scholarly journals Hepatic Necrosis after Trans-Arterial Embolization of Metastatic Neuroendocrine Tumour

2020 ◽  
Author(s):  
Sarah Micallef ◽  
Kelvin Cortis ◽  
Claude Magri
Keyword(s):  
Portal Vein ◽  
Neuroendocrine Tumour ◽  
Arterial Embolization ◽  
Hepatic Necrosis ◽  
Selective Internal Radiotherapy ◽  
Cross Sectional ◽  
Internal Radiotherapy ◽  
Vein Thrombosis ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Liver metastases from neuroendocrine tumours (NETs) are usually seen on cross-sectional imaging at presentation. In such cases, curative surgical resection is usually not possible given that most patients have bilobar disease. Various locoregional approaches are now widely available that enable local control of disease and management of systemic symptoms. These include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), selective internal radiotherapy and thermal ablation. We describe a rare case of hepatic necrosis after TAE in a 61-year-old woman with a metastatic NET. Cross-sectional imaging showed extensive necrosis affecting segments VII and VIII of the liver. This occurred secondary to thrombosis in the portal vein branches to these segments, confirmed on a Doppler ultrasound scan. The mechanism of portal vein thrombosis after TAE could be due to the presence of occult arterioportal anastomoses. These allow transit of the embolizing agents into the portal vein branches supplying the treated segments and subsequent thrombosis.

Clinical and cross-sectional imaging features of spontaneous pancreatic pseudocyst-portal vein fistula

2017 ◽  
Vol 44 ◽  
pp. 22-26 ◽  
Author(s):  
Francesco Alessandrino ◽  
Corinne Strickland ◽  
Amirkasra Mojtahed ◽  
Steven C. Eberhardt ◽  
Koenraad J. Mortele
Keyword(s):  
Portal Vein ◽  
Pancreatic Pseudocyst ◽  
Imaging Features ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

scholarly journals Abdominal cross-sectional imaging of the associating liver partition and portal vein ligation for staged hepatectomy procedure

2017 ◽  
Vol 9 (16) ◽  
pp. 733 ◽  
Author(s):  
Michele Zerial ◽  
Dario Lorenzin ◽  
Andrea Risaliti ◽  
Chiara Zuiani ◽  
Rossano Girometti
Keyword(s):  
Portal Vein ◽  
Portal Vein Ligation ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Staged Hepatectomy

scholarly journals Glucagonoma-associated dilated cardiomyopathy refractory to somatostatin analogue therapy

2019 ◽  
Vol 2019 ◽  
Author(s):  
Michal Barabas ◽  
Isabel Huang-Doran ◽  
Debbie Pitfield ◽  
Hazel Philips ◽  
Manoj Goonewardene ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cardiac Failure ◽  
Neuroendocrine Tumour ◽  
Left Ventricular ◽  
Somatostatin Analogue ◽  
List Type ◽  
Cross Sectional ◽  
Dominant Feature ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Summary A 67-year-old woman presented with a generalised rash associated with weight loss and resting tachycardia. She had a recent diagnosis of diabetes mellitus. Biochemical evaluation revealed elevated levels of circulating glucagon and chromogranin B. Cross-sectional imaging demonstrated a pancreatic lesion and liver metastases, which were octreotide-avid. Biopsy of the liver lesion confirmed a diagnosis of well-differentiated grade 2 pancreatic neuroendocrine tumour, consistent with metastatic glucagonoma. Serial echocardiography commenced 4 years before this diagnosis demonstrated a progressive left ventricular dilatation and dysfunction in the absence of ischaemia, suggestive of glucagonoma-associated dilated cardiomyopathy. Given the severity of the cardiac impairment, surgical management was considered inappropriate and somatostatin analogue therapy was initiated, affecting clinical and biochemical improvement. Serial cross-sectional imaging demonstrated stable disease 2 years after diagnosis. Left ventricular dysfunction persisted, however, despite somatostatin analogue therapy and optimal medical management of cardiac failure. In contrast to previous reports, the case we describe demonstrates that chronic hyperglucagonaemia may lead to irreversible left ventricular compromise. Management of glucagonoma therefore requires careful and serial evaluation of cardiac status. Learning points: In rare cases, glucagonoma may present with cardiac failure as the dominant feature. Significant cardiac impairment may occur in the absence of other features of glucagonoma syndrome due to subclinical chronic hyperglucagonaemia. A diagnosis of glucagonoma should be considered in patients with non-ischaemic cardiomyopathy, particularly those with other features of glucagonoma syndrome. Cardiac impairment due to glucagonoma may not respond to somatostatin analogue therapy, even in the context of biochemical improvement. All patients with a new diagnosis of glucagonoma should be assessed clinically for evidence of cardiac failure and, if present, a baseline transthoracic echocardiogram should be performed. In the presence of cardiac impairment these patients should be managed by an experienced cardiologist.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

Sign in / Sign up

Export Citation Format

Share Document