Active Extravasation Of Contrast Medium Research Articles

Prognostic value of instrumental research methods in the diagnosis of complicated forms of liver malignant tumors

Objective: To determine prognostic value of instrumental methods in the diagnosis of complicated forms of malignant forms of focal liver lesion.Material and methods: The experience of treating 112 patients with primary and secondary tumor lesions of the liver was analyzed. Life-threatening complications, such as spontaneous rupture of the tumor node leading to massive intraperitoneal bleeding and cancerous peritonitis, were noted in 32 (28.5%) cases. Clinical and echographic signs of the threat of this complication developing were observed in 26 (23.2%) patient. Ultrasound (US) and CT semiotics of the tumor node rupture included signs of hemoperitoneum, focal heterogeneous formation with the presence of perilesional hematoma, active extravasation of contrast medium, and focal discontinuity of the liver contour at the site of the focal formation.Results and discussion: Most often, the size of the tumor node exceeded 8.0 cm (in 65% of patients). Protrusion of the tumor through the liver surface was noted in 23 (39.6%) cases. Invasion of the tumor into adjacent organs and tissues was observed in 16 (27.5%) patients. Sites of phlebothrombosis, predominantly in the system of hepatic veins, detected by echo-Dopplerography of liver vessels, were present in 12 (20.6%) patients.Conclusion: Predictors of spontaneous rupture of the tumor node may include: size of the formation more than 5 cm; protrusion of the tumor through the liver surface; phlebothrombosis by tumor masses, leading to increased intramural pressure; extraliver invasion of the tumor into adjacent organs and tissues.

Spontaneous Rupture of Ovarian Artery Aneurysm in a Postmenopausal Woman: A Case Report and Literature Review.

Spontaneous rupture of an ovarian artery aneurysm is an extremely rare, life-threatening disease and has been reported to be most highly associated with pregnancy. The current study presents a case of intraperitoneal and retroperitoneal hematoma caused by spontaneous rupture of a right ovarian artery aneurysm in a 56-year-old woman. A 56-year-old woman visited the emergency room with right lower quadrant abdominal pain. Contrast-enhanced computed tomography showed a large retroperitoneal and intraperitoneal hematoma and active extravasation of contrast medium in the right retroperitoneum. Consequently, transcatheter arterial embolization was successfully performed. Spontaneous rupture of an ovarian artery aneurysm should be suspected in multiparous women with abdominal or flank pain even if it is unrelated to pregnancy. Suspicion of this entity is needed for earlier diagnosis and management.

Massive hemothorax due to inferior phrenic artery injury after blunt trauma.

Injury to the inferior phrenic artery after blunt trauma is an extremely rare event, and it may occur under unanticipated conditions. This case report describes an injury to the left inferior phrenic artery caused by blunt trauma, which was complicated by massive hemothorax, and treated with transcatheter arterial embolization (TAE).An 81 year-old female hit by a car while walking at the traffic intersection was transferred to the emergency department, computed tomography scanning revealed active extravasations of the contrast medium within the retrocrural space and from branches of the internal iliac artery. The patient underwent repeated angiography, and active extravasation of contrast medium was observed between the retrocrural space and the right pleural space originating from the left inferior phrenic artery. The injured left inferior phrenic artery was successfully embolized with N-butyl cyanoacrylate, resulting in stabilization of the patient’s clinical condition.Inferior phrenic artery injury should be recognized as a rare phenomenon and causative factor for hemothorax. TAE represents a safe and effective treatment for this complication and obviates the need for a thoracotomy.

Mesenteric angiography for acute gastrointestinal bleed: predictors of active extravasation and outcomes

