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Uterine fibroids are the most common pelvic benign tumours occurring in women of reproductive age. Current treatment options include surgical procedures, pharmacological therapies, and minimally invasive procedures. The most commonly applied and accepted minimally invasive procedure used in the treatment of symptomatic uterine fibroid is uterine artery embolisation (UAE). Uterine artery embolisation is a minimally invasive procedure that can be used either as an auxiliary method or the main treatment method of symptomatic uterine fibroids. We would like to present the application of pre-operative UAE before hysterectomy in anaemic women with giant uterine fibroid (21.9 × 14.9 × 10.4 cm) and HIV-associated nephropathy. Among the possible treatment options for uterine fibroids in cases like the one presented in our manuscript, hysterectomy is the treatment of choice. However, surgical treatment in a patient with severe comorbid conditions and giant uterine fibroid carries serious risk of perioperative complications. Pre-operative UAE decreases such risk by reducing blood loss during hysterectomy and shortening operation/anaesthesia time. Although the benefits of pre-operative UAE before planned myomectomy or hysterectomy in high surgical risk patients with large fibroids has yet to be confirmed in a well-designed clinical trial, this procedure seems to be a promising tool to reduce the risk of perioperative complications in such patients.

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and one of the most malignant neoplasms with high incidence and mortality in humans worldwide. The complex nature of the disease and its high resistance to systemic therapies result in poor prognosis for patients with advanced HCC. Case Report: In March 2017, the patient was admitted to the Department of Oncological Surgery, where a non-anatomical tumor resection was performed. Three years later, the patient developed a single change in segment 8 of the liver that was a relapse of the neoplastic process. Based on the Bracelon Criteria, the patient was qualified for the 1st stage of chemoembolization using the Seldinger method. In the presented patient as a result of the applied treatment, the neoplastic process was stabilized. Conclusion: The chemoembolization treatment that was applied to the presented patient turned out to be the correct treatment option. After only the first stage of chemoembolization, the patient regressed the neoplastic lesion.

The present clinical practice recommendations are addressed to physicians of all specialties, who perform Doppler ultrasound examinations of the kidneys on a daily basis, and in particular to specialists in radiology and imaging diagnostics. The recommendations were based on the Ultrasonography Standards of the Polish Ultrasound Society and current scientific reports consistent with Evidence Based Medicine. The paper discusses patient preparation protocol, examinat ion technique with particular emphasis on patient’s position allowing to obtain proper Doppler angle of insonation, as well as diagnostic limitations of the technique. Normal blood flow parameters as well as those indicating hemodynamically significant stenosis are also presented. Although the 2013–2014 American guidelines for renal artery duplex sonography (AIUM Practice Parameter for the Performance of Native Renal Artery Duplex Sonography and AIUM Practice Guideline for the Performance of an Ultrasound Examination of Solid-Organ Transplants), which were the basis for many national recommendations, have not been significantly updated to date, a large body of scientific research indicates the need for revision of current Doppler ultrasound standards and parameters, particularly for patients receiving endovascular treatment due to renovascular hypertension. Therefore, the paper refers to the current issue of ultrasound scan interpretation in patients receiving endovascular stenting, after transplantation of kidney, as well as in pediatric patients.

External injuries are one of the common reasons for reporting to hospital emergency departments. Peripheral vascular injuries occur in up to about 25% of upper and lower extremity injury cases. Arteriovenous fistula is a type of arterial injury. Doppler ultrasound is currently the primary diagnostic method for vascular injuries as it allows for the implementation of appropriately targeted treatment, indicating the potential need for extended diagnosis or patient qualification for endovascular or classical surgery. Endovascular procedures are currently an acknowledged treatment method in peripheral vascular injuries. We present a case of endovascular treatment in a patient with posttraumatic arteriovenous fistula in the lower leg. Patient qualification and treatment efficacy assessment were performed using Doppler ultrasound.

