Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769774
Ran Jing, Travis Merritt, Joseph J Gemmete
Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the diaphragm and lung parenchyma. In this report, we present a case of diaphragmatic injury and subsequent empyema following MWA of a liver dome lesion.
{"title":"Diaphragmatic Injury with Empyema Development after Microwave Ablation of a Liver Dome Lesion.","authors":"Ran Jing, Travis Merritt, Joseph J Gemmete","doi":"10.1055/s-0043-1769774","DOIUrl":"10.1055/s-0043-1769774","url":null,"abstract":"<p><p>Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the diaphragm and lung parenchyma. In this report, we present a case of diaphragmatic injury and subsequent empyema following MWA of a liver dome lesion.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9864678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769764
Keith B Quencer
A case of transplant hepatic artery thrombosis treated with thrombolysis and vascular stenting is presented. Stenting was complicated by hepatic artery rupture necessitating emergent stent graft placement. Hepatic artery occlusion in a liver transplant often leads to biliary complications such as ischemic cholangiopathy, biliary necrosis, cholangitis, biloma formation, intrahepatic abscesses, and liver failure. Prompt recognition and appropriate treatment of hepatic artery thrombosis are necessary to avoid graft failure and possible death.
{"title":"Transplant Hepatic Artery Rupture.","authors":"Keith B Quencer","doi":"10.1055/s-0043-1769764","DOIUrl":"10.1055/s-0043-1769764","url":null,"abstract":"<p><p>A case of transplant hepatic artery thrombosis treated with thrombolysis and vascular stenting is presented. Stenting was complicated by hepatic artery rupture necessitating emergent stent graft placement. Hepatic artery occlusion in a liver transplant often leads to biliary complications such as ischemic cholangiopathy, biliary necrosis, cholangitis, biloma formation, intrahepatic abscesses, and liver failure. Prompt recognition and appropriate treatment of hepatic artery thrombosis are necessary to avoid graft failure and possible death.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769768
Asad Malik, Kent T Sato, Ahsun Riaz
The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.
{"title":"Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy.","authors":"Asad Malik, Kent T Sato, Ahsun Riaz","doi":"10.1055/s-0043-1769768","DOIUrl":"10.1055/s-0043-1769768","url":null,"abstract":"<p><p>The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769770
Bartley Thornburg
Hepatic encephalopathy (HE) is a complex condition that arises as a complication of chronic liver disease and portosystemic shunting. Its pathophysiology involves several factors, including impaired ammonia metabolism, portosystemic shunting, sarcopenia, and systemic inflammation. The symptoms of HE can vary significantly, with manifestations ranging from subclinical signs to a comatose state. The West Haven classification system is most commonly used to grade the severity of HE. There is a broad differential for the presenting symptomatology of HE and other causes of altered mental status must be excluded during the workup. HE is a well-known complication of transjugular intrahepatic portosystemic shunt (TIPS) placement. Even though newer stent designs help reduce the risk of HE with smaller diameter shunts, it is essential that patients are counseled regarding this potential risk prior to the procedure. Once a diagnosis of HE has been confirmed, the mainstay of therapy is lactulose and rifaximin. In cases where a patient has received a TIPS placement and continues to experience refractory HE despite medical therapy, it may be necessary to consider shunt reduction or closure.
肝性脑病(HE)是一种复杂的疾病,是慢性肝病和门静脉分流的并发症。其病理生理学涉及多个因素,包括氨代谢受损、门体分流、肌肉疏松症和全身炎症。高血压的症状差异很大,表现从亚临床症状到昏迷状态不等。最常用的是 West Haven 分类系统来对 HE 的严重程度进行分级。HE 的表现症状有多种鉴别方式,在检查过程中必须排除导致精神状态改变的其他原因。高血压是众所周知的经颈静脉肝内门体分流术(TIPS)并发症。尽管较新的支架设计有助于降低直径较小的分流管发生 HE 的风险,但在手术前向患者提供有关这一潜在风险的咨询至关重要。一旦确诊为高血压,治疗的主要方法是乳果糖和利福昔明。如果患者接受了 TIPS 置管术,但在接受药物治疗后仍出现难治性高血压,则有必要考虑缩小或关闭分流管。
{"title":"Hepatic Encephalopathy following Transjugular Intrahepatic Portosystemic Shunt Placement.","authors":"Bartley Thornburg","doi":"10.1055/s-0043-1769770","DOIUrl":"10.1055/s-0043-1769770","url":null,"abstract":"<p><p>Hepatic encephalopathy (HE) is a complex condition that arises as a complication of chronic liver disease and portosystemic shunting. Its pathophysiology involves several factors, including impaired ammonia metabolism, portosystemic shunting, sarcopenia, and systemic inflammation. The symptoms of HE can vary significantly, with manifestations ranging from subclinical signs to a comatose state. The West Haven classification system is most commonly used to grade the severity of HE. There is a broad differential for the presenting symptomatology of HE and other causes of altered mental status must be excluded during the workup. HE is a well-known complication of transjugular intrahepatic portosystemic shunt (TIPS) placement. Even though newer stent designs help reduce the risk of HE with smaller diameter shunts, it is essential that patients are counseled regarding this potential risk prior to the procedure. Once a diagnosis of HE has been confirmed, the mainstay of therapy is lactulose and rifaximin. In cases where a patient has received a TIPS placement and continues to experience refractory HE despite medical therapy, it may be necessary to consider shunt reduction or closure.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9864684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769772
Stephanie H Kim, Michael Samuel, Abouelmagd Makramalla
Transjugular intrahepatic portosystemic shunt (TIPS) is an important interventional option for the treatment of complications related to cirrhosis and portal hypertension. Emergent TIPS placement can be a life-saving measure in patients with uncontrolled variceal hemorrhage. After TIPS placement, patients may benefit from additional interventions for clinical optimization including stent dilation, stent extension, and embolization of varices. Here, we describe a case of emergent TIPS placement and revision which resulted in TIPS stent migration requiring stent removal and replacement. We discuss our technique and review previously reported methods for the management of migrated TIPS stents.
