Man Hon

Lower Gastrointestinal Bleeding from the Internal Iliac Artery: Angiographic Demonstration of an Iliac Arteriocolic Fistula

A rare source of potentially massive lower gastrointestinal hemorrhage in women is advanced gynecologic malignancy. Such patients can develop gastrointestinal hemorrhage with or without prior pelvic irradiation, due to arteriocolic fistulas. Angiography permits the correct diagnosis and subsequent embolotherapy.

Perinephric xanthogranulomatosis: CT diagnosis and confirmation by CT-guided percutaneous biopsy

Xanthogranulomatosis is an idiopathic, rare process in which lipid-laden histiocytes may deposit in various locations in the body, which if systemic is called Erdheim-Chester disease. A rare case of isolated retroperitoneal, bilateral perinephric xanthogranulomatosis is reported. The diagnosis was suspected on cross-sectional imaging and was confirmed by CT-guided percutaneous core biopsy.

Giant splenic hemangioma: confirmation of diagnosis with labeled erythrocyte scintigraphy

PURPOSE: To assess the use of a Tc-99m erythrocyte-labeled SPECT scan to characterize a giant splenic hemangioma. METHODS: A patient clinically mistaken to have a myelodysplastic disorder underwent a contrast-enhanced CT followed by a Tc-99m erythrocyte-labeled SPECT scan. RESULTS: CT showed a heterogeneous vascular lesion arising in the spleen. Percutaneous biopsy was nondiagnostic. A Tc-99m erythrocyte-labeled SPECT study revealed findings consistent with a giant splenic hemangioma, which was subsequently confirmed at surgery. CONCLUSION: A Tc-99m erythrocyte-labeled SPECT scan may be very useful in confirming the diagnosis of a large or giant splenic hemangioma.

Fine-needle aspiration as the initial diagnostic modality in malignant lung disease

Cytologic detection of lung cancer is accepted, accurate, and time‐honored. Typically, cytologic workup of a radiologic abnormality proceeds sequentially from sputum to bronchoalveolar cytology, and, if necessary, to fine‐needle aspiration biopsy (FNA). Initial use of FNA in lung cancer diagnosis is controversial, but increasingly popular. We therefore decided to objectively assess current practice in cytologic lung cancer diagnosis at our institution. All pulmonary cytologic diagnoses for 1993 and the first half of 1994 were retrieved. Positive diagnoses were then used to access all patient data. Patients were stratified according to the specimen from which the first positive diagnosis was obtained. Of 542 pulmonary cytology specimens, 15% were sputa, 65% were bronchoalveolar, and 20% were FNAs. One hundred sixty‐one of 172 malignant diagnoses were first diagnoses. Three percent of first malignant diagnoses were made from sputa, 47% were from lavages, and 50% were from FNAs. Although FNAs comprised just 20% of all pulmonary cytologies, 50% of all new malignant cytologic diagnoses were made by FNA. Initial use of FNA is successful, has a high diagnostic yield and low complication rate, and offers the most direct approach to diagnosis. Diagn Cytopathol 1996;14:268–272.

CT of inferior vena cava filters: normal presentations and potential complications

With massive pulmonary embolism (PE) being the first or second leading cause of unexpected death in adults, protection against PE is critical in appropriately selected patients. The use of inferior vena cava (IVC) filters has increased over the years, paralleling the increased detection of deep venous thrombosis (DVT) and PE by improved and more available imaging techniques. The use of IVC filters has become very common as an alternative and/or as a supplement to anticoagulation, and these filters are often seen on routine abdominal CT, including in the emergency setting; therefore, knowledge of the normal spectrum of findings of IVC filters by the radiologist on CT is critical. Additionally, CT can be used specifically to identify complications related to IVC filters, and CT may alternatively demonstrate IVC filter-related problems which are not specifically anticipated clinically. With multiple available IVC filters on the US market, and even more available outside of the USA, it is important for the emergency and the general radiologist to recognize the different models and various appearances and positioning on CT, as well as their potential complications. These complications may be related to venous access, but also include thrombosis related to the filter, filter migration and penetration, and problems associated with filter deployment. With the increasing number of inferior vena cava filters placed and their duration within patients increasing over time, it is critical for emergency and other radiologists to be aware of these findings on CT.

Multi-modality imaging of the leaking ureter: why does detection of traumatic and iatrogenic ureteral injuries remain a challenge?

Ureteral injuries are uncommon in trauma patients, accounting for fewer than 1% of all injuries to the urinary tract. These uncommon, yet problematic, injuries can often be overlooked in the standard search pattern on abdominal and pelvic multi-detector CT (MDCT) images, as radiologists focus on more immediate life-threatening injuries. However, early diagnosis and management are vital to reduce potential morbidity. If there is a high clinical index of suspicion for ureteral injuries with penetrating or blunt trauma, or if there is suspected iatrogenic ureteral injury, delayed-phase/urographic-phase MDCT images are essential for confirming the diagnosis. Moreover, making the distinction between partial and complete ureteral transection is critical, as it will guide management. The aim of this pictorial review is to overview the key imaging findings in blunt and penetrating traumatic and iatrogenic injuries of the ureter, as well as to discuss the advantages and disadvantages of different imaging modalities for accurately and rapidly establishing or excluding the diagnosis of ureteral injuries, with an emphasis on MDCT. The potential causes of missed ureteral injuries will also be discussed.

Utilization of the track embolization technique to improve the safety of percutaneous lung biopsy and/or fiducial marker placement ☆,☆☆

PURPOSE The purpose of the study was to describe and present outcomes of the track embolization technique with absorbable hemostat gelatin powder during percutaneous computed tomography (CT)-guided lung biopsy and/or fiducial marker placement versus the standard of care (no track embolization) in an attempt to decrease rates of pneumothorax (PTX), chest tube placement, hemorrhage and/or complications, and average cost per patient. MATERIALS AND METHODS An institutional review board-approved, case-control, retrospective study was performed in which 125 consecutive patients who underwent track embolization were compared with 124 consecutive controls at one institution. For subjects in whom the track embolization technique was utilized, it was performed passively through a coaxial needle as it was removed. All procedures were performed by one of three attending interventional radiologists. For each group, medical records and procedure images were reviewed for PTX occurring postprocedure, PTX requiring chest tube placement, and occurrence of minor or major complication and/or hemorrhage. Comparison was made with published complication rates, and a cost-per-patient analysis was performed. Statistical analysis was performed utilizing Fishers Exact Test. RESULTS In track embolization cases versus controls, there were statistically significant reduction in PTX (8.8% vs. 21%; P=.007) and reduction in PTX requiring chest tube placement (4% vs. 8.1%; P=.195). This compares favorably to previously published rates of PTX and chest tube placement of 8%-64% and 1.6%-17%, respectively. None of the pneumothoraces occurring at time of needle placement increased in size with use of the track embolization technique. There were no major complications (including neurological sequela) in the track embolization group. In track embolization cases versus controls, there was a statistically significant reduction in both the rate of major hemorrhage (0% vs. 4%; P=.029) and average cost per patient (

CT Angiography of the Lower Extremities and Aortoiliac System with a Multi–Detector Row Helical CT Scanner: Promise of New Opportunities Fulfilled

262.40 vs.

Current DVT imaging

352.07; P=.044). CONCLUSIONS CT-guided percutaneous lung biopsy and/or fiducial marker placement were safer utilizing the track embolization technique during trocar removal. In addition, this technique was cost effective in the study population.