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Antiangiogenic agents, such as ramucirumab, should be cautiously administered along with radiotherapy because of the enhanced risk of adverse events.

A 25-year-old man with a massive traumatic subcutaneous hematoma in his back was transferred to our emergency department. Contrast-enhanced computed tomography revealed a pseudoaneurysm with extravasation within the hematoma. The patient was unable to take a supine position due to the massive back hematoma. We thus performed a transcatheter embolization of bilateral cervical branches with the patient in the prone position, via a radial artery. After two embolizations, successful hemostasis was achieved. The prone transradial catheterization technique is useful for embolization in patients who cannot be in the supine position.

A 52-year-old woman with right-sided breast cancer was diagnosed with a left pulmonary arteriovenous malformation (PAVM) by computed tomography (CT). Percutaneous embolization of the PAVM after treatment of the breast cancer was scheduled to prevent a paradoxical embolic event. She underwent lumpectomy, followed by systemic chemotherapy in combination with tangential field radiotherapy. Subsequently, she received endocrine therapy with tamoxifen, anastrozole, and exemestane, sequentially. There was no change in the PAVM on CT performed during the administration of anastrozole. Subsequently, CT performed five months after switching to exemestane showed obviously decreased size of the affected vessels, and the sac had almost disappeared. To the best of our knowledge, this is the first case report to describe the spontaneous regression of a PAVM during endocrine therapy for breast cancer.

Leiomyosarcoma of the inferior vena cava is a rare malignant tumor originating from smooth muscle cells of the vascular media. Its preoperative diagnosis by conventional noninvasive examinations such as abdominal ultrasonography, X-ray computed tomography, and magnetic resonance imaging, may be difficult because of their nonspecific findings. We present the case of a 72-year-old woman with leiomyosarcoma of the inferior vena cava diagnosed by intravascular ultrasonography.

Aim The aim of this study was to evaluate the dose-volume histogram parameters for late hematuria and rectal hemorrhage in patients receiving radiotherapy after radical prostatectomy. Patients and methods Data of 86 patients treated between January 2006 and June 2019 were retrospectively evaluated. The median radiation dose was 64 Gy in 32 fractions. Receiver operating characteristic (ROC) curves were used to identify optimal cut-off values for late adverse events. Results Eleven patients experienced hematuria, and the 5-year cumulative rate was 18%. Four patients experienced rectal hemorrhage, and the 5-year cumulative rate was 7%. ROC curve analysis demonstrated the following significant cut-off values: bladder V50 Gy: 43% (p=0.02) and V40 Gy: 50% (p=0.03) for hematuria, and rectum V60 Gy: 13% (p=0.04) and V50 Gy: 33% (p=0.03) for rectal hemorrhage. Conclusion This is the first study to identify dose constraints that may reduce hematuria and rectal hemorrhage in patients receiving radiotherapy in the postoperative setting.

Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly, for which transcatheter embolization with metallic coils is the standard of care. Although detecting recanalization after embolotherapy is crucial, direct visualization of residual flow with computed tomography or magnetic resonance (MR) imaging is generally difficult due to metal artifacts. We present a case of recanalized PAVM after coil embolization detected by ultra-short echo time MR angiography using a modified signal targeting with an alternative radio frequency spin labeling technique.

Pulmonary varix is a rare entity that presents as a focal aneurysmal dilatation of the pulmonary vein and is frequently mistaken for a pulmonary arteriovenous malformation (PAVM). It is important to distinguish between pulmonary varix and PAVM because the former does not usually require treatment. We present the findings of non-contrast-enhanced magnetic resonance angiography with the time-spatial labeling inversion pulse technique in case of pulmonary varix and PAVM and the utility of this method for differentiating between these diseases.

We report a case of intractable chylothorax after right upper lobectomy and nodal dissection via median sternotomy for lung cancer in a 67-year-old man. Lymphangiography (LAG) with lipiodol and sequential computed tomography showed the thoracic duct in the left posterior mediastinum and massive lymphatic leakage in the anterior and middle mediastinum. The Chylous leakage was resolved by LAG with lipiodol. Our findings suggest that variation of the thoracic duct should be evaluated by LAG when intractable chylothorax or chylomediastinum develops after anterior mediastinal surgery.

An 83-year-old man with a history of carbon ion radiotherapy for hepatocellular carcinoma nine years ago presented to a primary care hospital with a fever and abdominal pain. He underwent computed tomography, which revealed the rupture of a hepatic pseudoaneurysm close to the fiducial marker for carbon ion radiotherapy and bleeding into the bile duct. He was successfully treated with transcatheter arterial embolization. Thereafter, re-rupture occurred from a site proximal to the first rupture, and this was treated similarly. It is necessary to be alert for not only tumor recurrence but also pseudoaneurysm occurrence after carbon ion radiotherapy.

