Masaki Gibo

Elective Use of Aortic Balloon Occlusion in Cesarean Hysterectomy for Placenta Previa Percreta

Background: Only few reports are available on the use of aortic balloon catheter for cesarean hysterectomy in placenta previa percreta. Case: A 32-year-old woman with placenta previa percreta underwent cesarean hysterectomy at 34 weeks of gestation. Before starting the surgery, an aortic occlusion balloon catheter (30 mm balloon, 5 Fr) was inserted. For total hysterectomy, the aortic balloon catheter was inflated and there was a sudden and dramatic reduction in blood loss, and the surgery was completed safely. An aortic occlusion was sustained for 80 min, with blood loss estimated at 3,200 ml. The postoperative course was uneventful. At 3 months after the operation, the mother and baby remained healthy. Conclusion: An aortic balloon is rapidly and easily inserted, and is an option for major hemorrhage in placenta previa percreta.

Hepatic falciform artery: angiographic observations and significance

AbstractBackground: The purpose of this study was to assess the angiographic incidence and appearance of the hepatic falciform artery (HFA) and discuss its clinical significance. Methods: Hepatic angiograms of 53 patients obtained with digital subtraction angiography were prospectively evaluated with regard to incidence, anatomic features, and flow speed of the HFA. We analyzed whether the background of chronic liver disease affected the incidence of the HFA. Transcatheter arterial chemoinfusion or chemoembolization for liver tumors was performed in 33 patients. We noted the occurrence of supraumbilical skin complications. Results: The HFA was observed in 13 (24.5%) of 53 patients on celiac or common hepatic angiograms. The blood flow of the HFA was slower than that of the peripheral hepatic arteries in all patients. No significant difference in the incidence of HFA between the 34 patients with chronic liver disease and the 19 patients with normal livers was found. One treated patient with an HFA and a history of gastrectomy developed a supraumbilical red skin rash. Conclusion: The angiographic incidence of the HFA is more common than previously reported. The delayed and persistent opacification of the HFA on hepatic angiograms caused by its slow blood flow is considered the key to its identification.

Frequent cause of the macklin effect in spontaneous pneumomediastinum : Demonstration by multidetector-row computed tomography

Objective: The purpose of this study was to evaluate the Macklin effect in patients with spontaneous pneumomediastinum by multidetector-row computed tomography (MDCT). Methods: Chest computed tomography (CT) reports between July 2000 and January 2003 at our institution were retrospectively reviewed. Nine patients with spontaneous pneumomediastinum were identified, and their CT scans were evaluated to detect the Macklin effect. The patient diagnoses included interstitial lung diseases (n = 4), bronchiolitis obliterans organizing pneumonia or pneumonia (n = 3), asthma (n = 1), and spontaneous pneumomediastinum without definite pulmonary disease (n = 1). Results: The Macklin effect was observed in 8 (89%) of 9 patients. In 4 patients, the Macklin effect was observed in perihilar and peripheral areas, and in 4 patients, it was observed only in the perihilar area. Conclusions: The Macklin effect can frequently be demonstrated in patients with spontaneous pneumomediastinum of nontraumatic respiratory causes by MDCT. A CT-proven Macklin effect may be useful in differentiating respiratory from other causes of pneumomediastinum.

Percutaneous ipsilateral portal vein embolization using a modified four-lumen balloon catheter with fibrin glue: initial clinical experience

PurposeThe purpose of the present study was to show the feasibility and safety of ipsilateral portal vein embolization (PVE) using an improved four-lumen balloon catheter with fibrin glue.Materials and methodsTo improve the ipsilateral PVE with fibrin glue, we modified a commercially available four-lumen balloon catheter to create a catheter comprising one lumen with a catheter tip for a guidewire, one lumen for an occlusion balloon, and two lumens, each with a side-hole just proximal to the balloon. Eight patients had hepatobiliary disease (three with bile duct carcinoma, two with gallbladder carcinoma, one with hepatocellular carcinoma, one with Caroli disease, and one with metastatic carcinoma).ResultsAll embolization procedures were technically successful. After embolization, the volume of the future remnant liver increased a mean of 131%. There was no inadvertent embolization of portal vein branches and no major procedure-related complications.ConclusionOur method is potentially easier and safer than the traditional ipsilateral method with fibrin glue using a three-lumen balloon catheter because the fourth lumen makes possible the use of a guidewire to access the targeted portal vein and measurement of any portal vein pressure elevation following PVE via the fourth lumen.

Infectious mediastinitis after cardiovascular surgery: role of computed tomography

PurposeThe aim of this study was to evaluate the effectiveness of computed tomography (CT) findings in the diagnosis of mediastinitis after cardiovascular surgery with median sternotomy.Material and methodsA total of 122 patients were divided into two groups: the early group (≤21 days after surgery) and the late group (>21 days after surgery). Among them, six patients were ultimately diagnosed with infectious mediastinitis. CT findings in each patient were evaluated. Mediastinal fluid collections or free gas bubbles were regarded as the primary findings of mediastinitis.ResultsIn the early group, sensitivity and specificity of the primary CT findings were 100% and 39%, respectively. In the late group, the sensitivity was 100% and the specificity 85%. Mediastinal fluid collections were observed in all six patients with mediastinitis.ConclusionMediastinal fluid collections or free gas bubbles are not specific during the early postoperative period. However, after 2 21 days, these observations could be indicative of mediastinitis.

