49 results on '"Ambarish P. Bhat"'
Search Results
2. Urinoma formation following renal mass cryoablation treated with nephroureteral stent placement
- Author
-
Megan E. Sweeney, BS, Ryan M. Davis, MD, Ambarish P. Bhat, MD, Zain M. Khazi, MD, and Katie Murray, MD
- Subjects
Cryoablation ,Renal mass ,Urinoma ,Nephroureteral stent ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Renal cryoablation (CA) has become an accepted treatment option for patients with small renal tumors and co-morbidities that make them less favorable for surgical intervention. Complications from renal CA have been previously reported and are generally associated with increasing size and central location of the tumor. Ureteral injury from renal CA, although rare, can be difficult to manage and may require complex surgeries in patients who are poor surgical candidates to begin with. We report a case of a renal mass CA complicated by proximal ureteral necrosis and transection, treated with multiple minimally invasive procedures ultimately resulting in successful bridging of the necrotic segment with nephroureteral stent and thus avoiding major surgery.
- Published
- 2022
- Full Text
- View/download PDF
3. Image-guided percutaneous cryo-ablation of peri-urethral unresectable recurrent pelvic malignancy: A case report and brief review
- Author
-
Michael E. Nance, PhD, MSc, Mark R. Wakefield, MD, Ambarish P. Bhat, MD, and Ryan M. Davis, MD
- Subjects
Cryo-ablation ,Recurrent pelvic tumor ,Image-guided ,Prostate cancer ,Anal cancer ,Peri-urethral cancer ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Recurrent or metastatic peri-urethral pelvic malignancies are a difficult-to-treat entity. Re-resection is recommended when possible but is frequently unfavorable due to scar tissue, fibrosis, and obliteration of tissue planes following previous interventions such as surgical resection and/or radiation therapy. Curative options for patients that have unresectable cancer are limited. Cryo-ablation has been extensively studied in the treatment of unresectable renal, liver and lung malignancies and has the potential to provide definitive treatment for recurrent pelvic malignancy. There is a paucity of reports of salvage cryo-ablation in patients with recurrent pelvic malignancies, as most of these tumors are located close to critical structures that could be irreversibly injured by thermal ablation and are hence treated with some form of radiation therapy. But, for patients who fail surgical and radiation treatments, options are limited. Here, we describe two cases of regional tumor recurrence in the pelvis treated with percutaneous cryoablation using protective techniques to avoid thermal injury to adjacent structures. In each case, cryo-ablation was performed successfully despite extensive previous surgical and radiation interventions. Salvage cryo-ablation resulted in a positive clinical and imaging response with an improvement in quality of life and absence of recurrence on follow-up imaging which continues to persist at the writing of this manuscript about 8 and 12-months following treatment.
- Published
- 2021
- Full Text
- View/download PDF
4. Balloon assisted stent deployment in the cephalic arch (BASCA)
- Author
-
Will Bryan, RRA and Ambarish P. Bhat, MD
- Subjects
Stent graft ,Brachiocephalic fistula ,Balloon assisted ,Cephalic arch ,Dialysis ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Cephalic arch stenosis causes repeated dysfunction and failure of arteriovenous access. Outcomes following balloon angioplasty alone in this location are unsatisfactory. Stent grafts have very good patency rates in this location. However, stent graft placement is technically challenging in this location due to the adverse angles and vectors of the cephalic arch. Stent graft deployment in this location is associated with a real risk of jailing the axillary vein, thereby precluding the use of that arm for future accesses and/or predisposes to venous edema. We describe a technique that was used to safely and effectively deploy a stent graft in the cephalic arch of a 65-year-old male patient.
- Published
- 2021
- Full Text
- View/download PDF
5. Extraosseous Ewing’s Sarcoma: Pictorial Review of Imaging Findings, Differential Diagnosis, and Pathologic Correlation
- Author
-
Alan Alexander, Kyle Hunter, Michael Rubin, and Ambarish P. Bhat
- Subjects
ewing’s sarcoma ,musculoskeletal soft tissue ,oncology ,pediatric ,rhabdomyosarcoma ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Extraosseous Ewing’s sarcoma (EES), first described in 1969, is a malignant mesenchymal tumor just like its intraosseous counterpart. Although Ewing’s sarcomas are common bone tumors in young children, EESs are rarer and more commonly found in older children/adults, often carrying a poorer prognosis. We discuss the multimodality imaging features of EES and the differential diagnosis of an aggressive appearing mass in proximity to skeletal structures, with pathologic correlates. This review highlights the need to recognize the variability of radiologic findings in EES such as the presence of hemorrhage, rich vascularity, and cystic or necrotic regions and its imaging similarity to other neoplasms that are closely related pathologically.
- Published
- 2021
- Full Text
- View/download PDF
6. Demystifying Sacral Masses: A Pictorial Review
- Author
-
Julie Senne, Van Nguyen, Derek Staner, James D. Stensby, and Ambarish P. Bhat
- Subjects
chondrosarcoma ,chordoma ,giant cell tumor ,metastasis ,osteosarcoma ,sacrum ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
The sacrum is a triangular shaped bone made up of five fused vertebral bodies. It is composed of bone, cartilage, marrow elements as well as notochord remnants and is a common site for both benign and malignant (primary and secondary) tumors. Familiarity with the imaging features and clinical presentations of sacral bone tumors could be helpful in narrowing the differential diagnosis. Magnetic resonance imaging and computed tomography are the preferred imaging modalities for evaluating sacral masses. This pictorial review will highlight imaging features of common sacral tumors with pathologic correlation. Additionally, this article will review some critical principles and helpful tips to successfully biopsy these lesions.
- Published
- 2021
- Full Text
- View/download PDF
7. CT-guided gastrostomy tube placement—a single center case series
- Author
-
Junaid T. Yasin, Philip A. Schuchardt, Naomi Atkins, Dave Koch, Ryan M. Davis, Sachin S. Saboo, and Ambarish P. Bhat
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSEThe role of computed tomography (CT)-guided gastrostomy tube placement is still evolving. It is a valuable alternative to guide gastrostomy tube placement in a few selected patients, who are not candidates for the established endoscopy- or fluoroscopy-guided gastrostomy tube placement. Our objective was to describe our institutional experience placing gastrostomy tubes using CT guidance and to conduct a review of literature for similar studies to provide the best current evidence on success rates and complications.METHODSWe identified gastrostomy tubes placed under CT guidance at our institution using a comprehensive case log. We also identified studies in the literature, through a systematic search of PubMed. In both the local and literature analyses, we recorded success and complication rates.RESULTSA total of 31 patients underwent 33 attempted CT-guided gastrostomy tube placements at our institution, with 32 successful procedures yielding a success rate of 97%. The overall rate of successful gastrostomy tube placement using CT-guidance was 94.9% (634/668), as reported in the existing literature.CONCLUSIONCT-guidance is an effective method for gastrostomy tube placement and may play an important role in patients for whom endoscopic or fluoroscopic gastrostomy tube placement is not feasible.
- Published
- 2020
- Full Text
- View/download PDF
8. Appendiceal diverticulosis in a patient with family history of Birt-Hogg-Dubé syndrome––a case report
- Author
-
Alan Alexander, Kyle Hunter, Stephen Passerini, Roopa Bhat, and Ambarish P. Bhat
- Subjects
Birt-Hogg-Dubé syndrome ,Chromophoberenal cell carcinoma ,Appendicealdiverticulosis ,Computed tomography ,Pneumothorax ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder that predisposes patients to cutaneous tumors, pulmonary cysts with recurrent spontaneous pneumothoraces, and a variety of renal neoplasms including hybrid oncocytic and chromophobe renal cell carcinomas. There has been much debate regarding the genetic link with the occurrence of colorectal cancer and other colonic anomalies. Associations between BHD and intestinal adenomatous polyposis and sigmoid diverticulosis have been described in the literature, but there have been no prior reports of appendiceal diverticulosis in patients with BHD. Here, we present a 40-year-old female patient with a known family history of BHD, who was found to have diverticulosis of the appendix and pulmonary blebs on computed tomography upon routine screening for renal and pulmonary abnormalities, suggesting additional focus be given to the gastrointestinal tract (including the appendix) at the time of CT assessment.
- Published
- 2020
- Full Text
- View/download PDF
9. Metalophagia: Splenic artery pseudoaneurysm after foreign body ingestion and retrieval
- Author
-
Jasraj Marjara, Alhareth Al Juboori, MD, Arpit Aggarwal, MD, Ryan M. Davis, MD, and Ambarish P. Bhat, MD
- Subjects
Metal bezoar ,Pseudoaneurysm ,Endoscopy ,Pica ,Foreign body ,Transarterial embolization ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Persistent eating of non-nutritive, nonfood substances (Pica) is seen in children and adult patients with psychiatric problems. Ingestion of multiple metallic FBs with resultant bezoar formation is rare. While many FBs are passed without complication, mucosal injury, bleeding, obstruction or perforation can occur in some cases. Endoscopic FB removal is performed in 20% of patients following FB ingestion. Generally, these are safe procedures, and very effective in extracting ingested FBs. We report, a 25-year-old male patient with a metal ingestion predominant Pica, requiring multiple prior extraction procedures (including open gastrostomy). He developed a splenic artery pseudoaneurysm following his latest endoscopic FB removal, that was successfully treated with transarterial coil embolization. The unique circumstances leading to this rare complication and its successful endovascular management make this case worthy of report.
