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Rao K, Aswani Y, Bindner H, Patel A, Averill S, Davis T, Amarneh M. Intra-abdominal Venous Thromboses and Their Management. Acad Radiol 2024:S1076-6332(23)00693-1. [PMID: 38184416 DOI: 10.1016/j.acra.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
While a plethora of articles discuss management of deep venous thromboses in extremities, there is a relative scarcity of literature comprehensively describing intra-abdominal venous thromboses, and their management. Intra-abdominal venous thromboses include iliocaval venous obstruction (ICVO), hepatic venous thrombosis (HVT), portal venous thrombosis (PVT), renal vein thrombosis (RVT), splenic vein thrombosis (SVT), and gonadal vein thrombosis (GVT); each of which provides unique microenvironmental challenges to management. Doppler ultrasound is the first line imaging modality for diagnosis, and computed tomography and magnetic resonance imaging can help define the extent of thrombus burden and aid with interventional planning. Systemic anticoagulation remains the common medical treatment for intra-abdominal venous thrombosis, however, catheter directed thrombolysis and thrombectomy show positive outcomes in ICVO, HVT, PVT, and RVT, with transjugular intrahepatic portosystemic shunt (TIPS) creation especially beneficial in HVT and PVT. In this review article, we describe pathophysiology, clinical features, imaging findings, and current management options for intra-abdominal venous thromboses.
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Affiliation(s)
- Karan Rao
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Yashant Aswani
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Hans Bindner
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Aditi Patel
- Department of Vascular and Interventional Radiology, University of Iowa, lowa city, lowa, USA (K.R., Y.A., H.B., A.P.)
| | - Sarah Averill
- Roswell Park Comprehensive Cancer Institute, Buffalo, New York, USA (S.A.)
| | - Trent Davis
- Dignity Health St. Joseph's Radiology, Phoenix, Arizona, USA (T.D.)
| | - Mohammad Amarneh
- Department of Pediatric Interventional Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, Massachusetts 02115, USA (M.A.).
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McDermott T, Amarneh M, Sato Y, Watal P, Charmi V, Fuortes M, Faruqui S, Sato TS. Pediatric focal calvarial lesions: an illustrated review. Pediatr Radiol 2023; 53:2699-2711. [PMID: 37964037 DOI: 10.1007/s00247-023-05795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Focal skull lesions in children can be diagnostically challenging with a wide variety of potential etiologies. Understanding the diverse pathologies and recognizing their associated clinical and imaging characteristics is crucial for accurate diagnosis and appropriate treatment planning. We review pertinent anatomy of the scalp and calvarium and review different pathologies that can present with focal skull lesions in pediatric patients. These include neoplastic, non-neoplastic tumor-like, congenital, post traumatic, and vascular-associated etiologies. We review the key clinical and imaging features associated with these pathologies and present teaching points to help make the correct diagnosis. It is important for radiologists to be aware of the common and rare etiologies of skull lesions as well as the clinical and imaging characteristics which can be used to develop an accurate differential to ensure a timely diagnosis and initiate appropriate management.
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Affiliation(s)
- Tyler McDermott
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohammad Amarneh
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Yutaka Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pankaj Watal
- Department of Radiology, Nemours Children's Health, Orlando, FL, USA
| | - Vijapura Charmi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michaelangelo Fuortes
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sami Faruqui
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - T Shawn Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Amarneh M, Carney B, Davis TW. The Use of the Internal Thoracic Vein for Placement of Large-Bore Tunneled Catheters. J Vasc Interv Radiol 2023; 34:2038-2040. [PMID: 37437803 DOI: 10.1016/j.jvir.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Mohammad Amarneh
- Vascular and Interventional Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242.
| | - Brendan Carney
- Vascular and Interventional Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242
| | - Trent W Davis
- Vascular and Interventional Radiology, St Joseph's Hospital and Medical Center, Creighton University, Omaha, NE
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Eddin AS, Amarneh M, Goetz S, Donato Jr F. Successful endovascular treatment of superior mesenteric artery-duodenal fistula secondary to Rapunzel syndrome. Radiol Case Rep 2023; 18:2689-2691. [PMID: 37273725 PMCID: PMC10238254 DOI: 10.1016/j.radcr.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023] Open
Abstract
Rapunzel syndrome is a rare clinical entity in pediatric patients with a history of trichotillomania and trichophagia that has only been mentioned a few times in the literature. It is characterized by abnormal gastric bezoar formation that sometimes extends to the duodenum, jejunum, or colon. Here, we present a case of a 16-year-old previously healthy female patient who had prolonged hospitalization due to complications related to a significant gastric bezoar that led to massive bleeding due to a superior mesenteric artery (SMA)-duodenal fistula successfully treated with stent graft placement. Undiagnosed trichobezoar can lead to rare and unexpected complications, such as SMA-duodenal fistula, with life-threatening hemorrhagic shock. Prompt activation of massive transfusion protocol and endovascular control of the hemorrhage was vital to successfully treating our patient.
