneurysmal necks were situated symmetrically at the terminal ICA (37/66, 56.1%) or slightly deviated to the proximal A1 segment (29/66, 43.9%). The steam-shaped S microcatheter (73.8%) was most commonly used to select the aneurysms, and the single microcatheter technique was most commonly applied (56.1%) to perform coil embolization, followed by balloon remodelling (21.2%), multiple microcatheter (15.1%), and stent-protection (7.6%). Successful aneurysmal occlusion was achieved in 100% of cases, with no procedure-related morbidity or mortality. Imaging performed in the course of follow-up (mean duration 27.3 months) confirmed stable occlusion of most lesions (47/53, 88.7%). Conclusion: Through tailored technical strategies, ICA BA are amenable to safe and effective endovascular coil embolization, with a tendency for stable occlusion long-term

  12. Treatment of Non variceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    International Nuclear Information System (INIS)

    To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute non variceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute non variceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% post embolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

  13. Evaluation of emergency transcatheter arterial embolization in intractable postpartum hemorrhage

    International Nuclear Information System (INIS)

    Objective: To assess the efficacy and safety of emergency transcatheter arterial embolization in the management of intractable postpartum hemorrhage. Methods: Twenty-five patients with intractable postpartum hemorrhage were undertaken superselective catheterization into the bilateral internal iliac arteries or uterial arteries to find the causes and sites of bleeding through DSA and then followed by arterial embolization with gelfoam particles. Result: All of the 25 patients with obstetrical bleeding were successfully controlled by TAE, the procedure lasted for 25-60 min, (mean 42.5 ± 4.6 min); with both catheterization and bleeding halt successful rates of 100%. Comparison of hemoglobin and heartbeat before and after the procedure showed significance (t=29.49, P<0.01; t=16.51, P<0.01). The uterus showed reintegration on time and menstruation resumed in all patients. Conclusions: Emergency arterial embolization is a safe and effective means for control of intractable postpartum hemorrhage, providing less trauma and no severe complications, especially as an unique management for fetal postpartum hemorrhage. (authors)

  14. Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy

    Directory of Open Access Journals (Sweden)

    Jolina Pamela Santos

    2012-01-01

    Full Text Available Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF or arteriovenous graft (AVG. Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD, atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.

  15. A model of bubble growth leading to xylem conduit embolism.

    Science.gov (United States)

    Hölttä, T; Vesala, T; Nikinmaa, E

    2007-11-01

    The dynamics of a gas bubble inside a water conduit after a cavitation event was modeled. A distinction was made between a typical angiosperm conduit with a homogeneous pit membrane and a typical gymnosperm conduit with a torus-margo pit membrane structure. For conduits with torus-margo type pits pit membrane deflection was also modeled and pit aspiration, the displacement of the pit membrane to the low pressure side of the pit chamber, was found to be possible while the emboli was still small. Concurrent with pit aspiration, the high resistance to water flow out of the conduit through the cell walls or aspirated pits will make the embolism process slow. In case of no pit aspiration and always for conduits with homogeneous pit membranes, embolism growth is more rapid but still much slower than bubble growth in bulk water under similar water tension. The time needed for the embolism to fill a whole conduit was found to be dependent on pit and cell wall conductance, conduit radius, xylem water tension, pressure rise in adjacent conduits due to water freed from the embolising conduit, and the rigidity and structure of the pits in the case of margo-torus type pit membrane. The water pressure in the conduit hosting the bubble was found to occur almost immediately after bubble induction inside a conduit, creating a sudden tension release in the conduit, which can be detected by acoustic and ultra-acoustic monitoring of xylem cavitation.

  16. When a pulmonary embolism is not a pulmonary embolism: a rare case of primary pulmonary leiomyosarcoma

    Directory of Open Access Journals (Sweden)

    Nargiz Muganlinskaya

    2015-12-01

    Full Text Available Arterial leiomyosarcomas account for up to 21% of vascular leiomyosarcomas, with 56% of arterial leiomyosarcomas occurring in the pulmonary artery. While isolated cases of primary pulmonary artery leiomyosarcoma document survival up to 36 months after treatment, these uncommon, aggressive tumors are highly lethal, with 1-year survival estimated at 20% from the onset of symptoms. We discuss a rare case of a pulmonary artery leiomyosarcoma that was originally diagnosed as a pulmonary embolism (PE. A 72-year-old Caucasian female was initially diagnosed with ‘saddle pulmonary embolism’ based on computerized tomographic angiography of the chest 2 months prior to admission and placed on anticoagulation. Dyspnea escalated, and serial computed tomography scans showed cardiomegaly with pulmonary emboli involving the right and left main pulmonary arteries with extension into the right and left upper and lower lobe branches. An echocardiogram on admission showed severe pulmonary hypertension with a pulmonary artery pressure of 82.9 mm Hg, and a severely enlarged right ventricle. Respiratory distress and multiorgan failure developed and, unfortunately, the patient expired. Autopsy showed a lobulated, yellow mass throughout the main pulmonary arteries measuring 13 cm in diameter. The mass extended into the parenchyma of the right upper lobe. On microscopy, the mass was consistent with a high-grade primary pulmonary artery leiomyosarcoma. Median survival of patients with primary pulmonary artery leiomyosarcoma without surgery is one and a half months, and mortality is usually due to right-sided heart failure. Pulmonary artery leiomyosarcoma is a rare but highly lethal disease commonly mistaken for PE. Thus, we recommend clinicians to suspect this malignancy when anticoagulation fails to relieve initial symptoms. In conclusion, early detection and suspicion of pulmonary artery leiomyosarcoma should be considered in patients refractory to anticoagulation

  17. Differentiation at necropsy between in vivo gas embolism and putrefaction using a gas score.

    Science.gov (United States)

    Bernaldo de Quirós, Yara; Saavedra, Pedro; Møllerløkken, Andreas; Brubakk, Alf O; Jørgensen, Arve; González-Díaz, Oscar; Martín-Barrasa, Jose L; Fernández, Antonio

    2016-06-01

    Gas bubble lesions consistent with decompression sickness in marine mammals were described for the first time in beaked whales stranded in temporal and spatial association with military exercises. Putrefaction gas is a post-mortem artifact, which hinders the interpretation of gas found at necropsy. Gas analyses have been proven to help differentiating putrefaction gases from gases formed after hyperbaric exposures. Unfortunately, chemical analysis cannot always be performed. Post-mortem computed tomography is used to study gas collections, but many different logistical obstacles and obvious challenges, like the size of the animal or the transport of the animal from the stranding location to the scanner, limit its use in stranded marine mammals. In this study, we tested the diagnostic value of an index-based method for characterizing the amount and topography of gas found grossly during necropsies. For this purpose, putrefaction gases, intravenously infused atmospheric air, and gases produced by decompression were evaluated at necropsy with increased post-mortem time in New Zealand White Rabbits using a gas score index. Statistical differences (Ptool to distinguish between fatal decompression, iatrogenic air embolism and putrefaction gases at autopsies. PMID:27234535

  18. Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

    OpenAIRE

    Eleonora Arboscello; Irene Ponassi; Agnese Lomeo; Maria Nives Parodi; Paolo Barbera; Michela Morfino; Nicoletta Pollicardo; Roberto Delfino; Dahane Mhamed; Roberto Tallone

    2010-01-01

    Pulmonary embolism (PE) is a relative common cardiovascular emergency. Computed tomography (CT) angiography has became the method of choice for suspected PE in routine clinical practice but CT should not be the first-line test for all patients, except suspected high-risk patients and high clinical probability or “PE likely” patients. In these situations emergency phisician ‘s echographic cardiac study can be particularly helpful for a rapid patient management. The two cases ...

  19. Selective arterial embolization for control of haematuria secondary to advanced or recurrent transitional cell carcinoma of the bladder.

    LENUS (Irish Health Repository)

    Halpenny, D

    2014-05-02

    Haematuria is a common symptom in patients with advanced transitional cell carcinoma of the bladder. We report our experience of selective pelvic embolization using gelfoam as an embolic agent to treat intractable haematuria in these patients.

  20. Stroke from Delayed Embolization of Polymerized Glue Following Percutaneous Direct Injection of a Carotid Body Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Krishnamoorthy, Thamburaj; Gupta, Arun Kumar; Rajan, Jayadevan E; Thomas, Bejoy [Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, (India)

    2007-06-15

    Direct percutaneous embolization of hypervascular tumors results in more effective preoperative devascularization. Migration of glue is a well known complication of direct glue injection and it may lead to stroke or cranial nerve deficits. We report here on a case of carotid body tumor in a 52-year-old man; the tumor was mainly embolized by percutaneous injection of 50% glue and this was supported with balloon protection of the internal carotid artery. Thirteen hours later, he developed hemiparesis from delayed migration of glue. The possible mechanisms of this migration are discussed and preventive measures are suggested. Preoperative embolization of hypervascular tumors of the head and neck, including carotid body tumor, is often performed to decrease the amount of blood loss during surgery. Devascularization is mainly performed with particulate agents and by employing the transarterial route. More effective embolization may be achieved by performing percutaneous direct embolization of hypervascular tumors with liquid embolic agents. Even though there are few reports available on direct embolization, complications from glue migration have been reported, and this mainly happens during the procedure when the glue is in a liquid state. We report here on a case of delayed migration of polymerized glue (n-butyl-2-cyanoacrylate [NBCA]), many hours after the procedure, into the intracranial circulation and the final result was stroke. A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.

  1. Relax and refill: xylem rehydration prior to hydraulic measurements favours embolism repair in stems and generates artificially low PLC values.

    Science.gov (United States)

    Trifilò, Patrizia; Raimondo, Fabio; Lo Gullo, Maria A; Barbera, Piera M; Salleo, Sebastiano; Nardini, Andrea

    2014-11-01

    Diurnal changes in percentage loss of hydraulic conductivity (PLC), with recorded values being higher at midday than on the following morning, have been interpreted as evidence for the occurrence of cycles of xylem conduits' embolism and repair. Recent reports have suggested that diurnal PLC changes might arise as a consequence of an experimental artefact, that is, air entry into xylem conduits upon cutting stems, even if under water, while under substantial tension generated by transpiration. Rehydration procedures prior to hydraulic measurements have been recommended to avoid this artefact. In the present study, we show that xylem rehydration prior to hydraulic measurements might favour xylem refilling and embolism repair, thus leading to PLC values erroneously lower than those actually experienced by transpiring plants. When xylem tension relaxation procedures were performed on stems where refilling mechanisms had been previously inhibited by mechanical (girdling) or chemical (orthovanadate) treatment, PLC values measured in stems cut under native tension were the same as those measured after sample rehydration/relaxation. Our data call for renewed attention to the procedures of sample collection in the field and transport to the laboratory, and suggest that girdling might be a recommendable treatment prior to sample collection for PLC measurements.

  2. Evaluation of the effect of partial splenic embolization on platelet values for liver cirrhosis patients with thrombocytopenia

    Institute of Scientific and Technical Information of China (English)

    Chi-Ming Lee; Ting-Kai Leung; Hung-Jung Wang; Wei-Hsing Lee; Li-Kuo Shen; Jean-Dean Liu; Chun-Chao Chang; Ya-Yen Chen

    2007-01-01

    AIM: To investigate the effect of partial splenic embolization (PSE) on platelet values in liver cirrhosis patients with thrombocytopenia and to determine the effective embolization area for platelet values improvement.METHODS: Blood parameters and liver function indicators were measured on 10 liver cirrhosis patients (6 in Child-Pugh grade A and 4 in grade B) with thrombocytopenia (platelet values < 80 × 103/μL) before embolization. Computed tomography scan was also needed in advance to acquire the splenic baseline. After 2 to 3 d, angiography and splenic embolization were performed. A second computed tomography scan was made to confirm the embolization area after 2 to 3 wk of embolization. The blood parameters of patients were also examined biweekly during the 1 year follow-up period.RESULTS: According to the computed tomography images after partial splenic embolization, we divided all patients into two groups: low (< 30%), and high (≥ 30%) embolization area groups. The platelet values were increased by 3 times compared to baseline levels after 2 wk of embolization in high embolization area group. In addition, there were significant differences in platelet values between low and high embolization area groups. GPT values decreased significantly in all patients after 2 wk of embolization. The improvement in platelet and GPT values still persisted until 1 year after PSE.In addition, 3 of 4 (75%) Child-Pugh grade B patients progressed to grade A after 2 mo of PSE. The complication rate in < 30% and ≥ 30% embolization area groups was 50% and 100%, respectively.CONCLUSION: Partial splenic embolization is an effective method to improve platelet values and GPT values in liver cirrhosis patients with thrombocytopenia and the ≥ 30% embolization area is meaningful for platelet values improvement. The relationship between the complication rate and embolization area needs further studies.

  3. [Elective cerebral arteriovenous malformation treatment with onyx after coil embolization of ruptured, flow-realeted aneurysm of the posterior circulation].

    Science.gov (United States)

    Poncyljusz, Wojciech; Falkowski, Aleksander; Rać, Monika; Sagan, Leszek; Kojder, Ireneusz

    2012-01-01

    Intracranial arteriovenous posterior circulation malformation was planned to embolize by onyx injection after acute coil embolization of ruptured flow-realeted aneurysm of posterior cerebral artery. Control angiography revealed completely embolized malformation with normal vessel patency at the end of procedure. There were no adverse events related to this procedure and no neurologic deficit at the discharge. PMID:23276020

  4. Warfarin for the prevention of systemic embolism in patients with non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Andersen, L V; Vestergaard, P; Deichgraeber, P;

    2008-01-01

    Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism.......Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism....

  5. Transcatheter Removal of Embolized Port Catheters from the Hearts of Two Children

    Directory of Open Access Journals (Sweden)

    Osman Baspinar

    2015-01-01

    Full Text Available Embolization of a port catheter is a dangerous and serious complication. In this paper, we present two cases of children, aged 4.5 months and 6 years, in whom port catheters had embolized to the right ventricle one month and 1.5 years priorly, respectively; the port catheters were retrieved via snaring.

  6. Paradoxical embolism in acute myocardial infarction in a patient with congenital heart disease

    Directory of Open Access Journals (Sweden)

    Abdelrahman Jamiel

    2012-01-01

    Full Text Available We present a case of a young male with severe pulmonary stenosis, hypoplastic right ventricle, and atrial septal defect. Acute embolic myocardial infarction, followed by cardiac arrest, occurred during hospitalization after Glenn operation. The therapeutic challenges are discussed. Insufficient anticoagulation therapy during the postoperative period was a possible contributing factor leading to embolic myocardial infarction.

  7. Splendors and miseries of expired CO2 measurement in the suspicion of pulmonary embolism

    OpenAIRE

    Verschuren, Franck; Perrier, Arnaud

    2010-01-01

    Capnography has been studied for decades as a potential diagnostic tool for suspected pulmonary embolism. Despite technological refinements and its combination with other non-invasive instruments, no evidence to date allows recommending the use of expired carbon dioxide measurement as a rule-out test for pulmonary embolism without additional radiological testing. Further investigations are, however, still warranted.

  8. Preoperative Embolization of Cerebellar Hemangioblastoma with Onyx: Report of Three Cases

    OpenAIRE

    Shin, Gi Won; Jeong, Hae Woong; Seo, Jeong Hwa; Kim, Sung Tae; Choo, Hye Jung; Lee, Sun Joo

    2014-01-01

    Hemangioblastoma is a benign and highly vascular tumor. Complete surgical resection of highly vascular tumor such as hemangioblastoma may be challenging due to excessive bleeding. Preoperative embolization of these lesions may decrease the intraoperative blood loss and facilitate excision. We report three cases of cerebellar hemangioblastomas that were embolized using Onyx.

