Eliodoro Faiella

Bile Leak Refilling an Intrahepatic Biloma Managed with AMPLATZER Vascular Plug

tumor sizes. Although hysterectomy remains the gold-standard treatment for uterine myomas, it is an unacceptable treatment option for patients who want their uterus to be preserved. For this group of patients, several treatment options exist, including myomectomy and uterine artery embolization. As myomectomy is an invasive surgical procedure, it is associated with the risks of intraoperative blood loss, emergency hysterectomy, cesarean section, and uterine rupture during pregnancy after treatment (3). In patients with submucosal myomas treated with uterine artery embolization, complications of infection and pain during vaginal myoma expulsion have been reported (4). Currently, in cases of submucosal myomas, transvaginal resection with resectoscopy is a good option, but the indications for this technique are limited to small myomas with penetration into the uterine cavity greater than 50% (3). MRgFUS treatment of uterine myomas has clearly demonstrated myoma shrinkage and significant symptom reduction, with only minor complications such as skin burn and nerve heating, which have shown complete improvement with conservative therapy (1). A report of vaginal expulsion of a very large necrotic submucosal myoma after MRgFUS describes removal by hysteroscopy without injury to the uterine endometrium (5). Here we have described successful MRgFUS treatment of an intracavitary submucosal myoma by selective targeting of the stalk connecting it to the uterus, and the resulting disconnection of the myoma, without the need for any additional invasive procedures and without associated complications of infection, pain, or excessive vaginal bleeding during spontaneous expulsion of the myoma. In addition, during the 3-month follow-up period after MRgFUS treatment, the patient experienced decreased menstrual bleeding. In cases of very large submucosal myomas, there may be complications related to the expulsion of the large mass through the vagina, for which a subsequent hysteroscopic resection would be required. The present case suggests the potential exploratory use of MRgFUS for the disconnection of an intracavitary submucosal myoma to the uterine cavity, but further work is required to provide additional knowledge of possible outcomes or complications.

Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions

PURPOSE To validate a CT-navigation system during percutaneous lung biopsy (PLB). METHODS Four hundred-ninety-six patients underwent low-dose CT-guided PLB. Lesion diameter (LD), procedural time (PT), histologic validity, lesion distance from pleural surface (DPS), needle distance travelled during procedure (DTP), complications and radiation exposure were recorded. RESULTS Hysto-patological diagnosis was obtained in 96.2% cases. Mean PT, DPS, DTP, LD were respectively 29.5min, 12.4mm, 17.9mm, 20.7mm. In cases of major complications (4.6%), higher values of DTP were measured. CONCLUSIONS CT-navigation system allowed a good success in terms of diagnosis in small lesions and when a long DTP is required.

Imaging of Renal Medullary Carcinoma

Renal medullary carcinoma (RMC) is a rare, highly aggressive tumor recognized as an independent pathological entity. African-descent adolescents and young adults with sickle cell hemoglobinopathy are the most affected groups. This rare subtype of renal cell carcinoma has its own morphogenetic and pathological characteristics. The major clinical manifestations include gross hematuria, abdominal or flank pain, and weight loss. The prognosis is very poor, with 95% of cases diagnosed at an advanced stage of the disease. In this review, we summarize the morphologic and dynamic characteristics of RMC under various imaging modalities such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis and management strategies are also discussed.

Ultrasound Imaging of Cystic Nephroma

Cystic nephroma is a rare, benign multicystic lesion of the kidney. This tumor occurs both in children and in adults. In children, it is highly prevalent in males; in adults, it is more frequent in women. The term “cystic nephroma” represents two apparently different entities: pediatric cystic nephroma, a benign form thought to originate from metanephric tissue, and adult cystic nephroma, considered as a lesion of mixed epithelial stromal tumor. The clinical presentation may be a palpable mass or nonspecific symptoms such as abdominal pain, hematuria, and urinary tract infections. In this review, we summarize the ultrasound imaging features of cystic nephroma and describe the characteristics of the most common renal cystic lesions and the differential diagnosis of cystic nephroma with other renal cystic lesions.

Bilateral transrenal ureteral occlusion by means of n-butyl cyanoacrylate and AMPLATZER vascular plug.

AMPLATZER vascular plug is a widely used embolic agent. In the present paper, we present a case of an 86-year-old female patient who underwent bilateral ureteral occlusion by means of AMPLATZER vascular plug II coupled to n-butyl cyanoacrylate (NBCA) because of recurring pyelonephritis following cystectomy with subsequent bilateral ureterosigmoidostomy (sec. Mainz type II).

