Spontaneous Renal Artery Pseudoaneurysm Treated By Arterial Embolization

Renal artery pseudoaneurysm is a rare vascular lesion. It is found with increasing frequency as a result of unrelated abdominal imaging or on work-up for hypertension. The pseudoaneurysm can be defined as a pulsatile hematoma that communicates with the artery through a small hole in the arterial wall. However, the rupture of pseudoaneurysmis the most dreaded complication because it causes death. There are many causes of renal artery pseudoaneurysm and are generally related to renal biopsy, nephrectomy or percutaneous procedures. In addition, there is a relationship with penetrating traumas and, more rarely, with blunt traumas. We report a case of renal artery pseudoaneurysm treated successfully with vascular plug embolization. A 22-year-old woman with hypertension presented with an incidental left renal artery pseudoaneurysm measuring 35x23 mm. We successfully performed endovascular treatment with vascular plug embolization without any complications.

Right ventricle Outflow Tract Acceleration Time: Correlation with Left Ventricular Diastolic Function

Background: There are no available data about the measurement of acceleration time at the right ventricle outflow tract (AcT) and its relevance in the analysis of the left ventricular diastolic function (LVDF). Objective: To correlate AcT with echocardiographic parameters of LVDF. Method: Eighty-seven patients (58.4±14.5 years; 52% women) submitted to transthoracic echocardiogram assessing spectral and tissue Doppler of the transmitral flow and mitral annulus, AcT, left atrial volume (LAV), and pulmonary artery systolic pressure (PASP). Patients with systolic dysfunction of the LV and grades II and III diastolic dysfunction (DD) were excluded. Main analyses were performed using the Spearman’s Correlation Coefficient (SCC) and Pearson’s Linear Correlation Coefficient (PLCC). Results: A negative correlation between AcT value and age (PLCC – 0.36; Student’s t-test; p <0.001) and a positive correlation between AcT and E/A ratio (SCC 0.38; p<0.001), between AcT and E/e’ ratio (SCC 0.26; p=0.01), between AcT and E wave of the mitral flow (PLCC 0.36; p= 0.001) were found. LAV and PASP did not correlate with AcT. In patients with a normal diastolic function, AcT was higher when compared with the AcT in patients with Grade I DD (0.150±0.029ms versus 0.127±0.023ms; p<0.001; Student’s t-test). The threshold suggested in this subgroup of patients was 0.135s. Conclusions: The present study correlated, unprecedentedly, AcT with echocardiographic parameters of the LV diastolic function. AcT values lower than 0.135s were associated with grade I diastolic dysfunction and higher than 0.135s values were associated with normal diastole.

Portal Annular Pancreas with portal cavernoma formation wtih associated dorsal pancreatic agenesis-A rare case report

Portal annular pancreas is a uncommon congenital anomaly resulting from fusion of the pancreatic parenchyma around the portal vein. Its causing portal cavernoma formation and association with dorsal pancreatic agenesis is rare Case report We report a 51-year-old female who underwent contrast enhanced computed tomography for vague right hypochndrial pain.On CECT abdomen images there was presence of rind of pancreatic tissue around the portal vein causin its luminal narrowing with proximal dilation of portal vein tributaries with cavernoma formation.There was also presence of agenesis of dorsal pancreas in this patient.Conclusion This variant of portal annular pancreas with cavernoma formation associated with dorsal pancreatic agenesis has not yet been reported and we propose a new CT classification of the same.