  9. Preoperative embolization of cerebellar hemangioblastoma with onyx: report of three cases.

    Science.gov (United States)

    Shin, Gi Won; Jeong, Hae Woong; Seo, Jeong Hwa; Kim, Sung Tae; Choo, Hye Jung; Lee, Sun Joo

    2014-02-01

    Hemangioblastoma is a benign and highly vascular tumor. Complete surgical resection of highly vascular tumor such as hemangioblastoma may be challenging due to excessive bleeding. Preoperative embolization of these lesions may decrease the intraoperative blood loss and facilitate excision. We report three cases of cerebellar hemangioblastomas that were embolized using Onyx. PMID:24644530

  10. Investigation on the clinical practice of transcatheter embolization for acute gastrointestinal hemorrhage

    International Nuclear Information System (INIS)

    Objective: To study the tactics, methods and relevant factors of transcatheter embolization for acute gastrointestinal hemorrhage. Methods: Fifteen patients with acute gastrointestinal hemorrhage were embolized by one of the methods of Polyvinyl Alcohol (PVA), gelfoam or metal coils. Four of the fifteen patients were upper gastrointestinal hemorrhage, the other cases were lower gastrointestinal hemorrhage which were embolized using coaxial microcatheter. Results: Fourteen of the fifteen patients were treated successfully by these methods. There were total 17 times of embolization for 16 parts, the success rate reached 94. 1%. The other one revealed an infarction of intestine after the embolization and was cured by resection. One of the fifteen patients appeared a recurrent hemorrhage 3 months later, and confirmed to be a hemangiolymphangioma. Two patients with malignant tumor were operated upon selectively. The other patient of intestinal hemorrhage was embolized successfully by using a metal coil after shock. Leiomyoma complicated with large area of bleeding was finally proven by operation. Conclusions: Transcatheter embolization for acute massive gastrointestinal hemorrhage is safe and efficient under different choice of methods. The key of success is the right selection of embolized target artery and dosage of emboli

  11. Paradoxical Embolism in Acute Myocardial Infarction in a Patient with Congenital Heart Disease

    OpenAIRE

    Abdelrahman Jamiel; Ahmed Alsaileek; Kamal Ayoub; Ahmad Omran

    2012-01-01

    We present a case of a young male with severe pulmonary stenosis, hypoplastic right ventricle, and atrial septal defect. Acute embolic myocardial infarction, followed by cardiac arrest, occurred during hospitalization after Glenn operation. The therapeutic challenges are discussed. Insufficient anticoagulation therapy during the postoperative period was a possible contributing factor leading to embolic myocardial infarction.

  12. Aortic Arch Atherosclerosis——An Important Potential Source Of Cerebral Embolic Stroke

    Institute of Scientific and Technical Information of China (English)

    Yi Guo; Shao wen Zhang; Si Chen

    2000-01-01

    Background and purpose: Recent years with use of transesophageal echography renew awareness of aortic atherosclerosis. The purpose of this study was to determine the prevalence, clinical significance, and embolic potential of thoracic aortic plaque in patients with cerebral emblism; and further study the correlation aortic plaque with carotid or heart disease. Method: 49 consecutive patients with cerebral embolism was included in this sutdy. We uscd TEE to evaluated potential source of emboli in aortic arch and heart, and duplex in carotid artery. A atherosclerotic lesion of thoracic aorta was defined as normal(O); mild plaque (1); moderate plaque (2); protruding plaque or mobile plaque (3). Result: 31(63%) patients showed evidence of AAA; 7 (14.3%) patients had mild AAA, 9 (18.4%) patients had moderate AAA and 15 (32.7%) patients had severe AAA, In these 15 patients 11 patients neither severe ICAA or embolic heart disease, the AAA may be responsible to the cerebral embolism; 33 patients had internal carotid arterial atherosclerosis(ICAA), 9 patients had embolic heart disease; Age, ICAA had significant correlated with aortic plaque. Conclusion: Aortic atherosclerosis is common in cerebral embolism. Aortic plaque might be not only responsible for some unexplained embolic event, but also for some of the embolic stroke in the group of patient do have carotid artery or heart disease. Age might be important risk factor for the development of atherosclerotic lesion in the thoracic aorta.

  13. Venous barium embolization, a rare, potentially fatal complication of barium enema: 2 case reports

    International Nuclear Information System (INIS)

    Venous embolization of barium has been recognized for 4 decades as one of the most dreaded complications of barium enema. Fortunately, the condition is extremely rare. In this report, the radiographic findings in 2 cases of venous embolization (one involving the portal vein and one systematic) are described, and ways to decrease the risk of this complication are discussed. (author)

  14. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

    Energy Technology Data Exchange (ETDEWEB)

    Laborda, Alicia [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Tejero, Carlos [Hospital Clinico Universitario Lozano Blesa, Servicio de Neurologia (Spain); Fredes, Arturo, E-mail: fredesarturo@gmail.com [Universidad de Zaragoza, Hospital Quiron, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain)

    2013-06-15

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  15. Embolization of an unusual metastatic site of hepatocellular carcinoma in the humerus

    Institute of Scientific and Technical Information of China (English)

    Andreas Hansch; Rotraud Neumann; Alexander Pfeil; Ivan Marintchev; Stefan Pfleiderer; Mieczyslaw Gajda; Werner A Kaiser

    2009-01-01

    Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. This case documents an unusual metastatic presentation of HCC in the humerus. Preoperative palliative arterial embolization of the tumor was performed to arrest severe tumor bleeding caused by the biopsy. Embolization turned out to be useful also in limiting/preventing potential uncontrolled bleeding during subsequent amputation.

  16. Revascularization Using an Extracorporeal Pump for the Treatment of Cerebral Embolism in the Acute Stage: For Protection of the Brain Tissue from Irreversible Change due to Cerebral Embolism

    OpenAIRE

    Sonobe, M.; Nakai, Y.; Matsumaru, Y.; Sugita, K.

    2001-01-01

    Object. For patients with cerebral embolism, we are using an extracorporeal pump to revascularize the more peripheral brain tissues far from the thrombus, proceeding the microcatheter beyond the thrombus, and dissolving the thrombus during a satisfactory time as required.

  17. Clinical efficacy of superselective arterial embolization in the treatment of hemorrhage from malignant gestational trophoblastic tumor

    Institute of Scientific and Technical Information of China (English)

    Geng Shuo; Wan Xi-run; Xiang Yang; Feng Feng-zhi; Yang Xiu-yu; Li Xiao-guang; Liu Wei; Yang Ning

    2010-01-01

    Objective: To evaluate the efficacy of superselective arterial embolization in controlling hemorrhage from malignant gestational trophoblastic tumor. Methods: From February 1990 to January 2008, 44 patients with hemorrhage from malignant gestational trophoblastic tumor (including 29 cases of choriocarcinoma and 15 cases of invasive mole) were treated with superselective arterial embolization. The hemorrhage sites included uterus (40 cases), cervical metastasis (1 case) and vaginal metastasis (3 cases).Results: In 41 cases (93.2 %), superselective arterial embolization successfully controlled the hemorrhage. Hysterectomy was performed in the 3 failed cases and uterine perforation was revealed by laparotomy. Five patients had normal term delivery after successful superselective arterial embolization and chemotherapy, and two patients are now in the healthy second trimester of pregnancy.Conclusion: Superselective arterial embolization can effectively control the hemorrhage from malignant gestational trophoblastic tumor.

  18. Fat embolism syndrome managed by non-invasive ventilation--a case report.

    Science.gov (United States)

    Ashok, R; Kumar, R Vinoth; Saravanan, K; Kalaivani

    2012-02-01

    A 31-year-old male was struck by a motor cycle and diagnosed to have closed injury to the thigh involving right sided femur shaft fracture. Patient was operated on the next day by the orthopaedic surgeon. The patient did not have any signs of fat embolism syndrome before and after surgery. But the rare ECG change of S1Q3T3 (pulmonary embolism) was present before and after surgery. The presence of oedematous retina and cherry red spots in the macula was also present in the young patient. Patient developed all the classical signs of fat embolism syndrome 18 hours after surgery. The case had classic presentations of fat embolism syndrome managed by non-invasive ventilation. The role of steroids and albumin is also discussed as it was always a controversy in the management of fat embolism syndrome. PMID:23029849

  19. Portal Vein Embolization Before Liver Resection: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Lienden, K. P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands); Esschert, J. W. van den; Graaf, W. de [Academic Medical Center, Department of Surgery (Netherlands); Bipat, S.; Lameris, J. S. [Academic Medical Center, Department of Radiology (Netherlands); Gulik, T. M. van [Academic Medical Center, Department of Surgery (Netherlands); Delden, O. M. van [Academic Medical Center, Department of Radiology (Netherlands)

    2013-02-15

    This is a review of literature on the indications, technique, and outcome of portal vein embolization (PVE). A systematic literature search on outcome of PVE from 1990 to 2011 was performed in Medline, Cochrane, and Embase databases. Forty-four articles were selected, including 1,791 patients with a mean age of 61 {+-} 4.1 years. Overall technical success rate was 99.3 %. The mean hypertrophy rate of the FRL after PVE was 37.9 {+-} 0.1 %. In 70 patients (3.9 %), surgery was not performed because of failure of PVE (clinical success rate 96.1 %). In 51 patients (2.8 %), the hypertrophy response was insufficient to perform liver resection. In the other 17 cases, 12 did not technically succeed (0.7 %) and 7 caused a complication leading to unresectability (0.4 %). In 6.1 %, resection was cancelled because of local tumor progression after PVE. Major complications were seen in 2.5 %, and the mortality rate was 0.1 %. A head-to-head comparison shows a negative effect of liver cirrhosis on hypertrophy response. The use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but the difference with other embolization materials did not reach statistical significance. No difference in regeneration is seen in patients with cholestasis or chemotherapy. Preoperative PVE has a high technical and clinical success rate. Liver cirrhosis has a negative effect on regeneration, but cholestasis and chemotherapy do not seem to have an influence on the hypertrophy response. The use of n-butyl cyanoacrylate may result in a greater hypertrophy response compared with other embolization materials used.

  20. Partial pulmonary embolization disrupts alveolarization in fetal sheep

    Directory of Open Access Journals (Sweden)

    Hooper Stuart B

    2010-04-01

    Full Text Available Abstract Background Although bronchopulmonary dysplasia is closely associated with an arrest of alveolar development and pulmonary capillary dysplasia, it is unknown whether these two features are causally related. To investigate the relationship between pulmonary capillaries and alveolar formation, we partially embolized the pulmonary capillary bed. Methods Partial pulmonary embolization (PPE was induced in chronically catheterized fetal sheep by injection of microspheres into the left pulmonary artery for 1 day (1d PPE; 115d gestational age; GA or 5 days (5d PPE; 110-115d GA. Control fetuses received vehicle injections. Lung morphology, secondary septal crests, elastin, collagen, myofibroblast, PECAM1 and HIF1α abundance and localization were determined histologically. VEGF-A, Flk-1, PDGF-A and PDGF-Rα mRNA levels were measured using real-time PCR. Results At 130d GA (term ~147d, in embolized regions of the lung the percentage of lung occupied by tissue was increased from 29 ± 1% in controls to 35 ± 1% in 1d PPE and 44 ± 1% in 5d PPE fetuses (p VEGF and Flk-1, although a small increase in PDGF-Rα expression at 116d GA, from 1.00 ± 0.12 in control fetuses to 1.61 ± 0.18 in 5d PPE fetuses may account for impaired differentiation of alveolar myofibroblasts and alveolar development. Conclusions PPE impairs alveolarization without adverse systemic effects and is a novel model for investigating the role of pulmonary capillaries and alveolar myofibroblasts in alveolar formation.

  1. The watering of trees. Embolization and recovery in xylem microtubes

    CERN Document Server

    Gouin, Henri

    2014-01-01

    In any tree, crude sap is driven through xylem microtubes. The crude sap is submitted to intermolecular forces shaping it into very thin liquid films in embolized xylem microtubes. The concept of disjoining pressure must be taken into account and a strong negative pressure can be present in liquid-water bulks. The disjoining pressure gradient induced by the flux of transpiration initiates crude sap motion. Applications enable to understand why the xylem microtubes can be refilled and why the ascent of sap is possible even for the tallest trees avoiding the problems due to cavitation.

  2. The diagnosis and treatment of severe cerebral fat embolism

    Institute of Scientific and Technical Information of China (English)

    周东生; 王甫; 王伯珉; 王鲁博; 李连欣; 许世宏; 穆卫东

    2003-01-01

    Objective: To improve the diagnosis and treatment of severe cerebral fat embolism (SCFE).Methods: The data of nine patients with SCFE were retrospectively analyzed. The manifestations of the central nerve system, respiratory system and hemorrhage were recorded, at the same time, accessory examination including arterial oxygen, fat macroglobules in venous blood and image examination was adapted. The patients were treated with exopexy, pharmocotherapy and oxygentherapy.Results: Two of the nine patients died of severe complications, the other seven recovered without severe sequela.Conclusions: Gurd standard should be improved for early diagnosis of SCFE. If svere complications can be prevented, patients who receive early treatment will have favourable prognosis.

  3. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  4. [Emergency embolization in gynaecological bleeding. Two case reports].

    Science.gov (United States)

    Hatremi, Rajhi; Sameh, Amous; Azza, Salem; Najla, Mnif; Rym, Ben Hmid; Sami, Mahjoub; Faouzia, Zouari; Radhi, Hamza

    2005-08-01

    Two patients with gynaecological hemorrhage underwent successfully trans-arterial embolization. The first womanhad an uncontrollable perineal hemorrhage following a delivery with forceps. Angiography showed extravasation of contrast from right and left vaginal artery. Hyperselective embolisation stopped the vaginal bleeding. The second woman had massive hemorrhage following radiotherapy for cervical cancer. Angiography demonstrated extravasation of contrast from both uterine arteries. The bleeding was controlled after hyperselective embolisation. Emergency arterial embolisation is a safe and effective means of control of irrepressible genital hemorrhage. PMID:16238279

  5. Inadvertent Embolization of a Persistent Sciatic Artery in Pelvis Trauma

    International Nuclear Information System (INIS)

    We describe a case of unilateral persistent sciatic artery (PSA), a rare vascular anomaly, in a 43-year-old woman with severe multiple trauma. A small amount of diluted embolization particles went into this vessel during emergent endovascular therapy under fluoroscopic monitoring. The procedure was immediately stopped when the true nature of the anatomic variant was recognized. Fortunately, an ischemic event of the lower leg did not occur. The imaging findings of computed tomography and digital subtraction angiography are presented and the relevant literature is reviewed

  6. Acute Paraplegia as a Presentation of Aortic Saddle Embolism

    Directory of Open Access Journals (Sweden)

    Lisandro Irizarry

    2016-01-01

    Full Text Available Background. Acute onset paraplegia has a myriad of causes most often of a nonvascular origin. Vascular etiologies are infrequent causes and most often associated with postsurgical complications. Objective. To describe the occurrence and possible mechanism for aortic saddle embolism as a rare cause of acute paraplegia. Case Report. Described is a case of a 46-year-old female who presented with the sudden onset of nontraumatic low back pain with rapidly progressive paraplegia which was subsequently determined to be of vascular origin.

  7. Pulmonary cement embolism after pedicle screw vertebral stabilization

    Directory of Open Access Journals (Sweden)

    Massimo Tonolini

    2012-01-01

    Full Text Available Pulmonary arterial embolization of polymethylmethacrylate cement, most usually occurring after vertebroplasty or kyphoplasty, is very uncommon following vertebral stabilization procedures. Unenhanced CT scans viewed at lung window settings allow confident identification of cement emboli in the pulmonary circulation along with possible associate parenchymal changes, whereas hyperdense emboli may be less conspicuous on CT-angiographic studies with high-flow contrast medium injection. Although clinical manifestations are largely variable from asymptomatic cases to severe respiratory distress, most cases are treated with anticoagulation.

