Arteriovenous Fistula/diagnostic imaging* ; Central Nervous System Vascular Malformations/diagnostic imaging* ; Embolization, Therapeutic ; Humans

A girl, aged 15 years, was admitted due to sudden convulsion once and multiple pulmonary nodules on lung CT. Acrocyanosis or acropachy/toe deformity was not observed. Laboratory examinations showed an increase in hemoglobin (162 g/L) and a reduction in arterial partial pressure of oxygen (61.5 mm Hg). Lung CT showed irregular slightly high-density nodules in the middle lobe of the right lung, and contrast-enhanced CT scan showed obvious enhancement with thick vascular shadow locally. An investigation of medical history revealed that the girl's mother had a history of epistaxis and resection of pulmonary mass and the girl presented with tongue telangiectasia. The girl was diagnosed with hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformation. she was given interventional embolization therapy. Transcutaneous oxygen saturation reached 98% without oxygen inhalation on the day after surgery. Pulmonary angiography at 3 months after surgery showed the recurrence of pulmonary vascular malformation, and embolization of pulmonary arterial fistula was not performed since the guide wire could not enter the branch artery. There was still a need for long-term follow-up.
Adolescent ; Arteriovenous Fistula ; Arteriovenous Malformations ; Female ; Humans ; Multiple Pulmonary Nodules ; Neoplasm Recurrence, Local ; Pulmonary Artery/diagnostic imaging* ; Seizures

OBJECTIVETo evaluate the capability of multidetector CT (MDCT) for the diagnosis of arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC).

METHODSTwo hundred and eighty-two patients with HCC were examined by both enhanced thin slice MDCT scanning in early hepatic arterial phase, late hepatic arterial phase, portal venous phase and digital subtraction angiography (DSA). The criteria for diagnosis of APS: (1) Earlier enhancement or stronger opacification of main portal trunk and/or the first order branches compared with that of superior mesenteric vein or splenic vein; (2) Earlier enhancement or stronger opacification of the second order and smaller portal venous branches compared with that of main portal trunk. The presence and degree of APS demonstrated with MDCT and DSA were analysed by double blind method.

RESULTSIn 282 HCC patients, 56 were complicated with APS. MDCT demonstrated central APS in 48 patients with 41 severe and 7 moderate shunt, one revealing no APS by DSA due to the giant HCC focus. Among 7 patients with light peripheral APS, two lesions were not revealed by DSA due to faint shunt and the last lesion in the patient with mixed APS was revealed both by APS and DSA.

CONCLUSIONMultidetector CT was a simple, effective and noninvasive new technique for the diagnosis of arterioportal shunt associated with hepatocellular carcinoma.

Adult ; Aged ; Angiography, Digital Subtraction ; Arteriovenous Fistula ; diagnostic imaging ; etiology ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; abnormalities ; diagnostic imaging ; Tomography, Spiral Computed ; methods

The diagnostic value of 16-slices spiral computed tomography (CT) for portal vein disorders was evaluated. Forty-one patients were scanned by the 16-slices spiral-CT. The celiac trunk, portal vein and their branches were reconstructed by volume rendering (VR), multiplanar volume reconstruction (MPVR) and maximum intensity projection (MIP) technique, and the results were compared with digital subtraction angiography (DSA). VR, MPVR and MIP could display celiac trunk, portal vein, inferior vena cava and their branches and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery-portal vein. The results from 16-slices CT were better than DSA and identical with pathologic ones. The vessel three-dimension reconstruction technique of 16-slices spiral CT is valuable for evaluating the portal systemic disorders.
Adult ; Aged ; Angiography ; methods ; Angiography, Digital Subtraction ; Arteriovenous Fistula ; diagnostic imaging ; Embolism ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; Humans ; Hypertension, Portal ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; abnormalities ; diagnostic imaging ; Tomography, Spiral Computed ; Vena Cava, Inferior ; diagnostic imaging

BACKGROUNDCoronary artery fistulas (CAFs) are rare congenital abnormality often unintentionally found in patients with coronary artery disease. Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms. Dual-source computed tomography (DSCT) might be a useful diagnostic tool for CAFs. The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution.

