Giri Shivaram

Ultrasound-Guided Liver Biopsy With Gelatin Sponge Pledget Tract Embolization in Infants Weighing Less Than 10 kg.

Objectives: The aim of the study was to describe and assess the technical success and safety of ultrasound-guided liver biopsy with gelatin sponge pledget tract embolization technique in infants <10 kg across 3 tertiary pediatric hospitals. Materials and Methods: There were 67 pediatric patients weighing <10 kg (36 boys; 31 girls; average age 202 days; average weight 6 kg, range 1.5–9.9 kg) referred for liver biopsy performed with ultrasound guidance and gelatin sponge pledget tract embolization during a 2-year period. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Results: A total of 67 procedures were included. There was 100% technical success rate and all samples obtained provided adequate tissue for histological assessment. Average number of 18 G biopsy passes was 3 (range 1–6). There were no procedure-related deaths. There was 1 complication (1%) in a 5-kg infant who was readmitted 36 hours after biopsy with a fever and fully recovered after antibiotics were administered. Biliary atresia was the most common underlying diagnosis (20%), whereas others included acute rejection (16%) and biliary obstruction (7%). Conclusions: Ultrasound-guided percutaneous liver biopsy with gelatin sponge pledget tract embolization technique in children weighing <10 kg is safe, effective, and use of this technique may lead to a reduction in rates of adverse events reported in other pediatric series.

Transsplenic splenoportography and portal venous interventions in pediatric patients

BackgroundData regarding transsplenic portal venous access for diagnostic imaging and endovascular intervention in children are limited, possibly due to concerns regarding high bleeding risks and resultant underutilization.ObjectiveTo investigate the safety and utility of transsplenic splenoportography and portal venous interventions in children.Materials and methodsA retrospective review was performed of all pediatric patients undergoing percutaneous transsplenic portal venous access and intervention at two large tertiary pediatric institutions between January 2012 and April 2017 was performed. Parameters assessed included procedural indications, procedural and relevant prior imaging, technical details of the procedures, laboratory values and clinical follow-up.ResultsTranssplenic portal venous access was achieved in all patients. Diagnostic transsplenic splenoportography was performed in 22 patients and was 100% successful at providing the desired anatomical and functional information. Four transsplenic portal venous interventions were performed with 100% success: meso-Rex shunt angioplasty, snare targeted transjugular intrahepatic portosystemic shunt (TIPS) creation through cavernous transformation, pharmacomechanical thrombectomy for acute thrombosis, and transplant portal vein angioplasty. Intraperitoneal bleeding occurred in 2/26 (7.7%) and one case required transfusion (3.8%). No cases of hemorrhage were observed when transsplenic access size was 4 Fr or smaller.ConclusionTranssplenic splenoportography in children is safe and effective when noninvasive imaging methods have yielded incomplete information. Additionally, a transsplenic approach has advantages for complex portal interventions. Bleeding risks are proportional to tract access size and may be mitigated by tract embolization.

Emergent stent-graft repair of a massive aortic pseudoaneurysm secondary to Behçet’s disease in a child

An 11-year-old male with vasculitis was found to have a large abdominal aortic pseudoaneurysm on diagnostic angiography. This report describes endovascular repair of the pseudoaneurysm by stent-graft exclusion. The existing literature surrounding this rare and potentially fatal condition is also reviewed.

Diagnostic Imaging and Image-Guided Therapy for Hemangiomas and Vascular Malformations: What the Dermatologist Needs to Know

Pediatric vascular tumors (VTs) and vascular malformations (VMs) can be confusing entities both clinically and on imaging. These lesions are commonly misdiagnosed on diagnostic imaging studies by the inexperienced radiologist, which can lead to inappropriate management, especially when there is additional uncertainty in the clinical diagnosis. However, by using a few simple clinical and imaging rules, the majority of VTs and VMs can be correctly classified, and appropriate treatment can be selected. The purpose of this article is to present a simple and practical approach to the selection and interpretation of diagnostic imaging studies for VTs and VMs. Basic interventional radiology treatment options for their management will also be outlined.