Hughes-Stovin syndrome is an extremely rare entity. We present a case of a 42-year-old man, who developed deep vein and inferior vena cava (IVC) thrombosis, repeated internal bleeding and pulmonary artery aneurysms (PAAs). The patient presented with massive hemoptysis and with PAAs of a 2.5 cm maximum diameter. We describe the successful percutaneous transhepatic venous embolization of the PAAs due to occluded common vascular pathways to the pulmonary artery.
Adult ; Aneurysm* ; Hemoptysis ; Hemorrhage ; Humans ; Pulmonary Artery* ; Thrombosis ; Veins ; Vena Cava, Inferior

We performed a retrospective analysis of twenty-four consecutive hip arthroplasties (Total Hip Arthroplasty 18, Bipolar Arthroplasty 1, Cup revision 5) during which intraoperative frozen sections were analyzed to identify the occult active infection. We also reviewed the data such as laboratory findings (ESR, CRP), intraoperative culture, hip joint sonographic evaluation and permanent histologic section. Among the twenty-four patients those who received hip arthroplasties, 10 cases received revisional hip arthroplasties due to painful hip prosthesis loosening, 9 cases with infected hip prosthesis, 3 cases with infection after open reduction and internal fixation due to hip fracture and 2 cases with septic hip sequelae. Intraoperative frozen section had been obtained during staged revisional hip arthroplasties to determine the presence of active infection. We considered positive for infection if it shows more than 10 PML/HPF (Polymorphonuclear leukocyte /high power field) in at least 5 distinct microscopic fields from intraoperative tissue frozen section and postponed implantation of prosthesis. If it shows less than 5 PML/HPF, we performed revisional hip prosthesis implantation. We decided the implantation based on patient's condition, laboratory findings and intraoperative tissue conditions if it shows between 5 and 10 PML/HPF from intraoperative frozen section. At last follow up, 20 of 21 patients who had a revisional hip arthroplasties as below 10 PML/HPF from intraoperative frozen section remained free of infection (Specificity; 95%). We concluded that analysis of the intraoperative frozen sections is a reliable predictor as a guide to sepsis for the successful hip joint arthroplasties.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Frozen Sections* ; Hip Joint ; Hip Prosthesis ; Hip* ; Humans ; Leukocytes ; Prostheses and Implants ; Retrospective Studies ; Sepsis* ; Ultrasonography

BACKGROUND/AIMS: To investigate the feasibility of Bakri balloon and Coda balloon placement as a spacer between the liver and bowels using a swine model. METHODS: Six adult female swine weighing from 24.0 to 41.5 kg (mean, 31.5 kg) were included for the study. After peritoneal puncture using a 21-G micro-puncture needle under ultrasound and fluoroscopic guidance, a 0.035-inch guidewire (Terumo, Tokyo, Japan) was advanced through the micro-introducer sheath. With sequential dilation of the tract with dilators up to 18-Fr or 10 mm balloon, the Coda and Bakri balloon was advanced between the liver and bowels. 50 mL and 200 mL of contrast were inflated for Coda and Bakri balloon, respectively. Gross examinations focused on whether placement of the Coda or Bakri balloon was at the correct location. RESULTS: Technical success was achieved for Coda balloon placement in six of the six (100%) swine, and for Bakri balloon placement in five of the six (83.3 %) swine. The median placement time for the Coda balloon was 10 minutes (range, 7-15 minutes), while the median placement time for the Bakri balloon was 25 minutes (range, 17-35 minutes), which was significantly longer (p<0.05). Gross observations at necropsy revealed that the Coda and Bakri balloon was well placed between the liver and bowel. CONCLUSIONS: Placement of Coda and Bakri balloons between the liver and bowels was feasible. These balloons have a potential role as spacers between the liver and bowel during radiation therapy for hepatocellular carcinoma patients.
Adult ; Carcinoma, Hepatocellular ; Feasibility Studies* ; Female ; Humans ; Liver* ; Needles ; Punctures ; Swine* ; Ultrasonography

Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.
Adenomyosis ; Analgesia, Patient-Controlled ; Angiography ; Dexamethasone ; Dexmedetomidine ; Gonadotropin-Releasing Hormone ; Humans ; Injections, Intravenous ; Leiomyoma ; Lidocaine ; Magnetic Resonance Imaging ; Respiratory Insufficiency ; Uterine Artery Embolization ; Uterine Artery ; Uterus

Because it is rare, acute small bowel obstruction due to right paraduodenal hernia is an entity with which radiologists are not entirely familiar. Its clinical importance, however, lies in the fat that delayed diagnosis leads to significantly increased morbidity and mortality rates. We report a case of small bowel obstruction due to right paraduodenal hernia in which all the known characteristic findings were demonstrated.
Delayed Diagnosis ; Hernia* ; Mortality

PURPOSE: To compare the effectiveness of the in-phase(IP) sequence and the opposed-phase(OP) sequence in the detection of focal hepatic lesions in the single breath-hold hepatic MR imaging with fast gradient T1-weighted pulse sequences. MATERIALS AND METHODS: If and OP T1-weighted breath-hold imaging was performed using fast gradient echo sequences in 45 patients referred for known focal hepatic lesions, in which 78 lesions were detected. There blind readers independently reviewed the images for lesion detectability. The signal-to-noise ratio(SNR) of the liver, the lesion-to-liver contrast-to-noise ratio(CNR) and the liver-to-spleen CNR were also compared. A consensus was reached by three readers to determine which sequence is better in image quality. RESULTS: On OP images, 61(78%), 61(78%), and 63(89%) lesions were correctly identified for reader 1, 2 and 3, respectively. On IP images, 66(85%), 65(83%), and 65(93%) lesions were detected for each reader, respectively. When two image sets were combined, 71(91%), 69(88%), and 76(97%) lesions respectively were detected for each reader. In cases of hepatocellular carcinoma, liver-to-lesion CNR was greater on the OP images(p<0.05), but in other lesions significant differences was not demonstrated. Liver-to-spleen CNR was higher in OP images(p<0.1), but the SNR of the liver was higher on the If images. CONCLUSION: Use of both If and OP imaging can be helpful to avoid erroneous missing of some focal hepatic lesions.
Carcinoma, Hepatocellular ; Consensus ; Humans ; Liver* ; Magnetic Resonance Imaging*

Spindle-cell carcinoma of the esophagus is a rare malignant tumor composed of both carcinomatous and sarcomatous elements, and has generated many terminology problems. It is characterized by a bulky polypoid intraluminal mass with a lobulated surface located in the middle third of the esophagus. Local expansion of this organ is observed. The lesion may be pedunculated but despite its bulk, causes little obstruction. We report the imaging findings of a case of spindle-cell carcinoma arising in the upper esophagus.
Carcinoma* ; Esophagus*

Aortocaval fistula is a rare complication arising from an abdominal aortic aneurysm. A typical feature observed during the arterial phase of contrast-enhanced CT scanning in such patients is simultaneous enhancement of the dilated inferior vena cava and aorta. Awareness of the specific radiologic features of aortocaval fistula may facilitate diagnosis when the condition is unsuspected clinically. We report a case of aortocaval fistula secondary to abdominal aortic aneurysm, and review the previous literature.
Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Diagnosis ; Fistula* ; Humans ; Tomography, X-Ray Computed ; Vena Cava, Inferior