- Published
- 2020
- Full Text
- View/download PDF
10. Chemorefractory liver metastasis from cervical cancer successfully treated with a combination of yttrium-90 and immunotherapy
- Author
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Michael E. Nance, Gregory B. Biedermann, MD, Ambarish P. Bhat, MD, and Ryan M. Davis, MD
- Subjects
Endocervical carcinoma ,Liver metastasis ,Yttrium 90 microspheres ,Radioembolization ,Pembrolizumab ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Liver metastases in cervical cancer is rare and can be difficult-to-treat. The current guidelines established by the Gynecologic Oncology Group recommend platinum-based systemic chemotherapy in combination with an anti-angiogenic agent such as bevacizumab, however, overall survival remains poor following diagnosis and options for patients who fail chemotherapy are limited. Yttrium-90 (Y90) radioembolization (RE) has shown great promise in the treatment of chemo-refractory colorectal liver metastases. We describe a 30-year-old female with a history of stage IB endocervical adenocarcinoma who later developed metastases to the liver, that were unresponsive to multiple chemotherapeutics and chemoembolization, and was successfully treated with Y90 RE with concurrent systemic Pembrolizumab. The Y90 RE treatment resulted in positive clinical and imaging responses with improvement in her quality of life, all of which continue to persist at the time of writing this manuscript about 8-months into her RE treatment.
- Published
- 2020
- Full Text
- View/download PDF
11. Spontaneous hemorrhage of an adrenal myelolipoma treated with transarterial embolization: A case report
- Author
-
Khalid Kabeel, MD, Jasraj Marjara, Roopa Bhat, MD, Ayman H. Gaballah, MD, Amr Abdelaziz, MD, and Ambarish P. Bhat, MD
- Subjects
Adrenal myelolipoma ,Transarterial embolization ,Adrenal hemorrhage ,Pheochromocytoma ,Coils ,Trauma ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.
- Published
- 2020
- Full Text
- View/download PDF
12. Commentary: Metalophagia: Splenic Artery pseudoaneurysm after foreign body ingestion and retrieval
- Author
-
Jasraj Marjara, Alhareth Al Juboori, MD, Arpit Aggarwal, MD, Ryan M. Davis, MD, and Ambarish P. Bhat, MD
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Published
- 2021
- Full Text
- View/download PDF
13. Mechanical thrombectomy associated with a shorter length of hospital stay and lower readmission rates compared with conservative therapy for acute submassive pulmonary embolism: a propensity-matched analysis
- Author
-
Zain M Khazi, Justin Pierce, Shahrzad Azizaddini, Ryan Davis, and Ambarish P Bhat
- Subjects
Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
14. Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism
- Author
-
Catalin Toma, Wissam A. Jaber, Mitchell D. Weinberg, Matthew C. Bunte, Sameer Khandhar, Brian Stegman, Sreedevi Gondi, Jeffrey Chambers, Rohit Amin, Daniel A. Leung, Herman Kado, Michael A. Brown, Michael G. Sarosi, Ambarish P. Bhat, Jordan Castle, Michael Savin, Gary Siskin, Michael Rosenberg, Christina Fanola, James M. Horowitz, and Jeffrey S. Pollak
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Evidence supporting interventional pulmonary embolism (PE) treatment is needed.We aimed to evaluate the acute safety and effectiveness of mechanical thrombectomy for intermediate- and high-risk PE in a large real-world population.FLASH is a multicentre, prospective registry enrolling up to 1,000 US and European PE patients treated with mechanical thrombectomy using the FlowTriever System. The primary safety endpoint is a major adverse event composite including device-related death and major bleeding at 48 hours, and intraprocedural adverse events. Acute mortality and 48-hour outcomes are reported. Multivariate regression analysed characteristics associated with pulmonary artery pressure and dyspnoea improvement.Among 800 patients in the full US cohort, 76.7% had intermediate-high risk PE, 7.9% had high-risk PE, and 32.1% had thrombolytic contraindications. Major adverse events occurred in 1.8% of patients. All-cause mortality was 0.3% at 48-hour follow-up and 0.8% at 30-day follow-up, with no device-related deaths. Immediate haemodynamic improvements included a 7.6 mmHg mean drop in mean pulmonary artery pressure (-23.0%; p0.0001) and a 0.3 L/min/mMechanical thrombectomy with the FlowTriever System demonstrates a favourable safety profile, improvements in haemodynamics and functional outcomes, and low 30-day mortality for intermediate- and high-risk PE.
- Published
- 2022
15. The Pain Crisis: Interventional Radiology's Role in Pain Management
- Author
-
Anna Hulbert, Kelli J Moore, Ryan M. Davis, Austin Fletcher, Ambarish P. Bhat, James Derek Stensby, and Arash M Saemi
- Subjects
Ablation Techniques ,medicine.medical_specialty ,MEDLINE ,Radiology, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pain crisis ,medicine ,Humans ,Pain Management ,Radiology, Nuclear Medicine and imaging ,medicine.diagnostic_test ,business.industry ,Opioid use ,Vertebral compression fracture ,Nerve Block ,Interventional radiology ,Opioid use disorder ,General Medicine ,Pain management ,medicine.disease ,Embolization, Therapeutic ,Celiac plexus block ,030220 oncology & carcinogenesis ,Physical therapy ,Chronic Pain ,business - Abstract
Pain is a complex syndrome that is difficult to treat. The increasing numbers of patients living with chronic diseases has led to increasing pain management needs and the rise of opioid use disorder (OUD) as a major and potentially lethal public health concern. Treatment of chronic pain with prescription opioids alone is not always successful, and a multidisciplinary approach is paramount to address the needs of patients at risk of developing or suffering from OUD. Interventional radiologists trained to perform minimally invasive procedures with negligible downtime and postprocedure pain can help stem the tide of opioid-related deaths and disability. This article reviews a wide range of minimally invasive procedures, including vertebral augmentation, sacroplasty, thermal ablation of osseous metastasis, nerve blocks, and gonadal vein embolization, that interventional radiologists are now using successfully to treat chronic pain. The evidence to support use of such procedures is highlighted. This article also briefly discusses emerging techniques such as arterial embolization and ablation for knee and shoulder osteoarthritis that have not yet been fully tested but exhibit strong potential in chronic pain management. By reducing opioid use in patients suffering from chronic pain, these minimally invasive procedures can potentially prevent escalation to OUD.
- Published
- 2021
16. Balloon assisted stent deployment in the cephalic arch (BASCA)
- Author
-
William D Bryan and Ambarish P. Bhat
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:R895-920 ,Case Report ,Balloon ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Cephalic arch ,0302 clinical medicine ,Stent deployment ,Angioplasty ,Stent graft ,Medicine ,Radiology, Nuclear Medicine and imaging ,Arch ,Dialysis ,business.industry ,Stent ,Brachiocephalic fistula ,medicine.disease ,Surgery ,Balloon assisted ,Stenosis ,surgical procedures, operative ,business ,Axillary vein ,030217 neurology & neurosurgery - Abstract
Cephalic arch stenosis causes repeated dysfunction and failure of arteriovenous access. Outcomes following balloon angioplasty alone in this location are unsatisfactory. Stent grafts have very good patency rates in this location. However, stent graft placement is technically challenging in this location due to the adverse angles and vectors of the cephalic arch. Stent graft deployment in this location is associated with a real risk of jailing the axillary vein, thereby precluding the use of that arm for future accesses and/or predisposes to venous edema. We describe a technique that was used to safely and effectively deploy a stent graft in the cephalic arch of a 65-year-old male patient.
