Mercedes Arias

Interventional therapeutic techniques in Budd-Chiari syndrome

PurposeTo analyze the results obtained with percutaneous therapeutic procedures in patients with Budd-Chiari syndrome (BCHS).MethodsBetween August 1991 and April 1993, seven patients with BCHS were treated in our hospital. Three presented with a congenital web; in another three cases the hepatic veins and/or the inferior vena cava (IVC) were compromised after major hepatic surgery; one patient presented with a severe stenosis of the intrahepatic IVC due to hepatomegaly.ResultsOne of the patients with congenital web has required several new dilatations due to restenosis; one patient required a transjugular intrahepatic portosystemic shunt procedure while awaiting a liver transplantation. The two postsurgical patients with stenosed hepatic veins did not require any new procedure after the placement of metallic endoprostheses. However, the patient with liver transplantation presented IVC restenosis after balloon angioplasty that required the deployment of metallic endoprostheses. In the patient with hepatomegaly a self-expandable prosthesis was placed in the intrahepatic portion of the IVC before (4 months) a liver transplantation.ConclusionInterventional therapeutic techniques offer a wide variety of possibilities for the treatment of patients with BCHS. For IVC stenoses, the results obtained with balloon angioplasty are at least as good as those obtained with surgery.

MR imaging findings in granular cell tumor of the neurohypophysis: a difficult preoperative diagnosis.

Abstract. Granular cell tumor is a rare neoplasm arising within the neurohypophysis. We describe the MR imaging findings in two symptomatic patients. In one patient with history of panhypopituitarism, MR images showed a large sellar and suprasellar mass. The other patient presented with acute loss of vision in her left eye, and MR images showed a suprasellar mass with compression of the optic chiasm.

Percutaneous transhepatic treatment of a posttransplant portal vein thrombosis and a preexisting spontaneous splenorenal shunt

Percutaneous transhepatic treatment of portal vein thrombosis after liver transplantation in a patient with a preexisting high volume spontaneous splenorenal shunt is presented. Local thrombolysis with urokinase and balloon angioplasty of the main portal vein stenosis were performed followed by shunt embolization to restore hepatopetal portal blood flow.

Relationship between radiologic morphology of the bone lengthening formation and its complications.

The objective was to study the different types of lengthened bone regeneration and their development during the various phases of the process to correlate them with patient factors and the surgical technique used, and to establish a possible relation between the development of the bone lengthening formation and the problems or complications. The authors studied the radiographs of a random group of 55 patients taken at three points during the course of treatment. The callus was classified with regard to its transverse diameter and the presence or absence of hypodense areas. The overall callus type was significantly influenced by the etiology, the osteotomy site, and the percentage lengthened. The percentage by which the limb was lengthened at the beginning of the process influences the overall morphology of the callus. Poor callus had been lengthened the most, atrophic callus the least. There was a correlation between the morphology of the overall callus at the end of treatment and the percentage lengthened, and between the percentage lengthened and the presence of bands at the end of treatment. The authors also found a significant correlation between age and the appearance of bands at the end of distraction. A central band was found among younger patients. The type of osteotomy affected the overall callus at the end of distraction and at the end of treatment and also influenced the transverse diameter. All the elongations with poor bone formation at the end of treatment were found to have undergone a diaphyseal osteotomy. The most common complication at the first follow-up and at the end of distraction was angulation. The diameter of the callus and the presence of bands at the end of treatment were significantly related to the complications. Fracture occurred in the first 2 weeks after removal of the external fixator in 88% of cases and in the third and fourth week in the rest. However, the segment had no significant influence on the appearance of complications. Lengthened callus with incomplete trabecular formations and hypodense areas at the end of the treatment has a high risk of fracture at the end of treatment. Callus with axial deviation, hypodense areas, or an insufficient transverse diameter during the lengthening procedure must be manipulated so that it reaches the maturing phase in better condition.

Tumoral calcinosis presenting as an extradural mass: MR findings and pathological correlation.

Abstract. Two cases of idiopathic tumoral calcinosis presenting as an extradural mass are reported. There are few reports in the literature of this pathological process presenting as extradural masses, so both cases represent very unusual locations for tumoral calcinosis. Magnetic resonance imaging features and pathological correlation of these two cases are presented. Tumoral calcinosis might be considered as a rare but possible cause of extradural mass.

MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation

Abstract. We report the MR imaging findings of an unusual case of neurosarcoidosis of the gasserian ganglion associated with trigeminal neuralgia. No other neurological or extraneurological localization was found. Magnetic resonance imaging demonstrated a mass in the Meckels diverticulum that was isointense on T1-weighted images and hypointense on T2-weighted images. Gadolinium-enhanced MR imaging showed heterogeneous enhancement. Although rare, sarcoid infiltration of the gasserian ganglion must be considered in the differential diagnosis of an isolated mass in this localization in patients with trigeminal neuralgia.

Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts

Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.

Quiste aracnoideo complicado con hemorragia intraquística y hematoma subdural espontáneo: hallazgos en resonancia magnética

Los quistes aracnoideos son colecciones intraaracnoideas, rellenas de liquido cefalorraquideo. Son lesiones benignas y mayoritariamente de origen congenito. Habitualmente son asintomaticos, sin embargo pueden sangrar y hacerse sintomaticos. El quiste aracnoideo asociado a hemorragia intraquistica y hematoma subdural de forma espontanea es una complicacion poco frecuente, sin embargo es una causa conocida de urgencia neuroquirurgica. Presentamos los hallazgos en un nino de 10 anos diagnosticado de quiste aracnoideo complicado con hemorragia intraquistica y hematoma subdural espontaneo, efectuado el diagnostico con resonancia magnetica.

Unusual presentation of a pancreatic insulinoma in helical CT and dynamic contrast-enhanced MR imaging: case report

Abstract Insulinomas are pancreatic neoplasms that can be radiologically characterized typically because of their tendency to present intense and early contrast enhancement with a wash-out phenomenon. In this sense, we report an unusual case of a hypovascular solid pancreatic insulinoma confirmed with surgery and pathologic analysis, in a patient with normal serum insulin levels. In the two-phase helical CT, the mass behaved as a hypodense lesion with respect to the surrounding pancreatic parenchyma during the arterial phase and as a hypointense lesion during the dynamic contrast-enhanced MR imaging. Pathologic examination demonstrated a hypercellular tumor with poor vascularization of intervening stroma which showed prominent amyloid deposits.

Primary amyloidosis presenting as renal infarction

We report a case of primary amyloidosis affecting the kidney and presenting as a renal infraction on computed tomography and ultrasound examination. To our knowledge, it is the first case in the radiological literature with these imaging characteristics.