  8. Deep venous thrombosis and pulmonary embolism following physical restraint

    DEFF Research Database (Denmark)

    Laursen, S B; Jensen, T N; Bolwig, T;

    2005-01-01

    OBJECTIVE: We describe a case of deep venous thrombosis (DVT) and pulmonary embolism (PE) following the use of physical restraint in a patient with a diagnosis of acute delusional psychotic disorder. METHOD: A new case report of DVT and PE associated with prolonged physical restraint is presented...... physical restraint may occur in spite of no pre-existing risk factors. Medical guidelines for the prevention of thrombosis following physical restraint are presented. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of DVT and PE warrants early and vigorous...

  9. Differences in clinical features and computed tomographic findings between embolic and non-embolic acute ischemic stroke. A quantitative differential diagnosis

    International Nuclear Information System (INIS)

    A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic (cardiac or artery-to-artery) and 107 with non-embolic (thrombotic or hemodynamic) stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic (CT) findings were then compared. Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings (location of hypodense area, findings of brain edema and hemorrhagic transformation) were discriminatory factors between the two groups (p<0.01). According to these 11 items, we prepared a numerical table for quantitative differential diagnosis. A diagnostic accuracy of 98.9% for embolic and 87.9% for non-embolic stroke in internal verification, and 90.0% and 82.9%, respectively, in external verification was observed. The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia. (author)

  10. Differences in clinical features and computed tomographic findings between embolic and non-embolic acute ischemic stroke. A quantitative differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Takano, Kentaro; Yamaguchi, Takenori; Minematsu, Kazuo; Sawada, Tohru; Omae, Teruo [National Cardiovascular Center, Suita, Osaka (Japan)

    1998-02-01

    A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic (cardiac or artery-to-artery) and 107 with non-embolic (thrombotic or hemodynamic) stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic (CT) findings were then compared. Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings (location of hypodense area, findings of brain edema and hemorrhagic transformation) were discriminatory factors between the two groups (p<0.01). According to these 11 items, we prepared a numerical table for quantitative differential diagnosis. A diagnostic accuracy of 98.9% for embolic and 87.9% for non-embolic stroke in internal verification, and 90.0% and 82.9%, respectively, in external verification was observed. The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia. (author)

  11. Air Pollution

    Science.gov (United States)

    Air pollution is a mixture of solid particles and gases in the air. Car emissions, chemicals from factories, dust, pollen and ... Ozone, a gas, is a major part of air pollution in cities. When ozone forms air pollution, ...

  12. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

    2016-03-15

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

  13. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    International Nuclear Information System (INIS)

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding

  14. Radiation dose reduction in fluoroscopic procedures: left varicocele embolization as a model

    Energy Technology Data Exchange (ETDEWEB)

    Verstandig, Anthony G.; Shraibman, Vladimir [Shaare Zedek Medical Center, Department of Radiology, Interventional Radiology Unit, POB 3235, Jerusalem (Israel); Shamieh, Bashar [St. Joseph Hospital, Department of Radiology, Jerusalem (Israel); Raveh, David [Shaare Zedek Medical Center, Infectious Diseases Unit, POB 3235, Jerusalem (Israel)

    2015-06-01

    To investigate the effect of a radiation reduction program on total dose, fluoroscopy dose per second corrected for body habitus and degree of collimation in left varicocele embolizations (LVE). A radiation reduction program for LVE was implemented, consisting of a technique minimizing fluoroscopy time, using low-dose presets, virtual collimation, and virtual patient positioning. Height, weight, fluoroscopy time, kerma area product (KAP) and reference air kerma (Ka,r) were recorded for 100 consecutive cases satisfying the inclusion criteria. For each patient, a device specific dose correction factor, determined using a phantom, was used to standardize the KAP to that of the cylindrical diameter of the standard man and a collimation index was derived from the KAP and Ka,r. Median fluoroscopy time was 3 minutes (mean 4.5, range 1-23.8). Median KAP was 0.54 Gy/cm{sup 2} (mean 0.82, range 0.12-6.52). There was a significant decrease in KAP/second corrected for cylindrical diameter (p < 0.001) and the collimation index (p < 0.001) over time. This study shows that a dedicated dose reduction program can achieve very low total radiation dose rates for LVE. The significant decrease in collimation index and standardized KAP per second during this study suggest a learning curve for collimation. (orig.)

  15. Pulmonary embolism and pulmonary infarction; Lungenembolie und Lungeninfarkt - pathologische Anatomie

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, K.M.; Mueller, A.M. [Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum (Germany). Inst. fuer Pathologie]|[Bochum Univ. (Germany). Universitaetsklinikum

    1998-03-01

    Radiological and nuclear medical evaluation of pulmonary embolisms and their consequences is often problematic, since parenchymal alterations in the form of possible pulmonary infarctions occur in only 10-15% after vessel obliteration. Small embolisms rather frequently cause hemorrhagic pulmonary infarctions, which can clinically be demonstrated by radiological and nuclear medical methods, after obliteration of the pre-capillary arterio-arterial anastomoses type I. In pre-existing chronic lung diseases with often markedly developed bronchial artery systems and additional anastomoses hemorrhagic pulmonary infarctions are extremely rare. Thus, today, radiological and nuclear medical studies, such as spiral computer scanning, have to rely largely on the results of thrombembolic vessel obstruction and transitory perfusion deficits and less on parenchymal infiltration patterns. (orig./MG) [Deutsch] Die radiologischen und nuklearmedizinischen Begutachtungen von Lungenembolien und deren Folgen sind oft problematisch, weil Parenchymveraenderungen in Form moeglicher Lungeninfarkte in nur 10-15% nach der Gefaessverlegung entstehen. Kleine Embolien fuehren haeufiger zu haemorrhagischen Lungeninfarkten, die mit radiologischen und nukelarmedizinischen Verfahren fassbar werden. Bei vorbestehenden chronischen Lungenerkrankungen mit meist verstaerkt ausgebautem Bronchialartheriensystem und zusaetzlichen Anatomosen sind haemorrhagische Lungeninfarkte besonders selten. Die radiologische und nuklearmedizinische Diagnostik muss sich daher heute nach vielversprechenden Studien, z.B. unter Einsatz der Spiralcomputertomographie, wesentlich auf die Befunde der thrombembolischen Gefaessobstruktion und transitorische Perfusionsausfaelle und weniger auf parenchymatoese Infiltratmuster stuetzen. (orig./MG)

  16. Treatment of Nonvariceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    Science.gov (United States)

    Ali, Muhammad; Ul Haq, Tanveer; Salam, Basit; Beg, Madiha; Azeemuddin, Muhammad

    2013-01-01

    Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention. PMID:23844289

  17. [Nephrotic syndrome revealed by pulmonary embolism: about four cases].

    Science.gov (United States)

    Chaudesaygues, E; Grasse, M; Marchand, L; Villar, E; Aupetit, J-F

    2014-11-01

    Nephrotic syndrom is an association of proteinuria>3g/d or 50mg/kg/d, an hypoalbuminemiadiabetes, high blood pressure and amyloidosis. We present four cases about nephrotic syndrome after thromboembolic disease. In every case, patients show a pulmonary embolism symptomatic of a nephrotic syndrom, whose diagnostic could be delayed up to six months after first pulmonary symptoms. This raised the problem of renal biopsy in these patients who need anticoagulation. In minimal change nephrosis, without hematuria, high blood pressure or renal dysfonction, a corticosteroid therapy test could be done assuming that is corticosensitive minimal glomerular injury. In every case, anticoagulation course must be completed and maintained in case of patent nephrotic syndrom with an albuminemia under 20g/L. In case of pulmonary embolism or deep vein thrombosis, idiopathic-looking, a nephrotic syndrome must be sought-after. The two diagnosis ways are the proteinuria on the urine dipstick and the hypoproteinemia on usual biology. The main mechanism is the coagulation factor leak, side effect of the nephrotic syndrom, notably because of the antithrombin III. PMID:25281996

  18. Cerebral fat embolism: Use of MR spectroscopy for accurate diagnosis

    Directory of Open Access Journals (Sweden)

    Laxmi Kokatnur

    2015-01-01

    Full Text Available Cerebral fat embolism (CFE is an uncommon but serious complication following orthopedic procedures. It usually presents with altered mental status, and can be a part of fat embolism syndrome (FES if associated with cutaneous and respiratory manifestations. Because of the presence of other common factors affecting the mental status, particularly in the postoperative period, the diagnosis of CFE can be challenging. Magnetic resonance imaging (MRI of brain typically shows multiple lesions distributed predominantly in the subcortical region, which appear as hyperintense lesions on T2 and diffusion weighted images. Although the location offers a clue, the MRI findings are not specific for CFE. Watershed infarcts, hypoxic encephalopathy, disseminated infections, demyelinating disorders, diffuse axonal injury can also show similar changes on MRI of brain. The presence of fat in these hyperintense lesions, identified by MR spectroscopy as raised lipid peaks will help in accurate diagnosis of CFE. Normal brain tissue or conditions producing similar MRI changes will not show any lipid peak on MR spectroscopy. We present a case of CFE initially misdiagnosed as brain stem stroke based on clinical presentation and cranial computed tomography (CT scan, and later, MR spectroscopy elucidated the accurate diagnosis.

  19. Follow-up of pulmonary perfusion recovery after embolism

    International Nuclear Information System (INIS)

    Blood flow recovery in a group of 69 patients with pulmonary embolism was followed by serial lung scans over a six month period. Each patient underwent perfusion lung scan at diagnosis then 7, 30 and 180 days later; i.v. heparin was systematically administered for one week after diagnosis, followed by oral warfarin for six months. Blood flow impairment was evaluated by assessing the total number of unperfused lung segments (ULS), as calculated on both lateral views at each scan. The number of ULS was significantly reduced at each interval (P<0.001), ranging from 8.4±3.3 at diagnosis to 3.6±2.7 six months later; most of the recovery (79%) occurred within the first month. No patient had complete restoration of pulmonary blood flow during the whole follow-up period. No difference was found between the number of ULS in right lung versus that in left lung at each interval. Recovery of blood flow was heavily affected by coexisting cardiac or pulmonary disease. In fact, those patients with underlying cardiopulmonary disease (49.2% of the total) showed significantly smaller perfusion improvement after six months (P<0.001). Eight patients (6 with and 2 without cardiopulmonary disease) had clinical and scintigraphic evidence of recurrent embolism during the follow-up period

  20. Treatment of Nonvariceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    International Nuclear Information System (INIS)

    Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention

  1. Partial splenic embolization in patients with idiopathic portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Maurizio E-mail: maurizio.romano@ibb.cnr.it; Giojelli, Angela; Capuano, Gaetano; Pomponi, Domenico; Salvatore, Marco

    2004-03-01

    Purpose: To evaluate the effectiveness of partial splenic embolization (PSE) in patients with idiopathic portal hypertension (IPH) in reducing variceal bleeding episodes, splenomegaly and thrombocytopenia. Materials and methods: Six patients (2M, 4F, mean age 30.3 years) with IPH presenting with splenomegaly, thrombocytopenia and recurrent variceal bleeding were treated with PSE using gelatin sponge (four patients) or Contour particles (two patients) as embolization material. Results: PSE was performed successfully in all cases; 3F coaxial microcatheters were necessary in two patients due to extreme splenic artery tortuosity. The average amount of devascularized parenchyma at CT 1 week after PSE was 71%. Splenomegaly and thrombocytopenia improved in all cases, with a mean platelet count increase of 120000/mm{sup 3} and an average 68% reduction of spleen volume at follow up. Variceal bleeding did not recur after PSE. Esophageal or gastroesophageal varices disappeared (one patient) or significantly reduced (five patients) at endoscopic controls. No significant complications were noted. The follow up was of at least 18 months in all patients; mean follow up was 28.2 months. Conclusion: In patients with IPH PSE can be effective in preventing variceal bleedings, in reducing spleen volume and in significantly increasing platelet count; therapeutic results were durable in our population.

  2. Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment

    Directory of Open Access Journals (Sweden)

    Fahri Halit Besir

    2011-01-01

    Full Text Available Context: Retroperitoneal hematoma may usually occur as a result of trauma. A life threatening retroperitoneal hematoma is not expected complication of anticoagulation treatment and rarely reported. Low molecular weight heparins (Enoxaparin which are used as effective and safe medicine in the venous thromboemboly treatment have some major complications such as hematomas of different organs. We aim to present a giant spontaneous retroperitoneal hematoma after anticoagulant treatment of pulmonary embolism with enoxaparin. Case Report: A 73-year-old male patient with the diagnosis of pulmonary embolism underwent anticoagulant treatment (enoxaparin. In the second day of admission, the patient had an episode of abdominal and back pain. Abdominal ultrasonography and computerized tomographic scan revealed a giant retroperitoneal hematoma. Enoxaparin treatment was then stopped and the supportive treatment was started. In the following days, hemoglobin levels returned to normal and a control CT revealed regression of hematoma size. Conclusion: The anticoagulant treatment with enoxaparin may lead to severe hematomas. Therefore, the clinical suspicion is required especially in elderly patients and patients with impaired renal function for retroperitoneal hematoma, when they suffer from acute abdominal pain.

  3. Current role of lung scintigraphy in pulmonary embolism

    International Nuclear Information System (INIS)

    The pivotal role of lung scintigraphy in the diagnosis of pulmonary embolism (PE) has been questioned in recent years due to the introduction of spiral computed tomography. However, the scintigraphic results used for comparisons are often those of the authoritative PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) study, carried out in the 1980s. Pulmonary scintigraphy has progressed from those years both in the methodological and interpretative fields, although perhaps too slowly. Results better than those of PIOPED's have been presented by study groups who used: 1) perfusion-only approach; 2) SPET imaging; 3) new interpretative criteria; 4) different prediction rules to integrate clinical and scintigraphic probabilities of PE. These advances are still insufficiently recognised by the nuclear medicine community, possibly due to a sort of PIOPED-based cultural globalisation. This paper reviews the actual advantages and limitations of nuclear medicine techniques, the diagnostic role of scintigraphy within the diagnostic algorithms proposed by international working groups and scientific societies and the results obtained from SPET imaging in the diagnosis of PE

  4. Embolization of intracranial dural arteriovenous fistulas with Onyx-18

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China); Wu Zhongxue [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China)], E-mail: ttyyzjb@sina.com

    2010-03-15

    Background and purpose: The use of Onyx in the treatment of AVMs has been reported in the literature, but experience in the treatment of DAVF is lacking. We report the clinical outcome obtained in the treatment of dural arteriovenous fistulas (DAVFs) using a new liquid embolic agent, Onyx-18. Methods: The present series included 21 patients; 9 had DAVFs draining directly into the cortical veins, 6 had DAVFs draining directly into the dural sinus, 4 had DAVFs draining through the ophthalmic veins and 2 had DAVFs involving the dural sinus with leptomeningeal retrograde venous drainage Clinical data were extracted from hospital files and all patients were followed. Results: In 14 patients (70%) there was complete angiographic elimination of the shunts and resolution of the symptoms. The remaining 7(30%) patients was not cured with residual shunts. Adverse events occurred in 6(30%) of 21 patients with 1 DAVF located at the transverse sigmoid sinus, 2 at tentorium, and 3 at the cavernous sinus. Cranial deficits occurred in 3(15%) patients, brain infarction in 1(5%) patient and microcatheter gluing in 1(3.2%) patient. At final follow up, 20 patients were asymptomatic with 1 showed clinical improvement. Conclusion: Definitive cure may be attained effectively with Onyx in dural arteriovenous fistulas and adjunctive to surgery and radiotherapy. Location of the DAVFs affected the outcome of transarterial embolization.