- Published
- 2021
17. Image-guided percutaneous cryo-ablation of peri-urethral unresectable recurrent pelvic malignancy: A case report and brief review
- Author
-
Mark R. Wakefield, Ryan M. Davis, Michael E. Nance, and Ambarish P. Bhat
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Percutaneous ,Cryo-ablation ,medicine.medical_treatment ,lcsh:R895-920 ,Case Report ,Recurrent pelvic tumor ,Prostate cancer ,Fibrosis ,medicine ,Anal cancer ,Radiology, Nuclear Medicine and imaging ,Pelvis ,business.industry ,Cancer ,Image-guided ,Ablation ,medicine.disease ,Radiation therapy ,medicine.anatomical_structure ,Peri-urethral cancer ,Radiology ,business - Abstract
Recurrent or metastatic peri-urethral pelvic malignancies are a difficult-to-treat entity. Re-resection is recommended when possible but is frequently unfavorable due to scar tissue, fibrosis, and obliteration of tissue planes following previous interventions such as surgical resection and/or radiation therapy. Curative options for patients that have unresectable cancer are limited. Cryo-ablation has been extensively studied in the treatment of unresectable renal, liver and lung malignancies and has the potential to provide definitive treatment for recurrent pelvic malignancy. There is a paucity of reports of salvage cryo-ablation in patients with recurrent pelvic malignancies, as most of these tumors are located close to critical structures that could be irreversibly injured by thermal ablation and are hence treated with some form of radiation therapy. But, for patients who fail surgical and radiation treatments, options are limited. Here, we describe two cases of regional tumor recurrence in the pelvis treated with percutaneous cryoablation using protective techniques to avoid thermal injury to adjacent structures. In each case, cryo-ablation was performed successfully despite extensive previous surgical and radiation interventions. Salvage cryo-ablation resulted in a positive clinical and imaging response with an improvement in quality of life and absence of recurrence on follow-up imaging which continues to persist at the writing of this manuscript about 8 and 12-months following treatment.
- Published
- 2021
18. Extraosseous Ewing’s Sarcoma: Pictorial Review of Imaging Findings, Differential Diagnosis, and Pathologic Correlation
- Author
-
Kyle Hunter, Alan Alexander, Ambarish P. Bhat, and Michael Rubin
- Subjects
Pathology ,medicine.medical_specialty ,R895-920 ,ewing’s sarcoma ,030218 nuclear medicine & medical imaging ,musculoskeletal soft tissue ,03 medical and health sciences ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,Vascularity ,Pathologic correlation ,medicine ,Radiology, Nuclear Medicine and imaging ,Rhabdomyosarcoma ,business.industry ,Ewing's sarcoma ,medicine.disease ,pediatric ,030220 oncology & carcinogenesis ,Malignant mesenchymal tumor ,oncology ,Pictorial Essay ,Sarcoma ,rhabdomyosarcoma ,medicine.symptom ,Differential diagnosis ,business ,Extraosseous ewing's sarcoma - Abstract
Extraosseous Ewing’s sarcoma (EES), first described in 1969, is a malignant mesenchymal tumor just like its intraosseous counterpart. Although Ewing’s sarcomas are common bone tumors in young children, EESs are rarer and more commonly found in older children/adults, often carrying a poorer prognosis. We discuss the multimodality imaging features of EES and the differential diagnosis of an aggressive appearing mass in proximity to skeletal structures, with pathologic correlates. This review highlights the need to recognize the variability of radiologic findings in EES such as the presence of hemorrhage, rich vascularity, and cystic or necrotic regions and its imaging similarity to other neoplasms that are closely related pathologically.
- Published
- 2021
19. CT-guided gastrostomy tube placement—a single center case series
- Author
-
Ambarish P. Bhat, Ryan M. Davis, Dave Koch, Philip A Schuchardt, Sachin S Saboo, Junaid T Yasin, and Naomi K. Atkins
- Subjects
medicine.medical_specialty ,Computed tomography ,Single Center ,Catheterization ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Case log ,Interventional Radiology ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Retrospective Studies ,Gastrostomy ,Gastrostomy tube placement ,medicine.diagnostic_test ,business.industry ,Surgery ,Endoscopy ,Gastrostomy tube ,Fluoroscopy ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Systematic search - Abstract
Purpose The role of computed tomography (CT)-guided gastrostomy tube placement is still evolving. It is a valuable alternative to guide gastrostomy tube placement in a few selected patients, who are not candidates for the established endoscopy- or fluoroscopy-guided gastrostomy tube placement. Our objective was to describe our institutional experience placing gastrostomy tubes using CT guidance and to conduct a review of literature for similar studies to provide the best current evidence on success rates and complications. Methods We identified gastrostomy tubes placed under CT guidance at our institution using a comprehensive case log. We also identified studies in the literature, through a systematic search of PubMed. In both the local and literature analyses, we recorded success and complication rates. Results A total of 31 patients underwent 33 attempted CT-guided gastrostomy tube placements at our institution, with 32 successful procedures yielding a success rate of 97%. The overall rate of successful gastrostomy tube placement using CT-guidance was 94.9% (634/668), as reported in the existing literature. Conclusion CT-guidance is an effective method for gastrostomy tube placement and may play an important role in patients for whom endoscopic or fluoroscopic gastrostomy tube placement is not feasible.
- Published
- 2020
20. Appendiceal diverticulosis in a patient with family history of Birt-Hogg-Dubé syndrome––a case report
- Author
-
Kyle Hunter, Stephen Passerini, Roopa Bhat, Alan Alexander, and Ambarish P. Bhat
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Colorectal cancer ,lcsh:R895-920 ,Chromophobe cell ,Birt–Hogg–Dubé syndrome ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Renal neoplasm ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Family history ,Computed tomography ,business.industry ,Birt-Hogg-Dubé syndrome ,Pneumothorax ,medicine.disease ,Appendix ,Diverticulosis ,Appendicealdiverticulosis ,medicine.anatomical_structure ,Chest ,Chromophoberenal cell carcinoma ,business ,030217 neurology & neurosurgery - Abstract
Birt-Hogg-Dube syndrome (BHD) is a rare autosomal dominant disorder that predisposes patients to cutaneous tumors, pulmonary cysts with recurrent spontaneous pneumothoraces, and a variety of renal neoplasms including hybrid oncocytic and chromophobe renal cell carcinomas. There has been much debate regarding the genetic link with the occurrence of colorectal cancer and other colonic anomalies. Associations between BHD and intestinal adenomatous polyposis and sigmoid diverticulosis have been described in the literature, but there have been no prior reports of appendiceal diverticulosis in patients with BHD. Here, we present a 40-year-old female patient with a known family history of BHD, who was found to have diverticulosis of the appendix and pulmonary blebs on computed tomography upon routine screening for renal and pulmonary abnormalities, suggesting additional focus be given to the gastrointestinal tract (including the appendix) at the time of CT assessment.
- Published
- 2020
21. Metastatic retro-crural lymph nodes from transitional cell carcinoma of bladder successfully treated with single session cryoablation
- Author
-
Jaffar Hilli, Ambarish P. Bhat, Ryan M. Davis, and Jasraj Marjara
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,Cryoablation ,Muscle invasive bladder cancer, Positron emission tomography ,medicine.medical_specialty ,lcsh:R895-920 ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Retro-crural ,medicine.artery ,Interventional Radiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Aorta ,Bladder cancer ,business.industry ,Immunotherapy ,medicine.disease ,Transitional cell carcinoma ,Localized disease ,Transitional cell cancer (TCC) ,Radiology ,Lymph ,business ,Single session ,030217 neurology & neurosurgery - Abstract
Bladder cancer (BC) is a relatively common tumor, with a male preponderance. High-grade muscle invasive bladder cancer (MIBC) has a very high incidence of pelvic lymph node metastasis at presentation. Involvement of the retro-crural lymph nodes, although has been described in other pelvic tumors, is very uncommon for BC. Cryoablation in the retro-crural region is extremely challenging due to the proximity to the critical structures like inferior venacava and aorta and has not been extensively reported. We describe a 56-year old male patient with MIBC who underwent extensive treatments including radical cystoprostatectomy, chemoradiation and immunotherapy, ultimately with localized disease in the retro-crural region. Single session cryoablation of these lymph nodes was performed with a curative intent yielding a positive response that has persisted for more than 2 years.
- Published
- 2020
22. Spontaneous hemorrhage of an adrenal myelolipoma treated with transarterial embolization: A case report
- Author
-
Ambarish P. Bhat, Ayman H. Gaballah, Amr Abdelaziz, Roopa Bhat, Khalid Kabeel, and Jasraj Marjara
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Transarterial embolization ,lcsh:R895-920 ,medicine.medical_treatment ,Pheochromocytoma ,Trauma ,030218 nuclear medicine & medical imaging ,Benign tumor ,03 medical and health sciences ,0302 clinical medicine ,Interventional Radiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Embolization ,Retroperitoneal hemorrhage ,Adrenal myelolipoma ,business.industry ,Adrenal cortex ,Coils ,medicine.disease ,Adrenal artery ,medicine.anatomical_structure ,Adrenal hemorrhage ,Radiology ,business ,Adrenal Hemorrhage ,030217 neurology & neurosurgery - Abstract
Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.