{"title":"Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision.","authors":"Stephanie H Kim, Michael Samuel, Abouelmagd Makramalla","doi":"10.1055/s-0043-1769772","DOIUrl":"10.1055/s-0043-1769772","url":null,"abstract":"<p><p>Transjugular intrahepatic portosystemic shunt (TIPS) is an important interventional option for the treatment of complications related to cirrhosis and portal hypertension. Emergent TIPS placement can be a life-saving measure in patients with uncontrolled variceal hemorrhage. After TIPS placement, patients may benefit from additional interventions for clinical optimization including stent dilation, stent extension, and embolization of varices. Here, we describe a case of emergent TIPS placement and revision which resulted in TIPS stent migration requiring stent removal and replacement. We discuss our technique and review previously reported methods for the management of migrated TIPS stents.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Life-threatening arterial complications after pancreatic transplantation can be dire. Pseudoaneurysms can be challenging to treat. There are multiple strategies to treat such complications. We present a case of pancreatic pseudoaneurysm which was initially treated by coiling followed by subsequent covered stent placement for a more durable outcome. We advocate for a "stent first" approach to these lesions if feasible.
{"title":"Persistent Bleeding after Coil Embolization of a Pancreatic Transplant Pseudoaneurysm: Should Covered Stents Be the Primary Management?","authors":"Keshav Anand, Ziga Cizman, Tyler Smith, David Strain, Suraj Patel, Jeffrey Campsen, Talia Baker, Wael Saad","doi":"10.1055/s-0043-1769763","DOIUrl":"10.1055/s-0043-1769763","url":null,"abstract":"<p><p>Life-threatening arterial complications after pancreatic transplantation can be dire. Pseudoaneurysms can be challenging to treat. There are multiple strategies to treat such complications. We present a case of pancreatic pseudoaneurysm which was initially treated by coiling followed by subsequent covered stent placement for a more durable outcome. We advocate for a \"stent first\" approach to these lesions if feasible.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769771
Michelle Wiese, Shankar Rajeswaran
Image-guided percutaneous biopsies are routine, safe procedures and complications are infrequent and usually directly related to the biopsy itself. This report describes a biopsy of a retroperitoneal mass with extension into the spinal canal, following which the patient developed paralysis unrelated to the biopsy itself but secondary to spinal cord ischemia during the procedure. Multiple factors contributed to the ischemia, including prone positioning, compression of spinal vasculature by the mass, low arterial pressures, and an extended duration of anesthesia. While the patient eventually recovered neurologic function, it is an important reminder to consider individual patient factors that may complicate typically routine procedures. In masses with intraspinal extension, patient positioning is critical to prevent positional ischemia, and maintaining elevated mean arterial pressures is crucial for ensuring adequate spinal perfusion throughout the procedure.
{"title":"New-Onset Paralysis following Biopsy of a Retroperitoneal Mass with Intraspinal Extension in a Pediatric Patient.","authors":"Michelle Wiese, Shankar Rajeswaran","doi":"10.1055/s-0043-1769771","DOIUrl":"10.1055/s-0043-1769771","url":null,"abstract":"<p><p>Image-guided percutaneous biopsies are routine, safe procedures and complications are infrequent and usually directly related to the biopsy itself. This report describes a biopsy of a retroperitoneal mass with extension into the spinal canal, following which the patient developed paralysis unrelated to the biopsy itself but secondary to spinal cord ischemia during the procedure. Multiple factors contributed to the ischemia, including prone positioning, compression of spinal vasculature by the mass, low arterial pressures, and an extended duration of anesthesia. While the patient eventually recovered neurologic function, it is an important reminder to consider individual patient factors that may complicate typically routine procedures. In masses with intraspinal extension, patient positioning is critical to prevent positional ischemia, and maintaining elevated mean arterial pressures is crucial for ensuring adequate spinal perfusion throughout the procedure.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769769
Keith B Quencer, Alan Massouh, Keshav Anand
We describe a case of right adrenal hemorrhage from adrenal vein sampling treated conservatively with overnight admission and pain control. We review the existing literature on rates of this complication, typical clinical outcomes, and practical tips to avoid its occurrence.
