Cases

The cases presented in this website are those performed by IR physicians at various institutes. These include a mix of simple to complex cases. These are meant to be educational and didactic in nature. Some are self-explanatory while some require additional reading. As these are very time consuming, efforts were made to include as much information as possible.

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  • Case presentations
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  • Obstetrics & Gynaecology
  • Orthopedics
  • Paediatrics
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  • Trauma
  • Uncategorized
  • Vascular
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Hematuria

Hematuria

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A Young female in mid 30’s, with a complex history of colovaginal fistula, and cT4N2M0 (stage III) invasive rectal adenocarcinoma,  s/p chemo radiotherapy, proctocolectomy with complex right pelvic surgery and intraoperative radiotherapy and right ureteral reimplant. Now have findings suggestive of progression of recurrent tumor in pelvis. Presented to OSH with massive hematuria.

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Traumatic Renal Bleed

Traumatic Renal Bleed

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An elderly male presented to ER after a fall from the ladder. Initial examination did not reveal any acute injuries. During the course of admission, developed severe loin pain, and labs demonstrated acute drop in Hb. Patient was transferred to radiology department for imaging.  

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Retroperitoneal Bleed

Retroperitoneal Bleed

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A woman in 80’s transferred from outside hospital with right hemiparesis, concerning for acute stroke. With other comorbid conditions, CT demonstrating acute infarct and out of window for thrombolysis and thrombectomy, she was admitted for conservative management and physical rehabiliation.  

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Chest wall hematoma during pericardial drain placement

Chest wall hematoma during pericardial drain placement

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A patient in early 70’s presented to the clinic with type A and B acute aortic dissection. Underwent emergency surgical intervention where TEVAR was placed from the arch to the mesenteric segment of the aorta. The dissection extends to the common iliac arteries. Post operative patient developed moderate pericardial effusion which was not amenable for […]

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Dismantled IVC filter removal

Dismantled IVC filter removal

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A patient in his mid 60’s has an IVC filter placed at an outside hospital presents now for removal as he is on adequate anticoagulation.   The procedure was performed as an elective procedure. No prior imaging available for comparison. With the way the filters are designed, the only approach for removal is via the […]

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Hemarthrosis

Hemarthrosis

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Old female who is post knee arthroplasty few years ago had been suffering from recurrent hemarthrosis. Failed conservative management, recurrent aspirations were done for comfort. Considered for surgical exploration. Before surgical attempt, referral made for possible endovascular intervention.  

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Mycotic aneurysms

Mycotic aneurysms

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Mycotic aneurysms are infectious break in the wall of an artery with formation of a blind, saccular outpouching that is contiguous with the arterial lumen. Earlier detection of infected aneurysms is critical for timely treatment to optimize patient outcome. An young male with HTN, Type A and B dissection, developed fungal mass after surgery.

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Vasculitis

Vasculitis

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A case not be missed. An unfortunate young female presented with unexplained abdominal pain. What followed next are the series of events exploring the complex history,  diagnosis and management at each level based on the clinical presentation.  

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Case series 1

Case series 1

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Its a first big mile stone for the website. We have reached case 50. As a tribute to the first success, following is a case series 1 which is compilation of cases. A short history is given followed by the images. Most of them are straight forward in diagnosis. Where necessary, further reading is recommended […]

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Acute abdominal pain

Acute abdominal pain

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An young female presented to the ED with acute abdominal pain. A CT abdomen and pelvis was obtained, concerning for an atypical presentation of appendicitis. CT demonstrated an incidental finding of splenic artery aneurysm. What follows next…..  

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Post Whipple’s Ascites

Post Whipple’s Ascites

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Patient with pancreatic cancer, underwent Whipple’s procedure, Now presenting with large volume of abdominal ascites requiring frequent tapping (3-4 litres every 3 days). CT Abdomen and pelvis demonstrate focal narrowing of the portal vein confluence, Gastric varices, Gastro-colic varices. Reasons for ascites?  

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Upper GI Bleed

Upper GI Bleed

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61 yo F w/sharp abdo pain after leaving a concert. OSH CT shows a large intraabdominal mass, sent to CCF for further eval. – Hx of many surgeries (cholecystectomy, lap band, appendectomy, lap band, roux-en-Y, aborted roux-en-Y revision) – Was on Eliquis until 2 days ago – Tachy and mildy hypotensive

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Optease Filter retreival

Optease Filter retreival

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Optease filter is not recommended in the present day due to its design and difficulties associated with removal. Still we do come across cases with these type of filters. The strict recommendation is to get these removed within few weeks of placement. This is a case where the filter was placed 8 weeks ago and […]

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Post Whipples anastomotic leak

Post Whipples anastomotic leak

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Middle aged female presents 1 week after whipples procedure, with increasing abdominal pain. CT demonstrate peri-anastomotic collection. Within next few hours, patient becomes HD unstable and on pressors. Transferred to university hospital for further management. Decision was made to drain the peri-anastomotic collection. Based on the findings, PTHC and drain placement was considered.  

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Provocative angiogram

Provocative angiogram

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A middle aged person, on anticoagulants for MVR presents with acute drop in Hb, Non invasive tests including endoscopy, colonoscopy along with NM study were negative. Negative angiograms x 2,  still continues to bleed requiring multiple transfusions. Decision was made to perform provocative angiogram before exploring surgical options,  

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Splenic artery Pseudoaneurysm embolization: Coils migration

Splenic artery Pseudoaneurysm embolization: Coils migration

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A middle aged person with acute pancreatitis developed PSA over the course. Referred to IR for embolization, which was successful. Over the course, it was noted unraveling of the coils and the patient was asymptomatic. A combined plan between the surgeons and IR, leading to removal of the coils and placement of plug across. No […]

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Pelvic Bleed

Pelvic Bleed

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Young female with metastatic cervical cancer, S/P chemo therapy, radiotherapy, surgery. S/P bilateral neph tubes placements secondary to ureteric involvement from the pelvic mass. Present admission for exchange of the tubes, during which had acute drop in hemoglobin from vaginal bleed. No surgical options and patient was in the process of palliative care.  

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Adrenal venous sampling

Adrenal venous sampling

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Young male with resistant hypertension requiring at least 3 or more Hypertensive medications. Underwent tests including blood work and Imaging. Imaging revealed a left adrenal adenoma. For further evaluation, patient was referred to interventional radiology for adrenal venous sampling to localize the side of abnormality.  

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Renal bleed and dissection

Renal bleed and dissection

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Post nephrolithotomy and nephrostomy tube insertion by nephrologist: Persistent drop in Hb and clots in the urine, suspecting bleed. Successful embolization. Repeat angiogram demonstrate residual bleeding, with the host catheter tip moving forward with respiration causing a focal dissection of the main renal artery. No bleeding thru the true lumen. Patient stable.  

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