- Published
- 2020
23. Metalophagia: Splenic artery pseudoaneurysm after foreign body ingestion and retrieval
- Author
-
Arpit Aggarwal, Ryan M. Davis, Jasraj Marjara, Ambarish P. Bhat, and Alhareth Al Juboori
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Transarterial embolization ,lcsh:R895-920 ,medicine.medical_treatment ,Perforation (oil well) ,Splenic artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,medicine.artery ,Interventional Radiology ,medicine ,Ingestion ,Radiology, Nuclear Medicine and imaging ,Pica (disorder) ,business.industry ,Endoscopy ,medicine.disease ,Gastrostomy ,Surgery ,Metal bezoar ,Foreign body ,Pica ,Bezoar ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Persistent eating of non-nutritive, nonfood substances (Pica) is seen in children and adult patients with psychiatric problems. Ingestion of multiple metallic FBs with resultant bezoar formation is rare. While many FBs are passed without complication, mucosal injury, bleeding, obstruction or perforation can occur in some cases. Endoscopic FB removal is performed in 20% of patients following FB ingestion. Generally, these are safe procedures, and very effective in extracting ingested FBs. We report, a 25-year-old male patient with a metal ingestion predominant Pica, requiring multiple prior extraction procedures (including open gastrostomy). He developed a splenic artery pseudoaneurysm following his latest endoscopic FB removal, that was successfully treated with transarterial coil embolization. The unique circumstances leading to this rare complication and its successful endovascular management make this case worthy of report.
- Published
- 2020
24. Lumbar Puncture and Intrathecal Drug Administration
- Author
-
Clayton Reece Burgoon, Will Bryan, and Ambarish P. Bhat
- Published
- 2022
25. Percutaneous Lymphatic Maceration and Glue Embolization for High-output Chylous Ascites after Robot-assisted Laparoscopic Nephrectomy and Lymphadenectomy
- Author
-
Ambarish P. Bhat, Brandon L. Henslee, Paige Hargis, and Naveen Pokala
- Subjects
Chyle leak ,medicine.medical_specialty ,Chyle ,Percutaneous ,Radical nephrectomy ,business.industry ,Chylous ascites ,medicine.medical_treatment ,Vascular and International Radiology ,Chylothorax ,Case Report ,medicine.disease ,Nephrectomy ,Surgery ,Postoperative complications ,Renal cell carcinoma ,medicine ,Lymphangiography ,Radiology, Nuclear Medicine and imaging ,Lymphadenectomy ,Embolization ,business - Abstract
To propose minimally invasive percutaneous techniques in the management of high output chylous ascites, a known potential complication of retroperitoneal surgery associated with significant morbidity and mortality. Management has traditionally been based on successful treatment reported in the literature. However, refractory or high-output leaks often prove difficult to treat and there is little evidence on superior management. We report percutaneous maceration and embolization for the management of high-volume abdominal chyle leak after robot-assisted laparoscopic (RAL) radical nephrectomy and lymph node dissection for renal cell carcinoma. A 68-year-old male with incidentally found renal cell carcinoma underwent RAL radical nephrectomy with paraaortic lymph node dissection. He initially improved after surgery but developed significant abdominal pain and distension approximately 7 weeks postoperative. This proved to be chyloperitoneum. Conservative management was initiated, but after continued high-output (>1 L) fluid drainage, we pursued adjunct intervention involving Interventional Radiological percutaneous procedures. This included lymphatic maceration and glue embolization of leaking lymphatics. The patient tolerated the percutaneous procedures well with significant improvement in drain output ultimately leading to complete resolution of ascites without further complication. Similar interventions have previously been reported in the literature for cases of chylothorax with success. However, there is a lack of reports on utilizing this minimally invasive procedure for chyloperitoneum after retroperitoneal urologic surgery. We report our successful experience with percutaneous lymphatic maceration and embolization for high output chylous ascites after RAL radical nephrectomy with lymphadenectomy. We believe that early initiation utilizing these percutaneous techniques can achieve timely resolution and should be considered in the management of these patients.
- Published
- 2021
26. Demystifying Sacral Masses: A Pictorial Review
- Author
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Ambarish P. Bhat, Julie Senne, Derek Staner, James Derek Stensby, and Van Nguyen
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,sacrum ,R895-920 ,Sacral Bone ,030218 nuclear medicine & medical imaging ,Medical physics. Medical radiology. Nuclear medicine ,03 medical and health sciences ,0302 clinical medicine ,osteosarcoma ,Biopsy ,medicine ,metastasis ,Radiology, Nuclear Medicine and imaging ,chordoma ,giant cell tumor ,chondrosarcoma ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,musculoskeletal system ,medicine.disease ,Sacrum ,body regions ,Pictorial Essay ,Osteosarcoma ,Chordoma ,Radiology ,Chondrosarcoma ,Differential diagnosis ,business ,030217 neurology & neurosurgery - Abstract
The sacrum is a triangular shaped bone made up of five fused vertebral bodies. It is composed of bone, cartilage, marrow elements as well as notochord remnants and is a common site for both benign and malignant (primary and secondary) tumors. Familiarity with the imaging features and clinical presentations of sacral bone tumors could be helpful in narrowing the differential diagnosis. Magnetic resonance imaging and computed tomography are the preferred imaging modalities for evaluating sacral masses. This pictorial review will highlight imaging features of common sacral tumors with pathologic correlation. Additionally, this article will review some critical principles and helpful tips to successfully biopsy these lesions.
- Published
- 2021
27. Pelvic Trauma: What the Radiologist Needs to Know
- Author
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Ryan M. Davis, Nanda Deepa Thimmappa, Junaid T Yasin, Philip A Schuchardt, and Ambarish P. Bhat
- Subjects
Pelvic trauma ,medicine.medical_specialty ,business.industry ,medicine ,General Medicine ,Radiology ,business - Published
- 2019
28. Metastatic appendiceal cancer treated with Yttrium 90 radioembolization and systemic chemotherapy: A case report
- Author
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Ambarish P. Bhat, Philip A Schuchardt, Sindhu Singh, Roopa Bhat, and Ryan M. Davis
- Subjects
musculoskeletal diseases ,Oncology ,medicine.medical_specialty ,Colorectal cancer ,chemistry.chemical_element ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Liver metastases ,0302 clinical medicine ,Internal medicine ,Case report ,medicine ,Radioembolization ,Systemic chemotherapy ,business.industry ,Cancer ,Yttrium ,medicine.disease ,Hyperthermic intraperitoneal chemotherapy ,surgical procedures, operative ,Appendix cancer with peritoneal metastasis ,chemistry ,Yttrium-90 microspheres ,Yttrium 90 microspheres ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND Primary appendiceal cancers are rare, and they generally present with liver and/or peritoneal metastases. Currently there are no guidelines to treat metastatic appendiceal cancer, and hence they are treated as metastatic colorectal cancer. Combining Yttrium 90 (Y-90) radioembolization (RE) with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival. Based on this data, a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer. CASE SUMMARY A 76-year-old male presented to the emergency room with progressive right lower quadrant pain. A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation. Urgent laparoscopic appendectomy was then followed by histological analysis, which was significant for appendiceal adenocarcinoma. After complete workup he underwent right hemicolectomy and lymph node dissection. He received adjuvant chemotherapy as the local lymph nodes were positive. Follow-up imaging was significant for liver metastasis. Due to rapid growth of the liver lesions and new peritoneal nodules, the patient was treated with a combination of Y-90 RE and folinic acid, fluorouracil, and irinotecan with bevacizumab and not microwave ablation as previously planned. Follow up imaging demonstrated complete response of the liver lesions. At 12-mo follow-up, the patient continued to enjoy good quality of life with no recurrent disease. CONCLUSION Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.
- Published
- 2019
29. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges
- Author
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Ashish Khandelwal, Nanda Deepa Thimmappa, Prashant Nagpal, Sachin S Saboo, Maaz A. Ghouri, Nishant Gupta, and Ambarish P. Bhat
- Subjects
medicine.medical_specialty ,Modalities ,medicine.diagnostic_test ,business.industry ,Vascular anatomy ,Imaging diagnostic ,Mr angiography ,Review Article ,030204 cardiovascular system & hematology ,Mr imaging ,030218 nuclear medicine & medical imaging ,Imaging modalities ,03 medical and health sciences ,0302 clinical medicine ,Angiography ,Medicine ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Radiation treatment planning ,psychological phenomena and processes - Abstract
Imaging is needed for diagnosis, treatment planning, and follow-up of patients with pathologies affecting upper extremity vasculature. With growth and evolution of imaging modalities [especially CT angiography (CTA) and MR angiography (MRA)], there is need to recognize the advantages and disadvantages of various modalities and obtain the best possible imaging diagnostic test. Understanding various limitations and pitfalls as well as the best practices to minimize and manage these pitfalls is very important for the diagnosis. This article reviews the upper extremity arterial vascular anatomy, discusses the CTA and MRA imaging, various pitfalls, and challenges and discuss imaging manifestations of upper extremity arterial pathologies.
