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Abstract Purpose The purpose of this systematic review and meta-analysis was to evaluate the safety, technical, and clinical effectiveness of percutaneous Transarterial Embolization (TAE) in treating spontaneous retroperitoneal hematomas as well as assess treatment outcomes in patients who underwent target or empirical embolization. Materials and methods Through the PubMed, Embase, and Google Scholar databases, an extensive search was performed in the fields of spontaneous retroperitoneal hematomas treated with transcatheter arterial embolization. We collected pooled data on 141 patients from 6 separate articles selected according to the inclusion and exclusion criteria. Results Technical success rate was 100% in all six studies, for both targeted and empirical embolization. The clinical success rate varied from 56.3 to 89.5%. The total number of complications related to the embolization procedure was 10 events out of 116 procedures analyzed. Empirical or empirical embolization was performed in three studies, where the source of active bleeding was not evident during DSA. A meta-analysis compared the rebleeding rates between targeted and empirical embolization groups. The odds ratio from pooled data from the three assessed studies (72 patients) showed no significant difference in rebleeding rates after empirical TAE compared with targeted TAE. Conclusions TAE is a safe, effective, and potentially life-saving procedure for the treatment of life-threatening spontaneous retroperitoneal hematomas. Empirical and targeted TAE procedures demonstrate a relatively low risk of complications, compared to the high technical and relatively high clinical success rates.

Abstract Background This retrospective multicentric study aims to report on technical safety and effectiveness of pseudoaneurysms embolization with glue (N-butyl cyanoacrylate) adopting a percutaneous direct puncture approach. Results Fifty-four patients data were collected from five centers. All patients at the time of treatment presented with unruptured PAs and were hemodynamically stable. True aneurysms and lesions treated with embolics other than glue were excluded. Pseudoaneurysms diagnosis was based on CT and anamnestic data; initial investigation with digital-subtracted arteriography was acquired in all cases; then, percutaneous embolizations were performed in the angio-suite (ultrasound, fluoroscopy, ConeBeam CT guidance) or in CT. Technical success was considered as complete pseudoaneurysm embolization at final imaging with sole percutaneous strategy, without need for additional endovascular embolization. Clinical success was intended as pseudoaneurysm resolution within one week follow-up with stabilization or restored clinical conditions. Pseudoaneurysms origins were traumatic (57.4%), inflammatory (24.1%) or spontaneous (18.5%); 39 patients (72.2%) were symptomatic, presenting with pain and/or pulsatile mass. Mean lesions diameter was 19.3 mm (range: 7–30); pseudoaneurysms were located in abdomen (48.1%), limbs (42.6%) and thorax (9.3%). Coagulation function was impaired in 16.6% and 48.1% was under antiplatelets/anticoagulation therapy. In 16.6% the percutaneous approach followed previous treatments failure. The image-guidance modality for percutaneous puncture was most often ultrasound combined with fluoroscopy (38%). Clinical success was obtained in all patients while technical success occurred in 94.4% because 3 patients required an additional endovascular embolization. Complications were registered in 14.8%, all of low grade without clinical sequelae neither prolonged recovery (7 non target embolizations, 1 post-embolization syndrome). Conclusions In this study, pseudoaneurysms embolization with glue via percutaneous direct puncture was safe and effective with a low rate of minor complications.

Gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalisation. Although 80–85% of cases of gastrointestinal bleeding resolve spontaneously, it can result in massive haemorrhage and death. The presentation of gastrointestinal bleeding can range from asymptomatic or mildly ill patients requiring only conservative treatments to severely ill patients requiring immediate intervention. Identifying the source of the bleeding can be difficult due to the wide range of potential causes, the length of the gastrointestinal tract and the intermittent nature of the bleeding. The diagnostic and therapeutic approach is fully dependent on the nature of the bleeding and the patient’s haemodynamic status. Radiologists should be aware of the appropriate uses of computed tomography angiography and other imaging modalities in patients with acute gastrointestinal bleeding, as well as the semiotics of bleeding and diagnostic pitfalls in order to appropriately diagnose and manage these patients. The learning objective of this review is to illustrate the computed tomography angiography technique, including the potential role of dual-energy computed tomography angiography, also highlighting the tips and tricks to identify the most common and uncommon features of acute gastrointestinal bleeding and its obscure form.

Ureteral involvement by a tumor is common, and both partial and complete obstructions can result in symptoms that are distressing and debilitating, especially in cancer patients for whom the resection of the primary tumor is not considered an option. Maintaining ureteric patency in these patients is a challenge. In addition, in cases where a patient has undergone nephroureterectomy due to primary transitional cell cancer, it becomes necessary to decompress the urinary tract to preserve the contralateral kidney from irreversible damage. This is possibly due to ureteral stenting, both retrograde and anterograde, and percutaneous nephrostomy (PCN). Since imaging plays an important role in the routine monitoring of stents, their more and more increasing use requires radiologists to be familiar with these devices, their correct position, their potential complications, and their consequences. The aim of this review is to offer a comprehensive review of the imaging features of some urinary stents and to show the complications encountered in cancer patients as a direct consequence of an invasive diagnostic or therapeutic procedure. Specifically, we focus on ureteral stents and PCN.

