Haneef scans, interventions and diagnostics

Interventional radiology offers various options like sclerotherapy with VENASEAL, endovenous laser / Radiofrequency ablation. These are sutureless procedures with least hospital stay and side effects.
Sclerotherapy is most effective of all.

Tumor ablations-
Certain liver, renal and lung cancers, benign bone tumors can be burnt using special probes in radiofrequency and microwave ablations
Here is a liver tumor where microwave ablation was used to burn liver tumor. Immediate CT showed complete resolution.

TRANS ARTERIAL CHEMO EMBOLISATION-
This a procedure used to treat certain liver cancers, liver metastasis.
In this procedure, chemotherapy drug is directly given to the artery feeding the tumor so that side effects like hair loss are least.
Recently drug eluting beads are used to treat liver cancers.

stenting can be done for not only bile radicals and vessels but also for intestines.
Here is a case of Carcinoma pancreas causing obstruction to both duodenum and biliary tract for which stents were placed to relieve obstruction.

Embolisation of duodenal varices:
This is a case of young male with massive hematemesis due to duodenal varices, where endoscopy was not able to reach the varices. Embolisation was done using coils, access thorough liver. No further such episodes were encountered later.

STENT can be placed in order to relieve obstruction due to repeated narrowing in a vessel or to exclude aneurysms from circulation.
Here is a case of carotid vessel narrowing for which a stent was placed. post stenting flow is normal in internal carotid vessel

STENT can be placed in order to relieve obstruction due to repeated narrowing in a vessel or to exclude aneurysms from circulation.
Here is a case mycotic aneurysm was there in a patient with a lung abscess. Stent was placed to exclude aortic aneurysm from circulation. post stenting, flow in aorta is unremarkable.

BALLOON ANGIOPLASTY-
when ever a vessel is narrowed, initially with the help of a balloon catheter, narrowing can be dilated
Here is such an example
a liver transplant patient developed repeated narrowing in hepatic vein anastomosis with IVC, for which he had undergone stenting. he again developed in-stent narrowing for which a balloon catheter was used to dilate the narrowing. Post plasty narrowing showed food flow across the narrowing.

sclerotherapy can be done for venous malformations, varices, recurrent cystic lesion/ lymphoceles.
here is a case of venous malformation in cheek and lower neck, sclerotherapy was done using absolute alcohol.

CO2 ANGIOGRAM- indicated when angiogram is required in a renal failure patient.
Here is a case with a past h/o aortic and bi renal stenting for abdominal aortic aneurysm, presented with acute onset hypertension, papilledema in fundoscopy with a suspicion for renal occlusion. there was complete in-stent occlusion in right renal artery.

PERMACATH/ PERMCATH- used for a long term dialysis catheter.

peripherally inserted central venous catheter-
Indications-
Infusion therapies with hypertonic solutions, medications
that may irritate venous endothelium
– Antibiotics
– Chemotherapy
– Cytotoxins
○ Vasopressors
○ Inotropes in heart failure patients
○ Total parenteral nutrition
○ Provide access for aspiration of blood products (lab
work), for administering radiographic contrast
○ Bacteremia, sepsis, or coagulopathy preventing more
permanent access

TRANSJUGULAR LIVER/ RENAL BIOPSY - can be done when percutaneous biopsy is not possible in diffuse diseases.
Here is a case where percutaneous biopsy was not possible for a liver biopsy, transjugular liver biopsy was done.

BREAST WIRE LOCALISATION-
For a smaller breast lesions which are difficult to be palpated, a wire can be placed under ultrasound guidance into the lesion, just before the procedure, that can facilitate the surgeon.

when ever bone shows abnormal areas either lytic or sclerotic, Jamshidi needle can be used to take samples from the bone.
Here is an example where vertebral spinous process was biopsied.
Pathology report- Paget's disease.

various interventional radiology techniques can be used to take biopsy from any where in the body using ultrasound, fluoroscopy, CT and sometimes MRI.
Here is such a case of para aortic mass
CT guided biopsy was done.
Lymphoma was given in pathology report.

Epidural nerve root injection- indications-
Radiculopathy corresponding to spinal nerve root
○ Degenerative disc or facet disease
○ Extrinsic compression from neoplasm/other cause
Pain after vertebroplasty/kyphoplasty
Here is such a case of degenerative disc disease causing radiculopathy

Here is a case of diabetic peripheral neuropathy with unrelenting pain in lower limbs

INDICATION- PERINEAL REGION PAIN
OR AS A LOCAL ANESTHESIA FOR PERINEAL ANORECTAL SURGERIES LIKE HEMORRHOIDS, VAGINAL PROCEDURES,
SECOND STAGE OF LABOUR

In a trigeminal neuralgia patient, local anesthetic can be injected in to foramen ovale at skull base to relieve pain in face or ablation can be done using absolute alcohol

When there is obstruction to intestines, a stent is placed to relieve the obstruction.
Here is such a case of pancreatic cancer causing duodenal and biliary obstruction for which stents were placed to relieve obstruction of intestines and biliary system

Here is a case of esophageal cancer patient, who was unable to take oral feeds. In order to provide feeds to the patient, a catheter is placed inside the stomach whose other end will be outside. this procedure is called percutaneous gastrostomy.
PERCUTANEOUS GASTROSTOMY
INDICATIONS-
Long-term nutritional support
○ Neurologic disorders impairing swallowing
– Stroke, amyotrophic lateral sclerosis
○ Esophageal malignancy/obstruction
○ Head and neck cancer
• Gastric decompression
• Consider GJ tube if history of
○ Aspiration
○ Gastroesophageal reflux
○ Gastroparesis

PERCUTANEOUS CHOLECYSTOSTOMY-
INDICATIONS –
1] Definitive- acalculus cholecystitis, non surgical candidates due to
chronic illness or as a palliative care.
2] Temporary- pregnancy / critical illness preventing surgery
3] Biliary access when others failed

When ever there is gall bladder wall thickening due to stones or infection and patient is not fit or cant undergo surgery, catheter is placed in the gall bladder under ultrasound guidance usually.
Here is such a case where a pig tail catheter was placed in gall bladder to remove pus from gall bladder where patient was not fit for surgery. Catheter was removed before surgery after 4 weeks of catheter placement

Here is a case where metal stents were kept to relieve obstruction due to cancer at hilar region of liver leading to jaundice

PTBD- PERCUATENOUS TRANSHEPATIC BILIARY DRAINGE-
INDICATIONS--> JAUNDICE DUE TO
BILIARY OBSCTRUCTION/ LEAK LEADING TO BILE PERITONITIS
WHEN ERCP NOT POSSIBLE [POST OP or HILAR]

Here is a case of chronic cholangitis with multi ductal obstruction. Patient has undergone PTBD in which catheters were kept across the obstruction

FLUID COLLECTIONS LIKE BLOOD OR PUS ANYWHERE IN BODY CAN BE DRAINED OUT WITHOUT SURGERY OR SUTURES USING ULTRASOUND, CT OR FLUOROSCOPY LESS COMMONLY MRI WITH THE HELP OF SPECIALIZED CATHETERS LIKE MALECOT/ PIG TAIL CATHETERS

FLUID COLLECTIONS LIKE BLOOD OR PUS ANYWHERE IN BODY CAN BE DRAINED OUT WITHOUT SURGERY OR SUTURES USING ULTRASOUND, CT OR FLUOROSCOPY LESS COMMONLY MRI WITH THE HELP OF SPECIALIZED CATHETERS LIKE MALECOT/ PIG TAIL CATHETERS