Liquefaction and Rupture of Angiomyolipoma after Embolization.
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ABSTRACT:
SUBMITTER: Uzzo RN
PROVIDER: S-EPMC7710590 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Publications
Liquefaction and Rupture of Angiomyolipoma after Embolization.
Uzzo Robert N RN Drevik John J Panaro Joseph J Geynisman Daniel M DM
Journal of vascular and interventional radiology : JVIR 20200826 12
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Project description:Arteriovenous shunting associated with angiomyolipoma is an unusual entity, which carries important implications to embolization approach. We present a distinctive case involving a 41-year-old woman who presented with retroperitoneal hemorrhage relating to renal angiomyolipoma. During angiography for urgent embolization, a complex vascular supply with arteriovenous shunting was encountered. Superselective embolization using alcohol or small particles is the standard approach to definitive treatment of symptomatic angiomyolipoma; however; their use is precluded in the setting of arteriovenous shunt hemodynamics. In this case, a 2-step approach was employed by which the initial hemorrhage was treated with proximal embolization using large gelatin foam and metallic coils. This resulted in decreased flow through the arteriovenous shunt, allowing the use high viscosity ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide for definitive treatment.
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Project description:Introduction and importanceThis is a case of giant renal angiomyolipoma treated with partial nephrectomy without pre-embolization of the supplying arteries.Case presentationThe patient presented for regular checkup, a mass in the left flank was found on examination. No other symptoms were present. No history of medical or surgical importance was found.Clinical discussionCT scan revealed a heterogenous mass in the left kidney at the upper pole. The treatment options were discussed with the patient and he opted for complete removal of the mass. Partial nephrectomy was done without pre embolization of the arteries. The procedure went without complications, the blood loss was manageable during the operation (200 cc). The patient was admitted for 48 h post operation and was discharged shortly after. The excised mass was sent for histopathological examination, the report was received, the features of the mass was consistent with angiomyolipoma without other types of malignant masses present.ConclusionThe takeaway is that partial nephrectomy provides a convenient option for treatment of giant renal angiomyolipomas. Preservation of the renal function, reduction of the recurrence risk or re embolization of the supplying arteries makes it a viable alternative for other treatment modalities.
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Project description:IntroductionHemorrhage from a recurrent aneurysm is a major concern after coiling for intracranial aneurysms. We aimed to identify aneurysm recurrence patterns associated with hemorrhage.Material and methodsWe investigated radiological data of patients who underwent coiling for intracranial aneurysms in 2008-2016 and were followed-up for at least 6 months. Aneurysm recurrence patterns were classified as: type Ⅰ, enlargement of aneurysm neck; type Ⅱ, recurrent cavity within the coil mass; type Ⅲ, recurrent cavity along the aneurysm wall; and type Ⅳ, formation of a daughter sac. We evaluated the incidence of various recurrence patterns with or without hemorrhage.ResultsOf the 173 aneurysms included in the study (mean follow-up period, 32 months; range, 6-99 months), 22 (13%) recurred and required re-treatment. The recurrence patterns included type Ⅰ, Ⅱ, Ⅲ, and Ⅳ in 7 (4%), 4 (2%), 9 (5%), and 2 (1%) cases, respectively. Most of the type Ⅰ, Ⅱ, and Ⅲ recurrences occurred within 1 year, and type Ⅳ occurred at 7 years after coiling. Three aneurysms exhibited hemorrhage, one with type Ⅲ and two with type Ⅳ pattern. The two aneurysms with type Ⅳ recurrence initially occurred as type Ⅰ; however, the recurrent neck enlarged gradually, resulting in new sac formation.ConclusionsWe recommend prompt re-treatment for aneurysms recurring with type Ⅲ or Ⅳ patterns, as such patterns were associated with hemorrhage. Furthermore, we need a special care to type Ⅰ recurrence with enlargement of recurrent neck because this specific pattern may develop to type Ⅳ.
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Project description:PurposeThe aim of this study was to explore a radiomics-clinical model for predicting the response to initial superselective arterial embolization (SAE) in renal angiomyolipoma (RAML).Materials and methodsA total of 78 patients with RAML were retrospectively enrolled. Clinical data were recorded and evaluated. Radiomic features were extracted from preoperative contrast-enhanced CT (CECT). Least absolute shrinkage and selection operator (LASSO) and intra- and inter-class correlation coefficients (ICCs) were used in feature selection. Logistic regression analysis was performed to develop the radiomics, clinical, and combined models where the fivefold cross-validation method was used. The predictive performance and calibration were evaluated by the receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was used to measure clinical usefulness.ResultsThe tumor shrinkage rate was 29.7% in total, and both fat and angiomyogenic components were significantly reduced. In the radiomics model, 12 significant features were selected. In the clinical model, maximum diameter (p = 0.001), angiomyogenic tissue ratio (p = 0.032), aneurysms (p = 0.048), and post-SAE time (p = 0.002) were significantly associated with greater volume reduction after SAE. Because of the severe linear dependence between radiomics signature and some clinical parameters, the combined model eventually included Rad-score, aneurysm, and post-SAE time. The radiomics-clinical model showed better discrimination (mean AUC = 0.83) than the radiomics model (mean AUC = 0.60) and the clinical model (mean AUC = 0.82). Calibration curve and DCA showed the goodness of fit and clinical usefulness of the radiomics-clinical model.ConclusionsThe radiomics-clinical model incorporating radiomics features and clinical parameters can potentially predict the positive response to initial SAE in RAML and provide support for clinical treatment decisions.