METHODSForty-eight patients underwent DSCT angiography by using retrospective electrocardiographic (ECG) gating after infusion of 70 ml of intravenous contrast material during breath hold. Maximum intensity projection (MIP), curved planar reconstruction (CPR), and volume rendering technique (VR) were obtained. Anomalous termination of coronary artery in each subject was evaluated by two radiologists (with more than 10 years experience with cardiovascular imaging), and disagreement between diagnosis readers was settled by a consensus reading. Ten of 48 patients also underwent traditional coronary angiography (CAG) simultaneously.

RESULTSIn each CAF case, DSCT angiography clearly demonstrated the origin, the termination, the size of abnormal vessel and its course in relation to surrounding great vessels. CAF arising from right coronary artery was the most common type, left circumflex was the least one involved among three coronaries, and pulmonary artery was the most common drainage site. Aneurismal fistulous tract, coronary atherosclerosis, myocardial bridging and anomalous origin of coronary artery were also detected in this group. The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients, and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography.

CONCLUSIONSDSCT angiography could provide accurate delineation of anomalous communications, size and numbers of fistulas in patients with CAFs. It suggested that DSCT is a useful tool for the assessment of CAFs and may be considered as the first-choice imaging modality, especially for patients with coronary artery disease.

Adult ; Aged ; Aged, 80 and over ; Arteriovenous Fistula ; diagnostic imaging ; Coronary Artery Disease ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

Adult ; Aged ; Arteriovenous Fistula ; complications ; diagnostic imaging ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Hepatic Artery ; abnormalities ; Hepatic Veins ; abnormalities ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

Arteriovenous Fistula ; diagnostic imaging ; pathology ; surgery ; Hemoptysis ; surgery ; Humans ; Male ; Middle Aged ; Pulmonary Artery ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Pulmonary Veins ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed

Arteriovenous Fistula ; complications ; diagnosis ; diagnostic imaging ; Child ; Contrast Media ; Coronary Angiography ; Coronary Vessels ; pathology ; Female ; Humans ; Superior Vena Cava Syndrome ; diagnosis ; diagnostic imaging ; etiology ; Tomography, X-Ray Computed ; Vena Cava, Superior ; abnormalities ; diagnostic imaging

OBJECTIVETo evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.

METHODSA total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles (PVA) in 9, and gelfoam particles in 6 cases.

RESULTSRenal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months (mean, 48 months). Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor). Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range.

CONCLUSIONTranscatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.

Adult ; Aged ; Arteriovenous Fistula ; therapy ; Embolization, Therapeutic ; Emergency Medical Services ; Female ; Humans ; Iatrogenic Disease ; epidemiology ; Low Back Pain ; etiology ; Male ; Middle Aged ; Radiography ; Renal Artery ; diagnostic imaging ; injuries ; Renal Veins ; diagnostic imaging ; injuries

Splenic arteriovenous fistula (SAVF) is an unusual cause of portal hypertension, and is rarely associated with an infective aetiology. It is often difficult to identify SAVF clinically, and thus, radiological modalities are invariably required for diagnosis and treatment. We herein describe a case of SAVF occurring in a patient with compensated cirrhosis as a sequel to salmonella gastroenteritis, and presenting with acute gastric variceal bleeding. Selective transcatheter embolisation of the splenic artery was effective in controlling bleeding.
Adult ; Angiography ; Arteriovenous Fistula ; diagnostic imaging ; microbiology ; therapy ; Colonoscopy ; Embolization, Therapeutic ; methods ; Esophageal and Gastric Varices ; etiology ; Gastroenteritis ; microbiology ; Gastrointestinal Hemorrhage ; etiology ; Humans ; Liver Cirrhosis ; microbiology ; Male ; Salmonella Infections ; microbiology ; Splenic Artery ; abnormalities ; diagnostic imaging ; Splenic Vein ; abnormalities ; diagnostic imaging ; Tomography, X-Ray Computed