- Published
- 2019
30. A rare case of bleeding duodenal varices from superior mesenteric vein obstruction -treated with transhepatic recanalization and stent placement
- Author
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Ryan M. Davis, Ambarish P. Bhat, and William D Bryan
- Subjects
endoscopic procedures ,Gastrointestinal bleeding ,medicine.medical_specialty ,SMV stent ,R895-920 ,pancreatitis ,Case Report ,030218 nuclear medicine & medical imaging ,Medical physics. Medical radiology. Nuclear medicine ,03 medical and health sciences ,Transjugular intrahepatic porto-sytemic shunt ,0302 clinical medicine ,balloon-occluded retrograde transvenous obliteration ,Occlusion ,medicine ,Radiology, Nuclear Medicine and imaging ,Superior mesenteric vein ,medicine.diagnostic_test ,business.industry ,ectopic varices ,Interventional radiology ,SMV recanalization ,medicine.disease ,Balloon-occluded antegrade transvenous obliteration ,Surgery ,030220 oncology & carcinogenesis ,Hemostasis ,Etiology ,Pancreatitis ,business ,Varices - Abstract
Ectopic varices are complex and highly variable entities that are not fully understood. Duodenal varices from pancreatitis have rarely been reported. Ectopic varices have much higher bleeding rates than the more common gastro-esophageal varices, and are associated with higher mortality. The ideal management of this difficult problem is not only to ensure prompt hemostasis, but also address the etiology or hemodynamics of the ectopic varices. We discuss the endovascular management of bleeding duodenal varices, which developed from superior mesenteric vein occlusion, following repeated attacks of pancreatitis. This unusual case was managed by a multidisciplinary collaborative approach between the gastrointestinal service and Interventional radiology. The classification system for ectopic varices and management options has been discussed in some detail. Medium term follow-up (8 months), at the time of this writing, showed that the patient is doing well, without interval hematemesis, imaging findings of recurrent/new varices or stent occlusion.
- Published
- 2019
31. Ultrasonography and X-Ray guided drain placement to evacuate a pneumopericardium/pneumomediastinum in a 1-day-old infant
- Author
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Ambarish P. Bhat, Peter C. Dyke, and Ashwin Pimpalwar
- Subjects
medicine.medical_specialty ,pneumopericardium ,Radiography ,medicine.medical_treatment ,R895-920 ,Thoracentesis ,Case Report ,Pneumopericardium ,030218 nuclear medicine & medical imaging ,ultrasound guided drain of pneumopericardium ,03 medical and health sciences ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,Cardiac tamponade ,medicine ,Radiology, Nuclear Medicine and imaging ,Pneumomediastinum ,Pelvis ,Respiratory distress ,pneumomediastinum ,business.industry ,medicine.disease ,respiratory distress syndrome ,medicine.anatomical_structure ,Abdomen ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Ultrasonographic (US) guided procedures have wide range of application in the abdomen and pelvis, however their role is somewhat limited in the chest due to complete reflection of the ultrasound beam by the air in the lungs, preventing the direct imaging of the tissues deep to the air-sound interface. Most of the chest procedures, other than the exception of thoracentesis, rely on the use of CT (computed tomography) scan. The disadvantages of using CT scan is the cost, lack of portability, and most importantly the radiation involved, particularly in case of infants and children, whose tissues are more radiosensitive than the adults. Identification of air by Ultrasonography can help direct needles and wires, to accomplish procedures which may otherwise need CT. A 1-day-old infant with respiratory distress syndrome (RDS) on a ventilator, developed an expanding symptomatic pneumopericardium/pneumomediastinum. The patient was too unstable to leave the neonatal intensive care unit (NICU), so a pericardial/mediastinal drain was placed under ultrasonographic and radiographic guidance. This case, highlights a method for bedside treatment of pneumopericardium/pneumomediastinum in an unstable neonate. This procedure may be equally effective in older children and adults.
- Published
- 2019
32. Current Endovascular Treatment Options in Acute Pulmonary Embolism
- Author
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Prashant Nagpal, Kelli J Moore, Mohammed Alnijoumi, Ambarish P. Bhat, and Jeff Kunin
- Subjects
medicine.medical_specialty ,business.industry ,Chronic thromboembolic pulmonary hypertension ,Pulmonary embolism response team ,Review Article ,030204 cardiovascular system & hematology ,medicine.disease ,FlowTriever ,Pulmonary embolism ,03 medical and health sciences ,Catheter ,Vascular and Interventional Radiology ,Massive pulmonary embolism ,0302 clinical medicine ,Risk stratification ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Endovascular treatment ,business ,Intensive care medicine ,Thrombectomy - Abstract
Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.
- Published
- 2021
33. Computerized tomography-Guided Microwave Ablation of Patients with Stage I Non-small Cell Lung Cancers: A Single-Institution Retrospective Study
- Author
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Ryan M. Davis, Zain Khazi, Michael E. Nance, Mohammed Alnijoumi, Diego M. Avella, Ambarish P. Bhat, and Jussuf T. Kaifi
- Subjects
Univariate analysis ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,Hazard ratio ,Microwave ablation ,Urology ,Odds ratio ,medicine.disease ,Exact test ,Early-stage lung cancer ,Vascular and Interventional ,Non-small cell lung cancer ,medicine ,Adenocarcinoma ,Radiology, Nuclear Medicine and imaging ,Lung cancer ,business ,Original Research ,Computerized tomography-guided - Abstract
Objectives: The objective of the study was to retrospectively investigate the safety and efficacy of computerized tomography-guided microwave ablation (MWA) in the treatment of Stage I non-small cell lung cancers (NSCLCs). Material and Methods: This retrospective, single-center study evaluated 21 patients (10 males and 11 females; mean age 73.8 ± 8.2 years) with Stage I peripheral NSCLCs treated with MWA between 2010 and 2020. All patients were surveyed for metastatic disease. Clinical success was defined as absence of FDG avidity on follow-up imaging. Tumor growth within 5 mm of the original ablated territory was defined as local recurrence. Welch t-test and Fisher’s exact test were used for univariate analysis. Hazard ratio (HR) and odds ratio (OR) were determined using Cox regression and Firth logistic regression. Significance was P < 0.05. Data are expressed as mean ± standard deviation. Results: Ablated tumors had longest dimension 17.4 ± 5.4 mm and depth 19.7 ± 15.1 mm from the pleural surface. Median follow-up was 20 months (range, 0.6–56 months). Mean overall survival (OS) following lung cancer diagnosis or MWA was 26.2 ± 15.4 months (range, 5–56 months) and 23.7 ± 15.1 months (range, 3–55 months). OS at 1, 2, and 5 years was 67.6%, 61.8%, and 45.7%, respectively. Progression-free survival (PFS) was 19.1 ± 16.2 months (range, 1–55 months). PFS at 1, 2, and 5 years was 44.5%, 32.9%, and 32.9%, respectively. Technical success was 100%, while clinical success was observed in 95.2% (20/21) of patients. One patient had local residual disease following MWA and was treated with chemotherapy. Local control was 90% with recurrence in two patients following ablation. Six patients (28.6%) experienced post-ablation complications, with pneumothorax being the most common event (23.8% of patients). Female gender was associated with 90% reduction in risk of death (HR 0.1, P = 0.014). Tumor longest dimension was associated with a 10% increase in risk of death (P = 0.197). Several comorbidities were associated with increased hazard. Univariate analysis revealed pre-ablation forced vital capacity trended higher among survivors (84.7 ± 15.2% vs. 73 ± 21.6%, P = 0.093). Adjusted for age and sex, adenocarcinoma, and neuroendocrine histology trended toward improved OS (OR: 0.13, 0.13) and PFS (OR: 0.88, 0.37) compared to squamous cell carcinoma. Conclusion: MWA provides a safe and effective alternative to stereotactic brachytherapy resulting in promising OS and PFS in patients with Stage I peripheral NSCLC. Larger sample sizes are needed to further define the effects of underlying comorbidities and tumor biology.
- Published
- 2020
34. Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study
- Author
-
Tanya Aggarwal, Aidan Mullan, Sarv Priya, Ambarish P. Bhat, Prashant Nagpal, Sabarish Narayanasamy, Ali Eskandari, Jessica C. Sieren, and Kamesh Parashar
- Subjects
Logistic regression ,Effective dose (radiation) ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Medical imaging ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Original Research ,Computed tomography angiography ,Radiation ,medicine.diagnostic_test ,business.industry ,Pulmonary embolism ,Radiobiology ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,Emergency ,Diagnostic imaging ,business ,Nuclear medicine ,Body mass index - Abstract
Objectives: Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods: This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy−1•cm−1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results: There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2–104.4 years) and BMI of 31.3 kg/m2 (range 12–91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median – 4.27 mSv; range 0.1–43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose (P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion: Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.
