state of the art pediatric interventional radiology brent cully, md
DESCRIPTION
State of the Art Pediatric Interventional Radiology Brent Cully, MD. Doug Rivard , DO Brenton Reading MD. CMH Interventional Radiology. 3 Physicians 2 Nurse Practitioners 3 Technologists 2 IR Rooms 1 CT Fluoro Dedicated Ultrasound. CMH Interventional Radiology. - PowerPoint PPT PresentationTRANSCRIPT
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State of the ArtPediatric Interventional
Radiology
Brent Cully, MD• Doug Rivard, DO Brenton
Reading MD
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CMH Interventional Radiology
• 3 Physicians• 2 Nurse
Practitioners• 3 Technologists• 2 IR Rooms • 1 CT Fluoro• Dedicated Ultrasound
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CMH Interventional Radiology
• Full sedation team under supervision of Dept of Anesthesiology
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Sedation• 8 Work Up /
Recovery rooms
• Most patients get sedation
• Must be npo 6 hours– 2 hrs clears
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CMH Interventional Radiology
• Services Provided– Vascular Access– Angiography / Angioplasty– GI Access– Lumbar Puncture– Image-Guided Biopsy / Drainage– Ablation / Embolization – Catheter Stripping– Intravascular Foreign Body Retrieval
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CMH Interventional Radiology
• Services Provided
– Vascular Anomalies Clinic• In Conjunction with Dermatology and Plastic Surgery• Contact Dermatology Clinic
– Direct Interventional Consults• Imaging Guided Biopsies, Drainages, Vascular Access• Contact CMH Radiology
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Vascular Access
109 Port-A-Caths in 2010
• Placed 368 PICCs in 2010• In addition to dedicated Vascular
Access Team of 8 nurses• As small as 2.6 Fr DL
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Newborn PICC Placed in NICU
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• 23 year old w/ cystic fibrosis
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CT Port
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Angiography / Angioplasty
• 15 year old with recurrent dialysis graft issues
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Balloon Angioplasty
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Post Angioplasty
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• 4 yo playing with Mom’s BP cuff
• 190 /110 mmHg
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• 6 year old girl s/p liver transplant, now with elevated LFTs and splenomegaly
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• CT angio shows stenosis at the portal vein anastomosis
• Post-stenotic dilation of the intrahepatic portal vein
• Dilated intrahepatic bile ducts
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• Ultrasound-Guided Percutaneous Transhepatic Cholangiogram
• Internal / External Biliary Drain
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• Post Angioplasty
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GI Access - Cecostomy
• Provide easy colon access for patients needing daily enema therapy
Constipation
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GI Access – Perc GT and GJ
• Initial placement of percutaneous GT tubes
• Ultrasound liver margin, contrast enema to outline colon, inflate stomach thru NG
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New All-In-1
GT Tube
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Jejunal Port
Gastric Port
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Percutaneous Drainage
• Percutaneously drained approx 50 periappendiceal abscesses last year
• Currently in study of tPA infusion into abscesses to ? decrease hospital stay
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• Can utilize US or CT-Fluoro guidance
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Abscess Drainage
• 17 yo female treated with 1 month of steroid therapy for inflammatory bowel disease
• Developed chest pain and right shoulder pain, fever
Pneumonia
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• CT chest shows a large liver abscess with diaphragm perforation
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• Placed percutaneous drain with US guidance• Cultures grew Streptococcus anginosus
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• Percutaneous Drainage
• 15 year old who developed fever and cough after visiting her father in Michigan
• Positive Histoplasma titers
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Mediastinal Abscess
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• Primary care team requested IR drainage
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• Primary care team requested IR drainage
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• Primary care team requested IR drainage
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Percutaneous Biopsies
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Pulmonary Hamartoma
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Sclerotherapy
• Imaging – guided injection of lymphatic and venolymphatic malformations for nonsurgical treatment, or size reduction prior to surgery
• Irritation of internal lining of the fluid cavity• Resultant scarring, limited re-expansion• Doxycycline, Sotradecol (detergent)
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• 2 year old girl who developed left neck and axilla swelling following URI
• Findings consistent with infected or reactive lymphatic malformation
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• Access obtained with Ultrasound• Contrast injected to assess communication between cavities and
ensure no systemic venous runoff • Sclerosant injected, +/- small drain for next few days
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Sclerotherapy
• Does not completely resolve lesion
• Goal is cosmetic improvement, functionality
• Will require multiple treatments
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Laser Ablation• 2 year old girl with large venous malformation of
right leg
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• Laser catheter introduced into vein lumen• Saline injected around vein to act as heat sink• Laser “fired” and slowly withdrawn
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Laser Ablation
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Pre Operative Embolization
• 18 year old male with lifelong flank mass, biopsy proven AVM
• Requesting excision, surgeon concerned about bleeding
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Pre Operative Embolization
• Feeding arteries occluded by nBCA glue injected thru microcatheter
• Blood loss at surgery = 100 mL
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Pre Operative Embolization
BEFORE AFTER
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Radiofrequency Ablation of Osteoid
Osteoma
• Thermal ablation of osteoid osteoma nidus• If successful, can avoid more invasive excision
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Radiofrequency Ablation of Osteoid
Osteoma
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Pediatric Interventional Radiology - Summary
• Most Procedures are Less Invasive than Surgery
• Low Radiation Doses, or No Radiation w/ US
• Often Performed with Sedation Rather than General Anesthesia
• Happier, Healthier Patients and Families