Daiji Uchiyama

Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

PurposeThe aim of this study was to evaluate the indications, efficacy, and safety of arterial catheterization and embolization for the management of emergent or anticipated massive obstetrical hemorrhage and its effects on menses and fertility.Materials and methodsEighteen patients underwent arterial catheterization and embolization for intractable obstetrical hemorrhage between January 2001 and December 2005. Three groups of patients were identified: group 1 (n = 6) experienced postpartum hemorrhage; group 2 (n = 5) had anticipated severe postpartum hemorrhage; and group 3 (n = 7) had a risk factor for anticipated severe hemorrhage after dilation and evacuation. Gynecological information after embolization was obtained from medical records and telephone interviews.ResultsAll patients in group 1 had a favorable outcome after treatment with a single embolization. All patients in group 2 had a placenta previa with an estimated blood loss of 1215–3250 ml. In group 3, bleeding was controlled in six patients; one patient had a hysterectomy because embolization was not possible. There were no short-or long — term complications, and normal menstruation resumed. Four patients became pregnant after embolization.ConclusionArterial catheterization and embolization is an effective, safe method for treating intractable obstetrical hemorrhage and might eliminate the need for hysterectomy and maintain reproductive ability.

Bronchial Arteriovenous Malformation: MDCT Angiography Findings

WEB This is a Web exclusive article. rimary bronchial arteriovenous malformation (AVM) is an extremely rare congenital disease characterized by enlarged convoluted vessels and anomalous communication between the bronchial artery and pulmonary artery or pulmonary vein (bronchopulmonary shunt). The bronchial arteriography and hemodynamic findings of this condition have been reported [1–3]. To our knowledge, however, primary bronchial AVM diagnosed using reconstructed 3D images of contrast-enhanced MDCT has not been previously described. We report the usefulness of multiphase fusion 3D images (i.e., superimposed display of the arterial and venous phases) of MDCT in one case.

Detection of Neck Recanalization with Follow-up Contrast-enhanced MR Angiography after Renal Artery Aneurysm Coil Embolization

embryologic development, there is a metameric disposition of the arteries of the trunk. These trunk arteries provide blood supply to the parietal wall (ie, posterior arteries), to the urogenital tract (ie, lateral arteries) and to the intestinal tract (ie, anterior arteries). During evolution, regression of several of these ventral, metameric arteries is observed, as well as the regression of the ventral anastomoses of these metameric arteries. This embryonic development eventually results in the formation of three residual anterior arteries at the 10th, 13th, and 21st or 22nd root, respectively, corresponding to celiac, superior mesenteric, and inferior mesenteric arterial anatomy as seen in the adult vasculature. However, in some cases the mechanism of regression of metameric arteries and of their ventral anastomoses can be distorted, resulting in different anatomic variants. In the present case, it can be hypothesized that the proximal anastomosis between the root, which later formed the superior and inferior mesenteric artery, persisted and progressively developed at the level of the initial 21st or 22nd root, the normal origin of the inferior mesenteric artery. Additionally, persistence of another root, located at the level of the 12th to 14th root, could have resulted in the presence of an accessory branch, originating from the aorta at the level of the first lumbar vertebra and supplying a part of the ileum. Finally, it is clear that the knowledge of variant or aberrant vascular anatomy is of importance so as not to overlook a potential source of gastrointestinal hemorrhage during visceral angiography.

Successful Transcatheter Arterial Embolization for Spontaneous Rupture of the Posterior Tibial Artery in a Patient with Ehlers-Danlos Syndrome Type IV

From: Daiji Uchiyama, MD Masamichi Koganemaru, MD Toshi Abe, MD Hidetoshi Akashi, MD Naofumi Hayabuchi, MD Kurume University School of Medicine 67 Asahi-machi, Kurume Fukuoka 830-0011, Japan Editor: Ehlers-Danlos syndrome type IV (EDS IV) is an inherited disorder of the connective tissue that is characterized by spontaneous visceral and vascular injuries (1). Vascular surgery might induce an arterial tear with uncontrollable bleeding (2). Therefore, transcatheter arterial embolization (TAE) is currently considered to be the most appropriate treatment of spontaneous arterial rupture. We report successful embolization with use of a microcoil and n-butyl cyanoacrylate

Carpal tunnel syndrome caused by neural fibrolipoma.

A 45-year-old woman presented with progressive right hand numbness in the area of distribution of the median nerve, and inadequate thumb opposition. On physical examination, a soft elastic mass was noted on the distal volar aspect of her forearm (figure 1, dot circle), with an atrophy of the thenar eminence (figures 1 and 2, red circle). Phalens test and Tinels sign were positive. Motor and sensory nerve conduction velocity of the right median nerve were not evoked. MRI revealed the enlarged median nerve extended into the carpal tunnel (figures 2⇓–4). The characteristic ‘coaxial cable-like’ appearance was observed on T1-weighted and T2-weighted axial images (figures 2 and 4), in which …

Calcific Tendinitis of the Longus Colli

A 47-year-old woman presented with severe neck pain and stiffness associated with dysphagia. The laboratory data showed slight leukocytosis of 10,680/μL and slight elevation of C-reactive protein. The findings of a lateral radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated calcification in front of the axis (Picture 1, 3. red arrows) and swelling of the prevertebral soft tissue from C1 to C5 (Picture 1-3. white arrows). We diagnosed the lesion to be calcific tendinitis of the longus colli and treated her with a non-steroidal anti-inflammatory drug. Two weeks later, the symptoms, prevertebral soft tissue swelling, and calcium deposition almost completely disappeared. Although calcific tendinitis of the longus colli is rare, physicians must keep in mind the possibility of this disease, as retropharyngeal abscesses and infectious spondylitis present with very similar symptoms and imaging findings. CT and MRI are useful in both the detection and differential diagnosis of longus colli muscle abnormalities.