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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.

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

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  • 1. Interventional Radiology Radiologist ; Dr. Salah M. Fateh
  • 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.
    • P.B. is possible for most radiologically detected abnormalities.
    • In the chest usually fluoroscopy or CT used as guide
    • Fluoroscopy usually provides suitable guidance for biopsy of large parenchymal or perihilar masses in the chest.
    • CT guidance is an alternative , particularly for small lesions.
  • 4.  
  • 5.
    • In the abdomen, US or CT is used for guidance. Where possible, US should be used.
    • Small lesions & lesions that cannot be adequately imaged with US, particularly within the retroperitoneum, are more appropriately biopsied under CT control.
  • 6.  
  • 7.
    • 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.
  • 8.  
  • 9.
    • 1-Liver Biopsy:
    • It is a commonly performed procedure, either targeted towards a focal lesion or taken from the Rt. Lobe in diffuse dis.
    • The major risk is hemorrhage after the procedure so before the biopsy the platelets and must be checked.
  • 10.
    • A-ERCP
    • used in patients with obst. Jaundice when there is distal CBD obstruction;
    • Advantages;
    • Both biliary & pancreatic ducts are studied
    • Direct inspection & biopsy of papilla & duodenum
    • sphincterotomy.
    • Removal of stone
    • Stent placement .
  • 11.
    • B-Percutaneous Transhepatic Cholengiography(PTC)
    • 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.
  • 12.
    • Through PTC, we can do ;
    • Balloon dilatation.
    • Simple external drainage.
    • External/Internal drainage.
    • Stent insertion (plastic or expanding metal)
  • 13.  
  • 14.
    • 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.
  • 15.
    • 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.
  • 16.
    • 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.
  • 17.  
  • 18.
    • 1-Enteric strictures:
    • Esophageal structures:
    • Dilatation of benign or malig. esoph. strictures can be performed with either endoscopic or fluoroscopic guidance.
    • In patients with malig. esoph. disease considered incurable by surgery, esophageal stent placement provides good palliation.
  • 19.  
  • 20.  
  • 21.  
  • 22.
    • Pyloric strict. & gastric out flow obst.
    • Benign dis. may be treated by balloon dilatation.
    • Malig. dis. causing obst. to gastric outlet or duodenum may be palliated with self-expanding metal stents.
  • 23.
    • Colorectal strictures:
    • Stents inserted per rectum have two main uses in colorectal malignancy causing obstruction;
    • - as palliative therapy in inoperable cases or patient with Ca colon but unfit for GA .
    • -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.
  • 24.
    • Percut. gastrostomy & gastrojejunostomy
    • Percut. gastrostomy placement provides a more comfortable alternative to long-term nasogastric feeding .
  • 25.
    • Percut. nephrostomy:
    • The most common indication is relief of urinary obst. to preserve renal function or to allow successful treatment of infection.
    • The procedure is usually best performed under combined US & fluoroscopic control.
    • Antegrade ureteric stent insertion
  • 26.
    • A wide range of intervention vascular techniques
    • has developed from basic angiographic
    • principles and has a profound impact on
    • many aspects of medicine & surgery.
  • 27.
    • 1-Percut. transluminal angioplasty:
    • A deflated balloon is inserted through a guidewire into a stenosis or occlusion & then inflated.
    • 2-Vascular stenting:
    • For osteal renal artery stenosis stents have been shown to be superior to balloon angioplasty alone.
  • 28. Rt renal artery stenosis After stenting
  • 29.
    • 3-Intravascular thrombolysis:
    • Thrombolytic agents can be used to treat thrombo-embolic dis.
    • 4-IVC filters:
    • can be used in pat. with recurrent pulmonary embolism despite of anticoagulation.
    • 5-Arterial embolization:
    • GIT embolization ; management of refractory upper GI bleeding by this method can be life saving.
  • 30.
    • Gonadal vein embolization
    • Occlusion of testicular vein by coils appear to be the agents of choice in the treatment of symptomatic varicocele.
    • Occlusion of ovarian veins in pelvic congestion syndrome.
    • Treatment of AVM( arteriovenous malformation) by embolization .
  • 31.
    • thank you

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