Murthy Chamarthy

Image-guided percutaneous ablation of lung malignancies: A minimally invasive alternative for nonsurgical patients or unresectable tumors.

Lung cancer remains the malignancy with the highest mortality and second highest incidence in both men and women within the United States. Image-guided ablative therapies are safe and effective for localized control of unresectable liver, renal, bone, and lung tumors. Local ablative therapies have been shown to slow disease progression and prolong disease-free survival in patients who are not surgical candidates, either due to local extent of disease or medical comorbidities. Commonly encountered complications of percutaneous ablation of lung tumors include pneumothorax, pleural inflammation, pleural effusions, and pneumonia, which are usually easily managed. This review will discuss the merits of image-guided ablation in the treatment of lung tumors and the underlying mechanism, procedural techniques, clinical utility, toxicity, imaging of tumor response, and future developments, with a focus on radiofrequency ablation.

Celiac Artery Stenting to Facilitate Hepatic Yttrium-90 Radioembolization Therapy

Radioembolization offers a novel way to treat the nonresectable, liver predominant hepatic malignancies with better tumor response and overall progression-free survival rates. Transarterial catheter-based radioembolization procedure involves the hepatic arterial administration of glass- or resin-based beta emitting Yttirum-90 microspheres. Safe delivery of the tumoricidal radiation dose requires careful angiogram planning and coil embolization to quantify lung shunting and prevent systemic toxicity, respectively. Diagnostic pretreatment angiogram also serves to identify the hepatic arterial variant anatomy and other coexisting pathologies that might require a different or alternative approach. We describe a complex case of celiac artery stenosis with tortuous pancreaticoduodenal arterial arcade precluding access to the right hepatic artery for performing radioembolization. Celiac artery stenting of the stenosis was performed to facilitate subsequent safe and successful Yttrium-90 microsphere radioembolization.

A Tight Spot

a 0 PRESENTATION On occasion, patients are surprised to discover that they have lived for decades with a congenital anomaly. This was the case for a 48-year-old woman who had progressively increasing dysphagia over a period of several years. Significant worsening over 3-4 weeks spurred her to again seek medical attention for this condition. She reported difficulty swallowing solid food and a feeling of retrosternal obstruction upon swallowing. Results of an upper endoscopy and biopsies performed a few months earlier had been normal. The patient had a history of breast cancer. A left-sided mastectomy and reconstructive surgery were followed by chemotherapy. Her physical examination and laboratory data were unremarkable.