Klippel-Trénaunay syndrome (KTS)is arare angio-osteo-hypertrophic syndrome characterized by vascular malformations,soft tissue and/or bone hypertrophy, and varicose veins.For the purpose of describing the imaging...Klippel-Trénaunay syndrome (KTS)is arare angio-osteo-hypertrophic syndrome characterized by vascular malformations,soft tissue and/or bone hypertrophy, and varicose veins.For the purpose of describing the imaging findings and elucidating the role of medical imaging in the diagnosis and assessment of patient with KTS,we have reviewed the imaging data of 14 KTS patients.The imaging features on different imaging modalities were analyzed.Unilateral lower limb involvement was evident in 71% of cases (n=10)and bilateral but asymmetric lower limb involvement in the remaining 29% of cases (n=4).The most commonly depicted imaging features were varicosities in 93% (n=13),muscle hypertrophy in 79%(n=11)and venous anomalies in 64%(n=9).Other less common imaging findings included lymphedema in 29%(n=4),arterial malformations 29%(n=4),soft tissue hemangiomas 21%(n=3),pelvic and thigh phleboliths 21%(n=3), venous aneurysrns 21%(n=3),bone abnormalities 14%(n=2)and lymphadenopathy 14%(n=2).A severe unilateral lower limb deformity resulting in contractures and muscle atrophy of the whole limb was depicted in 1 case.The pathognomonic marginal vein of Servelle was identified in 2 cases.AV shunt was highly suspected in 4 cases and was confirmed by DSA in 1 case,making Klippel-Trénaunay-Weber syndrome a more apt diagnosis.Associated ipsilateral duplicated renal artery:was found in 1 case.We have concluded that medical imaging is the cornerstone in the.diagnosis and assessment of severity and complications,follow-up and differentiation of KTS from other similar conditions.Different imaging modalities play complementary roles in the evaluation of KTS patients.展开更多
AIM：To evaluate the efficacy and safety of emergency transcatheter arterial embolization （ETAE） for patients with acute massive duodenal ulcer hemorrhage. METHODS：Twenty-nine consecutive patients with acute massiv...AIM：To evaluate the efficacy and safety of emergency transcatheter arterial embolization （ETAE） for patients with acute massive duodenal ulcer hemorrhage. METHODS：Twenty-nine consecutive patients with acute massive bleeding of duodenal ulcer were admitted to our hospital from 2006 to 2011. Superselective angiography of the celiac and gastroduodenal arteries was performed to find out the bleeding sites before ETAE, then, embolotherapy was done with gelatin sponge particles or microstrips via a 5 French angio-graphic catheter or 3 French microcatheter. After ETAE, further superior mesenteric arteriography was under-taken in case collateral circulation supplied areas of the duodenal ulcer. Technical and clinical success rates were analyzed. Changes in the mucous membrane were observed using endoscopy following ETAE. RESULTS：Angiography showed active bleeding with extravasation of contrast medium in seven cases with a 24% positive rate of celiac artery bleeding, and in 19 cases with a 65.5% rate of gastroduodenal artery bleeding. There were no angiographic signs of bleeding in three patients who underwent endoscopy prior to ETAE. Twenty-six patients achieved immediate hemostasis and technical success rate reached 90%. No hemostasis was observed in 27 patients within 30 d after ETAE and clinical success rate was 93%. Recurrent hemorrhage occurred in two patients who drank a lot of wine who were treated by a second embolotherapy in the same way. Five patients underwent transient ischem with light abdominal pain under xiphoid, spontaneous restoration without special treatment. No mucous necrosis happened to 29 cases for ischem of gastroduodenal arteries embolized. CONCLUSION：ETAE is an effective and safe measure to control acute massive bleeding of duodenal ulcer.展开更多
Background Embolization of collateral arteries is important for transcatheter hepatic arterial chemoembolization （TACE）in patients with hepatocellular carcinoma （HCC）. We evaluated the efficacy and safety of TACE,...Background Embolization of collateral arteries is important for transcatheter hepatic arterial chemoembolization （TACE）in patients with hepatocellular carcinoma （HCC）. We evaluated the efficacy and safety of TACE, and the prevention and management of complications among patients in whom the internal thoracic artery （ITA） was involved.Methods A total of 3614 cases of HCC were treated with 12 645 TACEs and 211 of these cases were given ITA angiography, including 156 cases of which the ITA was involved. We performed 562 TACEs in the 156 cases. We analyzed imaging examinations, types of embolization, and the incidence, prevention, and treatment of complications.Results The ITA was successfully embolized in 156 cases. Angiography of the ITA showed that the major trunks were thickened with an increased number of branching vessels, contributing to intrahepatic and extrahepatic tumor blood supply. Different embolization methods were selected according to the blood supply, to effectively embolize the tumor and mitigate or avoid serious complications. TACE with ITA embolization extended the mean interval time between two treatments from 2.54 months （1-17 months） to 4.23 months （1-30 months） compared with that without ITA embolization.The ITA supplied the HCC in the following instances： HCC was located in the ventral hepatic area and abutted the diaphragm （P=0.0064） and repeated TACE （P=0.0003）. The survival rate of TACE with ITA embolization for HCC was better than TACE without ITA embolization （P ＜0.00001 ）.Conclusions In cases with massive HCC or nodular HCC, the ITA may be involved in supplying blood to the tumor.This occurs when the tumor is positioned in the ventral hepatic area and abuts the diaphragm （S2, S4, and S8）, and especially if cases have a previous history of TACE. In this case series, embolization was effective, extended the mean interval time of interventional therapy, and prolonged survival time.展开更多