| S-EPMC10949893 | biostudies-literature
Project description:BackgroundA diverse clinical course after the spontaneous rupture of hepatocellular carcinoma (HCC) renders nonstandardized treatment protocols.PurposeTo evaluate clinical course and role of transcatheter arterial embolization (TAE) in patients with rupture of HCC.Materials and methodsThis retrospective study included 127 patients who were treated for ruptured HCC at single institution between 2005 and 2014. After multidisciplinary discussion, patients underwent medical management, TAE, emergency surgery or staged surgery. Patients were retrospectively divided into two groups based on the intent of treatment: curative and palliative. The rebleeding rate and 1-month and overall survival (OS) were compared between two groups. The incidence and survival of patients with intraperitoneal drop metastasis (IPDM) were also analyzed.ResultsThe overall rebleeding rate in patients who underwent TAE was 3.1% (3/96). One-month mortality rate was 6.3% (8/127). The rebleeding and 1-month mortality rates were not significantly different between two groups. OS was significantly higher in the curative treatment group (median: 12.0 vs 2.2 months, p<0.001). Among 96 patients who initially received TAE, ten patients underwent staged operation (10.4%). The median OS for medical management, TAE, emergency surgery and staged surgery was 2.8, 8.7, 19.1 and 71.1 months, respectively. Of all patients, 15.2% developed IPDM mostly within 1 year and their survival was poorer than that of patients without IPDM (median: 6.3 vs. 15.1 months, p<0.001).ConclusionTAE provided effective immediate hemostasis with a low rebleeding rate and may serve as a bridge to elective surgery. IPDM frequently occurred within 1 year and manifested poor survival; thus, close surveillance should be considered for patients with spontaneous rupture of HCC.
| S-EPMC9483098 | biostudies-literature
Project description:Background and purposePostinterventional rupture of intracranial aneurysms (IAs) remains a severe complication after flow diverter treatment. However, potential hemodynamic mechanisms underlying independent predictors for postinterventional rupture of IAs remain unclear. In this study, we employed arteriography-derived radiomic features to predict this complication.MethodsWe included 64 patients who underwent pipeline flow diversion for intracranial aneurysms, distinguishing between 16 patients who experienced postinterventional rupture and 48 who did not. We performed propensity score matching based on clinical and morphological factors to match these patients with 48 patients with postinterventional unruptured IAs at a 1:3 ratio. Postinterventional digital subtraction angiography were used to create five arteriography-derived perfusion parameter maps and then radiomics features were obtained from each map. Informative features were selected through the least absolute shrinkage and selection operator method with five-fold cross-validation. Subsequently, radiomics scores were formulated to predict the occurrence of postinterventional IA ruptures. Prediction performance was evaluated with the training and test datasets using area under the curve (AUC) and confusion matrix-derived metrics.ResultsOverall, 1,459 radiomics features were obtained, and six were selected. The resulting radiomics scores had high efficacy in distinguishing the postinterventional rupture group. The AUC and Youden index were 0.912 (95% confidence interval: 0.767-1.000) and 0.847 for the training dataset, respectively, and 0.938 (95% confidence interval, 0.806-1.000) and 0.800 for the testing dataset, respectively.ConclusionRadiomics scores generated using arteriography-derived radiomic features effectively predicted postinterventional IA ruptures and may aid in differentiating IAs at high risk of postinterventional rupture.
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Project description:Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.
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Project description:BackgroundOmental artery aneurysms are extremely rare. Their rupture is related to high mortality and often treated by open surgery. We describe a case of a spontaneous rupture of a left omental artery aneurysm (OAA) that was successfully treated by transcatheter arterial embolization (TAE).Case presentationA 68-year-old man presented with acute abdominal pain. On examination, he was hypotensive and tachycardic with a blood pressure of 90/50 mm Hg. He had diffuse abdominal distension and tenderness.An abdominal enhanced computed tomography scan (CT) showed a rupture of the left OAA responsible for moderate hemoperitoneum. We performed a successful TAE.ConclusionRuptured OAA causes high mortality. OAA represents the rarest form of splanchnic artery aneurysms. Interventional radiology permits to avoid unnecessary surgery.TAE is a safe procedure to control ruptured OAA. We highlight the importance of a rapid embolization if the patient is hemodynamically stable.
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