  5. Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta

    International Nuclear Information System (INIS)

    Aim: To evaluate the efficacy and safety of uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Materials and methods: Between January 2005 and August 2011, 45 women with placenta accreta, which was discovered during delivery, were managed conservatively in Peking Union Medical College Hospital. They did not experience severe bleeding during delivery. Ten patients (mean age 31 ± 6.4 years) developed secondary postpartum haemorrhage and underwent uterine artery embolization. The complications, control of haemorrhage, and outcome of the placenta left inside the uterus were retrospectively reviewed. Results: All patients underwent transcatheter embolization of bilateral uterine arteries. The median time between delivery and uterine artery embolization was 11 days (range 3–76 days). The technical success rate of embolization was 100%. Bleeding was controlled in all patients during follow-up (11 ± 6.9 months; range 3–24 months), and no further bleeding occurred. One patient developed lower-extremity deep venous thrombosis after uterine artery embolization, and no other major complications occurred. The placentae that were left inside the uteri gradually decreased in size during follow-up, except in one case. Nine patients resumed normal menstruation. One patient subsequently became pregnant and had an uneventful intrauterine pregnancy carried to term. Conclusion: Uterine artery embolization is safe and effective for the management of secondary postpartum haemorrhage associated with placenta accreta.

  6. Studies of ventilation and perfusion in rabbits with experimental pulmonary embolism

    International Nuclear Information System (INIS)

    Ventilation and perfusion studies were performed on 38 experimental rabbits with multiple pulmonary emboli. These embolic materials were human thrombin, lipiodol ultrafluide, gelfoam fragments, ivalon fragments, iron powder and VX-2 cancer. Immediately after the embolization, Xe-133 washout study was begun with the intravenous injection of dissolved xenon. Thereafter, perfusion images were obtained using Tc-99m albumin microspheres (7 to 25μm in diameter). When Xe-133 gas was used, the ventilation study consisting of single-breath, equilibrium after 2.5 minutes and sequential washout images, was carried out in the rabbits. Perfusion scintigrams after embolization showed multiple segmental and subsegmental defects of blood flow to the embolic regions within the both lungs. Xe-133 ventilation images showed homogeneous washout. These thromboemboli had almost disappeared perfusion scintigraphically at 24 hours after embolization. However, in a rabbit after embolization with ivalon fragments mixed with iron powders, a lobar defect in the anterior lobe of the left lung persisted perfusion scintigraphically after 24 hours. Xe- 133 washout from the nonperfused area was considerably prolonged at 20 minutes after embolization. In rabbits after diffuse pulmonary oily microembolization, the washout studies after equilibrium breathing of xenon gas showed remarkable delay in clearing the gas from the whole lung. The perfusion images revealed the fissure sign as a linear area of decreased radioactivity which corresponds to the interlobar fissure. (author)

  7. An experimental study on transcatheter embolization with mixture of ethanolamine oleate and microfibrillar collagen in rabbits

    International Nuclear Information System (INIS)

    To evaluate ethanolamine oleate (EAO)-microfibrillar collagen (MFG) mixture as a new scleroembolic material for the interventions requiring both permanent obliteration of vascular lumen and atrophy of mass, such as for the facial AVM and other hypervascular soft tissue masses. Twenty-nine transcatheter transarterial embolization of renal arteries were performed in six groups of rabbits classified by the EAO concentration and the addition of MFC. Post embolization angiography, gross morphological and microscopic examinations of embolized kidneys were performed immediately, 3 days, 2 weeks and 4 weeks after embolization. Analysing points were the usefulness as a scleroembolic material (endovascular retention, thrombogenic-sclerosing effect, perivascular fibrosis and inflammatory reaction), effects of the EAO concentration and the addition of MFC. EAO-MFC mixture satisfied all ideal conditions of scleroembolic agent; persistent endovascular retention, good thrombogenic-sclerosing effect with a mild inflammatory reaction and significant atrophy of kidney. The effect of increasing concentration of EAO was proximal embolization. The effects of MFC were promotion of proximal embolization, endovascular retention and sclerosing effect. EAO-MFC mixture can be used as a new effective scleroembolic material for the various hemodynamic situations in which embolic level can be controlled by EAO concentration and the addition of MFC

  8. A Preclinical Study of the Safety and Efficacy of Occlusin™ 500 Artificial Embolization Device in Sheep

    International Nuclear Information System (INIS)

    Introduction: This study evaluated the safety, effectiveness, and biodegradation of a new embolic agent, Occlusin™ 503 Artificial Embolization Device (OCL 503). The agent consists of biodegradable poly-lactic-co-glycolic acid microspheres (150–212 μm) coated with type I bovine collagen and was compared with Embosphere® Microspheres (300–500 μm) in this controlled study of uterine artery embolization (UAE) in sheep. Methods: Unilateral UAE was performed in 32 adult ewes randomly assigned. Vessels were embolized to effective stasis. The cohort was divided into four groups, which were sacrificed at 1, 3, 6, and 12 months. Results: Both agents were 100% effective in achieving stasis. At 6 months, all OCL 503-treated arteries were occluded, the microspheres degraded with time, and at 12 months all four animals examined demonstrated recanalization. OCL 503 was found in the untreated uterine artery in one animal with no other evidence of non target embolization. In the Embosphere-treated group, all vessels remained occluded and microspheres were detected in the contralateral uterine artery in 6 of 15 examined vessels and in 10 vaginal, 2 ovarian, and 1 vesical artery. No procedural-related complications were seen in either group. Conclusions: OCL 503 is as effective an embolic agent as Embosphere® Microspheres when embolizing ovine uterine arteries and resorbs with time, allowing recanalization of the treated arteries. No device-related issues or adverse events were observed.

  9. Transcatheter embolization for high blood flow vascular malformations of oral maxillofacial region

    International Nuclear Information System (INIS)

    Objective: To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods: 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results: Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions: Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region. (authors)

  10. Arterial steal syndrom in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries

    International Nuclear Information System (INIS)

    Purpose: To evaluate transaterial embolization of splenohepatic and gastroduodenal steal syndrome in patients with impaired liver function tests after liver transplantation. Methods and Material: In a prospective study 22 patients (10 male, 12 female; mean age 49.5 years) with unexplained elevation of hepatic enzymes after liver transplantation underwent transcatheter arterial embolization of splenohepatic (n = 18) and gastroduodenal (n = 4) steal syndrome with use of Gianturco coils or microcoils. Liver and spleen parenchyma were surveyed and evaluated before and after embolization with plain helical CT, including volumetry of liver and spleen. Results: DSA examinations revealed a dilated splenic artery (n = 18) or gastroduodenal artery (n = 4) combined with a slightly decreased perfusion of the hepatic arteries, while immediately after successful embolization a normal perfusion of the hepatic arteries could be noted. Volumetric measurements before and after embolization showed no significant changes in liver parenchyma (x = + 7% ± 2), and variable changes in splenic volume of - 5% to + 28% (mean, + 11%), with initial measurements. Clinical follow-up examinations revealed a normalization of the previously elevated hepatic enzymes and a normalization of liver function tests after successful embolization. Complications were observed in 4 patients (infarction of the spleen). Conclusions: The preliminary results reveal that in liver transplant candidates with splenohepatic and gastroduodenal steal syndrome successful embolization results in an improvement of organ perfusion with normalization of function tests. (orig.)

  11. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Giuseppe [Rizzoli Orthopaedic Institute, Department of Interventional Angiographic Radiology, Bologna (Italy); Rimondi, Eugenio; Vanel, Daniel [Rizzoli Orthopaedic Institute, Department of Radiology, Bologna (Italy); Bartalena, Tommaso [University of Bologna, Bologna (Italy); Gerardi, Antonio [Rizzoli Orthopaedic Institute, Department of Anatomical Human Science and Physiopathology of the Musculoskeletal System, Bologna (Italy); Alberghini, Marco [Rizzoli Orthopaedic Institute, Department of Pathological Anatomy, Bologna (Italy); Staals, Eric Lodwijk; Errani, Costantino; Bianchi, Giuseppe; Toscano, Angelo; Mercuri, Mario [Rizzoli Orthopaedic Institute, V Division of Musculoskeletal Tumors, Bologna (Italy)

    2010-02-15

    Aneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. The lesion causes pain and swelling, which are generally present for less than 3 months. From April 2003 to April 2008 36 patients affected by aneurysmal bone cysts were treated by selective arterial embolization with N-2-butyl cyanoacrylate. The study population comprised 20 male and 16 female patients with an age range of 3.3-60.8 years. Nine lesions were localized in the appendicular skeleton (1 in the upper and 8 in the lower limb), 4 in the thoracic cage (1 rib lesion and 3 scapular lesions), 17 in the pelvis and 6 in the spine (1 thoracic and 5 sacral localizations). A total of 55 embolizations were performed: in 22 cases (61%) only one embolization was needed, whilst two embolizations were necessary in 9 cases (25%) and 3 in the remaining 5 patients (14%). The treatment was effective in 32 patients (94%): follow-up was 0.9-5 years. In one patient, previously surgically treated, only the cyanoacrylate embolization turned out to be useful for healing the lesion. Another 7 patients underwent surgery during the study period. In the 55 procedures we performed we had 3 complications (5%): 2 cases of skin necrosis and 1 of transient paresis. Arterial embolization with cyanoacrylate may be the treatment of choice for aneurysmal bone cysts. Embolization is a less invasive, lower cost, simpler procedure than surgery and is easily repeatable. (orig.)

  12. Feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy:a preliminary study

    Institute of Scientific and Technical Information of China (English)

    Fu-Yu Li; Ning Li; Li-Sheng Jiang; Jing-Qiu Cheng; Nan-Sheng Cheng; Xing-Wu Wu; Sheng He

    2006-01-01

    BACKGROUND: The high operative risk of hepatectomy for specially located intrahepatic stones is still a problem to be solved. This study was undertaken to investigate the feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy. METHODS: Oxybenzene or absolute ethanol plus N-butyl-cyanoacrylate was employed for embolization. The feasibility, effectiveness and mechanism of chemical hepatectomy were preliminarily analyzed histologically or by Fas, TIMP-1, TGF-β1, and collagenⅠ. RESULTS:Oxybenzene plus cyanonacrylate can preferably destroy and embolize the intrahepatic biliary duct, leading to the disappearance of hepatocytes in the periphery of embolized lobe and the achievement of effective chemical hepatectomy. The expressions of Fas, TIMP-1 and TGF-β1 in oxybenzene embolism group (88.90±38.10, 619.43± 183.42, 185.22±70.39) and ethanol embolism group (72.39± 29.51, 407.55±134.74, 163.56±51.75) were higher than those of biliary duct-ligated group (26.31±12.07, 195.31±107.67, 74.84±40.73) (P CONCLUSION: The effect of chemical hepatectomy may be achieved by chemical bile duct embolization.

  13. Evaluation of arterial impairment after experimental gelatin sponge embolization in a rabbit renal model

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jung Suk; Lee, Hae Gi; Chun, Ho Jong; Choi, Byung Gil; Choi, Yeong Jin [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2015-02-15

    Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

  14. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail: okabone@gmail.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Frank, Michael, E-mail: michael.frank@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Pellerin, Olivier, E-mail: olivier@pellerin.as; Primio, Massimiliano Di, E-mail: massimiliano.di.primio@gmail.com; Angelopoulos, Georgios, E-mail: giorginos78@msn.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Boughenou, Marie-Fazia, E-mail: marie-fazia.boughenou@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Anesthesia and Surgical Intensive Care Unit (France); Pagny, Jean-Yves, E-mail: jean-yves.pagny@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Messas, Emmanuel, E-mail: emmanuel.messas@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France)

    2013-05-09

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

  15. Bronchial artery embolization for therapy of pulmonary bleeding in patients with cystic fibrosis

    International Nuclear Information System (INIS)

    Introduction: Acute pulmonary emergencies in patient with cystic fibrosis (CF) can be found in cases of pneumothorax as well as hemoptysis. If the bleeding cannot be stopped by conservative methods, an embolization of the bronchial arteries should be done. Materials and Method: 11 patients were embolized using a combination of PVA particles and microcoils. Results: From January 1996 to June 2001 17 bronchial arteries in 11 patients were embolized. 7 patients suffered from chronical hemoptysis, 4 patients had an acute hemoptysis. In 4 patients both sides were embolized, in 3 patients only one side. The remaining 4 patients needed a second intervention, embolizing the other side. The primary embolizated bronchial artery was still closed in all 4 patients. In 1 patient the selective catheterization of a bronchial artery was not successful, thus the embolization could not be carried out. 1 patient died 5 days after the intervention due to a fulminant pneumonia (Pseudomonas aeruginosa) without recurrent bleeding. In two patients atypical branches from intercostal arteries feeding the bronchial arteries were detected and successfully embolized. All patients profited from the therapy, as bleeding could be stopped or at least be reduced. 3 patients suffered from back pain during or after intervention. There were no severe complications like neurological deficiencies or necroses. (orig.)

  16. Sequential MRI and MR spectroscopy in embolized meningiomas: correlation with surgical and histopathological findings

    International Nuclear Information System (INIS)

    The preoperative embolization of meningiomas is commonly used to facilitate surgery. The purpose of this study was to evaluate the morphological and metabolic changes in embolized meningiomas and to correlate the results with surgical and histopathological findings. In a prospective study, 36 patients with intracranial meningiomas were included. The extent of devascularization was assessed by angiography and MR volumetry. MRI and MR spectroscopy (MRS) were performed before and sequentially after embolization. At surgery, blood loss was measured and intraoperative duplex-mode ultrasound was applied to identify avascular tumor portions. Histopathological specimens were evaluated for the histological subtype, localization and extent of necrotic tumor portions. Postembolization MRI revealed a variable pattern of secondary revascularization and devascularization with an early onset following embolization. In all patients, peripheral secondary enhancement was present which histopathologically represented a thin layer of vital tumor tissue. MRS revealed lactate in devascularized areas immediately after embolization. Lipids were not observed before the 3rd day after embolization and were always associated with avascular and soft tissue at the time of surgery. Embolized meningiomas feature a variable dynamic with the potential for revascularization and secondary devascularization. Lipid signals indicate avascular and soft tissue at surgery. In case of delayed surgery, MRI and MRS should be performed in order to exclude revascularization and to establish the fatty degeneration of the meningioma. (orig.)

