A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.
Female ; Fluorodeoxyglucose F18/chemistry ; Humans ; Leiomyoma/pathology/radiography ; Leiomyomatosis/pathology/*radiography ; Lung Neoplasms/radiography/*secondary ; Magnetic Resonance Imaging ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Uterine Neoplasms/pathology/radiography ; Vena Cava, Inferior/pathology

Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and selfexpanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.
Catheters ; Comorbidity ; Disease Progression ; Drainage ; Edema ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Iliac Vein ; Leg ; Middle Aged ; Radiography, Interventional ; Stents ; Stomach Neoplasms ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*

Congenital extrahepatic portocaval shunt (CEPS) is a rare anomaly of the mesenteric vasculature in which the intestinal and splenic venous drainage bypasses the liver and drains directly into the inferior vena cava, the left hepatic vein or the left renal vein. This uncommon disease is frequently associated with other malformations and mainly affects females. Here we report a case of pulmonary arterial hypertension associated with CEPS (Abernethy type 1b shunt) in a 20-yr-old man who was incidentally diagnosed during evaluation of multiple nodules of the liver. The patient was treated by inhalation of iloprost (40 microg/day) with improved condition and walking test. Physicians should note that congenital portocaval shunt may cause pulmonary hypertension.
Echocardiography, Doppler ; Humans ; Hypertension, Pulmonary/*diagnosis/drug therapy ; Iloprost/therapeutic use ; Liver/blood supply/radiography ; Magnetic Resonance Imaging ; Male ; Thoracic Arteries/ultrasonography ; Tomography, X-Ray Computed ; Vasodilator Agents/therapeutic use ; Vena Cava, Inferior/*abnormalities/ultrasonography ; Young Adult

The diameter and collapsibility of the inferior vena cava (IVC) should be interpreted in consideration with other clinical and echocardiographic parameters before drawing definitive diagnostic conclusions. We report a case of a 46-year-old female with isolated IVC dilation and diminished inspiratory collapse without other abnormalities, and provide a brief review of the literature.
Atrial Function, Right ; Atrial Pressure ; Cardiac Catheterization ; Dilatation, Pathologic ; Echocardiography, Doppler, Color ; Female ; Humans ; Middle Aged ; Phlebography/methods ; Respiratory Mechanics ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*pathology/physiopathology/radiography/ultrasonography

A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
Carcinoma, Renal Cell/pathology ; Diagnosis, Differential ; Humans ; Kidney Neoplasms/diagnosis/*pathology ; Lymph Node Excision/methods ; Male ; Middle Aged ; Nephrectomy/methods ; Renal Veins/*radiography ; Thrombectomy/methods ; Thrombosis/*radiography ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*radiography

A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
Carcinoma, Renal Cell/pathology ; Diagnosis, Differential ; Humans ; Kidney Neoplasms/diagnosis/*pathology ; Lymph Node Excision/methods ; Male ; Middle Aged ; Nephrectomy/methods ; Renal Veins/*radiography ; Thrombectomy/methods ; Thrombosis/*radiography ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*radiography

Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement.
Child, Preschool ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal/*diagnosis/pathology/ultrasonography ; Renal Veins/pathology/*radiography ; Thrombosis/pathology/radiography ; *Tomography, X-Ray Computed ; Vena Cava, Inferior/pathology/*radiography

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

OBJECTIVEDue to its minimal-invasive approach, endovascular procedure had replaced surgery in treating Budd-Chiari syndrome (BCS). The interventional therapy was a safe and effective treatment in adults with BCS and the cure rate was high. However Budd-Chiari syndrome in children and adolescents is rare. Published literature on interventional procedure for Budd-Chiari syndrome in children and adolescents is scarce. The aim of the study was to present results of percutaneous transluminal angioplasty (PTA) and stents placement in children and adolescents with BCS and to evaluate the efficacy and safety in these patients of this approach.

METHODTwenty-five patients [16 boys and 9 girls; average age of (14.5 ± 3.4) years old; age ranged from 5 to 17 years] with Budd-Chiari syndrome who were hospitalized from December 1990 to August 2012 were presented. All of them were diagnosed by color Doppler ultrasound scan while 12 of them had magnetic resonance venography (MRV) scan. All of the patients had undergone angiographic examination. Four cases with membranous obstruction of the inferior vena cava (IVC) were treated with PTA. One case with segmental block of IVC was treated with PTA and stent placement. Five cases with membranous obstruction of IVC and hepatic vein (/and accessory hepatic vein) were treated with PTA. Among 8 cases with membranous obstruction of hepatic veins, 6 cases were treated with PTA and the others with PTA and stent placement. Among 4 cases with blocks of 3 hepatic veins (HVs), one was treated with PTA, one with PTA plus catheter thrombolysis plus PTA, one with PTA and stent placement and the other one was unsuccessful. Three cases with obstruction of HV and accessory HV (AHV) were treated with PTA. Totally, 24 patients were treated with interventional approach and followed up.

RESULTThe procedure was successful in 24 patients. The involved veins (hepatic veins or IVC) were patented after interventional procedure. The pressure of hepatic vein was (42.1 ± 4.2) cm H2O (37-50 cm H2O) (1 cm H2O = 0.098 kPa) before the interventional therapy, while it was (17.3 ± 3.3) cm H2O (14-26 cm H2O) after it. The pressure of IVC was (30.6 ± 2.9) cm H2O (26-36 cm H2O) before the interventional therapy, while it was (18.8 ± 4.2) cm H2O (15-26 cm H2O) after it. The symptoms and signs vanished instantly after interventional procedure. There were no procedure-related complications. The rate of overall initial cure was 96%. The patients were followed up for a mean of 25.8 months (range 6 months to 8 years). Seven cases developed restenosis after first procedure. Five of them were treated with PTA, one with PTA plus catheter thrombolysis plus PTA, one with PTA and stent placement. All of the involved veins were patented again. Clinical symptoms were relieved. There were no procedure-related complications as well.

CONCLUSIONThe interventional procedure in children and adolescents with BCS is the same as in adults. Radiological therapeutic intervention is efficacious and safe in children and adolescents with BCS.

Adolescent ; Angioplasty ; Budd-Chiari Syndrome ; diagnostic imaging ; surgery ; therapy ; Catheterization, Peripheral ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hepatic Veins ; diagnostic imaging ; surgery ; Humans ; Liver ; blood supply ; diagnostic imaging ; Male ; Phlebography ; methods ; Radiography, Interventional ; Retrospective Studies ; Stents ; Thrombolytic Therapy ; Treatment Outcome ; Vena Cava, Inferior ; diagnostic imaging ; surgery ; Venous Thrombosis ; therapy

A 60-year-old female presented with abdominal pain and tenderness of five-day duration. Contrast enhanced CT showed a mass of 9 x 6 x 5.5 cm in size with almost complete obliteration of the inferior vena cava and massive extension to the extravascular space. CT-guided biopsy demonstrated a low-grade leiomyosarcoma. The patient underwent 125Iodine seeds implantation in two sessions, and another balloon cavoplasty. Abdominal pain and tenderness gradually improved and the patient continues to remain as disease free state for three years after the procedures.
Brachytherapy/*methods ; Contrast Media/diagnostic use ; Female ; Humans ; Iodine Radioisotopes/therapeutic use ; Leiomyosarcoma/radiography/*radiotherapy ; Middle Aged ; Tomography, X-Ray Computed ; Vascular Neoplasms/radiography/*radiotherapy ; *Vena Cava, Inferior