Ongoing gastrointestinal bleeding (GIB) following endoscopic therapy and deciding between mesenteric angiography and surgery often challenge surgeons. We sought to identify predictors of positive angiographic study (active contrast medium extravasation) and characterize outcomes of embolization for acute GIB. We retrospectively analyzed angiographies for GIB at 2 teaching hospitals from January 2005 to December 2008. The χ2, Wilcoxon rank sum and t tests determined significance. A Cox proportional hazards model was used for multivariate analyses. Eighteen of 83 (22%) patients had active extravasation on initial angiography and 25 (30%) were embolized. Patients with active extravasation had more packed red blood cell (PRBC; 5.3 v. 2.8 units, p < 0.001) and fresh frozen plasma (4.8 v. 1.7 units, p = 0.005) transfusions 24 hours preangiography and were more likely to be hemodynamically unstable at the time of the procedure (67% v. 28%, p = 0.001) than patients without active extravasation. Each unit of PRBC transfused increased the risk of a positive study by 30% (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6 per unit). Embolization did not decrease recurrent bleeding (53% v. 52%) or length of stay in hospital (28.1 v. 27.5 d, p = 0.95), but was associated with a trend toward fewer emergency surgical interventions (13% v. 26%, p = 0.31) and greater 30-day mortality (33% v. 7%, p = 0.006) than nonembolization. Blind embolization was performed in 10 of 83 (12%) patients and was found to be an independent predictor of death in patients without active extravasation (HR 9.2, 95% CI 1.5-55.9). The number of PRBC units transfused correlates with greater likelihood of a positive study. There was a significant increase in mortality in patients who underwent angioembolization. Large prospective studies are needed to further characterize the indications for angiography and blind embolization.

Emergency gastroduodenal artery embolization by sandwich technique for angiographically obvious and oblivious, endotherapy failed bleeding duodenal ulcers

To determine the feasibility, safety, and efficacy of adopting a standardized protocol for emergency transarterial embolization (TAE) of the gastroduodenal artery (GDA) with a uniform sandwich technique in endotherapy-failed bleeding duodenal ulcers (DU). Between December 2009 and December 2010, 15 patients with endotherapy-failed bleeding DU were underwent embolization. Irrespective of active extravasation, the segment of the GDA supplying the bleeding DU as indicated by endoscopically placed clips was embolized by a uniform sandwich technique with gelfoam between metallic coils. The clinical profile of the patients, re-bleeding, mortality rates, and response time of the intervention radiology team were recorded. The angioembolizations were reviewed for their technical success, clinical success, and complications. Mean duration of follow-up was 266.5 days. Active contrast-medium extravasation was seen in three patients (20%). Early re-bleeding was noted in two patients (13.33%). No patient required surgery. There was 100% technical success, while primary and secondary clinical success rates for TAE were 86.6 and 93.3%, respectively. Focal pancreatitis was the single major procedure-related complication. There was no direct bleeding-DU-related death. The response time of the IR service averaged 150min (range 60-360min) with mean value of 170min. Emergency embolization of the GDA using the sandwich technique is a safe and highly effective therapeutic option for bleeding DUs refractory to endotherapy. A prompt response from the IR service can be ensured with an institutional protocol in place for such common medical emergencies.

Lumbar Artery Injury Following Posterior Spinal Instrumentation for Scoliosis

Vascular injuries are uncommon but potentially serious complications of spinal surgery. Lumbar artery lesion complicating posterior spinal instrumentation for scoliosis has been occasionally described. A 39-year-old woman with adult scoliosis was treated with correction and stabilization from T8 to L5 via a midline posterior approach. Transpedicular screws were inserted from levels L1 to L5 on the convex left side and at T11, T12, L4, and L5 on the concavity right side. Pedicle screws were not inserted from L2 to L4 on the right side due to difficulty identifying the pedicle channel with the probe. The instrumentation was completed with 2 hooks at T8 and T5 on the left side and 1 at T7. Five hours postoperatively, the patient suffered a hypotensive attack and her abdomen was distended. Her hemoglobin level was 4.5 g/dL. Hemodynamic stabilization was achieved with emergent therapy, including fluid resuscitation, blood, and plasma transfusion. An urgent contrast-enhanced abdominal computed tomography scan showed a large hematoma at the right retroperitoneum with active extravasation of contrast medium, but the source of bleeding was not detectable because of metallic artifacts. Immediate angiography demonstrated rupture of the third right lumbar artery. Selective microcoil embolization was performed with occlusion of the corresponding branch. The bleeding stopped and hemodynamic parameters were stable. No spinal cord impairment or muscle infarction occurred, and 1-year follow-up was uneventful. Lumbar artery injury should be considered as a complication after posterior spinal surgery for scoliosis and prompt diagnosis and intervention are required. Selective lumbar artery embolization is a safe and effective procedure to stop bleeding in hemodynamically stable patients after fluid resuscitation and blood transfusion.