{"title":"Hemorrhage from Adrenal Vein Rupture during Adrenal Vein Sampling.","authors":"Keith B Quencer, Alan Massouh, Keshav Anand","doi":"10.1055/s-0043-1769769","DOIUrl":"10.1055/s-0043-1769769","url":null,"abstract":"<p><p>We describe a case of right adrenal hemorrhage from adrenal vein sampling treated conservatively with overnight admission and pain control. We review the existing literature on rates of this complication, typical clinical outcomes, and practical tips to avoid its occurrence.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9864679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769745
Anthony Finnay Blackburn, Gina P Landinez, Robert K Kerlan, R Peter Lokken
Patent foramen ovale (PFO) is a common congenital abnormality of high prevalence in adults. Its clinical significance is magnified in a right-to-left shunt, where paradoxical embolism can have catastrophic outcomes involving the brain, heart, mesenteric circulation, or extremities. Right-to-left shunting through a PFO is caused by increased right atrial pressure, as seen in the setting of pulmonary artery hypertension or pulmonary embolism. This case highlights the relevance of central venous catheter placement in the setting of a PFO. While the patient did not experience clinical sequelae from line placement, she was at high risk for paradoxical embolus. Recognizing the possibility of a PFO during central venous catheter placement, especially in the setting of increased right pressures, should be a consideration of all interventional radiologists.
{"title":"Malposition of a Femoral Tunneled Dialysis Catheter through a Patent Foramen Ovale.","authors":"Anthony Finnay Blackburn, Gina P Landinez, Robert K Kerlan, R Peter Lokken","doi":"10.1055/s-0043-1769745","DOIUrl":"10.1055/s-0043-1769745","url":null,"abstract":"<p><p>Patent foramen ovale (PFO) is a common congenital abnormality of high prevalence in adults. Its clinical significance is magnified in a right-to-left shunt, where paradoxical embolism can have catastrophic outcomes involving the brain, heart, mesenteric circulation, or extremities. Right-to-left shunting through a PFO is caused by increased right atrial pressure, as seen in the setting of pulmonary artery hypertension or pulmonary embolism. This case highlights the relevance of central venous catheter placement in the setting of a PFO. While the patient did not experience clinical sequelae from line placement, she was at high risk for paradoxical embolus. Recognizing the possibility of a PFO during central venous catheter placement, especially in the setting of increased right pressures, should be a consideration of all interventional radiologists.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20eCollection Date: 2023-06-01DOI: 10.1055/s-0043-1769906
Dylan J Assael, Steven C Sauk
Paracenteses are considered safe procedures; however, in patients with portal hypertension, the rapid shifts in intraabdominal pressure can prompt hemorrhage from an ectopic varix. Little literature exists on the appropriate management in this clinical setting. Here, we describe a patient with portal hypertension secondary to Budd-Chiari syndrome, presenting with massive hemoperitoneum following paracentesis. Angiography was performed, without revealing an arterial source of bleeding. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed via a recanalized middle hepatic vein, reducing the patient's portosystemic gradient from 15 to 6 mm Hg. This patient developed no further signs or symptoms of bleeding and remained hemodynamically stable until discharge. Follow-up imaging confirmed patency of her shunt and resolution of her ascites, without the need for future paracentesis. This case highlights that in the absence of arterial extravasation, the possibility of ectopic variceal hemorrhage should be considered, which can be successfully treated with portosystemic shunt creation.
{"title":"Massive Hemoperitoneum after Paracentesis in a Patient with Budd-Chiari Syndrome: Treated with a TIPS after Negative Arteriogram.","authors":"Dylan J Assael, Steven C Sauk","doi":"10.1055/s-0043-1769906","DOIUrl":"10.1055/s-0043-1769906","url":null,"abstract":"<p><p>Paracenteses are considered safe procedures; however, in patients with portal hypertension, the rapid shifts in intraabdominal pressure can prompt hemorrhage from an ectopic varix. Little literature exists on the appropriate management in this clinical setting. Here, we describe a patient with portal hypertension secondary to Budd-Chiari syndrome, presenting with massive hemoperitoneum following paracentesis. Angiography was performed, without revealing an arterial source of bleeding. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed via a recanalized middle hepatic vein, reducing the patient's portosystemic gradient from 15 to 6 mm Hg. This patient developed no further signs or symptoms of bleeding and remained hemodynamically stable until discharge. Follow-up imaging confirmed patency of her shunt and resolution of her ascites, without the need for future paracentesis. This case highlights that in the absence of arterial extravasation, the possibility of ectopic variceal hemorrhage should be considered, which can be successfully treated with portosystemic shunt creation.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9864683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}