  17. Review of reported causes of device embolization following trans-catheter aortic valve implantation.

    Science.gov (United States)

    Ibebuogu, Uzoma N; Giri, Smith; Bolorunduro, Oluwaseyi; Tartara, Paolo; Kar, Saibal; Holmes, David; Alli, Oluseun

    2015-06-15

    Transcatheter heart valve (THV) embolization is a rare but serious complication of transcatheter aortic valve implantation. Studies, including case reports, case series, and original reports published between 2002 and 2013, with regard to THV embolization were identified with a systemic electronic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 19 publications describing 71 patients were identified. Most patients (64%) were men, with a mean age of 80 ± 6 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 22.4 ± 9.3%. Balloon-expandable valves were used in 72% of the patients. The reported transcatheter aortic valve replacement access site was transfemoral in 80% of patients. Most cases (90%) occurred <1 hour after implantation, whereas 10% had late embolization (range 4 hours to 43 days). The most common site of embolization was the ascending aorta (38%), followed by the left ventricle (31%), descending aorta (23%), and aortic arch (8%). Open-heart surgery was required in 28% for valve retrieval and replacement. The 30-day stroke and mortality rates were 11% and 17%, respectively. Ventricular embolization and urgent conversion to open-heart surgery were significantly associated with death during hospitalization (p = 0.017 and p = 0.029, respectively). Likely causes of embolization were identified in 59 patients, with positioning error as the most commonly reported (47%), followed by pacing error (13%). In conclusion, THV embolization occurred early after transcatheter aortic valve implantation. The ascending aorta was the most common site of embolization. Higher 30-day stroke and mortality rates were associated with THV embolization compared with most published series of transcatheter aortic valve implantation outcomes. PMID:25882773

  18. Interventional embolization of congenital arteriovenous fistula in the common femoral profunda artery in children

    International Nuclear Information System (INIS)

    Objective: To explore the effect and safety of interventional embolization of congenital arteriovenous fistula (CAVF) in the common femoral profunda artery in children. Methods: Eight children (aged 6 to 14 years; 6 males and 2 females) with CAVF underwent interventional embolization From January 2006 and December 2010. Color Doppler sonography and DSA were performed on all patients. Arterial duplex imaging revealed the arteriovenous fistula in the common femoral profunda artery and DSA further confirmed the presence of an AVF over the common femoral profunda artery via the other vein. All children were treated with interventional embolization therapy by the injection of coils or ethanol through a microcather. It was necessary to performed repeated interventional embolization if the lesion was not obliterated in 4 weeks. All patients were followed-up from 6 months to 2 years and the clinical symptoms were observed. Results: Arteriography can clearly demonstrate the femoral profunda artery and its branches as well as the fistula. Ten interventional embolization procedures were performed.Forty seven coils were deployed during the procedure and seven ethanol embolization procedures were performed. Post-procedural angiography revealed complete occlusion in 8 patients. No major complications such as ectopic coil embolization, tissue necrosis, peripheral nerve palsy or cardio-pulmonary collapse were found. The abnormal AVFs were embolized completely in 7 cases after only one therapy and there was no recurrent disease in the 6 months to 2 years follow-up. Some tiny AVFs were still found in another case which underwent three additional treatments. However, the clinical symptoms were under control. Conclusion: Interventional embolization is a safe and effective therapeutic method for CAVF of the common femoral profunda artery in children and it might become the primary treatment option. (authors)

  19. Contrast-enhanced CT of Pulmonary Embolism:Report of 20 cases

    Institute of Scientific and Technical Information of China (English)

    Feng Shiting; Li Ziping; Chen Jingdi; Meng Quanfei; Li Xiangmin; Kuang Jianyi; Zhou Xuhui

    2007-01-01

    Objectives To study the characteristic of pulmonary embolism (PE) in contrast-enhanced CT. Methods The radiological features were described in 20 patients with lobar and proximal PE diagnosed with a Toshiba Xpress/SX CT scanner after contrast material was administrated. Results There were 7 cases of pulmonary embolism (PE) secondary to lower limb deep vein thrombosis (DVT), of which 2 cases were related to sauna bath. We grouped the cases according to their extensiveness of embolism: mild, moderate, severe, or complete embolism. Mild embolism: the emboli occupied less than 30%, of the inner diameter of pulmonary artery (PA). Median embolism: the emboli occupied 30~50% of the PA diameter. Severe embolism: the emboli occupied over half of the PA (50%), but there were contrast flow. Completed embolism: there was no contrast found around the emboli. The direct sign of PE was a filling defect or no opacification in the affected branch of pulmonary artery (PA). There were 9 other secondary signs: ①widen PA, ②enlarged right ventricle and the right atrium, ③increased translucency of the lung and decreased bronchovascular shadows, ④shrunken pulmonary veins liked dried rattan, ⑤decreased left atrium and the left ventricle size, ⑥shifting of interventricular septum to the left and posterior direction,⑦The lateral lung parenchyma demonstrated in a triangular shape,⑧pleural effusion and ⑨pericardiacle effusion. Conclusions The diagnosis of PE was revealed by 10 radiological signs by contrast-enhanced CT:With full understanding of the pathophysiological basis of these 10 signs:correct diagnosis of pulmonary embolism can be made. PE is commonly caused by lower limb. And sauna bath is one of the main predisposing causes.

  20. Assessment of pulmonary ventilation scans using Xenon-127 in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Pulmonary ventilation scans using 127Xe were compared with scans using 133Xe in the diagonsis of pulmonary embolism. A perfusion scan using sup(99m)Tc-microspheres and ventilation scans with each of the xenon isotopes were performed on 44 patients referred for lung scanning to confirm or exclude a suspected clinical diagnosis of pulmonary embolism. No significant difference was found in the frequency of diagnosis of pulmonary embolism when comparing each of the ventilation scans with the corresponding perfusion scan. For reasons discussed, 127Xe may be more useful than 133Xe for pulmonary ventilation scanning. (orig.)

  1. Ventilation-perfusion studies and the diagnosis of pulmonary embolism: concise communication

    International Nuclear Information System (INIS)

    Various diagnostic strategies for the assessment of pulmonary embolism were developed using the results of scintigraphic examinations in 169 patients who had both scintigraphic studies and pulmonary angiography. Likelihood ratios for several perfusion and ventilation-perfusion patterns were first obtained, and Bayes' Theorem was then applied using a range of prior probabilities for pulmonary embolism. Resulting posterior probabilities ranged from under 10% to over 90%. The former values held for patients with small perfusion defects and no ventilation study, regardless of their prior probabilities for pulmonary embolism. The latter values held for patients with average to high prior probabilities and ventilation-perfusion mismatches

  2. Trans arterial embolization of primary and secondary tumors of the skeletal system

    International Nuclear Information System (INIS)

    Percutaneous transcatheter al embolization s of primary and secondary bone tumors are important minimal invasive angiographic interventions of the skeletal system. In most of the cases embolization is performed for preoperative devascularization or as a palliative measure to treat tumor-associated pain or other tumor bulk symptoms. The transarterial embolization of primary and secondary tumors of the skeletal system has been developed to a safe and very effective method. Indications, techniques, results and complications of this minimal invasive interventional therapy for treatment of primary and secondary bone tumors are described and discussed and compared with the newer literature and our own results

  3. Regenerative material for aneurysm embolization A 3-dimensional culture system of fibroblasts and calcium alginate gel

    Institute of Scientific and Technical Information of China (English)

    Jingdong Zhang; Kan Xu; Jinlu Yu; Jun Wang; Qi Luo

    2011-01-01

    Calcium alginate gel (CAG) has been shown to successfully model aneurysm embolization within a short period of time. However, gradually degrading CAG potentially results in aneurysm recanalization.In the present study, a regenerative embolic material was designed by seeding rat fibroblasts in a CAG. The study investigated the feasibility of constructing a 3-dimensional culture system. The fibroblasts grew well and firmly attached to the CAG. CAG was conducive for fibroblast growth, and resulted in a 3-dimensional culture system. Results show that CAG can be used theoretically as a vascular, regenerative, embolic material.

  4. New Oral Anticoagulants in the Treatment of Pulmonary Embolism: Efficacy, Bleeding Risk, and Monitoring

    Directory of Open Access Journals (Sweden)

    Kelly M. Rudd

    2013-01-01

    Full Text Available Anticoagulation therapy is mandatory in patients with pulmonary embolism to prevent significant morbidity and mortality. The mainstay of therapy has been vitamin-K antagonist therapy bridged with parenteral anticoagulants. The recent approval of new oral anticoagulants (NOACs: apixaban, dabigatran, and rivaroxaban has generated significant interest in their role in managing venous thromboembolism, especially pulmonary embolism due to their improved pharmacokinetic and pharmacodynamic profiles, predictable anticoagulant response, and lack of required efficacy monitoring. This paper addresses the available literature, on-going clinical trials, highlights critical points, and discusses potential advantages and disadvantages of the new oral anticoagulants in patients with pulmonary embolism.

  5. Possible therapeutic effect of naftidrofuryl oxalate on brain energy metabolism after microsphere-induced cerebral embolism.

    OpenAIRE

    Miyake, K.; Tanonaka, K; Minematsu, R.; Inoue, K.; Takeo, S.

    1989-01-01

    1. The present study was designed to determine whether naftidrofuryl oxalate exerts a possible therapeutic effect on brain energy metabolism impaired by microsphere-induced cerebral embolism in vitro. 2. Injection of microspheres into the right carotid canal resulted in a decrease in tissue high-energy phosphates both in the right and left hemispheres, and an increase in tissue lactate in the right hemisphere, on the 3rd and the 5th day after the embolism. The embolism also induced a marked r...

  6. Freeze/thaw-induced embolism: probability of critical bubble formation depends on speed of ice formation

    Directory of Open Access Journals (Sweden)

    Sanna eSevanto

    2012-06-01

    Full Text Available Bubble formation in the conduits of woody plants sets a challenge for uninterrupted water transportation from the soil up to the canopy. Freezing and thawing of stems has been shown to increase the number of air-filled (embolized conduits, especially in trees with large conduit diameters. Despite numerous experimental studies, the mechanisms leading to bubble formation during freezing have not been addressed theoretically. We used classical nucleation theory and fluid mechanics to show which mechanisms are most likely to be responsible for bubble formation during freezing and what parameters determine the likelihood of the process. Our results confirm the common assumption that bubble formation during freezing is most likely due to gas segregation by ice. If xylem conduit walls are not permeable to the salts expelled by ice during the freezing process, osmotic pressures high enough for air seeding could be created. The build-up rate of segregated solutes in front of the ice-water interface depends equally on conduit diameter and freezing velocity. Therefore, bubble formation probability depends on these variables. The dependence of bubble formation probability on freezing velocity means that the experimental results obtained for cavitation threshold conduit diameters during freeze/thaw cycles depend on the experimental setup; namely sample size and cooling rate. The velocity dependence also suggests that to avoid bubble formation during freezing trees should have narrow conduits where freezing is likely to be fast (e.g. branches or outermost layer of the xylem. Avoidance of bubble formation during freezing could thus be one piece of the explanation why xylem conduit size of temperate and boreal zone trees varies quite systematically.

  7. Numerical investigation of fluid-particle interactions for embolic stroke

    Science.gov (United States)

    Mukherjee, Debanjan; Padilla, Jose; Shadden, Shawn C.

    2016-04-01

    Roughly one-third of all strokes are caused by an embolus traveling to a cerebral artery and blocking blood flow in the brain. The objective of this study is to gain a detailed understanding of the dynamics of embolic particles within arteries. Patient computed tomography image is used to construct a three-dimensional model of the carotid bifurcation. An idealized carotid bifurcation model of same vessel diameters was also constructed for comparison. Blood flow velocities and embolic particle trajectories are resolved using a coupled Euler-Lagrange approach. Blood is modeled as a Newtonian fluid, discretized using the finite volume method, with physiologically appropriate inflow and outflow boundary conditions. The embolus trajectory is modeled using Lagrangian particle equations accounting for embolus interaction with blood as well as vessel wall. Both one- and two-way fluid-particle coupling are considered, the latter being implemented using momentum sources augmented to the discretized flow equations. It was observed that for small-to-moderate particle sizes (relative to vessel diameters), the estimated particle distribution ratio—with and without the inclusion of two-way fluid-particle momentum exchange—were found to be similar. The maximum observed differences in distribution ratio with and without the coupling were found to be higher for the idealized bifurcation model. Additionally, the distribution was found to be reasonably matching the volumetric flow distribution for the idealized model, while a notable deviation from volumetric flow was observed in the anatomical model. It was also observed from an analysis of particle path lines that particle interaction with helical flow, characteristic of anatomical vasculature models, could play a prominent role in transport of embolic particle. The results indicate therefore that flow helicity could be an important hemodynamic indicator for analysis of embolus particle transport. Additionally, in the presence

  8. Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Meneses, Luis, E-mail: lmeneseq@gmail.com; Fava, Mario; Diaz, Pia; Andia, Marcelo [Pontificia Universidad Catolica de Chile, Radiology Department and Biomedical Imaging Center (Chile); Tejos, Cristian; Irarrazabal, Pablo [Pontificia Universidad Catolica de Chile, Biomedical Imaging Center (Chile); Uribe, Sergio, E-mail: suribe@med.puc.cl [Pontificia Universidad Catolica de Chile, Radiology Department and Biomedical Imaging Center (Chile)

    2013-02-15

    We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.

  9. Pulmonary Embolism Related to Amisulpride Treatment: A Case Report

    Directory of Open Access Journals (Sweden)

    Maria Skokou

    2013-01-01

    Full Text Available Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.

  10. Pulmonary embolism related to amisulpride treatment: a case report.

    Science.gov (United States)

    Skokou, Maria; Gourzis, Philippos

    2013-01-01

    Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.

  11. Management of intermediate-risk pulmonary embolism: uncertainties and challenges.

    Science.gov (United States)

    Klok, Frederikus Albertus; Meyer, Guy; Konstantinides, Stavros

    2015-12-01

    Current guidelines on the treatment of acute pulmonary embolism (PE) recommend stratification of hemodynamically stable patients in 'low risk' and 'intermediate risk'. Validated risk scores, cardiac biomarkers, and imaging of the right ventricle all help in distinguishing both patient categories. The relevance of this risk stratification lies in the determination of the most optimal treatment for the individual patient. In this clinical review, we will discuss how patients with 'intermediate-risk' PE can be identified as well as recent advances in their therapeutic management. Based on a clinical case, we will highlight the indications for reperfusion therapy and the current experience with non-vitamin K-dependent oral anticoagulant (NOACs) in this specific patient's category.

  12. Selective Uterine Artery Embolization for Management of Interstitial Ectopic Pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Lee, Sang Jin; Joe, Hwan Sung; Goo, Dong Erk; Chang, Yun Woo [Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of); Kim, Dong Hun [Chosun University Hospital, Gwangju (Korea, Republic of)

    2007-04-15

    Interstitial pregnancy is defined as any gestation that develops in the uterine portion of the fallopian tubes lateral to the round ligament. Interstitial pregnancies account for 2-4% of all ectopic pregnancies and have been reported to have an associated 2% to 2.5% maternal mortality rate. The traditional treatment for interstitial pregnancy using surgical cornual resection may cause infertility or uterine rupture in subsequent pregnancies. Recently, the early identification of intact interstitial pregnancy has been made possible in many cases with high resolution transvaginal ultrasound as well as more sensitive assays for betahuman chorionic gonadotropin ({beta}-hCG). The treatment includes: hysteroscopic transcervical currettage, local and systemic methotrexate (MTX) therapy and prostaglandin or potassium chloride injection of the ectopic mass under sonographic guidance. We describe a case of successful treatment of interstitial pregnancy using uterine artery embolization, after failure of methotrexate treatment.

  13. Extracorporeal membrane oxygenation with danaparoid sodium after massive pulmonary embolism.

    Science.gov (United States)

    Bauer, Christian; Vichova, Zuzana; Ffrench, Patrick; Hercule, Christiane; Jegaden, Olivier; Bastien, Olivier; Lehot, Jean-Jacques

    2008-04-01

    During extracorporeal membrane oxygenation, anticoagulation therapy is usually achieved with unfractionated heparin. We report on an extracorporeal membrane oxygenation with danaparoid sodium for a patient with severe respiratory failure due to massive pulmonary embolism and suspected type 2 heparin-induced thrombocytopenia. Danaparoid, a low molecular weight heparinoid, is an alternative to heparin for patients who develop type 2 heparin-induced thrombocytopenia. Danaparoid was given at 400 IU/h with an objective of antifactor Xa activity of 0.6-0.8 U/mL, which was monitored twice a day. No excessive bleeding or clotting of the circuit was noted. The patient was weaned from extracorporeal membrane oxygenation after 9 days of treatment. PMID:18349178

  14. "Matching" ventilation/perfusion images in fat embolization.

