Causes of benign and malignant biliary obstruction • Common benign causes include bile duct calculi, benign strictures, pancreatitis, and sclerosing cholangitis • Less common benign causes include Caroli’s disease, Mirizzi syndrome, and parasitic infection. • Common malignant causes include pancreatic cancer, metastatic disease, and cholangiocarcinoma. • Less common malignant causes include gallbladder carcinoma and ampullary tumors.
What are the indications for percutaneous transhepatic biliary drainage? Percutaneous biliary drainage is indicated for the treatment of cholangitis or pruritus related to hyperbilirubinemia in the setting of benign or malignant obstructive biliary disease. Biliary drainage may also be performed in the setting of a traumatic bile leak to help divert bile and promote healing …
Indications for percutaneous transhepatic biliary drainage Read More »
When is uterine artery embolization used in a nonemergent setting? Uterine fibroids causing menorrhagia or pelvic pain can be treated effectively with bilateral UAE, also known as uterine fibroid embolization (UFE). UAE can be performed with permanent particles.
What findings suggest that postembolization gas is due to infection? Beyond 5 days post procedure, when postembolization syndrome is expected to resolve, persistent fever, elevated serum markers of inflammation (erythrocyte sedimentation rate, C-reactive protein), or a fluid level in the embolized area suggests superinfection of the embolized tissue.
What is the significance of gas in the target organ post embolization? There is little significance. Gas is often present in the target organ after embolization and, as mentioned earlier, is thought to arise from tissue necrosis. The presence of gas does not always indicate infection. Resorption of the gas may take weeks.
What happens when the cystic artery is embolized during hepatic lesion embolization/chemoembolization? A transient chemical cholecystitis may result. This condition can be self-limited and may resolve with conservative management. Incidental embolization of the cystic artery is believed to contribute to postembolization pain in patients undergoing hepatic chemoembolization.
How is chemoembolization theorized to work? Embolization of tumor vessels causes ischemia. This ischemia disables tumor cell membrane ion pumps and exocytosis functions and increases capillary permeability. As a result, there is increased intracellular accumulation and dwell time of the concomitantly delivered chemotherapeutic agent, leading to increased tumor cell apoptosis.