Radiology 5th year, 5th lecture (Dr. Salah Mohammad Fatih)


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The lecture has been given on May 26th, 2011 by Dr. Salah Mohammad Fatih.

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Radiology 5th year, 5th lecture (Dr. Salah Mohammad Fatih)

  1. 1. Interventional Radiology Radiologist ; Dr. Salah M. Fateh
  2. 2. Radiology has provoked from providing purely diagnostic information to therapy , offering effective alternatives in the Rx of abdominal & thoracic & vascular disorders. In some instances I.R. techniques have replaced the conventional surgical approach, removing the need for G.A .
  3. 3. <ul><li>P.B. is possible for most radiologically detected abnormalities. </li></ul><ul><li>In the chest usually fluoroscopy or CT used as guide </li></ul><ul><li>Fluoroscopy usually provides suitable guidance for biopsy of large parenchymal or perihilar masses in the chest. </li></ul><ul><li>CT guidance is an alternative , particularly for small lesions. </li></ul>
  4. 5. <ul><li>In the abdomen, US or CT is used for guidance. Where possible, US should be used. </li></ul><ul><li>Small lesions & lesions that cannot be adequately imaged with US, particularly within the retroperitoneum, are more appropriately biopsied under CT control. </li></ul>
  5. 7. <ul><li>Almost any fluid collection in the chest, abdomen or pelvis may be considered for percutanous catheter drainage, which has largely replaced surgery as the initial treatment of choice. </li></ul>
  6. 9. <ul><li>1-Liver Biopsy: </li></ul><ul><li>It is a commonly performed procedure, either targeted towards a focal lesion or taken from the Rt. Lobe in diffuse dis. </li></ul><ul><li>The major risk is hemorrhage after the procedure so before the biopsy the platelets and must be checked. </li></ul>
  7. 10. <ul><li>A-ERCP </li></ul><ul><li>used in patients with obst. Jaundice when there is distal CBD obstruction; </li></ul><ul><li>Advantages; </li></ul><ul><li>Both biliary & pancreatic ducts are studied </li></ul><ul><li>Direct inspection & biopsy of papilla & duodenum </li></ul><ul><li>sphincterotomy. </li></ul><ul><li>Removal of stone </li></ul><ul><li>Stent placement . </li></ul>
  8. 11. <ul><li>B-Percutaneous Transhepatic Cholengiography(PTC) </li></ul><ul><li>Those pt who are not suitable for ERCP , because of previous gastric surgery, difficulties with canulations of the ampula or a tight stricture that cannot be negotiated from below or where there is more proximal biliary obstruction ,in these patients, a percut. transhepatic approach is required. Dilated systems require drainage to reduce the risk of sepsis & relief jaundice. </li></ul>
  9. 12. <ul><li>Through PTC, we can do ; </li></ul><ul><li>Balloon dilatation. </li></ul><ul><li>Simple external drainage. </li></ul><ul><li>External/Internal drainage. </li></ul><ul><li>Stent insertion (plastic or expanding metal) </li></ul>
  10. 14. <ul><li>Percut. GB puncture & drainage may be beneficial in acute calculus & acalculus cholecystitis or GB empyema in patients who are at risk for surgery or whose medical condition is unstable. </li></ul>
  11. 15. <ul><li>Injection of liquid agents such as alcohol or acetic acid, heating the tumor by use of laser or radiofrequency probes and freezing the tumor by cryothrapy. Hepatomas are softer & spongier than metastases generally and are more amenable to injection. </li></ul>
  12. 16. <ul><li>Percut. creation of a communication bet. the portal & hepatic venous systems for the relief of portal hypertension. It is an alternative to surgery in patients with recurrent variceal bleeding who are resistant to sclerotherapy or endoscopic banding. </li></ul>
  13. 18. <ul><li>1-Enteric strictures: </li></ul><ul><li>Esophageal structures: </li></ul><ul><li>Dilatation of benign or malig. esoph. strictures can be performed with either endoscopic or fluoroscopic guidance. </li></ul><ul><li>In patients with malig. esoph. disease considered incurable by surgery, esophageal stent placement provides good palliation. </li></ul>
  14. 22. <ul><li>Pyloric strict. & gastric out flow obst. </li></ul><ul><li>Benign dis. may be treated by balloon dilatation. </li></ul><ul><li>Malig. dis. causing obst. to gastric outlet or duodenum may be palliated with self-expanding metal stents. </li></ul>
  15. 23. <ul><li>Colorectal strictures: </li></ul><ul><li>Stents inserted per rectum have two main uses in colorectal malignancy causing obstruction; </li></ul><ul><li>- as palliative therapy in inoperable cases or patient with Ca colon but unfit for GA . </li></ul><ul><li>-as initial strategy in pat. presenting with malig. Colonic obst. to allow medical optimization of the pat. prior to surgery to minimize surgical morbidity & allow a one-step surgical procedure. </li></ul>
  16. 24. <ul><li>Percut. gastrostomy & gastrojejunostomy </li></ul><ul><li>Percut. gastrostomy placement provides a more comfortable alternative to long-term nasogastric feeding . </li></ul>
  17. 25. <ul><li>Percut. nephrostomy: </li></ul><ul><li>The most common indication is relief of urinary obst. to preserve renal function or to allow successful treatment of infection. </li></ul><ul><li>The procedure is usually best performed under combined US & fluoroscopic control. </li></ul><ul><li>Antegrade ureteric stent insertion </li></ul>
  18. 26. <ul><li>A wide range of intervention vascular techniques </li></ul><ul><li>has developed from basic angiographic </li></ul><ul><li>principles and has a profound impact on </li></ul><ul><li>many aspects of medicine & surgery. </li></ul>
  19. 27. <ul><li>1-Percut. transluminal angioplasty: </li></ul><ul><li>A deflated balloon is inserted through a guidewire into a stenosis or occlusion & then inflated. </li></ul><ul><li>2-Vascular stenting: </li></ul><ul><li>For osteal renal artery stenosis stents have been shown to be superior to balloon angioplasty alone. </li></ul>
  20. 28. Rt renal artery stenosis After stenting
  21. 29. <ul><li>3-Intravascular thrombolysis: </li></ul><ul><li>Thrombolytic agents can be used to treat thrombo-embolic dis. </li></ul><ul><li>4-IVC filters: </li></ul><ul><li>can be used in pat. with recurrent pulmonary embolism despite of anticoagulation. </li></ul><ul><li>5-Arterial embolization: </li></ul><ul><li>GIT embolization ; management of refractory upper GI bleeding by this method can be life saving. </li></ul>
  22. 30. <ul><li>Gonadal vein embolization </li></ul><ul><li>Occlusion of testicular vein by coils appear to be the agents of choice in the treatment of symptomatic varicocele. </li></ul><ul><li>Occlusion of ovarian veins in pelvic congestion syndrome. </li></ul><ul><li>Treatment of AVM( arteriovenous malformation) by embolization . </li></ul>
  23. 31. <ul><li>thank you </li></ul>