Highlights • Serum lactate level is a useful clinical marker of nonocclusive mesenteric ischemia. • Some patients with NOMI may be unresponsive to continuous arterial infusion of papaverine. • Continuous arterial infusion of PGE1 may limit the extent of resection in refractory NOMI., Introduction Nonocclusive mesenteric ischemia (NOMI) after surgery has an extremely poor prognosis with a mortality rate of 30–100%. We report a patient with NOMI following aortic valve replacement who failed to improve despite continuous intra-arterial infusion of papaverine, but was successfully treated with alprostadil (prostaglandin E1 [PGE1]) infusion. Presentation of case The patient is a 77-year-old man who underwent aortic valve replacement. Due to elevated serum lactate levels five hours after intensive care unit admission, superior mesenteric arteriography was performed, establishing the diagnosis of NOMI. Although continuous intra-arterial infusion of papaverine was begun, lactate levels remained elevated. Repeat angiography and laparotomy revealed extensive ischemic changes of the intestine. The vasodilator was changed to PGE1, which improved arterial spasm. The patient ultimately needed an ileocecal resection, but the extent of the resection was limited with concomitant PGE1 administration. Discussion In the present patient, although NOMI was unresponsive to appropriate treatment including intra-arterial infusion of papaverine, continuous intra-arterial infusion of PGE1 salvaged most of the intestine. Conclusions In a patient with recurrent NOMI despite appropriate treatment including intra-arterial infusion of papaverine, continuous intra-arterial infusion of PGE1 may limit the extent of intestinal resection needed. Continuous intra-arterial infusion of PGE1 may be a useful treatment for patients with refractory NOMI.

To evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access. Twenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined. The mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p

Objective A puerperal vulvovaginal hematoma may continue to grow after a surgical procedure and may require blood transfusion. Thus, we selected arterial embolization for hemostasis as the first-line management in two cases of large vulvovaginal hematoma. Materials and methods Case 1 was a 32-year-old pregnant woman. After delivery, a 10-cm vulvar hematoma developed. An enhanced computed tomography (CT) scan revealed active bleeding. Arterial embolization was performed and complete hemostasis was obtained. Case 2 was a 34-year-old woman with a recurring hematoma after delivery. An enhanced CT scan revealed extravasation in the hematoma. Gelatin sponges were applied and complete hemostasis was obtained. In both cases, arterial embolization was successful without requiring blood transfusions. Results and conclusion We successfully managed two cases of puerperal vulvovaginal hematoma by arterial embolization based on the evaluation of an enhanced CT scan. In conclusion, we suggest arterial embolization to be a viable option for first-line treatment in the management of vulvovaginal hematomas.

Objective The purpose of this study was to review the high-resolution computed tomography (CT) findings in patients with pulmonary complications after allogeneic hematopoietic stem cell transplantation (HSCT), and to evaluate the relationship between CT findings and clinical outcomes. Patients and methods We collected the clinical data in 96 consecutive patients who underwent CT scan for pulmonary complications after allogeneic HSCT and analyzed the relationships among these clinical characteristics, CT findings and clinical responses. Radiologists who were blinded to clinical information evaluated the CT findings. Results In multivariate analyses, the presence of chronic graft-versus-host disease (GVHD) and non-segmental multiple consolidations were significantly associated with a poor response to antimicrobial therapies, and the disease risk was significantly associated with a poor corticosteroid response. In addition, the existence of cavity formation and pleural effusion were significantly associated with a fatal prognosis. Twenty-five patients underwent bronchoscopic examination and 4 of them also underwent transbronchial lung biopsy (TBLB), but diagnostic information was not obtained in 15 patients. There was no significant association between specific CT findings and the diagnosis based on bronchoscopic examination. Conclusions No specific CT finding was identified as a predictor for either an antimicrobial response or for a corticosteroid response in this study. The presence of cavity formation and pleural effusion may predict a poor prognosis.

Pseudoaneurysms (PsA) and arteriovenous fistulae (AVF) of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries. Most such injuries are iatrogenic and are associated with central venous catheterization. Historically, thyrocervical trunk PsA and AVF have been managed with open surgical repair; however, multiple treatment modalities are now available, including ultrasound-guided compression repair, ultrasound-guided thrombin injection, and endovascular repair with covered stent placement. We report a case of a 65-year-old woman with an iatrogenic thyrocervical trunk PsA with concomitant AVF that developed after attempted internal jugular vein cannulation for hemodialysis access. The PsA was successfully treated by transcatheter coil embolization using 0.010-inch detachable microcoils. Our case is the first published instance of a thyrocervical trunk PsA with concomitant AVF that was successfully treated by endovascular procedure.

A case of massive hemoptysis due to pulmonary sequestration is presented. Initially, the diagnosis of sequestration was unsuspected and bronchial artery embolization was done for management of hemoptysis from the left lower lobe, but 4 days later massive hemoptysis recurred. Repeat arteriography, including a thoracoabdominal aortogram, revealed two large abdominal arteries penetrating the left diaphragm and feeding the lower lung. Embolization of the aberrant artery from the celiac trunk and the left inferior phrenic artery resulted in complete hemostasis until elective surgical ligation of the two arteries was performed 2 months later. The massive hemoptysis from a pulmonary sequestration could only be controlled after embolization of the transdiaphragmatic aberrant pulmonary arteries.