C. Di Stasi

Congenital absence of the portal vein associated with focal nodular hyperplasia in the liver in an adult woman: imaging and review of the literature

We present a new case of congenital absence of the portal vein and focal nodular hyperplasia in the liver without additional congenital anomalies. Ultrasound, computed tomography, magnetic resonance imaging, and angiography depicted the splenic vein and the superior mesenteric vein joining and entering into the inferior vena cava without passing through the liver. The features of this patient and the 30 previously reported cases are reviewed.

Sonographic and Doppler assessment of the inferior mesenteric artery : normal morphologic and hemodynamic features

AbstractBackground: We wanted to evaluate prospectively the feasibility of sonographic and Doppler assessment of the inferior mesenteric artery (IMA) and to provide data on its normal morphological and hemodynamic characteristics. Methods: Sonography and Doppler study of the IMA were performed on 116 patients without splanchnic vessel pathology. Vessel diameter, systolic, diastolic, and time-averaged mean flow velocities, pulsatility index values, and flow volumes were correlated with patient age (<50 years vs. ≥50 years) using the Wilcoxon rank-sum test. Findings were verified by splanchnic angiography in 11 cases. Results: Technically valid studies were obtained in 103/116 cases (88.8%). Flowmetric data showed high peripheral resistance (mean ± SD: systolic flow velocity, 1.41 m/s ± 0.48; minimal diastolic flow velocity, 0.10 m/s ± 0.16; pulsatility index, 3.49 ± 0.49). Mean flow volume calculated in 80 cases was 0.13 L/min ± 0.06. Older subjects presented significantly higher time-averaged mean flow velocities and lower resistance than those younger than 50 years. Conclusions: The success rate for sonographic and Doppler study of the IMA is similar to that observed with larger splanchnic vessels. Knowledge of its normal characteristics is necessary for recognition of pathological conditions and for studies of its physiological behavior.

Preoperative right portal vein embolisation: indications and results

PurposeThe purpose of this retrospective study was to evaluate the efficacy of right portal vein embolisation (PVE) in inducing contralateral liver hypertrophy before extended hepatectomy.Materials and methodsTwenty-six consecutive patients, 14 with liver metastases (ten from colorectal cancer; four from carcinoid tumours) and 12 with biliary cancers (ten Klatskin tumours; one gallbladder tumour; one intrahepatic cholangiocarcinoma) with insufficient predicted future remnant liver (FRL) underwent right PVE to induce hypertrophy of the contralateral hemiliver prior to surgical resection. Total liver volume, tumour volume and FRL volume were calculated on a 3D workstation. The ratio of the FRL to the total functional liver volume was <30% in all patients.ResultsThe FRL volume increased by 5%–25% (15% on average) after right PVE in patients with liver metastases and by 9%–19% (14% on average) in patients with biliary cancers. In all patients, the ratio of FRL to functional liver volume was ≥30% after right PVE. No postoperative deaths due to severe liver failure occurred in the 20 patients who underwent extended hepatectomy.ConclusionsRight PVE extends the indications for hepatectomy in patients with liver metastases and those with biliary cancers who have an insufficient potential hepatic functional reserve.RiassuntoObiettivoLo scopo del nostro studio retrospettivo è stato di valutare l’efficacia dell’embolizzazione del ramo portale destro (RPVE) come trattamento pre-chirurgico per indurre l’ipertrofia del fegato sinistro in pazienti candidati a resezione epatica.Materiali e metodiVentisei pazienti consecutivi, 14 portatori di metastasi epatiche (colon-retto, 10 pazienti; carcinoide, 4 pazienti) e 12 portatori di neoplasia delle vie biliari (neoplasia di Klatskin, 10 pazienti; neoplasia della colecisti, 1 paziente; colangiocarcinoma intraepatico, 1 paziente) con potenziale riserva funzionale epatica (FRL) insufficiente sotto stati sottoposti a RPVE come trattamento pre-chirurgico. Mediante una workstation 3D è stato calcolato il volume epatico totale, il volume del tumore ed il volume del FRL. In tutti i pazienti il rapporto FRL/ volume epatico totale funzionante era <30%.RisultatiIl volume del FRL ha dimostrato un incremento volumetrico compreso tra il 5%–25% (15% in media) dopo RPVE nei pazienti con metastasi epatiche e tra il 9%–19% (14% in media) in pazienti con neoplasie biliari. In tutti i pazienti il rapporto FRL/volume epatico funzionante dopo RPVE era <30%. Venti pazienti sono stati sottoposti a chirurgia resettiva epatica e nessun paziente è deceduto per insufficienza epatica grave.ConclusioniL’embolizzazione portale allarga le indicazioni alla chirurgia resettiva epatica in pazienti con metastasi epatiche e neoplasie delle vie biliari con potenziale riserva funzionale insufficiente.

