Faculty Bibliography

Hyperparathyroidism is an excess of parathyroid hormone in the blood due to over-activity of one or more parathyroid gland. Localization of abnormal glands with noninvasive imaging modalities, such as technetium sestamibi scan and cross-sectional imaging, has a high success rate. Parathyroid venous sampling is performed for patients with persistent or recurrent disease after previous parathyroid surgery, when repeat noninvasive imaging studies are negative or discordant. The success of invasive localization studies and results interpretation is dependent on the interventional radiologist's understanding of the normal and ectopic anatomic locations of parathyroid glands, as well as their blood supply and venous drainage. Anatomic and technical considerations for selective parathyroid venous sampling are reviewed.

Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.

Hydatid disease (echinococcosis) is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. The disease is endemic in many parts of the world, particularly in the Middle East, Australia, New Zealand, South America and central and south Europe. Intracranial hydatid disease is considered a rare disease and may be sometimes very difficult to diagnose based on the clinical and laboratory findings. Therefore, it is important to be aware of the condition and the imaging findings even in the non-endemic parts of the world. We report the case of a 12-year-old boy who presented with headache and vomiting for a few months. The mass was totally excised, with no postoperative complications. We present MR spectroscopy (MRS) findings in this operatively proven case of hydatid cyst of the brain. We discuss imaging findings, in particular the findings on MRS, which is rarely reported in the literature.

Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care. Patient care before and after an interventional procedure, identification, and management of early and delayed complications of various procedures are equal in importance to the procedure itself. In this second part, we complete the comprehensive, methodical review of pre-procedural care and patient preparation before vascular and interventional radiology procedures.

Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care after the procedure is completed. After patient referral, contact with the referring physician and multidisciplinary team approach is vital. In addition, clinical history, physical examination, as well as full understanding of the pre-procedural laboratory results and imaging findings can guide the interventional radiologist to implement the most appropriate management plan, avoid unnecessary procedures, and prevent complications to achieve a successful outcome. We provide a comprehensive, methodical review of pre-procedural care and management in patients undergoing vascular and interventional radiology procedures.

Learning Objectives: 1. To demonstrate the importance of post-procedural care in achieving good outcomes. 2. To provide an overview of appropriate general guidelines for clinical and radiographic follow-up of patients in the post-procedural period. 3. To provide a simple post-procedural plan for commonly performed and challenging procedures. 4. To discuss the management plan for the most commonly encountered early and delayed complications in vascular and non-vascular interventions. Background: In thenearly50years sinceDr. Alexander Margulis first proposed it as a new subspecialty of radiology, interventional radiology has transformed into a dynamic fully-developed clinical specialty. Success in interventional radiology in the current era requires strong clinical skills and familiarity with not only a broad range of disease and procedural techniques, but also the diagnosis and management of their possible complications. Adverse events that occur during and immediately after vascular and interventional radiology (VIR) procedures may often be avoided by improved pre-procedural planning, more effective communication between healthcare team members, and more consistent and structured post-procedural care. Clinical Findings/Procedure Details: Structure for Post-procedural Care * Instructions (for outpatients and inpatient referring services) * General * Activity * Antibiotics * Analgesia * Resuming medications, in particular anticoagulation and antiplatelet therapy * Plan for follow-up clinic visits and imaging * Procedure-specific (vascular and non-vascular) * Warning signs * Catheter care * RED FLAGS: ominous signs and symptoms * Tachycardia, dizziness, near-syncope * Increasing pain * Fever * Essentials of managing common complications Conclusions: 1. Excellence in interventional radiology requires not only superb procedural skills, but also consistent and structured post-procedural care. 2. Accurate clinical and radiographic assessment in the post-procedural period, proper management of complications, and close follow-up are essential in appropriate management of patients undergoing interventional procedures