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Left-sided portal hypertension (LSPH) causes varices and splenomegaly due to splenic vein issues. Colonic varices are rare and lack standardized treatment. We report the successful treatment of colonic varices caused by LSPH, by addressing both the afferent and efferent veins. A 70-year-old man with distal cholangiocarcinoma had surgery without splenic vein resection, leading to proximal splenic vein stenosis and varices at multiple locations. Percutaneous transhepatic splenic venography revealed that collateral veins flowed into the ascending colonic varices and returned to the portal vein. Complete thrombosis of the varices was achieved by injecting sclerosants and placing coils in both the afferent and efferent veins. The procedure was safe and effective, with no variceal recurrence. This approach provides a minimally invasive option for treating colonic varices associated with LSPH.

A 52-year-old male patient presented with complaints of abdominal and back pain. CT revealed a deep pelvic abscess extending into the anterior sacral space. Since puncture via the conventional transgluteal approach cannot reach a deep abscess, percutaneous pelvic abscess drainage was performed under CT fluoroscopy using the cranio-caudal puncture technique. The cranio-caudal puncture requires needle insertion perpendicular to the CT cross-section. This method advances the CT gantry deeper than the needle tip and follows the CT cross-section with the needle tip. This series of images and movements continues until the needle reaches the target. The procedure was successful without complications, the abscess was reduced in size, and blood test data improved. The cranio-caudal puncture technique provides an alternative for the drainage of deep pelvic abscesses that avoids the complications associated with gluteal muscle puncture. Percutaneous drainage of pelvic abscesses under CT fluoroscopy-guided cranio-caudal puncture offers a safe option as a puncture route for deep pelvic abscesses.

Radiofrequency ablation (RFA) has emerged as a potent therapeutic modality for tumor treatment, and offers benefits such as reduced recovery time and minimal damage to nearby tissues. However, RFA is not devoid of complications, notably nerve damage during intrathoracic lesion treatments, which can significantly impact patients' quality of life. This report describes the unique case of a 71-year-old male who experienced hoarseness attributed to injury to the recurrent nerve after RFA for a locally recurrent lung cancer lesion in the mediastinum near the aortic arch. Although RFA has the advantages of a minimally invasive nature and positive outcomes, its risk of nerve injury, specifically in the thoracic region, highlights the need for improved techniques and preventive measures.

The standard treatment for ruptured duodenal varices remains to be established. Emergency balloon-occluded retrograde transvenous obliteration is challenging in patients with bleeding because re-rupture of varices can occur due to increased pressure when using the retrograde approach. Herein, we describe a case in which a catheter was retrogradely advanced to the afferent vein beyond bleeding duodenal varices; however, the varices re-ruptured during coil embolization, and a part of the catheter was deviated into the intestinal tract. The rupture site was embolized by liquid embolic materials from the microcatheter. Embolization via retrograde approach needs to be carefully performed.

Recently, combination therapy with atezolizumab, a humanized monoclonal antiprogrammed death ligand-1 antibody, and bevacizumab, has become available for treatment of unresectable hepatocellular carcinoma (HCC). We herein report a 73-year-old man with advanced stage HCC who developed fatigue during treatment with atezolizumab–bevacizumab combination therapy. Computed tomography identified intratumoral hemorrhage within the HCC metastasis to the right fifth rib metastasis of HCC, which was confirmed on emergency angiography of the right 4th and 5th intercostal arteries and some branches of the subclavian artery confirmed intratumoral hemorrhage, following which transcatheter arterial embolization (TAE) was performed to achieve hemostasis. He continued to receive atezolizumab-bevacizumab combination therapy after TAE, and no rebleeding was seen. Although uncommon, rupture and intratumoral hemorrhage in the HCC metastasis to the ribs can cause life-threatening hemothorax. However, to our knowledge, no previous cases of intratumoral hemorrhage in HCC during atezolizumab–bevacizumab combination therapy have been reported. This is the first report of intratumoral hemorrhage with the combination therapy of atezolizumab and bevacizumab, which was successfully controlled by TAE. Patients receiving this combination therapy should be observed for intratumoral hemorrhage, which can be managed by TAE if it does occur.

A 70-year-old woman with liver cirrhosis was admitted to our hospital for treatment of growing gastric varices in the fundus. Computed tomography showed gastric varices continuously draining the pericardiophrenic vein via the inferior phrenic vein. Balloon-occluded retrograde transvenous obliteration by a transjugular approach was planned. However, a conventional balloon catheter or microballoon catheter could not be inserted into the efferent vein near the varices because of the narrowness and tortuosity of the vein. Hence, coil-assisted retrograde transvenous obliteration was performed by an inverted catheter tip technique using a single conventional microcatheter. This technique might be useful for cases in which it is difficult to insert a balloon catheter into the efferent vein.