- Published
- 2020
35. Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the 'core' of the Problem? A Retrospective Case–control Study
- Author
-
Ambarish P. Bhat, Van Nguyen, Ryan M. Davis, Kunal Malhotra, Andrew O. Tarim, and Michael E. Nance
- Subjects
medicine.medical_specialty ,Blood transfusion ,Percutaneous ,Medullary cavity ,medicine.medical_treatment ,Renal Hemorrhage ,030232 urology & nephrology ,Urology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Vascular and Interventional Radiology ,0302 clinical medicine ,Biopsy ,Ultrasound ,medicine ,Radiology, Nuclear Medicine and imaging ,Renal hemorrhage ,Percutaneous renal biopsy ,Original Research ,medicine.diagnostic_test ,business.industry ,Case-control study ,Coil embolization ,Propensity score matching ,Renal biopsy ,business ,Renal angiogram - Abstract
Objectives: Percutaneous renal biopsy (PRB) plays a critical role in the work-up of renal parenchymal disease. Although it is considered a low-risk procedure, additional interventions may be required in about 7% of the cases following biopsy. The purpose of this study was to identify risk factors for major hemorrhage by microscopic analysis of the cores obtained following PRB, with an intent to enhance the sensitivity and specificity of the risk stratification process, especially in patients undergoing this procedure in an outpatient setting. Material and Methods: A retrospective review identified 17 of 179 patients (9.50%) with major hemorrhage following PRB between July 2014 and June 2019. Using propensity score matching, 26 controls (without major hemorrhage) were matched to 17 cases (with major hemorrhage). The biopsy cores obtained from the cases and controls were analyzed by a single pathologist for medullary, cortical, total (medullary + cortical) lengths, and the number of arcuate arteries (AAs). Medullary:cortical (M:C), cortical:total (C:T), and medullary:total (M:T) length ratios were then calculated. Results: A stratified version of logistic regression was used to test for an association between each of the variables identified on the cores and the probability of a major hemorrhage. The analysis revealed that there was a statistically significant association between the number of AAs per specimen with the risk of major hemorrhage (P = 0.0006). When 0, 1, or >2 AAs were identified, the frequency of major hemorrhage was 13.04%, 66.67%, and 75.00%, respectively. The odds of major hemorrhage were 6 times higher with one AA and (95% CI, 1.28–32.30) and 15 times higher with >2 AAs (95% CI, 1.41–169.57). No significant association was found between medullary length (P = 0.228), medulla:cortex (M:C) (P = 0.089), medulla:total (M:T) (P = 0.108), or cortex:total (C:T) (P = 0.112) length ratios and major hemorrhage. Conclusion: There was a strong and incremental correlation between major renal hemorrhage following PRB and the number of AAs per core specimen. Identification of AAs by the pathologist, while assessing for sample adequacy, in the US suite can help predict major hemorrhage in patients undergoing PRBs.
- Published
- 2020
36. Chest Imaging in Patients Hospitalized With COVID-19 Infection - A Case Series
- Author
-
Ambarish P. Bhat, Aws Hamid, Dhiraj Baruah, Sachin S Saboo, Kiran Batra, Roopa Bhat, and Jeffrey R. Kunin
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Betacoronavirus ,Pandemic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Medical diagnosis ,Lung ,Pandemics ,Aged ,Chest imaging ,biology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,biology.organism_classification ,Radiology Nuclear Medicine and imaging ,Female ,Radiography, Thoracic ,business ,Coronavirus Infections ,Tomography, X-Ray Computed ,Asymptomatic carrier - Abstract
COVID-19 (Corona Virus Disease-19) is a zoonotic illness first reported in the city of Wuhan, China in December 2019, and is now officially a global pandemic as declared by the World Health Organization. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 infected patients can be asymptomatic carriers or present with mild-to-severe respiratory symptoms. Imaging, including computed tomography is not recommended to screen/diagnose COVID-19 infections, but plays an important role in management of these patients, and to rule out alternative diagnoses or coexistent diseases. In our multicenter case series, we outline the clinical presentations and illustrate the most common imaging manifestations in patients hospitalized with COVID-19.
- Published
- 2020
37. CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis
- Author
-
Ambarish P. Bhat, Sachin S Saboo, Junaid T Yasin, Ryan M. Davis, Sanjit O Tewari, Nanda Deepa Thimmappa, Diego M. Avella, and Jussuf T. Kaifi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Chest Pain ,Percutaneous ,medicine.medical_treatment ,Intercostal nerves ,Radiography, Interventional ,Cryosurgery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Interventional Radiology ,medicine ,Retrospective analysis ,Humans ,Radiology, Nuclear Medicine and imaging ,Thoracotomy ,Aged ,Retrospective Studies ,Post-thoracotomy pain syndrome ,Pain, Postoperative ,business.industry ,Cryoablation ,Syndrome ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Pneumothorax ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
PURPOSE: Post-thoracotomy pain syndrome is a common condition affecting up to 50% of post-thoracotomy patients. However, percutaneous computed tomography (CT)-guided intercostal nerve cryoablation may provide symptomatic benefit in chronic and/or refractory cases. METHODS: A retrospective review of our institution’s comprehensive case log from October 2017 to September 2018 for patients who underwent cryoablation was analyzed. Thirteen patients with post-thoracotomy pain syndrome, refractory to medical management, were treated with CT-guided intercostal nerve cryoablation. Most patients had treatment of the intercostal nerve at the level of their thoracotomy scar, two levels above and below. The safety and technical success of this technique and the clinical outcomes of the study population were then retrospectively reviewed. RESULTS: Of the patients, 69% experienced significant improvement in their pain symptoms with a median pain improvement score of 3 points (range, −1 to 8 points) over a median follow-up of 11 months (range, 2–18.6 months). Complications included pneumothorax in 8% and pseudohernia in 23% of patients. CONCLUSION: CT-guided intercostal nerve cryoablation may be an effective technique in the treatment of post-thoracotomy pain syndrome and requires further study.
- Published
- 2019
38. Solitary fibrous tumor of the ischioanal fossa—a multidisciplinary approach to management with radiologic-pathologic correlation
- Author
-
Ryan M. Davis, Z. Wu, Lester J. Layfield, Ambarish P. Bhat, Sanjit O Tewari, and Ayman H. Gaballah
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,Solitary fibrous tumor ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:R895-920 ,Ischioanal ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Preoperative embolization ,Embolization ,0302 clinical medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Hemangiopericytoma ,Unusual case ,business.industry ,Ischioanal fossa ,Radiologic pathologic correlation ,medicine.disease ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Tumor vascularity ,Radiology ,business - Abstract
Solitary fibrous tumors are primary mesenchymal tumors, which may occur in any part of the body. Overall, these tumors are considered to have intermediate malignant potential with 5- and 10-year metastasis-free and overall disease-specific survival rates of 74% and 55%, and 89% and 73%, respectively (Demicco et al, 2012). Herein we present an unusual case of solitary fibrous tumors involving the ischioanal fossa in a 19-year-old woman with radiologic-pathologic correlation. This case was complicated by extensive tumor vascularity and was thus managed with preoperative embolization followed by en bloc surgical resection. Keywords: Solitary fibrous tumor, Embolization, Ischioanal, Hemangiopericytoma
- Published
- 2018
39. Preoperative cross-sectional mapping for deep inferior epigastric and profunda artery perforator flaps
- Author
-
Sachin S Saboo, Nanda Deepa Thimmappa, Prashant Nagpal, Kristen Bishop, Ambarish P. Bhat, and Martin R. Prince
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Deep Inferior Epigastric Artery ,Iodinated Contrast Agent ,Review Article ,Magnetic resonance angiography ,eye diseases ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Dissection ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Breast reconstruction ,Perforator flaps ,Computed tomography angiography ,Artery - Abstract
Perforator flap-based breast reconstruction in a post mastectomy patient requires dissection of the artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap. Traditionally, these reconstructions were performed with the transverse rectus abdominis myocutaneous (TRAM) flap, but autologous breast reconstruction using muscle sparing free flaps has become steadily more popular in recent years. Preoperative imaging to locate and evaluate candidate perforators has become an essential step before patients undergo the microsurgical procedure. Preoperative mapping assists with operative planning, reduces operating times, and brings anatomical variations to their attention. Pre-operative imaging also assists in choosing the appropriate donor site for harvesting flaps. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have been widely used for this type of preoperative imaging. Both MRA and CTA have their inherent advantages and disadvantages, and the preferred modality for this purpose varies by institution based on factors such as scanner availability, radiologist and surgeon experience, and comfort in interpreting the images. Concerns over excessive exposure to ionizing radiation and poor iodinated contrast agent enhancement of the intramuscular perforator course has made MRA the first-choice imaging modality in many centers. The purpose of the article is to review technique and protocols for the pre-operative CTA/MRA in patients who are being considered for a deep inferior epigastric artery perforator (DIEP) or profunda artery perforator (PAP) flap and to familiarize the reader with the normal and variant anatomic features of the deep inferior epigastric and PAP vessels along with the anatomic and surgical considerations used in the selection of perforator flap donor site for breast reconstruction post mastectomy.