Emergent Endovascular Repair as Damage Control Step of Aortic Injury After Posterior Spinal Instrumentation

Emergent Endovascular Repair as Damage Control Step of Aortic Injury After Posterior Spinal Instrumentation

Effectiveness of Coil Embolization in Angiographically Detectable versus Non-detectable Sources of Upper Gastrointestinal Hemorrhage

To determine whether the effectiveness of arterial embolization in patients with acute upper gastrointestinal hemorrhage is related to the visualization of contrast medium extravasation at angiography. Transcatheter embolization was performed in 108 patients who experienced acute upper gastrointestinal hemorrhage during a 5-year period. Patient charts were retrospectively reviewed. Thirty-six patients who underwent embolization after angiography demonstrated active contrast medium extravasation from an involved artery. Seventy-two patients underwent embolization in the absence of contrast medium extravasation into a bowel lumen. Embolization technique, requirement for further blood products, need for further surgery, and 30-day mortality were recorded. The gastroduodenal artery (GDA) was embolized in 26 of the 36 patients (72%) with extravasation, and the left gastric artery was embolized in 10 (28%). The GDA was embolized in 64 of the 72 patients (89%) without extravasation, and the left gastric artery was embolized in 13 (18%). After embolization, 23 of the 36 patients (64%) with extravasation and 44 of the 72 (61%) without extravasation required additional blood product transfusions. Seven of the 36 patients (19%) with extravasation and 16 of the 72 (22%) without extravasation required subsequent surgery secondary to bleeding. Thirty-day hemorrhage-related mortality was 17% (six of 36 patients) in the positive extravasation group and 22% (16 of 72 patients) in the negative extravasation group. The treatment success rate was 44% (16 of 36 patients) in the positive extravasation group and 44% (32 of 72 patients) in the negative extravasation group. In patients with acute upper gastrointestinal hemorrhage, arterial embolization is equally effective in patients who demonstrate active contrast medium extravasation at angiography as in those who do not show contrast extravasation.

Active abdominal bleeding: contrast-enhanced sonography

Active contrast medium extravasation is a recognized and important angiographic and computed tomographic (CT) sign of bleeding. It is an indicator of active, ongoing, and potentially life-threatening hemorrhage and, hence, of the need for an immediate surgical or interventional treatment. Sonography (US) is frequently used as the first imaging option for screening patients with traumatic and nontraumatic abdominal emergencies. Owing to the current possibilities of low-mechanical index, real-time, contrast-specific systems, it is now possible to detect a contrast leakage by using US. This finding opens new possibilities in the assessment and management of several abdominal emergencies, including trauma (initial workup and monitoring), spontaneous hematomas, and rupture of aneurysms or masses. This article describes the technique, findings, possibilities, and limitations of contrast-enhanced US in the evaluation of active abdominal bleeding.

Real-Time, Contrast-Enhanced Sonography: A New Tool for Detecting Active Bleeding

Active contrast medium extravasation is a known angiographic and computed tomographic sign of ongoing, potentially life-threatening hemorrhage. Sonography (US) is frequently the first imaging option for screening patients with abdominal emergencies. Because of the current possibilities of low-mechanical-index, real-time, contrast-specific systems, it is possible to detect contrast leakage by using US. The purpose of this article is report our pilot experience in the evaluation of active traumatic and nontraumatic bleeding with contrast-enhanced US. In a 2-year period, we performed 153 consecutive emergent contrast-enhanced US studies. Traumatic emergencies accounted for 83 examinations and nontraumatic emergencies accounted for 70. We used the contrast-specific mode Contrast Tuned Imaging and the contrast medium SonoVue. A 2.4- to 4.8-mL contrast medium bolus was injected with continuous US acquisition, starting immediately after contrast injection and lasting 1 to 6 minutes. Contrast extravasation was found in 20 cases (13%). These included spleen injury (n = 8), liver injury (n = 3), kidney injury (n = 1), abdominal aortic aneurysm rupture (n = 5), splenic angiosarcoma rupture (n = 1), postsurgical bleeding after abdominal aortic aneurysm repair (n = 1), and postsplenectomy bleeding (n = 1). Active extravasation appeared as a round, hyperechoic pool or as a fountain-like, hyperechoic jet. Our retrospective clinical study shows for the first time how US can detect contrast medium extravasation, a significant indicator of active hemorrhage and of need for prompt surgical or interventional treatment.