Search

Background: Endovascular management for vertebral artery dissecting aneurysms (VADA) is quite intricate which thereby necessitate different strategies per case. Our current study described various optimal strategies available for endovascular management of VADA other than flow diverter (FD). Results: 14 Patients presented with acute SAH and 4 patients with symptoms of mass effect. VADA were classified in 3 groups, viz contralateral vertebral artery is dominant group A (n = 5), co-dominant group B (n = 8) or group C hypoplastic (n = 5). Group A and B (n = 13) was further subdivided into three subtypes depending on location of aneurysm with respect to posterior inferior cerebellar artery (PICA), aneurysm proximal to the PICA, type I (n = 5); involving the PICA, type II (n = 1); and distal to the pica, type III (n = 4). Treatment strategy varied with type whether deconstructive or reconstructive methods using stents and coils in different fashion. Conclusion: Preprocedural angiographic work up delineating the anatomical location of the aneurysm, contralateral vertebral artery dominancy and nearby perforator status along with location of PICA is imperative in selecting the safest and optimal endovascular therapy option. [ABSTRACT FROM AUTHOR]

Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained. [ABSTRACT FROM AUTHOR]

Background: Posterior fossa malformations are less common than supratentorial malformations, but hemorrhages in posterior fossa are more serious due to presence of vital structures within this region. Most common cause of bleed in posterior fossa apart from hypertension is aneurysms but other vascular malformations are also there which cause hemorrhage. Here we discuss other causes of posterior fossa bleed beyond aneurysms. Results: A total of 80 patients were evaluated: 47 (58.8%) had aneurysms, 29 (36.3%) had arteriovenous malformations, one each had developmental venous anomaly and brainstem cavernoma. Thirty vascular malformations were detected, of which 18 (62.1%) were pial arteriovenous malformations (AVMs), 11 (37.9%) were dural arteriovenous fistulas (dAVF), and one had developmental venous anomaly (DVA). Six patients of AVM underwent both DSA and CTA, and CTA could correctly diagnose only 2 of 4 pial AVMs detected by DSA. Among two dAVFs detected by DSA, CTA could demonstrate dAVF only in one patient. Conclusion: CTA could be used as alternative to DSA in diagnosis and characterizing aneurysms in posterior fossa but for AVMs, 3D-CTA cannot replace DSA; however potential of time-resolved CTA (TR-CTA) appears promising. [ABSTRACT FROM AUTHOR]

Abstract: Despite all technological advances in imaging, many insulinomas remain occult. The aim of this study was to investigate the sensitivity of various pre-operative localization modalities used over the last three decades in our center. Tertiary care hospital, retrospective study (January 1990 and December 2020). This study consists of 36 patients of biochemically diagnosed cases of organic hyperinsulinemic hypoglycemia. Radiology findings were correlated with operative and histology findings. Median age of the patients was 45 years (M:F = 1:1.8). Multiple endocrine neoplasia type 1, islet cell hyperplasia (ICH), and malignancy were noted in 13.9, 5.6, and 5.6% patients, respectively. The median number of pre-operative localization tests used was 2 (1 = 41.7, 2–50, ≥ 3–8.4%). Contrast enhanced computerized tomography (CECT) was the commonest imaging modality used in 91.7% patients (standalone—39.5%) followed by ultrasonography (USG) in 41.7% patients. Pre-operative localization rate was 86.1% (66.6% vs 92.6% before and after 2005). The sensitivity of USG, CECT, MRI, and selective arterial calcium stimulation with hepatic venous sampling (ASVS) was 35.7%, 83.3%, 71.4%, and 75%, respectively. The pre-operative localization rates with one, two, and more modalities were 93.3, 77.7, and 100%, respectively. Bi-digital palpation and intraoperative USG were accurate in 97% cases resulting in successful primary surgery. Pre-operative localization techniques for insulinoma continue to evolve. CECT scan was found to be the most sensitive pre-operative localization modality in our experience. Almost all insulinomas can be detected pre-operatively by an experienced surgeon and expert performed IOUS. [ABSTRACT FROM AUTHOR]

Background: Reduction in height of barium column in timed barium esophagogram (TBE) and lower esophageal sphincter (LES) pressure on manometry has been used to assess efficacy of pneumatic dilation (PD) in patients with achalasia; data comparing these two methods to assess efficacy of PD are scanty. Methods: Sixty-two patients with achalasia undergoing PD were evaluated clinically (Eckardt's score), high-resolution manometry (HRM), and TBE (films at 1 and 5 min) before and 4 weeks after PD using 30 and 35 mm Rigiflex balloon (Microvasive, Milliford, MA, USA) in female and male patients, respectively. Response was defined clinically as Eckardt's score <3, by manometry as LES pressure <22.5 mmHg, and by TBE as adequate esophageal emptying (reduction in height of barium column by more than 50 % of pretreatment value in 5-min radiograph). Results: Forty-three out of sixty-two (69 %) patients [age 34 ± 12 years, 36 (58 %) male] responded, and 19 (31 %) did not respond to the first session of PD as assessed by post-PD Eckardt's score. Thirty-eight out of 43 (88 %) responders had adequate esophageal emptying of barium in TBE, while 31/43 (72 %) had LES pressure below 22.5 mmHg on HRM ( p = ns). Eight out of 19 (42 %) nonresponders showed failure in esophageal emptying (defined by lack of reduction in height of barium column by 50 %) in TBE, and 11/19 (58 %) had LES pressure >22.5 mmHg ( p = ns). Kaplan-Meier analysis showed that response on TBE and HRM at 1 month predicted clinical response well during 6 months follow up. Conclusion: TBE and esophageal HRM were comparable in assessing efficacy of PD in treatment of achalasia. [ABSTRACT FROM AUTHOR]

Fibromuscular dysplasia is the most common cause of renovascular hypertension in young patients. Digital subtraction angiography is still the best investigation used to determine the location, extent and complication of renal artery involvement. String of beads appearance (reflecting multiple stenoses), aneurysms, focal or tubular stenosis are classic angiographic appearances. The aim of this pictorial essay is to illustrate the various imaging findings of renal artery fibromuscular dysplasia. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 56-year-old man with a history of chest pain. Echocardiography revealed four equal size cusps in quadricuspid aortic valves and color doppler examination disclosed central aortic regurgitation. The patient underwent computed tomographic (CT) coronary angiography which revealed two separate origins of quadricuspid aortic valve.