Balloon-occluded retrograde transvenous obliteration for treatment of congenital intrahepatic portosystemic venous shunt:A case report

Congenital intrahepatic portosystemic venous shunt(CPSVS), a rare vascular malformation, has been described in both children and adults and can lead to severe neurophysiological complications. However, a standard therapeutic protocol for CPSVS has not been elucidated. With the advantage of minimally invasive techniques,transcatheter embolization has been used to treat CPSVS. The condition is challenging to manage, especially in patients with large or multiple shunts, through which rapid blood flow can cause ectopic embolism. Here, we describe a case of CPSVS with a large shunt that was successfully treated with balloon-occluded retrograde transvenous obliteration with interlocking detachable coils.

Ground glass nodules with scattered or eccentric island-shaped consolidations may have poor outcomes

Background:To explore the effect of scattered or eccentric shaped types of ground glass opacity(GGO)on outcomes of patients with solid-dominant peripheral lung adenocarcinoma.Methods:We evaluated patients with solid-dominant peripheral lung adenocarcinoma,who underwent radical surgery at Zhongshan Hospital,Fudan University,between January 2013 and December 2015.Morphologically heterogeneous solid-dominant lung adenocarcinoma in imaging findings was based on the last preoperative computed tomography(CT)scans.Endpoints were recurrence-free survival(RFS)and overall survival(OS).Kaplan-Meier analysis and the log-rank test were used to estimate survival differences.Impact factors were assessed by univariable logistic regression analysis.Results:We retrospectively collected data from 200 patients,including 170 patients with central island-shaped CT imaging,18 patients with scattered shaped CT imaging,and 12 patients with eccentric shaped CT imaging.Eleven patients experienced recurrence or metastases.Kaplan-Meier survival curves showed significant survival differences between the central island-shaped type and scattered shaped or eccentric shaped type for OS(c-stage IA:5-year OS:100%vs.92.1%;HR=0.019,p=0.0025;p-stage IA:100%vs.95.2%;HR=0.146,p=0.1139)and RFS(c-stage IA:5-year RFS:100%vs.59.7%;HR=0.001,p<0.0001;p-stage IA:100%vs.64.5%;HR<0.001,p<0.0001).Univariable logistic regression analysis showed that scattered and eccentric shaped types were related to poor outcomes(p<0.012,odds ratio=18.8)。Conclusions:Relative spatial position of GGO and solid components may affect patient outcomes.Patients with scattered or eccentric shaped GGO may have a poor prognosis.