    Science.gov (United States)

    Skarzynski, J J; Slavin, J D; Spencer, R P; Karimeddini, M K

    1986-01-01

    Forty-eight hours after fracture of the tibia and fibula, a 27-year-old man developed the triad of findings noted in the fat embolism syndrome (neurologic changes, respiratory distress, and petechiae). An initially normal chest-x-ray, which progressed to one of bilateral fluffy diffuse infiltrates, aided in making the diagnosis. Ventilation/perfusion lung images were performed at the time of the radiographic changes and showed "matching" defects. Transcapillary passage of lipid breakdown products was considered to be the cause. While all parts of the lung showed reduced ventilation/perfusion, the upper half of the lung fields was affected more prominently, as opposed to emboli of venous origin, which most frequently involve the lung bases. PMID:3943243

  15. Radiographic findings in pulmonary hypertension from unresolved embolism

    Energy Technology Data Exchange (ETDEWEB)

    Woodruff, W.W. III; Hoeck, B.E.; Chitwood, W.R. Jr.; Lyerly, H.K.; Sabiston, D.C. Jr.; Chen, J.T.T.

    1985-04-01

    Pulmonary artery hypertension with chronic pulmonary embolism is an uncommon entity that is potentially treatable with pulmonary embolectomy. Although the classic radiographic features have been described, several recent investigators report a significant percentage of these patients with normal chest radiographs. In a series of 22 patients, no normal radiographs were seen. Findings included cardiomegaly (86.4%) with right-sided enlargement (68.4%), right descending pulmonary artery enlargement (54.5%), azygos vein enlargement (27.3%), mosaic oligemia (68.2%), chronic volume loss (27.3%), atelectasis and/or effusion (22.7%), and pleural thickening (13.6%). Good correlation with specific areas of diminished vascularity was seen on chest radiographs compared with pulmonary angiograms.

  16. Atypical Presentation of Massive Pulmonary Embolism, a Case Report

    Directory of Open Access Journals (Sweden)

    Alireza Majidi

    2014-03-01

    Full Text Available The lack of pathognomonic signs and symptoms makes the diagnosis of pulmonary embolism (PE difficult. Here, we report a case of a 42-year-old man presented to the emergency department with worsening epigastric pain, hypotension, frank bradycardia, and final diagnosis of PE. Although previous studies have indicated that abdominal pain was observed in 6.7% of patients with PE, the exact reason for abdominal pain in PE still remains unknown. Tension on the sensory nerve endings, hepatic congestion, and distention of Gilson’s capsule are some of the possible mechanisms of abdominal pain in PE. We conclude that emergency physicians should pay more attention to PE, which is an important differential diagnosis of shock state. In this context, rapid ultrasound in shock (RUSH should be considered as a vital sign that needs to be evaluated when recording the history of patients presented to the emergency department with signs and symptoms of shock.

  17. Evolving imaging techniques in diagnostic strategies of pulmonary embolism.

    Science.gov (United States)

    Robert-Ebadi, Helia; Le Gal, Grégoire; Righini, Marc

    2016-04-01

    Modern non invasive diagnostic strategies for pulmonary embolism (PE) rely on the sequential use of clinical probability assessment, D-dimer measurement and thoracic imaging tests. Planar ventilation/perfusion (V/Q) scintigraphy was the cornerstone for more than two decades and has now been replaced by computed tomography pulmonary angiography (CTPA). Diagnostic strategies using CTPA are very safe to rule out PE and have been well validated in large prospective management outcome studies. With the widespread use of CTPA, concerns regarding radiation and overdiagnosis of PE have paved the way for investigating new diagnostic modalities. V/Q single photon emission tomography has arisen as a highly accurate test and a potential alternative to CTPA. However, prospective management outcome studies are still lacking and are warranted before implementation in everyday clinical practice. PMID:26691634

  18. [Acute pulmonary embolism: beware of the wolf in sheep's clothing].

    Science.gov (United States)

    Klok, Frederikus A; Vahl, Jelmer E; Huisman, Menno V; van Dijkman, Paul R M

    2012-01-01

    Two male patients aged 57 and 73 were referred to the cardiologist because of progressive dyspnoea. In one patient, the general practitioner had previously adopted an expectative policy because of a clean chest X-ray. At presentation after 4 weeks, the patient was diagnosed with and treated for acute coronary syndrome because of minor ECG abnormalities. Additional CT scanning showed a large saddle embolus. Despite adequate treatment, the patient suffered an electrical asystole and died. The other patient underwent ECG, bicycle ergometry, MRI adenosine, echocardiography and lung function tests over a period of 5 weeks before pulmonary embolism (PE) was diagnosed. As the signs and symptoms of PE are largely non-specific, diagnostic delay is common, with risk of poor clinical outcome. PE should at least be considered whenever a patient presents with acute or worsening breathlessness, chest pain, circulatory collapse or coughing, particularly in the presence of known thrombotic risk factors or when there is no clear alternative. PMID:22296892

  19. Review of Current Literature for Prostatic Artery Embolization.

    Science.gov (United States)

    Yu, Hyeon; Isaacson, Ari J; Burke, Charles T

    2016-09-01

    Prostatic artery embolization (PAE) is an emerging, novel interventional technique in the management of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is a common clinical condition in middle-aged and elderly men resulting in LUTS, including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Traditionally, LUTSs have been managed by medical or surgical therapies. Since the initial incidental discovery that selective PAE performed for uncontrolled bleeding secondary to BPH resulted in improved LUTS, the technique has continually evolved with a growing body of evidence supporting its safety and efficacy. However, despite the available data, PAE has yet to be established as a standard-of-care treatment option for patients with LUTS/BPH. In this article, the authors review the history and current state of PAE, including published data from case reports, animal studies, retrospective/prospective cohort studies, and prospective randomized controlled trials. PMID:27582611

  20. Comparison of efficacy of different treatments for pulmonary embolism.

    Science.gov (United States)

    Fan, Yang; Huang, He; Xiong, Jun; Yang, Mei; Kong, Bin; Liao, Jia-fen; He, Wang-wei; Wang, Zhi-qiang

    2016-04-01

    An optimal therapy for pulmonary embolism (PE) was explored by comparing three different methods in order to alleviate the sufferings of PE patients and reduce the mortality. Eighty patients with PE diagnosed by computed tomography angiography (CTA) were treated with thrombolysis, anticoagulation only, or surgery/intervention. The clinical efficacy of different treatments were compared and analyzed. Twenty-four out of the 26 patients (92%) in anticoagulation only group showed improvement in CTA and clinical presentations, which was significantly higher than that in the thrombolysis group (87%, n=39, Pthrombolysis group and anticoagulation only group. In the surgery/interventional group (n=15), the success rate was 47%, and the mortality rate was 14%. Both of them were significantly different from those in thrombolysis and anticoagulation only groups (both Pimportance to choose the appropriate therapeutic regimen for PE patients. Mortality may be reduced and prognosis may be improved with anticoagulation only and thrombolysis therapy. PMID:27072972

  1. Impact of 3D Rotational Angiography on Liver Embolization Procedures: Review of Technique and Applications

    Energy Technology Data Exchange (ETDEWEB)

    Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com; Corona, Mario, E-mail: mario.corona68@gmail.com; Argirò, Renato, E-mail: renato.argiro@gmail.com; Anzidei, Michele, E-mail: michele.anzidei@gmail.com [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences (Italy); Vallati, Giulio, E-mail: vallati@ifo.it [Istituto Nazionale Tumori, Regina Elena, Department of Angiography and Interventional Radiology (Italy); Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it; Bezzi, Mario, E-mail: mario.bezzi@uniroma1.it; Catalano, Carlo, E-mail: carlo.catalano@uniroma1.it [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences (Italy)

    2015-06-15

    In the last years, the interest into interventional applications of C-arm cone-beam CT (CBCT) progressively raised, widening its clinical application from the original field of interventional neuroradiology to the field of peripheral procedures. Liver embolization procedures, due to their complexity and potential treatment-related life-threatening complications, represent one of the main clinical applications of this novel angiographic technique. CBCT has been demonstrated to render procedures safer and technically easier, and to predict outcome as well as to avoid major complications in different treatment scenarios (trans-arterial embolization, trans-arterial chemoembolization, selective internal radiation therapy, percutaneous portal vein embolization). This review summarizes all technical, dosimetric and procedural aspects of CBCT techniques, underlying all its potential clinical advantages in the field of liver embolization procedures. Moreover, the paper provides all the instructions to obtain the best diagnostic performance out of this novel angiographic technique.

  2. Indications for embolization in a French level 1 trauma center.

    Science.gov (United States)

    Frandon, J; Arvieux, C; Thony, F

    2016-08-01

    Abdominal trauma accounts for nearly 20% of all traumatic injuries. It often involves young patients sustaining multiple injuries, with a high associated mortality rate. Management should begin at the scene of injury and relies on a structured chain of care in order to transport the trauma patient to the appropriate hospital center. Management is multi-disciplinary, involving intensive care specialists, surgeons and radiologists. Imaging to precisely define injury is best performed with whole body dual phase computed tomography, which can also identify the source of bleeding. Non-operative management has developed considerably over the years: this includes selective embolization in case of active bleeding or vascular anomalies in stable or stabilized patients after resuscitation. Embolization has become one of the corner stones of abdominal trauma management and interventional radiologists must play an active role on the trauma team. This overview details the different embolization procedures according to the involved organ and embolic agent used. PMID:27374109

  3. Cerebral embolism due to non-bacterial thrombotic endocarditis following pregnancy.

    OpenAIRE

    George, J.; Lamb, J T; Harriman, D G

    1984-01-01

    A case is reported of cerebral embolism with two very unusual features. Two bilaterally symmetrical haemorrhagic infarcts occurred, due to non-bacterial thrombotic cardiac valvular vegetations precipitated by the puerperium in a previously healthy young woman.

  4. Polyvinyl alcohol and gelatin sponge particle embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yong-Song Guan; Long Sun; Xiang-Ping Zhou; Xiao Li; Ze-Jun Fei; Xiao-Hua Zheng; Qing He

    2005-01-01

    AIM: To assess the effectiveness of and complications associated with polyvinyl alcohol (PVA) and gelatin sponge particles embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis.METHODS: A 42-year-old man with splenic artery pseudoaneurysm formation secondary to chronic alcoholic pancreatitis was admitted. We used PVA and gelatin sponge partides embo lization of splenic artery pseudoaneurysm by superselective embolization techniques.RESULTS: The splenic artery pseudoaneurysm was successfully controlled with splenic embolization. The patient was discharged in 9 d with complete recovery. CONCLUSION: This case confirms that superselective transcatheter embolization by PVA and gelatin sponge particles may represent an effective treatment for pseudoaneurysm caused by chronic alcoholic pancreatitis in the absence of other therapeutic alternatives.

  5. Lung scan perfusion defects limited to matching pleural effusions: low probability of pulmonary embolism

    International Nuclear Information System (INIS)

    Patients with a new pleural effusion are often sent for a ventilation-perfusion scan to exclude a pulmonary embolism. This retrospective study assessed the probability of pulmonary embolism when a pleural effusion and a perfusion defect of similar size are the only significant imaging abnormalities. In 451 reports of patients who were scanned for suspected pulmonary embolism, 53 had perfusion defects secondary to pleural effusion without other significant perfusion defects. Using pulmonary angiography, venography, analysis of pleural fluid, clinical course, and other radiographic and laboratory studies to establish the final diagnosis, only two patients had documented venous thrombotic disease: one had pulmonary emboli, the other thrombophlebitis. Lung scans having significant perfusion defects limited to pleural effusions and matching them in size have a low probability for pulmonary embolism

  6. 99m Tc scans in the diagnosis of pulmonary thrombosis and embolism

    International Nuclear Information System (INIS)

    1,500 pulmonary scans using technetium 99 are reported, and the value of this examination in the diagnosis of pulmonary embolism in patients with complex functional disorders and in their supervision is emphasized. The morphological aspect, especially in lateral films, and the variability of films taken at short intervals are well demonstrated and illustrated by scans which show their practical interest, in difficult cases, in the diagnosis of thrombosis and embolism. But is is above all in the supervision of such cases that radio-isotope scanning is the greatest interest to follow the course of thrombosis and embolism, diagnosed radiologically or clinically or by E.C.G., angiopneumography and radio-isotope scanning. The comparison of repeated lung scans permits to avoid repeated angiography and, alone, permits to follow up the embolic process and its pulmonary vascular consequences

  7. Evaluation of interventional angioplasty by using thrombolysis and balloon dilatation in treating pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the interventional angioplasty by using thrombolysis and balloon dilatation in the treatment of pulmonary embolism. Methods: Eight patients with pulmonary embolism were treated with interventional management including fragmentation of the thrombus, thrombolysis with urokinase flush infusion, balloon dilatation and continuing low-dose infusion for 24 hours. Anticoagulation with heparin was given simultaneously. Results: The pulmonary artery was completely recanalized in three patients, and partially recanalized in five patients. The blood oxygen saturation reached 100% in 3 cases and was over 93% in 5 cases. Conclusion: Interventional angioplasty by means of thrombolysis or balloon dilatation is an effective therapy for pulmonary embolism in reopening the embolized pulmonary artery, bringing the pulmonary hemodynamics to normal condition and correcting the hypoxemia. (authors)

  8. [Fat embolism still exists. A retrospective study of 17 cases in a surgical intensive care unit].

    Science.gov (United States)

    Gaertner, E; Simon, P; Pottecher, T

    1995-01-01

    Fat embolism is a severe complication in patients with femoral fractures. This retrospective study records 17 cases of post traumatic fat embolism diagnosed between 1979 and 1993 among 430 patients admitted for femoral fractures (incidence: 2.7%). These cases underline the high frequency of early hypovolaemia (10/17), of respiratory and cerebral disorders (15/17), all occurring during the first post trauma week. Three cases were observed in the postoperative period. Severity of fat embolism is proved by three deaths and a mean mechanical ventilation period of 13 days. With early osteosynthesis, incidence of fat embolism could be lowered to 0.2%. Prevention is based on osteosynthesis, avoidance of hypovolemia and of hypoalbuminemia. PMID:7671054

  9. [Prolonged coma due to fat embolism syndrome after fracture of the femur].

    Science.gov (United States)

    Ruiz-Gimeno, J I; Ferre, M A; Napal, M T; Pelegrín, F

    2006-03-01

    A 24-year-old male came to the emergency department with a diaphyseal fracture of the femur resulting from a motorcycle accident. Neurological deterioration was progressive, although a computed tomography scan was normal. Endotracheal intubation for mechanical ventilation was necessary. His condition progressed to sepsis and multiorgan failure before resolving. Magnetic resonance images of the brain suggested a fat embolism. The presence of a patent foramen ovale was investigated. The patient remained in a state of coma vigil for 3 months after the accident. After ruling out other more likely causes of neurological deterioration after trauma with fractures, fat embolism should be suspected. The prognosis for the neurological manifestations of fat embolism syndrome are generally good. Severe cases suggest massive (paradoxical) embolization of the brain and are associated with a patent foramen ovale. Early diagnosis will identify the patient at high surgical risk. A favorable course and outcome have been reported with preoperative closure of the foramen ovale. PMID:16671262

  10. Uterine arterial embolization for the treatment of adenomyosis: an analysis of therapeutic results in 80 cases

    International Nuclear Information System (INIS)

    Objective: To discuss the therapeutic effect of uterine arterial embolization in treating adenomyosis. Methods: Uterine arterial embolization was performed in 80 patients with adenomyosis. The patients were followed up for 3, 6, 12 and 24 months after the operation. After the treatment the degree of dysmenorrhea, the menstrual flow and the uterine volume were observed and were compared with those before the treatment. Results: After uterine arterial embolization the clinical symptoms were relieved in all 80 patients. The menstrual flow was markedly decreased, the anemia was obviously improved and the uterine volume was significantly reduced, while the ovary functioning was not apparently affected. The symptom of dysmenorrhea completely disappeared one month after the therapy in 76 cases and four months after the therapy in the remaining 4 cases. Conclusion: Uterine arterial embolization is a mini-invasive and safe therapy with remarkable therapeutic results and few side-effects. Therefore, this treatment can significantly improve the patient's living quality. (authors)

  11. Acquisition of endovascular skills for uterine artery embolization using a simulator

    DEFF Research Database (Denmark)

    McLucas, Bruce; Coats, Richard; Lönn, Lars Birger;

    2009-01-01

    This study addresses endovascular training using simulators for uterine artery embolization. A review of endovascular skill training for surgeons using simulators was performed. Surgeons possess varying levels of proficiency in endovascular techniques. A simulator will improve endovascular skills...