A Complex Component of the Nervous System: Brachial Plexus

Brachial plexopathy is a type of peripheral neuropathy. Injuries to the brachial plexus can be classified according to their severity, ranging from neuropraxia, the mildest form, to axonotmesis and neurotmesis, the most severe forms. The causes of brachial plexopathy include traumatic and non-traumatic injuries. Because the brachial plexus can sustain various types of injuries, different imaging modalities are required. Recent advances in diagnostic imaging have enabled better investigation of brachial plexopathy. This article reviews the major and most widely used imaging methods used for investigating brachial plexopathy along with newer modalities. The indications, advantages, and disadvantages of each modality are examined. The major factor in realizing the full potential of any imaging method is the knowledge of the requesting physician about the capabilities and limitations of each method. Magnetic resonance imaging (MRI) is the standard imaging modality for evaluating non-traumatic injury to the brachial plexus; however, there are several limitations to its use and, therefore, other modalities should be pursued. MR myelography should be used for traumatic meningoceles and root avulsions. MR neurography is a relatively new technique with massive potential. It is a tissue-specific modality with the ability to elicit morphological as well as pathological features of nerves. CT myelography is the gold standard for evaluating traumatic injury of the brachial plexus. Other potential uses are with tumors of the brachial plexus as well as obstetric brachial plexus palsies. Finally, sonography is addressed. With its ability to detect almost all plexopathies and the fact that it does not employ radiation and can be done in virtually every patient, it should be the baseline or, at least, the screening method for plexopathies.

Electrophysiological procedures for the use of the RPC: without hindrance and negligible radiation

Background: Fluoroscopy is the main visualization technique for EP procedures. A radiation protection cabin (RPC) shielded with 2 mm lead-equivalent walls was tested as an alternative protection tool (Cathpax®, Lemer Pax). Methods: To assess the scattered radiation to the operator inside the RPC an electronic personal dosimeter (EPD; Mk2, Thermo Electron) was placed at the neck level of the operator. A second EPD was located outside the RPC at 150 cm height from the floor, to record the presumable head radiation dose. Results: Radiation doses were measured in a total of 138 consecutive patients (age 54±16 yrs, BMI 28±5 kg/m2 (18-45), 64% male) undergoing a variety of ablation procedures (SVT=75, AFL=32, AF=17, VT=14). Median fluoroscopy time was 39 min (7-140), the cumulative dose-area product (DAP) 4702 cGy.cm2 (493-65620). Doses outside the RPC showed a median of 135 µSv (1-4881). Doses inside the RPC were detected only at sensitivity threshold or background levels (mean 0.2SD0.7 µSv, median 0.0, range 0-4). The dose reduction to the operator was highest for AF ablations (354 vs 0.5 µSv, respectively; p<0.001). The total accumulated dose outside the RPC was 37883 µSv for all 138 procedures, whereas for the protected operator inside only 30 µSv. Conclusions: There were highly concordant low dose values measured for the operator inside the RPC in comparison to high doses outside the RPC. The use of a RPC represents a major benefit over a lead apron and contributes to a significant dose reduction as low as reasonably achievable (ALARA principle).

The Developments of Innovative Technologies of Focal Radiotherapy a Viable, Safe, and Effective Option of Treatment

Objectives: To determine if the postoperative delivery of fractionated stereotactic radiotherapy (FSRT) for resection cavity for patients with single and resectable brain metastases is safe and effective. Methods: A prospective feasibility protocol was set up to include patients with single and resectable brain metastases who underwent surgery and had low risk profile according to RPA classification. Fractionated stereotactic radiotherapy was applied. Single dose: 3.8 Gy, total dose: 41.8 or 49.6 Gy. Results: There was no case of break due to clinical problems. There was no case of delay of FSRT. The onset acute toxicity was observed in 40 cases (76.9%), no grade 3 and more was seen. Local recurrence free survival was 32.6 months, local control rate at 6, 12, 18 and 24 months were 85%, 77.9%, 65.9% and 65.9%. Overall local failure occurred in 34.1% of patients. Overall survival rates at 6, 12, 18 and 24 months were 90.3%, 63.9%, 47.7% and 31.6%. Median survival was 18.3 months (13.8-22.8) and overall 17.3% were living at the time of last analysis. Distant control rates at 6, 12, 18 and 24 months were 49.4%, 38.2%, 25.5% and 22.3%. Median distant recurrence free survival was 6 months (0-12.0) with overall distant failure in 77.7% of patients. Conclusion: FSRT for surgical cavity might be one possible option in treatment of single and resectable brain metastases.