Massive hemoptysis represents a distressing and life-threatening condition: 95% of cases originate from the bronchial artery system, with pulmonary arteries accounting for 6%–11% of cases. The most common etiology of hemoptysis from the pulmonary artery system is represented by pulmonary artery pseudoaneurysms (PAPs). PAPs are defined as the focal dilation of a pulmonary artery branch, involving only the adventice, with a higher risk of rupture than a true aneurysm. It constitutes a rare finding, often underdiagnosed by radiologists. However, PAPs can be life-threatening if undiagnosed due to a high mortality rate (50%). They frequently occur in patients affected by erosive inflammatory processes and necrotising infections of the lung or heart, but other etiological factors include trauma, vasculitis, neoplasia, pulmonary hypertension and Hughes–Stovin Syndrome. PAPs due to oncologic etiologies are rare. Among oncologic etiologies, the most frequent are represented by primary lung cancer rather than metastases. Today, CT angiography represents the imaging modality of choice; not only to establish diagnosis, but if performed with an appropriate timing of intravenous contrast, it also helps to plan therapy with an endovascular approach. In fact, endovascular treatment is the preferred therapeutic approach in managing hemoptysis due to PAPs, since a surgical approach is associated with a high risk of morbidity and mortality, especially in patients who are poor surgical candidates. In this article we report the case of massive hemoptysis due to an unusual giant PAP of the posterior lower branch of the right pulmonary artery, in a patient affected by pulmonary colliquated and confluent metastases, successfully treated by endovascular embolisation.

Visceral artery pseudoaneurysms (VAPAs) are extremely rare and pseudoaneurysms in the superior mesenteric artery (SMA) and its branches, particularly the middle colic artery, are the rarest. These account for 6–8% of all VAPAs with an incidence of 0.01%. They can be associated with an inflammatory disease (such as pancreatitis), infection or arise as a post-surgical complication, but they can also be due to a traumatic damage to the artery caused by a full-thickness slit in the arterial wall. They can be asymptomatic or manifest with symptoms such as abdominal pain, nausea and vomiting, local pressure symptoms (such as a pulsatile mass or a bruit) and gastrointestinal bleeding. Imaging techniques play a key role in the diagnosis of VAPAs and angiography still represents the gold standard, although nowadays it has a pivotal role for treatment with the possibility to perform an endovascular embolisation. In fact, although rare, VAPAs are of clinical importance mainly because they can cause life-threatening intra-abdominal or retroperitoneal haemorrhage and so prompt treatments are crucial, whether they are symptomatic, haemorrhagic or incidentally found. In the past, surgery was the treatment of choice, but in recent years with the improvement and development of interventional vascular techniques, surgery has been replaced by transcatheter endovascular embolisation due to its low morbidity and mortality and high success rate. In this article, we report the case of an unusual giant spontaneous pseudoaneurysm of the middle colic artery in a patient with a scoliotic abdominal aortic aneurysm successfully treated by endovascular embolisation.

Background: Paratesticular tumors (PTs) are very uncommon, accounting for almost 5% of intrascrotal tumors. Of these, adenomatoid tumors (ATs) represent about 30% and most frequently arise in the tail of the epididymis. Ultrasound (US) examination is the first-choice imaging method employed for the evaluation of the scrotum. Unfortunately, there are no specific US-imaging features useful for distinguishing an AT from a malignant lesion. To increase diagnostic accuracy and confidence, new sonographic techniques have incorporated real-time tissue elastography (RTE) under the assumption that malignant lesions are “harder” than benign lesions. Case report: In our paper, we describe a very rare case of a 60-year-old patient with a giant paratesticular mass mimicking malignancy when examined using RTE, i.e., it was stiffer than the surrounding tissue (a hard pattern), which, upon histologic examination, was identified as an AT. Discussion: Our case underscores that there is also a significant overlap between different types of scrotal lesions when RTE is used for examination. Thus, if a PT is found, the imaging approach should always be supplemented with more definitive diagnostic methods, such as FNAC or FNAB, which are the only diagnostic methods capable of leading to a certain diagnosis. Conclusions: Alongside underlining the importance of pre-operative imaging for making correct diagnoses and selecting the correct therapy, we wish to draw our readers’ attention to this report in order to demonstrate the clinical implications of a giant AT presenting as stiff lesions when examined using SE.

Splenic artery pseudoaneurysm (PSA) is a contained vascular wall lesion associated with a high mortality rate, generally related to pancreatitis, trauma, malignancy, iatrogenic injury, and segmental arterial mediolysis. Computed tomography angiography allows us to visualize the vascular anatomy, differentiate a PSA from an aneurysm, and provide adequate information for endovascular/surgical treatment. The present review reports on the main state-of-the-art splenic artery PSA diagnosis, differentiating between the pros and cons of the imaging methods and about the endovascular treatment.