Aim: The aim of the study was to assess patient selection for embolization of varicoceles based on ultrasonography. An additional objective of the work was to evaluate the results of endovascular treatment. Material and methods: From January 2015 till August 2017, 53 patients with varicoceles diagnosed in an ultrasound examination underwent endovascular treatment in the Department of Interventional Radiology and Neuroradiology in Lublin, Poland. Each ultrasound examination was performed using the Logiq 7 GE Medical System with a linear probe at 6–12 MHz using the B-mode and Doppler functions. The study was performed in both the supine and standing position of the patient. The morphological structures of the scrotum and the width of the pampiniform venous plexus were assessed. Based on clinical signs and symptoms as well as ultrasound findings, the patients were selected for endovascular treatment. This procedure involved the implantation of coils in the distal and proximal parts of the testicular vein and administration of a sclerosing agent between the coils. Results: Varicoceles were confirmed in all patients during a color Doppler scan. Diagnostic venography confirmed venous stasis or retrograde flow in the testicular vein and widened vessels of the pampiniform venous plexus over 2 mm in diameter in all patients undergoing endovascular treatment. The diagnostic efficacy of ultrasound was 100%. The technical success of the procedure was 89%. One patient had a recurrence of varicose veins (2.2%). There were no complications in any of the patients. Conclusions: Ultrasound is the preferred method in the diagnosis of varicoceles and selection for their treatment. Testicular vein embolization is a minimally invasive procedure characterized by high efficacy and safety.

Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.

Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms.

Although visceral artery aneurysms are rare, mortality due to their rupture is high, estimated at even 25–75%. That is why it is significant to detect each such lesion. Visceral artery aneurysms are usually asymptomatic and found incidentally during examinations performed for other indications. Autopsy results suggest that most asymptomatic aneurysms remain undiagnosed during lifetime. Their prevalence in the population is therefore higher. The manifestation of a ruptured aneurysm depends on its location and may involve intraperitoneal hemorrhage, gastrointestinal and portal system bleeding with concomitant portal hypertension and bleeding from esophageal varices. Wide access to diagnostic tests, for example ultrasound, computed tomography or magnetic resonance imaging, helps establish the correct diagnosis and a therapeutic plan as well as select appropriate treatment. After a procedure, the same diagnostic tools enable assessment of treatment efficacy, or are used for the monitoring of aneurysm size and detection of potential complications in cases that are ineligible for treatment. The type of treatment depends on the size of an aneurysm, the course of the disease, risk of rupture and risk associated with surgery or endovascular procedure. Endovascular treatment is preferred in most cases. Aneurysms are excluded from the circulation using embolization coils, ethylene vinyl alcohol, stents, multilayer stents, stent grafts and histoacryl glue (or a combination of these methods).

Aim of the study: The aim of this study is to assess the prevalence and evolution of perirenal fluid collections in a group of 488 patients who have undergone kidney transplantation. Material and methods: Sonographic documentation of 488 deceased-donor kidney recipients was evaluated for the prevalence of perirenal fluid collections and their evolution in time, depending on selected demographic features of the patients, time of detection, initial dimensions and precise position of the collection relative to the kidney and the location of the transplanted organ in the right or left iliac fossa. The collected data were used for statistical analysis to determine the strength of the potential relationships. Results: In 146 out of 488 subjects perirenal fluid collections were found. In 1/3 of the patients more than one fluid collection was diagnosed. Over 40% of fluid collections were detected within 10 days from the date of the first scan and 24.11% were detected within 10–20 days from the date of the first scan. The majority of fluid collections were located near the lower pole of the kidney. Perihilar collections were the least common. Collections encapsulating the kidney and subcutaneous collections were the largest in size on average. A statistically significant difference between the size of collections located on the surface and the size of those located near the upper pole of the transplanted kidney was demonstrated. However, no correlation was proven to exist between the persistence of the fluid collection and its position relative to the transplanted kidney and its initial size. Conclusions: The correct evaluation of a fluid collection’s dynamics of development and nature requires periodic follow-up of the recipient, preferably in a single clinical center. Ultrasonography is an inexpensive, non-invasive and repeatable method for the determination of the presence of fluid collections. However, the decision whether treatment is necessary requires the sonographic image to be compared with the laboratory signs of inflammation and biochemical analysis of the contents of fluid collections.