Late Development of Splenic Artery Aneurysm After Orthotopic Liver Transplantation: A Case Report

Splenic artery aneurysm (SAA) is a rare complication after orthotopic liver transplantation (OLT). Although SAAs are often incidental findings, in some cases they present with signs and symptoms of abdominal mass or intra-abdominal hemorrhage. The diagnosis requires Doppler ultrasound and confirmation with computed tomography, magnetic resonance, or angiography. Endovascular techniques are preferred to surgery for the treatment of most SAAs. A variable interval from 6 days to 11 years has been reported between OLT and the diagnosis of SAA, justifying a lifelong scheduled surveillance of abdominal vessels by ultrasound after OLT. Herein we have reported a case of SAA that developed 16 years after OLT. This pathological condition was totally asymptomatic. Only routine abdominal ultrasound allowed its detection and subsequent successful treatment.

Computed tomography imaging of vena cava filter complications: a pictorial review.

Caval filters are widely used in the prevention of pulmonary embolism. Filters have proved to be effective, but the complication rate is not negligible. Computed tomography (CT) provides a complete evaluation of the filter, including both caval and extracaval complications. In this review, we describe the normal CT aspect of cava filters, the classification of complications and their CT findings. Technical considerations for adequate CT imaging are also highlighted.

Incidence and predictive factors for complications after uterine leiomyoma embolization

STUDY QUESTION What is the risk of complications after uterine leiomyoma embolization and what are the factors associated with complications? SUMMARY ANSWER The cumulative risk of complications after embolization is relatively low even in the long term, but submucosal leiomyoma location may increase the risk. WHAT IS KNOWN ALREADY A broad spectrum of complications after leiomyoma embolization have been described with widely varying rates. There is uncertainty over the actual risk of complications and the factors associated with this risk. STUDY DESIGN, SIZE, DURATION This was a prospective cohort study of 288 consecutive women undergoing leiomyoma embolization in the general gynaecology clinic of a university teaching hospital between January 2001 and December 2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Complications occurring after embolization were categorized as major or minor according to the severity of their impact on health, the level of care required and the outcome. Cumulative complication rates were estimated by survival analysis and log-rank tests according to baseline variables. Multivariable Cox proportional hazards analysis was performed to adjust for confounders. MAIN RESULTS AND THE ROLE OF CHANCE There were 48 patients who experienced a complication at a median of 5 months (95% confidence interval, 4.1-11.4) after embolization. Complications were minor in 38 patients and major in 10 patients. The cumulative overall complication rate was 13% (95% CI, 9.0-17.0) at 6 months, 16% (95% CI, 11.0-20.0) at 1 year, 17% (95% CI, 12.0-22.0) at 3 years and 18% (95% CI, 12.9-22.8) at 5 years. The most frequent complication (19/48, 39.6%) was leiomyoma expulsion, which occurred spontaneously in 13 (68.4%) of these cases and required assistance in 6 (31.6%) cases. Eight (2.8%) patients underwent re-intervention, including six hysteroscopic myomectomies, one laparoscopic myomectomy and one hysteroscopic adhesiolysis, as a result of a complication. Submucosal leiomyoma location was the only baseline variable associated with an increased risk for complications [Hazard ratio (HR), 2.28, 95% CI, 1.24-4.18, P = 0.008]. LIMITATIONS, REASONS FOR CAUTION Our population did not include women of African descent, who have been reported to be at higher risk of post-procedural complications compared with Causcasian women. If such women were involved in the study, higher morbidity rates might have been observed. WIDER IMPLICATIONS OF THE FINDINGS Women with submucosal leiomyomas at the time of embolization are more likely to have post-procedural complications. This is important new information for counselling patients contemplating this therapeutic approach. STUDY FUNDING/COMPETING INTERESTS The authors have no competing interests to declare. The study was not supported by any external grant.

Sonographic imaging of urinoma

infantile myofibromatosis. Am J Med Genet 2004; 126: 261–266. 8. Stenman G, Nadal N, Persson S, Gunterberg B, Angervall L. Del(6)(q12q15) as the sole cytogenetic anomaly in a case of solitary infantile myofibromatosis. Oncol Rep 1999; 6: 1101–1104. 9. Rumack C, Wilson S, Charboneau J. Diagnostic Ultrasound. Mosby Year Book: St. Louis, 1991. 10. Shelling AN, Ferguson LR. Genetic variation in human disease and a new role for copy number variants. Mutat Res 2007; 622: 33–41.

Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion

Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.