A 74-year-old patient presented with hematochezia and a history of liver cirrhosis with repeated bleeding from esophageal and rectal varices. Endoscopic examination revealed multiple rectal varices with positive red color signs. Ascites, severe portosystemic thrombosis and a splenorenal shunt were diagnosed on a contrast-enhanced dynamic computed tomography examination. From a transjugular approach, we circumvented thrombosed regions by maneuvering double balloon catheters through the shunt and dilated left colic marginal vein. We managed to successfully obliterate the varices.

Here, we present a very unusual case of orbital apex schwannoma with a high titer of proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA). A 67-year-old man presented with a 3-month history of double vision. Radiological examinations revealed a mass lesion at the left orbital apex, and laboratory examination revealed a high titer of PR3-ANCA, of 49.1 U/mL (reference range

Dysembryoplastic neuroepithelial tumors (DNTs) are benign brain tumors classified as grade 1 in the 2021 World Health Organization (WHO) classification of central nervous system tumors. DNTs rarely undergo malignant transformation and cause symptomatic intracranial hemorrhage. We report a case of malignant transformation of DNT presenting with intraventricular hemorrhage and review the literature on malignant transformation of DNTs. An 18-year-old woman with a history of epilepsy presented with a sudden headache and vomiting. Radiological examination revealed a mass lesion in the left parietal lobe and intraventricular hemorrhage. The patient underwent an emergency craniotomy for brain tumor resection. The lesion was pathologically diagnosed as a malignant transformation of DNT. She had been followed up without tumor recurrence for 2 years after surgery.

Capillary hemangiomas are benign vascular tumors usually diagnosed in infancy and involving skin and soft tissues. We report a rare case of an adult capillary hemangioma of the left sphenoid sinus extending into the intrasellar and parasellar regions. A 71-year-old woman presented with complaints of headaches and diplopia. Magnetic resonance imaging revealed a T2-hyperintense mass-like lesion involving the left posterior ethmoid and sphenoid sinuses and left cavernous sinus, that had extended into the intrasellar and parasellar regions. Dynamic contrast-enhanced computed tomography revealed enhancing vessel-like structures within the lesion during the arterial phase, which were observed to expand further in the late phase of the examination. This characteristic feature indicated increased vascularity, suggesting the presence of a capillary hemangioma. The patient underwent endoscopic resection via the endonasal transpterygoid approach, and the lesion was diagnosed histopathologically as a capillary hemangioma. To aid diagnosis and clinical management, radiologists should be aware of the imaging findings related to capillary hemangiomas.

Craniopharyngiomas located outside the intra/suprasellar region are rare and the incidence of intratumoral hemorrhage is also rare. A 45-year-old woman with visual field defect underwent subtotal resection of the tumor located in the skull base. CT revealed a well-defined mass with calcifications involving the clivus, and MRI showed anterior displacement of a normal pituitary gland by the mass consisting cystic portions with some fluid-fluid levels and enhancing solid portions. Surgery and histopathological examination revealed an ectopic adamantinomatous craniopharyngioma arising from the clivus with intratumoral hemorrhage. Though this condition is rare, detailed analysis of symptoms in association with imaging findings should alert the physician to the possibility of craniopharyngiomas. Keywords: Clivus, Craniopharyngioma, Ectopic, Intratumoral hemorrhage

Choroid plexus papillomas (CPPs) are rare neoplasms classified as World Health Organization grade I tumors. CPPs containing other tissues have occasionally been documented in the literature. However, few of these previous reports have provided clinical and radiological information. We herein report a case of a posterior fossa CPP with focal ependymal differentiation in a 42-year-old woman who presented with a 6-month history of progressive headache. Preoperative radiological images showed a hypervascular tumor protruding into the left foramen of Luschka with perilesional edema. Gross total resection of the tumor was performed. Histopathological examination revealed that the tumor was composed of papillary structures. Immunohistochemical staining of glial fibrillary acidic protein was focally positive around the capillaries, which was suggestive of “perivascular pseudorosette” formation. Our case showed similar imaging appearances as those of CPP; thus, it seems difficult to distinguish CPP with versus without ependymal differentiation by clinical and radiological features alone. The clinical significance and pathogenesis of ependymal differentiation in CPP remain unclear, and further case reports are required. Keywords: Choroid plexus papilloma, Ependymal differentiation, Fourth ventricle, Magnetic resonance imaging