- Published
- 2019
40. Simplified Rapid Protocol for Assessing the Thoracic Aortic Dimensions and Pathology with Noncontrast MR Angiography
- Author
-
Ambarish P. Bhat, Aditya Hendrani, Bharath Yarlagadda, Megha Verma, and Senthil R. Kumar
- Subjects
Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Mr angiography ,Gold standard (test) ,030204 cardiovascular system & hematology ,Magnetic resonance angiography ,eye diseases ,nervous system diseases ,03 medical and health sciences ,0302 clinical medicine ,Absolute measurement ,medicine.artery ,Descending aorta ,Dark blood ,cardiovascular system ,Medicine ,Thoracic aorta ,Acquisition time ,030212 general & internal medicine ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Contrast enhanced magnetic resonance angiography (CE-MRA) is limited by long acquisition time and contrast exposure in aortic emergencies. To compare the effcacy of dark blood (DB) and bright blood (BB) noncontrast sequences with the gold standard CE-MRA using a novel protocol for performing consistent thoracic aortic measurements and thoracic aortic pathologies identifications. A total of 66 patients with suspected or known thoracic aortic pathology who underwent CE-MRA underwent DB and BB imaging prior to CE-MRA for planning purposes. Aortic dimension was measured at 10 standard reference points in the ascending, arch, and descending aorta. Detection of aortic pathologies was recorded individually for each noncontrast sequence. When comparing the CE-MRA to the DB images and CE-MRA to the BB images, a majority of the measurement differences were less than or equal to 2 mm or resulted in no change of diagnostic class (95% for CE-MRA vs. DB and 96% for CE-MRA vs. BB). Of the patients who had major changes in diagnostic class (e.g., changes in two or three classes), the absolute measurements were not clinically significant in any given patient to warrant a change in management. Individually, the DB and BB sequences allowed for accurate recognition of all 47 aortic pathologies. DB and BB sequences produced comparable and consistent measurements of the thoracic aorta when compared with CE-MRA. In a situation where CE-MRA is not readily available or contraindicated, noncontrast MRA using our protocol is a reliable alternative to CE-MRA for assessment of aortic pathologies.
- Published
- 2019
41. The role of an IVC filter retrieval clinic-A single center retrospective analysis
- Author
-
Philip A Schuchardt, Ryan M. Davis, Ambarish P. Bhat, Sanjit O Tewari, and Junaid T Yasin
- Subjects
medicine.medical_specialty ,IVC filter ,pulmonary embolism ,loop snare ,venous thromboembolism ,R895-920 ,Ivc filter ,030204 cardiovascular system & hematology ,Single Center ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,Medical physics. Medical radiology. Nuclear medicine ,03 medical and health sciences ,Anticoagulation ,0302 clinical medicine ,Interventional Radiology ,Retrospective analysis ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,retrieval ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Hangman technique ,medicine.disease ,Pulmonary embolism ,medicine.vein ,Filter (video) ,cardiovascular system ,Radiology ,business - Abstract
Background: Inferior vena cava (IVC) filter placement still plays an essential role in preventing pulmonary embolism (PE) in patients with contraindications to anticoagulant therapy. However, IVC filter placement does have long-term risks which may be mitigated by retrieving them as soon as clinically acceptable. A dedicated IVC filter clinic provides a potential means of assuring adequate follow-up and retrieval. Aim: To assess the efficacy of our Inferior vena cava (IVC) filter retrieval clinic at improving the rate of patient follow-up, effective filter management, and retrieval rates. Materials and Methods: During the period of August 2017 through July 2018, 70 IVC filters were placed at our institution, and these patients were automatically enrolled into our IVC filter retrieval clinic for quarterly follow-up. We retrospectively reviewed data including appropriateness for removal at 3 months, overall retrieval rates, removal technique(s) employed, and technical success. Results: 62.9% of the potentially retrievable filters were removed during the study period. The technical success of extraction, using a combination of standard and advanced techniques, was 91.7%. Overall, 15% of the patients were lost to follow-up. Conclusion: Our findings add to the growing body of literature to support the need for a robust IVC filter retrieval clinic to ensure adequate follow-up and timely retrieval of IVC filters.
- Published
- 2019
42. Role of Computed Tomography-guided Biopsies in the Era of Electromagnetic Navigational Bronchoscopy: A Retrospective Study of Factors Predicting Diagnostic Yield in Electromagnetic Navigational Bronchoscopy and Computed Tomography Biopsies
- Author
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Jasraj Marjara, Ryan M. Davis, Jussuf T. Kaifi, Ambarish P. Bhat, Sachin S Saboo, Naomi K. Atkins, and Jeffrey R. Kunin
- Subjects
medicine.medical_specialty ,Solitary pulmonary nodule ,CTBS ,Population ,030204 cardiovascular system & hematology ,Malignancy ,030218 nuclear medicine & medical imaging ,Electromagnetic navigational bronchoscopy ,03 medical and health sciences ,0302 clinical medicine ,Non-small cell lung cancer ,Biopsy ,medicine ,Radiology, Nuclear Medicine and imaging ,education ,Lung cancer ,Computed tomography ,Original Research ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Pneumothorax ,Retrospective cohort study ,medicine.disease ,Radiology ,business - Abstract
Objectives: Over 25% of the high-risk population screened for lung cancer have an abnormal computed tomography (CT) scan. Conventionally, these lesions have been biopsied with CT guidance with a high diagnostic yield. Electromagnetic navigational bronchoscopy (ENB) with transbronchial biopsy has emerged as a technology that improves the diagnostic sensitivity of conventional bronchoscopic biopsy. It has been used to biopsy lung lesions, due to the low risk of pneumothorax. It is, however, a new technology that is expensive and its role in the diagnosis of the solitary pulmonary nodule (SPN) is yet to be determined. The purpose of this study was to evaluate the diagnostic yield of CT-guided biopsy (CTB) following non-diagnostic ENB biopsy and identify characteristics of the lesion that predicts a low diagnostic yield with ENB, to ensure appropriate use of ENB in the evaluation of SPN. Materials and Methods: One hundred and thirty-five lung lesions were biopsied with ENB from January 2017 to August 2019. Biopsies were considered diagnostic if pathology confirmed malignancy or inflammation in the appropriate clinical and imaging setting. We evaluated lesions for several characteristics including size, lobe, and central/peripheral distribution. The diagnostic yield of CTB in patients who failed ENB biopsies was also evaluated. Logistic regression was used to identify factors likely to predict a non-diagnostic ENB biopsy. Result: Overall, ENB biopsies were performed in 135 patients with solitary lung lesions. ENB biopsies were diagnostic in 52% (70/135) of the patients. In 23 patients with solitary lung lesions, CTBs were performed following a non-diagnostic ENB biopsy. The CTBs were diagnostic in 87% of the patients (20/23). ENB biopsies of lesions Conclusion: CTBs have a high diagnostic yield even following non-diagnostic ENB biopsies. Lesions
- Published
- 2020
43. Technical efficiency, short-term clinical results and safety of a large-bore aspiration catheter in acute pulmonary embolism – A retrospective case study
- Author
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Ambarish P. Bhat, Arash M Saemi, Hariharan Regunath, Ryan M. Davis, Sachin S Saboo, Armin Krvavac, and Junaid T Yasin
- Subjects
Pulmonary and Respiratory Medicine ,pulmonary embolism ,Unmet needs ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Medicine ,In patient ,030212 general & internal medicine ,lcsh:RC705-779 ,Aspiration catheter ,business.industry ,lcsh:Diseases of the respiratory system ,Hypoxia (medical) ,FlowTriever ,medicine.disease ,Pulmonary embolism ,Mechanical thrombectomy ,Safety profile ,030228 respiratory system ,right heart strain ,Anesthesia ,Pulmonary artery ,Chronic thromboembolic pulmonary arterial hypertension ,Original Article ,medicine.symptom ,business - Abstract
Background: Mechanical thrombectomy plays an important role in the management of acute pulmonary embolism (PE), either when rapid clot dissolution is needed or when thrombolytics are contraindicated. We describe our clinical and technical experience with the FlowTriever mechanical thrombectomy device in patients with acute PE. Materials and Methods: A retrospective analysis was performed on all cases of acute PE treated with the FlowTriever device at a single tertiary care hospital system during the trial period (November 2019–January 2020). Technical and clinical results, including complications, are reported. Results: Technical success was achieved in all eight successive cases (seven cases of submassive and 1 case of massive PE). Mean pulmonary artery pressure (MPAP) improved significantly after mechanical thrombectomy (27.8 ± 6.4 mmHg preprocedure; 20.5 ± 3.8 mmHg postprocedure; 7.3 ± 5.2 mmHg decrease after the procedure; P = 0.016). Hemoglobin levels did not change significantly after mechanical thrombectomy (11.8 g/dl ± 3.4 preprocedure; 9.9 g/dl ± 2.1 postprocedure; P = 0.20). Reduction in MPAP was achieved in 88% of cases (7/8) and hypoxia improved in all the nonintubated patients (7/7). Mortality observed in one patient with a massive central PE, was not related to the procedure. No mortality or procedural complications were observed in patients with submassive PE. Conclusions: The positive initial clinical experience and safety profile using the FlowTriever in the treatment of acute PE suggests, it has the potential to fill the unmet needs of a good mechanical thrombectomy device to treat massive and submassive high-risk PE especially when thrombolytics are contraindicated.