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Affiliation(s)
- Assim Saad Eddin
- Department of Radiology, University of Iowa Hospitals and Clinics, 738 Mission Point Rd, Iowa City, IA, 52242, USA
| | - Mohammad Amarneh
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sawyer Goetz
- Department of Radiology, Carver College of Medicine, Iowa City, IA, USA
| | - Francesco Donato Jr
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Oliva B, Amarneh M. Abstract No. 190 Fibrin sheath stripping of pediatric chest port catheters. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Amarneh M, Shaikh R. Clinical and imaging features in fibro-adipose vascular anomaly (FAVA). Pediatr Radiol 2020; 50:380-387. [PMID: 31834427 DOI: 10.1007/s00247-019-04571-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/11/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fibro-adipose vascular anomaly (FAVA) is a rare and recently described complex vascular malformation. The clinical and imaging features and morphology can be confusing and often overlap with features of other vascular malformations and tumors. OBJECTIVE To present the imaging characterization of FAVA in association with clinical features. MATERIALS AND METHODS We retrospectively evaluated clinical and imaging (MRI, sonography and venography) findings in FAVA. We documented the clinical presentation, lesion morphology, imaging characteristics, tissue distribution, pattern of contrast enhancement and vascular characteristics. RESULTS Thirty-eight people (31 female, 7 male) ages 1-30 years (mean 12 years) were diagnosed with FAVA based on clinical findings combined with imaging or histopathological findings (n=17). Most lesions were in the lower extremity (n=36). Three patterns were noticed: focal, focal infiltrative and diffuse. CONCLUSION Fibro-adipose vascular anomaly, a rare and complex vascular malformation, has distinct clinical and imaging features that a radiologist should be familiar with to avoid delay in diagnosis and to direct appropriate management.
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Affiliation(s)
- Mohammad Amarneh
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Iowa Hospitals and Clinics, Carver College of Medicine, Iowa City, IA, USA
| | - Raja Shaikh
- Division of Interventional Radiology, Boston Children's Hospital, 333 Longwood Ave., Boston, MA, 02115, USA.
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Amarneh M, Akhter A, Rajput MZ, LaBrecque DR, Abu-Yousef M. Gallbladder Scalloping, Mammillated Caudate Lobe, and Inferior Vena Cava Scalloping: Three Novel Ultrasound Signs of Cirrhosis. Acad Radiol 2018; 25:1374-1380. [PMID: 29602725 DOI: 10.1016/j.acra.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE We aimed to present three new ultrasound signs-gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping-and determine their accuracy in diagnosing liver cirrhosis. MATERIALS AND METHODS A total of 201 consecutive patients with a history of chronic liver disease who had undergone ultrasound imaging and liver biopsy were identified. A senior ultrasound radiologist blindly reviewed the ultrasound examinations. Specificity, sensitivity, positive predictive value, and negative predictive value of diagnosing cirrhosis were calculated for all evaluated ultrasound signs and selected combinations of signs, using the liver biopsy results as the reference standard. RESULTS Of the 201 patients, 152 (76%) had either pathology-proven cirrhosis or significant fibrosis. Caudate lobe hypertrophy was the most specific (88%) and most positive predictor (90%) for cirrhosis, whereas mammillated caudate lobe was the most sensitive (78%). Inferior vena cava scalloping was the most specific (78%) of the three proposed ultrasound signs. When signs were combined, the presence of either gallbladder scalloping or liver surface nodularity was highly sensitive for cirrhosis (87%), whereas the presence of either gallbladder scalloping or inferior vena cava scalloping with caudate lobe hypertrophy was highly specific (93%). CONCLUSIONS Gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping are three novel signs that improve the accuracy of ultrasound in diagnosing cirrhosis.
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