Huge uterine leiomyoma with adenomyotic cysts mimicking uterine sarcoma on MR imaging

Magnetic resonance imaging of a 39-year-old woman who presented with an abdominal mass revealed a tumor with hemorrhagic lesions extending from the intrauterine space to the subserosa. Hysterectomy was performed for probable uterine sarcoma. The histological examination diagnosed uterine leiomyoma with severe myxoid degeneration and without malignant components. Hemorrhagic lesions were diagnosed as adenomyotic cysts, resulting in findings similar to those of a uterine sarcoma.

Can maximum intensity projection images with multidetector-row computed tomography help to differentiate between the micronodular distribution of focal and diffuse infiltrative lung diseases?

Objective: The objective of this study was to evaluate whether maximum intensity projection (MIP) images increased the ability of experienced and resident radiologists to differentiate between the micronodular distribution of focal and diffuse infiltrative lung diseases. Methods: The cases used in the study were those of 26 patients with focal or diffuse micronodular lung diseases, including 7 cases of sarcoidosis, 6 of miliary tuberculosis, 3 of pulmonary tuberculosis, 3 of chronic bronchitis, 2 of human T-lymphotropic virus type 1-associated bronchoalveolar disorder, 2 of diffuse aspiration bronchiolitis, 1 of atypical mycobacterial infection, and 1 of lymphangitic carcinomatosis. Scans of the entire lung during a single breath hold at 1.25-2.5 mm thickness and a pitch of 6 were performed using a multidetector-row computed tomography (MDCT) apparatus with a 4-row detector. Additional MIP image slabs were produced from the initial axial images on all study patients on a workstation according to a protocol that incorporated a slab thickness of 10 mm, a reconstructed interval of 10 mm, and a window width of −1500 Hounsfield units. The ability of 10 radiologists (5 board-certified radiologists and 5 radiology residents) to interpret contiguous thin-section CT scans and additional MIP images was then studied in an observer performance study. The results of both sets of observer performances were compared using receiver operating characteristic analysis. Results: In the resident observers, the mean area under the receiver operating characteristic curve (Az) value increased significantly from 0.654 without the MIP images to 0.753 with the MIP images (P < 0.01). In the board-certified radiologists, however, the mean Az values remained unchanged at 0.867 without the MIP images and 0.846 with the MIP images. Conclusions: This study showed that MIP images may help radiologists in training to differentiate between the micronodular distribution of focal and diffuse infiltrative lung diseases.

CT of internal hernia through a defect of the perirectal fossa

We report a case of internal hernia due to a peritoneal defect of the perirectal fossa. This condition is extremely rare and has been reported in the literature only once. This is the first independent case report. CT findings as well as the differential diagnosis of the condition are discussed.

Small-bowel wall thickening related to a long intestinal tube: incidental CT finding mimicking a pathologic condition.

Purpose The purpose of this work is to describe the CT findings of small-bowel wall thickening related to a long intestinal tube in patients with bowel obstruction and to discuss the mechanism of this incidental finding. Method Ten consecutive patients with intubation of a long intestinal tube for bowel obstruction were studied retrospectively. Five cases were diagnosed as colon cancer, three as postoperative adhesion, one as Meckel diverticulitis, and one as internal hernia of the small bowel. The history and imaging studies of these patients were reviewed. Results Small-bowel wall thickening was demonstrated in 6 of the 10 patients on CT. All findings of small-bowel wall thickening were observed along the long intestinal tube. Multiple accordion-shaped pleats were seen in five patients on longitudinal sections of the small bowel. Conclusion Although definitive pathologic proof is lacking, small-bowel wall thickening related to a long intestinal tube was thought to represent a multiply “pleated” normal small bowel along a long intestinal tube.

Pseudoaneurysm with arteriovenous fistula due to placenta increta following 1st-trimester abortion

Introduction A pseudoaneurysm is defi ned as dilatation of an artery with partial or full disruption of the vessel wall; causes include infection and vascular injury. Blood escaping from a defect in the artery wall dissects the adjacent tissues, leading to a perivascular haematoma. If the haematoma maintains its communication with the parent vessel, a pseudoaneurysm may develop (Soyer et al. 2008). A pseudoaneurysm is a very rare cause of haemorrhage aft er spontaneous abortion. Placenta increta in the 1st trimester is also rare and may cause post-abortal profuse bleeding (Ju and Kim 2007). We report a case of a pseudoaneurysm with arteriovenous (AV) fi stula due to placenta increta following a 1st-trimester abortion.