- Published
- 2020
44. Percutaneous revascularization of chronic total occlusions
- Author
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Ambarish P. Bhat, Robert A. Hieb, and Parag J. Patel
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Limb salvage ,Population ,Arterial Occlusive Diseases ,Constriction, Pathologic ,Revascularization ,Radiography, Interventional ,Amputation, Surgical ,Ischemia ,Angioplasty ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Intensive care medicine ,Ultrasonography, Interventional ,Aged ,education.field_of_study ,business.industry ,Cardiovascular Agents ,Critical limb ischemia ,Equipment Design ,Intermittent Claudication ,Middle Aged ,Limb Salvage ,Intermittent claudication ,Surgery ,Treatment Outcome ,Amputation ,Chronic Disease ,Disease Progression ,Female ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Angioplasty, Balloon - Abstract
Many patients with severe intermittent claudication (IC) or critical limb ischemia (CLI) have chronic total occlusions (CTO) in their lower extremity vascular bed. The successful treatment of these lesions is becoming increasingly more important as the population ages and the prevalence of diseases such as diabetes mellitus and its consequences increases. Many of these patients have significant comorbidities and may benefit from less invasive treatment options. Several endovascular techniques have now become well established in the treatment of these lesions. Additionally, several new adjunctive tools have been developed to enhance the technical success of CTO revascularization. These tools and techniques offer a minimally invasive alternative for limb salvage in this compromised patient population and have become an established practice in many centers. Although some concerns about procedure durability and lower rates of primary patency exist, particularly when compared to surgical bypass, the limb salvage and amputation-free survival rates are much more encouraging. Advantages of these techniques compared to surgical bypass are reduced morbidity and mortality, reduced anesthesia requirements, and potential reductions in length of hospital stay and cost. In addition, bypass options are typically preserved after endovascular treatment. The more conventional and some newer endovascular treatment approaches, some of the adjunctive tools and techniques used in CTO revascularization as well as their clinical results will be discussed in this review.
- Published
- 2010
45. CT diagnosis of cecal diverticulitis
- Author
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Arjun Kalyanpur, PG Sridhar, Ambarish P. Bhat, N Sreenivasan, and Jagadeesh Singh
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Ct diagnosis ,Radiology ,Diverticulitis ,medicine.disease ,business - Published
- 2006
46. Metastatic retro-crural lymph nodes from transitional cell carcinoma of bladder successfully treated with single session cryoablation
- Author
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Jasraj Marjara, Jaffar Hilli, MD, Ryan M Davis, MD, and Ambarish P Bhat, MD
- Subjects
Transitional cell cancer (TCC) ,Cryoablation ,Retro-crural ,Muscle invasive bladder cancer, Positron emission tomography ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Bladder cancer (BC) is a relatively common tumor, with a male preponderance. High-grade muscle invasive bladder cancer (MIBC) has a very high incidence of pelvic lymph node metastasis at presentation. Involvement of the retro-crural lymph nodes, although has been described in other pelvic tumors, is very uncommon for BC. Cryoablation in the retro-crural region is extremely challenging due to the proximity to the critical structures like inferior venacava and aorta and has not been extensively reported. We describe a 56-year old male patient with MIBC who underwent extensive treatments including radical cystoprostatectomy, chemoradiation and immunotherapy, ultimately with localized disease in the retro-crural region. Single session cryoablation of these lymph nodes was performed with a curative intent yielding a positive response that has persisted for more than 2 years.
- Published
- 2020
- Full Text
- View/download PDF
47. Technical efficiency, short-term clinical results and safety of a large-bore aspiration catheter in acute pulmonary embolism – A retrospective case study
- Author
-
Junaid T Yasin, Ryan Davis, Arash Saemi, Hariharan Regunath, Armin Krvavac, Sachin S Saboo, and Ambarish P Bhat
- Subjects
chronic thromboembolic pulmonary arterial hypertension ,flowtriever ,pulmonary embolism ,right heart strain ,Diseases of the respiratory system ,RC705-779 - Abstract
Background: Mechanical thrombectomy plays an important role in the management of acute pulmonary embolism (PE), either when rapid clot dissolution is needed or when thrombolytics are contraindicated. We describe our clinical and technical experience with the FlowTriever mechanical thrombectomy device in patients with acute PE. Materials and Methods: A retrospective analysis was performed on all cases of acute PE treated with the FlowTriever device at a single tertiary care hospital system during the trial period (November 2019–January 2020). Technical and clinical results, including complications, are reported. Results: Technical success was achieved in all eight successive cases (seven cases of submassive and 1 case of massive PE). Mean pulmonary artery pressure (MPAP) improved significantly after mechanical thrombectomy (27.8 ± 6.4 mmHg preprocedure; 20.5 ± 3.8 mmHg postprocedure; 7.3 ± 5.2 mmHg decrease after the procedure; P = 0.016). Hemoglobin levels did not change significantly after mechanical thrombectomy (11.8 g/dl ± 3.4 preprocedure; 9.9 g/dl ± 2.1 postprocedure; P = 0.20). Reduction in MPAP was achieved in 88% of cases (7/8) and hypoxia improved in all the nonintubated patients (7/7). Mortality observed in one patient with a massive central PE, was not related to the procedure. No mortality or procedural complications were observed in patients with submassive PE. Conclusions: The positive initial clinical experience and safety profile using the FlowTriever in the treatment of acute PE suggests, it has the potential to fill the unmet needs of a good mechanical thrombectomy device to treat massive and submassive high-risk PE especially when thrombolytics are contraindicated.
- Published
- 2020
- Full Text
- View/download PDF
48. A rare case of bleeding duodenal varices from superior mesenteric vein obstruction -treated with transhepatic recanalization and stent placement
- Author
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Ambarish P Bhat, Ryan M Davis, and William D Bryan
- Subjects
balloon-occluded antegrade transvenous obliteration ,balloon-occluded retrograde transvenous obliteration ,ectopic varices ,endoscopic procedures ,gastrointestinal bleeding ,pancreatitis ,smv recanalization ,smv stent ,transjugular intrahepatic porto-sytemic shunt ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Ectopic varices are complex and highly variable entities that are not fully understood. Duodenal varices from pancreatitis have rarely been reported. Ectopic varices have much higher bleeding rates than the more common gastro-esophageal varices, and are associated with higher mortality. The ideal management of this difficult problem is not only to ensure prompt hemostasis, but also address the etiology or hemodynamics of the ectopic varices. We discuss the endovascular management of bleeding duodenal varices, which developed from superior mesenteric vein occlusion, following repeated attacks of pancreatitis. This unusual case was managed by a multidisciplinary collaborative approach between the gastrointestinal service and Interventional radiology. The classification system for ectopic varices and management options has been discussed in some detail. Medium term follow-up (8 months), at the time of this writing, showed that the patient is doing well, without interval hematemesis, imaging findings of recurrent/new varices or stent occlusion.
- Published
- 2019
- Full Text
- View/download PDF
49. Computed tomography guided radio-frequency ablation of osteoid osteomas in atypical locations
- Author
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Julie Senne, Ryan Davis, Junaid Yasin, Olubusola Brimmo, Andrea Evenski, and Ambarish P Bhat
- Subjects
atypical locations ,nerve damage ,osteoid osteoma ,protective techniques ,radio-frequency ablation ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Purpose: Percutaneous radio-frequency ablation is a minimally invasive treatment option for osteoid osteomas. The ablation process is straightforward in the more common locations like the femur/tibia. Surgery has historically been the gold standard, but is currently used in lesions, that may not be effectively and safely ablated, i.e. close to skin/nerve. Radio-frequency ablation can still be used in such cases along with additional techniques/strategies to protect the sensitive structures and hence improve the outcomes. The authors describe their experience with four challenging osteoid osteoma ablation cases. Methods: We retrospectively reviewed radio-frequency ablations of four osteoid osteomas in rather atypical locations, the protective techniques/strategies employed, the adequacy and safety of the radio-frequency ablation with the use of these techniques. Results: All patients had complete resolution of pain with no recurrence in the follow-up period. No complications were reported. Conclusion: RFA has been proven to be an effective and safe option for treatment of OOs in the common locations. It is generally recommended to have a 1 cm safety margin between the RF probe and any critical structures in the vicinity. However, with OOs in atypical locations this may not be always possible and hence additional techniques may be needed to ensure protection of the surrounding sensitive structures and also allow for effective ablation.
- Published
- 2019
- Full Text
- View/download PDF
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