Published: 2010 May
Issue: 4(5) :: Pages: 41-45

   

Abstract: Percutaneous nephrostomy is a safe procedure, performed routinely by interventional radiologists, and has a low complication rate. We report an unusual case of a fractured nephrostomy tube, retained within the kidney, having its fractured end trapped within the healed retroperitoneal tract. The catheter was retrieved by snaring it, using a percutaneous access to the collecting system. We describe the technique used and the alternative management options.

Published: 2010 May
Issue: 4(5) :: Pages: 1-6

   

Abstract: We present a case of a ruptured vertebral artery dissecting aneurysm that mimicked a presumed vascular anomaly by CTA (Computerized Tomographic Angiography). A parenchymal arteriovenous malformation (AVM) or a dural arteriovenous fistula (DAVF) at the craniocervical junction can present with a subarachnoid hemorrhage and cannot be differentiated from a vertebral artery dissection by non invasive imaging. Catheter based cerebral angiography revealed a dissecting pseudoaneurysm of a diminutive right vertebral artery terminating in the posterior inferior cerebellar artery (PICA) that to our knowledge has not been previously reported. NBCA (N-Butyl Cyanoacrylate) embolization of the pseudoaneurysm lumen and sacrifice of the parent vessel resulted in cerebellar infarction, requiring an emergent decompressive craniectomy. The patient recovered to a functional neurologic status.

Published: 2010 May
Issue: 4(5) :: Pages: 19-26

   

Abstract: The main cause of mortality among patients with breast cancer is the metastatic spread of the primary tumour. The urinary bladder is considered as an unusual site for breast cancer metastasis. A patient has presented with right breast tumour and qualified for surgical treatment. After removal of the mass, an intra-operative and final pathology evaluation indicated breast invasive lobular carcinoma. Adjuvant chemotherapy was given. Years later, an increase of serum CA15-3 tumour marker level was noted and physical examination revealed a lump at the mastectomy scar. A follow-up abdominal ultrasound scan demonstrated thickening of the urinary bladder wall segment, confirmed later by CT scan. A transurethral resection of bladder was performed, reaffirming a neoplastic mass, with histological assessment revealing invasive breast carcinoma. Palliative chemotherapy was given and another follow-up ultrasound scans were unremarkable. The patient is alive today.

Published: 2010 May
Issue: 4(5) :: Pages: 7-12

   

Abstract: Malrotation with associated volvulus is a potentially lethal event for a neonate. The gold standard for diagnosis is an upper gastrointestinal contrast study. However this can delay the diagnosis and the timing of surgical intervention. We present a novel abdominal radiographic sign; duodenal and gastric dilatation occurring in association with limited small bowel gas confined to the right lower quadrant of abdomen and the total absence of colonic air that is indicative of malrotation with associated volvulus. This allows for an earlier diagnosis and expeditious surgery.

Published: 2010 May
Issue: 4(5) :: Pages: 13-18

   

Abstract: Gout is a systemic, metabolic disease that typically affects the peripheral joints. We describe an unusual presentation of gout affecting the facet joints and costovertebral joints in the thoracic and lumbar spine. A 54-year old man presents to the emergency department with increasing swelling and pain at the left elbow for one week and difficulty ambulating. The imaging work-up included plain radiographs of the left elbow, left wrist, and chest with subsequent admission for possible septic arthritis. MRI of the elbow showed olecranon bursitis and an erosion of the lateral epicondyle. CT scan demonstrated lytic cloud-like lesions localized to the facet joints and costovertebral joints of the thoracic and lumbar spine as well as bilateral medullary nephrocalcinosis. Possible hyperparathyroidism manifestations (including Brown tumors and medullary nephrocalcinosis) were evaluated with plains films of the hands; x-rays instead showed classic gouty arthritis. Our report reviews the disease, epidemiology, classic radiologic findings, and treatment of gout.

Published: 2010 May
Issue: 4(5) :: Pages: 27-31

   

Abstract: Aneurysms and pseudoaneurysms of the portal venous system are rarely seen following abdominal trauma but clinicians need to be aware of them as possible vascular complications following blunt trauma. This case report of a 10 year old boy following a handlebar injury demonstrates a clear causal relationship between trauma and portal venous pseudoaneurysm. Portal venous aneurysms have a prevalence of less than 0.4% and most are found in patients with underlying hepatocellular disease. Many are asymptomatic in which case surveillance is an accepted management strategy, with Doppler ultrasound proving useful. Complications including thrombosis, distal embolism, compression of the biliary tree and haemorrhage are usually indications for surgical management. Portal venous pseudoaneurysms may be managed conservatively but transcatheter embolisation can be used if there are ongoing complications or haemorrhage.

Published: 2010 May
Issue: 4(5) :: Pages: 32-40

   

Abstract: We report a case of postpartum hemorrhage due to adherent placenta. A 28 year old primiparous woman who underwent manual removal of placenta for primary postpartum haemorrhage soon after delivery was referred to our Institute on her third postnatal day because of persistent tachycardia and low grade fever. Placenta accreta was suspected on initial ultrasonographic examination. MRI examination confirmed the diagnosis of placenta accreta in few areas and revealed increta in other areas. On expectant management she developed genital tract sepsis and hence she was treated with intravenous Methotrexate after controlling infection with appropriate antibiotics. Doppler Imaging showed decreased blood flow to the placental mass and increased echogenecity on gray scale USG after Methotrexate administration. She expelled the whole placental mass on 35th postnatal day and MRI performed the next day showed empty uterine cavity. Morbid adhesion of placenta should be suspected even in primiparous women without any risk factors when there is history of post-partum hemorrhage. MRI is the best modality for evaluation of adherent placenta.