We observed a rare case of invasive mucinous adenocarcinoma （IMA） with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Ho...We observed a rare case of invasive mucinous adenocarcinoma （IMA） with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml （reference value of negative is 〈 14 pg/ml）, Mycobacterium tuberculosis culture was positive, and tuberculin skin test （PPD） was negative （skin induration 〈 5 mm）. The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic- predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.展开更多
文摘Klippel-Trénaunay syndrome (KTS)is arare angio-osteo-hypertrophic syndrome characterized by vascular malformations,soft tissue and/or bone hypertrophy, and varicose veins.For the purpose of describing the imaging findings and elucidating the role of medical imaging in the diagnosis and assessment of patient with KTS,we have reviewed the imaging data of 14 KTS patients.The imaging features on different imaging modalities were analyzed.Unilateral lower limb involvement was evident in 71% of cases (n=10)and bilateral but asymmetric lower limb involvement in the remaining 29% of cases (n=4).The most commonly depicted imaging features were varicosities in 93% (n=13),muscle hypertrophy in 79%(n=11)and venous anomalies in 64%(n=9).Other less common imaging findings included lymphedema in 29%(n=4),arterial malformations 29%(n=4),soft tissue hemangiomas 21%(n=3),pelvic and thigh phleboliths 21%(n=3), venous aneurysrns 21%(n=3),bone abnormalities 14%(n=2)and lymphadenopathy 14%(n=2).A severe unilateral lower limb deformity resulting in contractures and muscle atrophy of the whole limb was depicted in 1 case.The pathognomonic marginal vein of Servelle was identified in 2 cases.AV shunt was highly suspected in 4 cases and was confirmed by DSA in 1 case,making Klippel-Trénaunay-Weber syndrome a more apt diagnosis.Associated ipsilateral duplicated renal artery:was found in 1 case.We have concluded that medical imaging is the cornerstone in the.diagnosis and assessment of severity and complications,follow-up and differentiation of KTS from other similar conditions.Different imaging modalities play complementary roles in the evaluation of KTS patients.
文摘AIM：To evaluate the efficacy and safety of emergency transcatheter arterial embolization （ETAE） for patients with acute massive duodenal ulcer hemorrhage. METHODS：Twenty-nine consecutive patients with acute massive bleeding of duodenal ulcer were admitted to our hospital from 2006 to 2011. Superselective angiography of the celiac and gastroduodenal arteries was performed to find out the bleeding sites before ETAE, then, embolotherapy was done with gelatin sponge particles or microstrips via a 5 French angio-graphic catheter or 3 French microcatheter. After ETAE, further superior mesenteric arteriography was under-taken in case collateral circulation supplied areas of the duodenal ulcer. Technical and clinical success rates were analyzed. Changes in the mucous membrane were observed using endoscopy following ETAE. RESULTS：Angiography showed active bleeding with extravasation of contrast medium in seven cases with a 24% positive rate of celiac artery bleeding, and in 19 cases with a 65.5% rate of gastroduodenal artery bleeding. There were no angiographic signs of bleeding in three patients who underwent endoscopy prior to ETAE. Twenty-six patients achieved immediate hemostasis and technical success rate reached 90%. No hemostasis was observed in 27 patients within 30 d after ETAE and clinical success rate was 93%. Recurrent hemorrhage occurred in two patients who drank a lot of wine who were treated by a second embolotherapy in the same way. Five patients underwent transient ischem with light abdominal pain under xiphoid, spontaneous restoration without special treatment. No mucous necrosis happened to 29 cases for ischem of gastroduodenal arteries embolized. CONCLUSION：ETAE is an effective and safe measure to control acute massive bleeding of duodenal ulcer.
文摘Background Embolization of collateral arteries is important for transcatheter hepatic arterial chemoembolization （TACE）in patients with hepatocellular carcinoma （HCC）. We evaluated the efficacy and safety of TACE, and the prevention and management of complications among patients in whom the internal thoracic artery （ITA） was involved.Methods A total of 3614 cases of HCC were treated with 12 645 TACEs and 211 of these cases were given ITA angiography, including 156 cases of which the ITA was involved. We performed 562 TACEs in the 156 cases. We analyzed imaging examinations, types of embolization, and the incidence, prevention, and treatment of complications.Results The ITA was successfully embolized in 156 cases. Angiography of the ITA showed that the major trunks were thickened with an increased number of branching vessels, contributing to intrahepatic and extrahepatic tumor blood supply. Different embolization methods were selected according to the blood supply, to effectively embolize the tumor and mitigate or avoid serious complications. TACE with ITA embolization extended the mean interval time between two treatments from 2.54 months （1-17 months） to 4.23 months （1-30 months） compared with that without ITA embolization.The ITA supplied the HCC in the following instances： HCC was located in the ventral hepatic area and abutted the diaphragm （P=0.0064） and repeated TACE （P=0.0003）. The survival rate of TACE with ITA embolization for HCC was better than TACE without ITA embolization （P ＜0.00001 ）.Conclusions In cases with massive HCC or nodular HCC, the ITA may be involved in supplying blood to the tumor.This occurs when the tumor is positioned in the ventral hepatic area and abuts the diaphragm （S2, S4, and S8）, and especially if cases have a previous history of TACE. In this case series, embolization was effective, extended the mean interval time of interventional therapy, and prolonged survival time.
基金The support from National Natural Science Foundation of China （No. 81200017） and Foundation of Traditional Chinese and Western Medicine of General Hospitals in Shanghai （No. ZHYY-ZXYJHZX- 2-201701 ） is gratefully acknowledged.
文摘We observed a rare case of invasive mucinous adenocarcinoma （IMA） with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml （reference value of negative is 〈 14 pg/ml）, Mycobacterium tuberculosis culture was positive, and tuberculin skin test （PPD） was negative （skin induration 〈 5 mm）. The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic- predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.