  12. Acute but not delayed amphetamine treatment improves behavioral outcome in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, Karsten; Kristiansen, Uffe;

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph-facilitate......OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph......: In conclusion, results showed that the acute amph group performed the best, while the late amph and the combination groups performed the worst. Amphetamine treatment in acute stroke may be warranted due to reduced detrimental effects of hypotension and improved brain plasticity....

  13. Development of a huge varix following endovascular embolization for cerebellar arteriovenous malformation

    Energy Technology Data Exchange (ETDEWEB)

    Mineura, K.; Sasajima, H.; Itoh, Y.; Kowada, M. [Akita Univ. Hospital (Japan). Neurosurgical Service; Tomura, N. [Akita Univ. Hospital (Japan). Dept. of Radiology; Goto, K. [Iizuka Hospital, Fukuoka (Japan). Dept. of Interventional Neuroradiology

    1998-03-01

    We report on the case of a huge varix that developed after the endovascular embolization of a cerebellar arteriovenous malformation (AVM) with a single drainer. A 21-year-old male presented with trigeminal neuralgia which was caused by the dilated drainer of the AVM. A varix was found at the basal vein of Rosenthal 2 months after an initial stage of embolization with polyvinyl alcohol particles; it diminished after the surgical extirpation of the AVM. The varix formation might have been facilitated by the stenosis in the vein of Galen and by the dynamic changes that followed the embolization. This rare complication should be kept in mind when embolization is performed for AVMs with impaired venous outlets. (orig.).

  14. Active implementation of a consensus strategy improves diagnosis and management in suspected pulmonary embolism

    NARCIS (Netherlands)

    A. Berghout (Arie); M. Oudkerk (Matthijs); S.G. Hicks; T.H. Teng; M. Pillay; H.R. Büller (Harry)

    2000-01-01

    textabstractOur consensus-based strategy in the diagnostic management of patients with pulmonary embolism involves a perfusion lung scan, a ventilation lung scan, compression ultrasonography and pulmonary angiography, in sequence. We compared the diagnostic approach in

  15. Coil Knotting during Endovascular Coil Embolization for Ruptured MCA Aneurysm: A Case Report

    OpenAIRE

    Kwon, S.C.; Lyo, I.U.; Shin, S. H.; Park, J B; Kim, Y.

    2008-01-01

    Complications during coil embolization of cerebral aneurysms include thromboembolic events, hemorrhagic complications related to procedural aneurysmal rupture and parent vessel perforation, and coil-related complications. The present report describes a rare coil-related complication involving spontaneous coil knotting.

  16. Percutaneous transsplenic embolization of esophageal varices in a 5-year-old child

    Energy Technology Data Exchange (ETDEWEB)

    Rasinska, G.; Wermenski, K.; Rajszys, P.

    A five-year-old girl with portal vein thrombosis and severe gastrointestinal hemorrhage recurring after repeated endoscopic sclerotherapy was successfully embolized via an ultrasonically guided transsplenic catheterization of the splenic vein.

  17. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization

    Directory of Open Access Journals (Sweden)

    Damiano Patrono

    2014-01-01

    CONCLUSION: Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy.

  18. Pulmonary embolism and patent foramen ovale thrombosis: the key role of TEE

    Directory of Open Access Journals (Sweden)

    Reverberi Claudio

    2007-08-01

    Full Text Available Abstract This is a case report of a 35 young man with Klinefelter Syndrome presented breathlessness, palpitations and chest pain. It shows a rare case of a thrombus located through the PFO, in patient with pulmonary and paradoxical embolism, which takes back to exciting hypothesis on thrombus growth. A thrombus, which has grown 'in situ' or trapped through the patent foramen ovale, may be a cause of relapsing pulmonary or systemic embolism during anticoagulation therapy. To prevent recurrent paradoxical embolism, percutaneous closure of PFO is recommended, but in this case, thrombus was trapped through the PFO and the patient was referred to the surgeon. We believe that under these circumstances the clinician should be informed of the presence of PFO in critical pulmonary embolism; this case points out the key role of TEE to face a diagnostic and therapeutic scenarios.

  19. Surgical treatment of acute pulmonary embolism--a 12-year retrospective analysis

    DEFF Research Database (Denmark)

    Lehnert, Per; Møller, Christian H; Carlsen, Jørn;

    2012-01-01

    Surgical embolectomy for acute pulmonary embolism (PE) is considered to be a high risk procedure and therefore a last treatment option. We wanted to evaluate the procedures role in modern treatment of acute PE....

  20. Right atrial thrombus and massive pulmonary embolism refractory to thrombolytic therapy: A case report

    Directory of Open Access Journals (Sweden)

    Simon De Freitas

    2016-01-01

    Conclusion: Although current data are insufficient to direct a high level of evidence-based care, this case report and others highlight the feasibility and safety of surgical embolectomy in complicated cases of massive pulmonary embolism.

  1. Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?

    Energy Technology Data Exchange (ETDEWEB)

    McQueen, A.S. [Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)], E-mail: andrewmcqueen7@hotmail.com; Worthy, S. [Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom); Keir, M.J. [Department of Medical Physics, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)

    2008-06-15

    Aims: To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard. Methods: A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians. Results: The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions. Conclusions: The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve

  2. Air Abrasion

    Science.gov (United States)

    ... delivered directly to your desktop! more... What Is Air Abrasion? Article Chapters What Is Air Abrasion? What Happens? The Pros and Cons Will I Feel Anything? Is Air Abrasion for Everyone? print full article print this ...

  3. [Stent-assisted mechanical removal of tromboembolism after embolization of middle cerebral artery aneurysm].

    Science.gov (United States)

    Poncyljusz, Wojciech; Falkowski, Aleksander; Rać, Monika; Sagan, Leszek; Kojder, Ireneusz

    2012-01-01

    Thrombotic occlusion of the middle cerebral artery's branch occurred just after embolization of a nonruptured cerebral aneurysm. Bail-out stent-assisted mechanical thrombectomy of the clot was performed. DSA revealed normal vessel patency at the end of the procedure. There were no adverse events related to this thrombectomy, and the patient recovered from the embolization with minor neurologic deficit. There was no neurologic deficit after 90 days follow-up. PMID:23276015

  4. Quantitative pulmonary perfusion and ventilation scintigraphy in patients with pulmonary embolism

    International Nuclear Information System (INIS)

    In 52 patients who were suspected of having pulmonary embolism, functional and static scintigrams obtained during perfusion and ventilation analysis of the lungs were quantified by calculating the counts per pixel within regions of interest. This procedure was valuable especially in patients with bordeline findings and during follow-up. It assisted to establish the diagnosis of pulmonary embolism in 45 patients so that rapid treatment could be initiated

  5. Ventilation-perfusion patterns in lung diseases (with reference to those observed in pulmonary embolism)

    International Nuclear Information System (INIS)

    The frequency distributions of ventilation-perfusion (V-P) patterns in various lung diseases were compared to those observed in pulmonary embolism in order to determine whether the V-P patterns for pulmonary embolism constituted a frequent finding in these disorders. The results showed that a segmental or labor perfusion defect with normal ventilation, was associated with a high probability of thromboembolic lung disease, and was not present in any of the other lung diseases studied. (orig.)

  6. Acute pulmonary embolism caused by enlarged uterine leiomyoma: A rare presentation

    OpenAIRE

    Khademvatani, Kamal; Rezaei, Yousef; Kerachian, Abdollah; Seyyed-Mohammadzad, Mir Hossein; Eskandari, Ramin; Rostamzadeh, Alireza

    2014-01-01

    Patient: Female, 42 Final Diagnosis: Acute pulmonary embolism Symptoms: Chest pain • dyspnea Medication: Streptokinase • Warfarin Clinical Procedure: — Specialty: Cardiology and Neoplasm Objective: Management of emergency care Background: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus. Case Report: We report a 42-year-old virgin woman with a history of leiomyoma who pr...

  7. Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

    Energy Technology Data Exchange (ETDEWEB)

    So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)

    2012-01-15

    The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

  8. Fatal brain gas embolism during non-invasive positive pressure ventilation

    OpenAIRE

    Rivara, Claire B; Chevrolet, Jean-Claude; Gasche, Yvan; Charbonney, Emmanuel

    2008-01-01

    Gas embolism is a dreaded complication following invasive medical procedures, traumatic lung injury and decompression accidents. We report a case of fatal gas embolism following the use of non-invasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). The patient initially underwent left bronchial artery embolisation for massive haemoptysis in the context of severe tuberculotic sequels. Under NIV and after heavy coughing he became hemiparetic and his level of consciousness sudd...

  9. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies.

    Science.gov (United States)

    Clark, Steven L; Romero, Roberto; Dildy, Gary A; Callaghan, William M; Smiley, Richard M; Bracey, Arthur W; Hankins, Gary D; D'Alton, Mary E; Foley, Mike; Pacheco, Luis D; Vadhera, Rakesh B; Herlihy, J Patrick; Berkowitz, Richard L; Belfort, Michael A

    2016-10-01

    Amniotic fluid embolism is a leading cause of maternal mortality in developed countries. Our understanding of risk factors, diagnosis, treatment, and prognosis is hampered by a lack of uniform clinical case definition; neither histologic nor laboratory findings have been identified unique to this condition. Amniotic fluid embolism is often overdiagnosed in critically ill peripartum women, particularly when an element of coagulopathy is involved. Previously proposed case definitions for amniotic fluid embolism are nonspecific, and when viewed through the eyes of individuals with experience in critical care obstetrics, would include women with a number of medical conditions much more common than amniotic fluid embolism. We convened a working group under the auspices of a committee of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation whose task was to develop uniform diagnostic criteria for the research reporting of amniotic fluid embolism. These criteria rely on the presence of the classic triad of hemodynamic and respiratory compromise accompanied by strictly defined disseminated intravascular coagulopathy. It is anticipated that limiting research reports involving amniotic fluid embolism to women who meet these criteria will enhance the validity of published data and assist in the identification of risk factors, effective treatments, and possibly useful biomarkers for this condition. A registry has been established in conjunction with the Perinatal Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development to collect both clinical information and laboratory specimens of women with suspected amniotic fluid embolism in the hopes of identifying unique biomarkers of this condition.

  10. Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Brian Lee

    2014-01-01

    Full Text Available We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients.

  11. Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis

    Science.gov (United States)

    Moosavy, Farid

    2014-01-01

    We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients. PMID:25530902

  12. Systemic embolism produced by subcutaneous injections of liquid silicone for esthetic purposes

    International Nuclear Information System (INIS)

    Even though its use is not recommended, liquid silicone is a substance that has been used illegally for esthetic purposes for a long time. A case report is presented in which a young woman was injected subcutaneously, by an uncertified practitioner, industrial fluid silicone and subsequently developed a case of systemic embolism with pulmonary, skin and ocular complications. This article explains the physiopathology and the different manifestations of systemic embolism produced by fluid silicone. TAC was used. (The author)

  13. Right portal vein embolization by laparoscopic catheterization of the inferior mesenteric vein

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Martins Cury

    2013-12-01

    Full Text Available Right portal vein embolization is often performed to prevent liver insufficiency after major hepatic resection. The procedure usually involves direct puncture of the portal vein, which requires hepatic hilum manipulation, and may be associated with liver injury, pneumothorax, and hemoperitoneum. This report describes a technique of laparoscopic insertion of a sheath into the inferior mesenteric vein followed by right portal vein embolization.

  14. Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay

    Science.gov (United States)

    Tresley, Jonathan; Bhatia, Shivank; Kably, Issam; Poozhikunnath Mohan, Prasoon; Salsamendi, Jason; Narayanan, Govindarajan

    2016-01-01

    The Amplatzer Vascular Plug (AVP) is a cylindrical plug made of self-expanding nitinol wire mesh with precise delivery control, which can be used for a variety of vascular pathologies. An AVP is an ideal vascular occlusion device particularly in high-flow vessels, where there is high risk of migration and systemic embolization with traditional occlusion devices. We performed 28 embolizations using the AVP from 2009 to 2014 and achieved complete occlusion without complications.

  15. Cerebral fat embolism as a rare complication of postgastrectomy: case report

    International Nuclear Information System (INIS)

    Cerebral fat embolism syndrome is a rare complication of trauma, and it particularly involves fractures of the long bones. This syndrome may occur in a diverse series of conditions such as diabetes mellitus, acute hemorrhagic pancreatitis, acute fatty cirrhosis, prolonged corticosteroid therapy, lymphography and liposuction. The author reports the CT and MRI findings in a patient with cerebral fat embolism that occurred as a rare complication of postgastrectomy

  16. Spontaneous Hepatic Rupture Associated with Preeclampsia: Treatment with Hepatic Artery Embolization

    International Nuclear Information System (INIS)

    Spontaneous rupture of the liver due to preeclampsia is a rare condition of pregnant women, and it can be very dangerous if not treated. We report here on a case of successfully treating spontaneous liver rupture associated with preeclampsia by performing transcatheter hepatic arterial embolization. A 41-year-old woman with spontaneous rupture of the liver associated with preeclampsia was treated by hepatic arterial embolization

  17. Spontaneous Hepatic Rupture Associated with Preeclampsia: Treatment with Hepatic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Chang, Yun Woo; Kim, Yong Jae; Hwang, In Cheol; Han, Hyo Sang; Yoon, Jong Hyun; Lee, Tae Il [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2010-02-15

    Spontaneous rupture of the liver due to preeclampsia is a rare condition of pregnant women, and it can be very dangerous if not treated. We report here on a case of successfully treating spontaneous liver rupture associated with preeclampsia by performing transcatheter hepatic arterial embolization. A 41-year-old woman with spontaneous rupture of the liver associated with preeclampsia was treated by hepatic arterial embolization

  18. Cerebral fat embolism as a rare complication of postgastrectomy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Ihn, Yon Kwon; Baik, Jun Hyun [College of Medicine, The Catholic University of Korea, Suwon (Korea, Republic of)

    2004-12-01

    Cerebral fat embolism syndrome is a rare complication of trauma, and it particularly involves fractures of the long bones. This syndrome may occur in a diverse series of conditions such as diabetes mellitus, acute hemorrhagic pancreatitis, acute fatty cirrhosis, prolonged corticosteroid therapy, lymphography and liposuction. The author reports the CT and MRI findings in a patient with cerebral fat embolism that occurred as a rare complication of postgastrectomy.

  19. Cross sectional Doppler echocardiography as the initial technique for the diagnosis of acute pulmonary embolism.

    OpenAIRE

    Cheriex, E. C.; Sreeram, N.; Eussen, Y F; Pieters, F A; Wellens, H J

    1994-01-01

    OBJECTIVE--To determine the value of cross sectional Doppler echocardiography and derived indices of right ventricular pressure and function in the initial diagnosis of pulmonary embolism. BACKGROUND--Most deaths from acute pulmonary embolism occur because of a delay in diagnosis. Ventilation-perfusion scans are not sufficiently sensitive, whereas angiography is invasive and associated with complications. The use of cross sectional Doppler echocardiography to assess acute changes in right ven...

