An idiopathic renal arteriovenous(AV) fistula is a rare malformation of the kidney that may present insidiously with heart failure or hematuria.The treatment may be challenging due to large fistula size that may limit...An idiopathic renal arteriovenous(AV) fistula is a rare malformation of the kidney that may present insidiously with heart failure or hematuria.The treatment may be challenging due to large fistula size that may limit endovascular management.The authors report a case of an 85-year-old Caucasian woman who presented with acute heart failure and was found to have a right renal AV fistula.Since she had no prior history of renal intervention or trauma,a diagnosis of idiopathic renal AV fistula was made.She was managed by endoluminal occlusion using multiple stainless steel coils and Amplatzer vascular plug II device.The follow-up computed tomography showed complete occlusion of the fistula.This report highlights the late presentation of this rare disease and presents the utility of the combination of coils and Amplatzer device for management of a large fistula.It also reiterates that even if large,these fistulas can be managed by endovascular occlusion.展开更多
Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patient...Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patients with NAFLD(68.4%male;mean age 63 years)with histology confirmed HCC and triphasic liver CT.CT images were independently reviewed by four readers blinded to clinical and pathology data.The reviewers assessed HCC for arterial phase hyper enhancement(APHE),portal venous phase washout(PVWO),delayed phase washout(DPWO),and enhancing capsule.Features of cirrhotic morphology and portal hypertension(PH)were also evaluated.The final CT features were determined by majority and a fifth reader reviewed cases lacking majority.Inter-rater agreement was determined by prevalence-adjusted kappa.Results:Mean HCC size was 3.6±2.8 cm(range,1.1-16.0 cm).The HCCs showed APHE in 92.1%,PVWO in 55.3%,DPWO in 81.6%,and enhancing capsule in 44.7%.Cirrhotic morphology was present in 65.8%and PH in 63.2%.Inter-rater agreement was moderate to almost perfect for APHE(0.74-1.0),cirrhosis(0.79-0.89),and PH(0.79-0.95),weak to perfect for DPWO(0.47-0.95)and poor for PVWO(0-0.42). ;Conclusion:NAFLD associated HCC demonstrate less frequent portal venous washout on CT which may affect their imaging diagnosis.展开更多
文摘An idiopathic renal arteriovenous(AV) fistula is a rare malformation of the kidney that may present insidiously with heart failure or hematuria.The treatment may be challenging due to large fistula size that may limit endovascular management.The authors report a case of an 85-year-old Caucasian woman who presented with acute heart failure and was found to have a right renal AV fistula.Since she had no prior history of renal intervention or trauma,a diagnosis of idiopathic renal AV fistula was made.She was managed by endoluminal occlusion using multiple stainless steel coils and Amplatzer vascular plug II device.The follow-up computed tomography showed complete occlusion of the fistula.This report highlights the late presentation of this rare disease and presents the utility of the combination of coils and Amplatzer device for management of a large fistula.It also reiterates that even if large,these fistulas can be managed by endovascular occlusion.
文摘Aim:To determine the computed tomography(CT)features of non-alcoholic fatty liver disease(NAFLD)associated hepatocellular carcinoma(HCC).Methods:In this institutional review board approved study,we reviewed 38 patients with NAFLD(68.4%male;mean age 63 years)with histology confirmed HCC and triphasic liver CT.CT images were independently reviewed by four readers blinded to clinical and pathology data.The reviewers assessed HCC for arterial phase hyper enhancement(APHE),portal venous phase washout(PVWO),delayed phase washout(DPWO),and enhancing capsule.Features of cirrhotic morphology and portal hypertension(PH)were also evaluated.The final CT features were determined by majority and a fifth reader reviewed cases lacking majority.Inter-rater agreement was determined by prevalence-adjusted kappa.Results:Mean HCC size was 3.6±2.8 cm(range,1.1-16.0 cm).The HCCs showed APHE in 92.1%,PVWO in 55.3%,DPWO in 81.6%,and enhancing capsule in 44.7%.Cirrhotic morphology was present in 65.8%and PH in 63.2%.Inter-rater agreement was moderate to almost perfect for APHE(0.74-1.0),cirrhosis(0.79-0.89),and PH(0.79-0.95),weak to perfect for DPWO(0.47-0.95)and poor for PVWO(0-0.42). ;Conclusion:NAFLD associated HCC demonstrate less frequent portal venous washout on CT which may affect their imaging diagnosis.