Radiofrequency ablation of renal cell carcinoma in patients with a solitary kidney: a retrospective analysis of our experience

PurposeThis study was done to evaluate the feasibility and safety of radiofrequency ablation (RFA) of renal cell carcinomas (RCCs) in patients with solitary kidney.Materials and methodsSeven patients (two men, five women; age range 52–70 years; mean age 59.7 years) were treated under computed tomography (CT) and ultrasound (US) guidance. Three patients had single lesions, and the remaining four had multiple lesions. Seventeen lesions (4 cortical, 13 exophytic, maximum diameter range 12–40 mm, mean 21.0 mm) not located close to the renal pelvis were treated. CT or magnetic resonance (MR) imaging follow-up studies were obtained for all patients at the end of the procedure and at 1, 3, 6 and 12 months; serum creatinine was also monitored.ResultsTen ablation sessions were performed. In two patients, a perinephric haematoma was detected, and one of these patients had two episodes of self-limiting haematuria. Contrast-enhanced CT and MR imaging at the end of the procedure and at 1 month demonstrated 100% technical success; these results were confirmed at 3, 6 and 12 month. Fisher’s test comparing serum creatinine obtained 1 day before and 1 day after the procedure showed no case of acute renal failure (mean serum creatinine 24 h before the procedure 1.02 mg/dl; mean serum creatinine 24 h after the procedure 0.95 mg/dl; p=0.114; not significant). Serum creatinine at follow-up was always within the normal range.ConclusionsRadiofrequency ablation in the solitary kidney is a safe and effective procedure for treating RCC.RiassuntoObiettivoScopo del nostro lavoro è stato valutare l’efficacia e la sicurezza dell’ablazione a radiofrequenza (RFA) del carcinoma renale (RCC) in pazienti con rene solitario.Materiali e metodiSette pazienti (2 uomini e 5 donne; età compresa tra 52 e 70 anni; età media 59,7 anni) sono stati trattati sotto guida tomografica computerizzata (TC) ed ecografica. Tre pazienti avevano una lesione singola; i restanti quattro presentavano multiple localizzazioni. Complessivamente diciassette lesioni (4 corticali e 13 esofitiche, con diametro massimo compreso tra 12 e 40 mm, in media 21 mm) non adiacenti alla pelvi renale sono state trattate. TC e risonanza magnetica (RM) sono state le metodiche scelte per il follow-up al termine di ogni procedura e a distanza di 1, 3, 6 e 12 mesi; sono stati monitorati anche i valori di creatinina sierica.RisultatiIn totale sono state condotte 10 sedute ablative. In 2 pazienti abbiamo riscontrato la presenza di un ematoma peri-renale ed in uno di questi due pazienti sono stati riportati anche 2 episodi di ematuria, regrediti spontaneamente. Il successo tecnico, raggiunto nel 100% dei casi, è stato dimostrato grazie al controllo mediante TC o RM con somministrazione di agente di contrasto al termine di ogni procedura e a distanza di un mese; i follow-up a 3, 6 e 12 mesi hanno confermato questo dato. Nessun caso di insufficienza renale acuta è stato riscontrato dopo aver applicato il test di Fisher comparando i valori di creatinina sierica misurati il giorno prima e il giorno dopo la procedura, (valore medio di creatinina sierica 24 ore prima della procedura: 1,02 mg/dl; valore medio di creatinina sierica il giorno dopo: 0,95 mg/dl; p=0,114, non significativo). I valori di creatinina sierica nei successivi controlli a distanza sono sempre stati nei limiti della norma.ConclusioniLa RFA si è rivelata una procedura sicura ed efficace nel trattamento dei carcinomi a cellule renali nei pazienti con rene solitario.

Percutaneous radiofrequency ablation of a bleeding pseudoaneurysm during CT-guided renal cancer treatment. A case report.

We describe a new emergency interventional radiology approach in percutaneous procedure complications. We present the case of an 81-year-old male with small renal cancer, approached with percutaneous radiofrequency ablation (RTA) and complicated by pseudoaneurysm bleeding of a renal artery branch. In the emergency setting, pseudoaneurysm was treated in the CT room by the same RTA needle, without any complications or local tumor recurrence during the next 6-month follow-up.

Cryoablation of lung malignancies recurring close to surgical clips following surgery: Report of three cases.

Background: Minimally ablative therapies are now available for the treatment of lung malignancies. However, selection of the appropriate technique is not always easy and requires accurate preoperative planning. Aims: To describe the treatment of lung tumors with cryoablation. Settings and Design: We report three cases of lung malignancies that recurred close to surgical clips after surgical treatment, successfully treated by cryoablation. Materials and Methods: An initial freezing cycle was performed for 10 min, followed by a 5-min thawing cycle, and an additional 10-min freezing cycle. A final 5-min thaw was necessary to remove the needle from the iceball formed during the freezing cycle. Results: The procedures were completed successfully with no signs of surgical-clip misplacement, and excellent ablation of the lesions. Conclusion: Cryoablation is a relatively new procedure that potentially permits the local treatment of lung tumors with minimal loss of lung parenchyma.