  20. Arterial embolization for management of hemoptysis in pulmonary tuberculosis : factors of rebleeding

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. Fifty-nine patients with massive or recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequently operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. The extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization,this was regarded as initial success in the control of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation, and extravasation. Using the chi-square test, differences in these findings between rebleedig and non-rebleeding cases were anlysed. Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemic collateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosis on plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant. There was no correlation between the period from initial diagnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. In cases with more advanced lesions of pulmonary tuberculosis on plain chese PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial

  1. Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

    Institute of Scientific and Technical Information of China (English)

    Long Sun; Yong-Song Guan; Hua Wu; Wei-Min Pan; Xiao Li; Qing He; Yuan Liu

    2006-01-01

    A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

  2. Ethanol embolization of arteriovenous malformations: results and complications of 33 cases

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Yong Hwan; Do, Young Soo; Shin, Sung Wook; Liu, Wei Chiang; Cho, Jae Min; Lee, Min Hee; Kim, Dong Ik; Lee, Byung Boong; Choo, Sung Wook; Choo, In Wook [School of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)

    2003-10-01

    To assess the effectiveness of ethanol embolization for the treatment of arteriovenous malformation (AVM), and the complications, if any, arising. Thirty-three patients with AVMs underwent 145 staged sessions of ethanol embolization. AVMs were located in an upper extremity (n=14), a lower extremity (n=10), the pelvis (n=7), the thorax (n=1), or the abdomen (n=1). Eighty-five transcatheter embolizations and 60 direct percutaneous puncture embolizations were performed, and seven patients underwent additional coil embolization of the dilated outflow vein. The therapeutic effectiveness of embolization was evaluated in terms of the extent to which an AVM was obliterated between baseline and the final angiogram. Complications were classified as minor or major. In 13 patients (39%), AVMs were totally obliterated. In eight patients (24%), more than 75% were obliterated; in three (9%), the proportion was 50-75%; and in four (12%), less than 50%. Five patients (15%), were not treated. The reasons for failure were the difficulty of approaching the nidus due to previous surgical ligation or coil embolization of the feeding artery, the subcutaneous location of an AVM, post-procedural infection, and massive bleeding during the follow-up period. Twenty-one minor complications such as focal skin necrosis or transient nerve palsy developed during 145 sessions of (an incidence of 14%), but these were relieved by conservative treatment. The five major complications arising (3%) were cerebral infarction, urinary tract infection, acute renal failure due to rhabdomyolysis, permanent median nerve palsy, and infection. Ethanol embolization by direct percutaneous puncture or using a transcatheter technique is an effective approach to the treatment of an AVM. However, to overcome the considerable number of complications, arising, further investigation is required.

  3. Embolization of Portosystemic Shunts for Treatment of Medically Refractory Hepatic Encephalopathy

    OpenAIRE

    Lynn, Amanda M.; Singh, Siddharth; Congly, Stephen E; Khemani, Disha; Johnson, David H.; Wiesner, Russell H.; Kamath, Patrick S.; Andrews, James C.; Leise, Michael D

    2016-01-01

    Treatment options for refractory hepatic encephalopathy (HE) are limited. Patients who fail medical management may harbor large portosystemic shunts (PSSs) which are possible therapeutic targets. This study aims to describe patient selection, effectiveness, and safety of percutaneous PSS embolization in those with medically refractory HE. A retrospective evaluation of consecutive adult patients with medically refractory HE referred for PSS embolization at a tertiary center was performed (2003...

  4. Pulmonary embolism after a single-stage, combined anterior and posterior approach lumbar surgery

    OpenAIRE

    2013-01-01

    Pulmonary embolism is a fatal complication in orthopaedics surgery. While, the incidence of this life-threatening condition is low in spine surgery and few detailed reports have been published in English literatures. We present a case of pulmonary embolism which occurred after a single-stage, combined anterior and posterior approach surgery for L2 burst fracture. Although positive and timely rescue measures were performed, the patient died finally. We report the case to help spine surgeons to...

  5. Limited value of novel pulmonary embolism biomarkers in patients with coronary atherosclerosis

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Hag, Anne Mette Fisker;

    2011-01-01

    Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1.......Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1....

  6. Endovascular Embolization of Ruptured Infundibular Dilation of Posterior Communicating Artery: A Case Report

    OpenAIRE

    Jinlu Yu; Honglei Wang; Kan Xu; Bai Wang; Qi Luo

    2010-01-01

    Hemorrhage due to the rupture of the infundibular dilatation of the posterior communicating artery (ID of the PCo-A) occurs infrequently. The preferred treatment of such hemorrhages is surgical clipping through craniotomy. There are few reports about endovascular coil embolization in such cases. We report such a case treated by endovascular embolization. A 35-year-old man, who had experienced 2 episodes of subarachnoid hemorrhage (SAH), was found to have a ruptured ID of the PCo-A by head com...

  7. An intractable case of lower gastrointestinal hemorrhage due to radiation colitis. Usefulness of transcatheter arterial embolization

    International Nuclear Information System (INIS)

    We tried transcatheter arterial embolization for lower gastrointestinal hemorrhage due to radiation colitis. In this case, colostomy and endoscopic therapy were not effective. We succeeded in arresting the hemorrhage without any complications. Transcatheter embolization is a low-invasive and safe method of treatment. For prevention of inflammation and iatrogenic abscess formation, we repeated this therapy and we tried arterial injection of antibiotics and steroid. And so, this therapy is one of the effective methods. (author)

  8. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, G.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Vermylen, J. [Department of Internal Medicine-Vascular Diseases, University Hospitals, Leuven (Belgium)

    2002-06-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  9. Pulmonary bone cement embolism: CT angiographic evaluation with material decomposition using gemstone special imaging

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sun; Lee, Heon [Dept. of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon (Korea, Republic of)

    2014-08-15

    We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition.

  10. Treatment strategy for arteriovenous malformation; Combination of open surgery, embolization and gamma knife

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Akira (Kohnan Hospital, Sendai, Miyagi (Japan)); Jokura, Hidefumi; Takahashi, Kou; Yoshimoto, Takashi

    1992-09-01

    Gamma knife has recently become available in the treatment of brain arteriovenous malformation (AVM). In an effort to examine treatment strategy for AVM, retrospective review was made on 80 AVMs treated primarily by embolization using a newly developed liquid embolization method (estrogen-alcohol combined with polyvinyl acetate polymer) in a total of 76 patients aged from 3 to 57 years (mean 28). After the embolization, 11 lesions (13.8%) disappeared angiographically. The number of nidi 3 cm or larger in diameter was decreased from 45 (56.2%) to 7 (8.7%). As an adjunctive treatment, conventional neurosurgical resection was performed and the residual nidus was irradiated by conventional manner (30 Gy in 3 weeks) in each 9 patients. At an average follow-up of 17 months for 39 patients, angiography revealed no evidence of revascularization in embolized nidi in 6, reduction of irradiated nidi in size in 5, unchanged nidi in 21, and enlargement of nidi in 7 patients. Death and morbidity attributable to embolization were seen in one (1.3%) and 18 (23.5%) patients, respectively. Recently performed gamma knife surgery has achieved complete obliteraiton of nidus in 80%, irrespective of AVM site, with a low complication rate (4%). This favorable outcome has, however, contributed to smaller nidus. These findings lead to the following conclusions. Surgical removal should be considered in small cortical lesions. Embolization would be the treatment of choice for lesions larger than 3 cm or 10 ml, except for hemorrhagic cases in which acute surgical removal of hematoma is required. After embolization, lesions could be surgically removed or treated by gamma knife. For hemorrhagic lesions smaller than 3 cm, embolization should be considered if the feeders were easily catheterized without significant risk. For non-hemorrhagic lesions less than 3 cm, gamma knife would become the treatment of choice. (N.K.).

  11. Case report: Combined transarterial and direct approaches for embolization of a large mandibular arteriovenous malformation

    Directory of Open Access Journals (Sweden)

    Chiramel George Koshy

    2011-01-01

    Full Text Available Arteriovenous malformations (AVMs that involve the mandible are difficult lesions to treat, with traditional options being surgery and embolization. This article describes a large mandibular AVM that was treated with embolization using transarterial as well as direct puncture approaches. Follow-up imaging showed thrombosis of the vascular spaces of the malformation. There were no complications. The patient is doing well and is on follow-up.

  12. Direct Needle Puncture and Embolization of Splenic Artery Pseudoaneurysm in Case of Chronic Atrophic Calcific Pancreatitis

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagadeesh Singh; Reddy, D. Nageshwar; Rao, Guduru Venkat

    2016-01-01

    Summary Background Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality. Case Report We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils. Conclusions The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess. PMID:27757174

  13. Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report

    Institute of Scientific and Technical Information of China (English)

    Yu Jin Kwon; Ji Hun Kim; Seung Hyoung Kim; Bong Soo Kim; Heung Up Kim; Eun Kwang Choi; In Ho Jeong

    2009-01-01

    We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction.

  14. Postoperative pulmonary embolism in a three year old with Klippel–Trenaunay syndrome

    OpenAIRE

    Hudcova, Jana; Kleinman, Monica; Talmor, Daniel

    2009-01-01

    Massive pulmonary embolism (PE) in a small child is a rare event and unified guidelines for its treatment are missing. Timely diagnosis and management of massive pulmonary embolism is of crucial importance for a good outcome. We describe a unique management of PE causing oxygenation failure using a combination of catheter extraction technique, and regional thrombolysis on top of systemic heparin administration and inferior vena cava filter placement. Pulmonary hypertension was treated with in...

  15. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    OpenAIRE

    Gerard O’Connor; Gareth Fitzpatrick; Ayman El-Gammal; Peadar Gilligan

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scena...

  16. Observations on the mechanism of hypoxaemia in acute minor pulmonary embolism.

    OpenAIRE

    Burton, G H; Seed, W A; Vernon, P.

    1984-01-01

    An automated computer analysis of ventilation-perfusion lung scans was used to derive graphical data from lung scans of 11 patients with acute minor pulmonary embolism, free of pre-existing cardiorespiratory disease, and with no evidence of intrapulmonary complication or pleural effusion. In each case the analysis showed the presence of areas of lung, remote from those affected by the pulmonary embolism, that had a pathological disturbance of ventilation-perfusion matching with relative overp...

  17. Selective Arterial Embolization in the Treatment of High Flow Priapism: Report of 5 Cases

    Directory of Open Access Journals (Sweden)

    H. Rokni Yazdi

    2005-06-01

    Full Text Available High flow priapism is a rare entity caused by a pathologic influx from lacerated arteries to the cavernous bodies. Transcatheter embolization of feeding arteries is the treatment of choice. We reviewed a series of 5 patients who un derwent transcatheter embolization in our hospital from 2000 to 2004. The mean age of patients was 32 years; dur ation of priapism was between one week and a year. All underwent bilateral pudendal artery ca theterization with No.5 French Cobra-II catheters. We did not microcatheters in our patien ts. Embolized materials were gel-foam, coils and polyvinyl alcohol microspheres. We could follow four of them for 6 to 40 months; one of the patients dropped out from our follow-up study. All the four patients had completed detumescence after a maximum of two days from embolization;none of them experienced signific ant complications and all returned to normal sexual function and remained symptom free thereafter (6-40 months. We noted no difference in complications and duration to restore erectile function and less recurrence rate with embolization of main br anch of pudendal artery instead of superselective embolization of arteriocavernous fistul a feeder artery with a microcatheter that is the method of choice for the treatment of high flow priapism, but due to small number of cases it needs further studies to be confirmed.

  18. Stereotactic Radiosurgery with Neoadjuvant Embolization of Larger Arteriovenous Malformations: An Institutional Experience

    Directory of Open Access Journals (Sweden)

    Richard Dalyai

    2014-01-01

    Full Text Available Objective. This study investigates the safety and efficacy of a multimodality approach combining staged endovascular embolizations with subsequent SRS for the management of larger AVMs. Methods. Ninety-five patients with larger AVMs were treated with staged endovascular embolization followed by SRS between 1996 and 2011. Results. The median volume of AVM in this series was 28 cm3 and 47 patients (48% were Spetzler-Martin grade IV or V. Twenty-seven patients initially presented with hemorrhage. Sixty-one patients underwent multiple embolizations while a single SRS session was performed in 64 patients. The median follow-up after SRS session was 32 months (range 9–136 months. Overall procedural complications occurred in 14 patients. There were 13 minor neurologic complications and 1 major complication (due to embolization while four patients had posttreatment hemorrhage. Thirty-eight patients (40% were cured radiographically. The postradiosurgery actuarial rate of obliteration was 45% at 5 years, 56% at 7 years, and 63% at 10 years. In multivariate analysis, larger AVM size, deep venous drainage, and the increasing number of embolization/SRS sessions were negative predictors of obliteration. The number of embolizations correlated positively with the number of stereotactic radiosurgeries (P<0.005. Conclusions. Multimodality endovascular and radiosurgical approach is an efficacious treatment strategy for large AVM.

  19. Dextran Microsphere Hepatic Artery Embolization for Hepatoma: Pathological Assessment of Its Efficacy in Resected Cases

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To evaluate the therapeutic effect and the mechanism of dextran microsphere hepatic artery embolization for hepatoma. Methods Partial hepatectomy was performed in 11 patients with hepatoma pretreated with dextran microsphere hepatic artery embolization. All specimens were for histopathologic studies in order to observe the destiny of dextran microspheres and necrotic degree of the tumor. Results complete necrosis of the tumor was found in seven cases and incomplete necrosis of the tumor in the rest 4. Tumors in the later were near to areas rich in arterial collateral anastomoses. The extent of tumor necrosis was unrelated to the presence and thickness of tumor capsule and capsular invasions. Dextran microspheres could cause permanent embolization of distal arterioles. The microspheres were very biocompatible and cause little foreign body reaction. No inflammatory changes were seen both inside and outside of the embolized artery 191 days after embolization. Dextran microspheres were not absorbed and the vessel recanalization was also not seen. Dextran microsphere was not found in portal veins. Conclusion Some hepatomas distant from the collateral circulation of arteries could be cured with dextran microsphere hepatic artery embolization alone.

  20. The Dynamics of Embolism Refilling in Abscisic Acid (ABA-Deficient Tomato Plants

    Directory of Open Access Journals (Sweden)

    Francesca Secchi

    2012-12-01

    Full Text Available Plants are in danger of embolism formation in xylem vessels when the balance between water transport capacity and transpirational demand is compromised. To maintain this delicate balance, plants must regulate the rate of transpiration and, if necessary, restore water transport in embolized vessels. Abscisic acid (ABA is the dominant long-distance signal responsible for plant response to stress, and it is possible that it plays a role in the embolism/refilling cycle. To test this idea, a temporal analysis of embolism and refilling dynamics, transpiration rate and starch content was performed on ABA-deficient mutant tomato plants. ABA-deficient mutants were more vulnerable to embolism formation than wild-type plants, and application of exogenous ABA had no effect on vulnerability. However, mutant plants treated with exogenous ABA had lower stomatal conductance and reduced starch content in the xylem parenchyma cells. The lower starch content could have an indirect effect on the plant’s refilling activity. The results confirm that plants with high starch content (moderately stressed mutant plants were more likely to recover from loss of water transport capacity than plants with low starch content (mutant plants with application of exogenous ABA or plants experiencing severe water stress. This study demonstrates that ABA most likely does not play any direct role in embolism refilling, but through the modulation of carbohydrate content, it could influence the plant’s capacity for refilling.