Tumor stenosis

Labs lytes, blood urea nitrogen (BUN)/creatinine, urine albumin, plasma aldosterone/plasma renin ratio to screen for excess aldosterone or mineralocorticoid production, or renin for renal artery stenosis (RAS) or renin-secreting tumor. 

In contrast to angiography, IVUS provides quantitative information from within the vessel on diameter, circumference, luminal diameter, plaque volume, and percent stenosis. Qualitative information regarding the amount of plaque elevation, plaque composition (e.g., calcific, fibrous, or fatty plaque), and the presence of plaque versus thrombus, thrombus versus tumor, and aneurysm and hematoma can be provided with IVUS. IVUS is also used as a therapeutic adjunct with PTCA, atherectomy, stent or graft placement, and fibrinolysis, although routine use may not be justified. These combination procedures may be monitored in real time as the procedure (e.g., atherectomy) is being performed. 

Fig. 14.3.Cholangio-MR showing common bile duct stenosis after liver radioembolization. The patient was a 64-year-old man with non-resectable liver metastasis from a neuroendocrine tumor. He became jaundiced 3 months after receiving radioembolization...

In radical trachelectomy, MRI depicts the end-to-end anastomosis and the development of a posterior neofornix (Fig. 7.44). The latter may develop in the process ofhealingandmustbe carefully distinguished from a recurrent tumor. The few recurrences of cervical cancer observed after trachelectomy occurred at the site of anastomosis [109]. Occasionally, stenosis has been observed after trachelectomy. Moreover,... 

Spinelli P, Dal Fante M, Mancini A (1992) Self-expanding metallic stent for endoscopic palliation of rectal tumors a preliminary report. Surg Endosc 6 72-74 Spinelli P, Dal Fante M, Mancini A (1993) Rectal metal stents for palliation of colorectal malignant stenosis. Bildgebung 60 48-50... 

The hepatic veins are stented before the IVC. In exceptional circumstances, a transhepatic approach can be used to stent a hepatic vein stenosis, when ascites have developed in a pseudo Budd-Chiari syndrome by malignant tumor compression (Fig. 5.9). 

Fig. 5.12a, b. A 71-year-old male patient with bronchogenic carcinoma invading the mediastinum and brain metastasis. Superior vena cava obstruction syndrome was treated by placement of a Wallstent endoprosthesis in the superior vena cava. At 3 weeks after endoluminal treatment, obstruction symptoms recurred, a Phlebography obtained by a femoral approach and catheterization of the stent lumen showed stent obstruction, and extensive filling of mediastinal veins, b After balloon dilatation at the junction of the stent with the internal jugular vein, a residual stenosis (arrow), due to insufficient stent covering of mediastinal tumor extent was evident... 

Tacke J, Antonucci F, Stuckmann G et al (1994) The palliative treatment of venous stenoses in tumor patients with selfexpanding vascular prostheses. ROFO 100 433-440 Tanigawa N, Sawada S, Mishima K et al. (1998) Clinical outcome of stenting in superior vena cava syndrome associated with malignant tumors. Comparison with conventional treatment. Acta Radiol 39 669-674 Trerotola SO (1994) Interventional Radiology in central venous stenosis and occlusion. Semin Interv Radiol 11 291-304... 

George and colleagues (1992) treated nine patients with malignant central airway obstruction due to tracheal (n=3) or main bronchial ( =6) stenosis with Gianturco stents. All patients suffered from severe dyspnea or asphyxia (four were emergency treatments). All patients had dramatic and rapid reUef of their symptoms after stent insertion. Two patients with intraluminal tumor growth required additional endobronchial measures to control local tumor progression. Patients survived between 3 weeks and 8 months after the intervention. Causes of death were cachexia or pneumonia. 

Malformations 166 Stenosis 167 Diverticula 169 Stones 170 Fistulae 171 Trauma 171 Cysts 171 Tumors 171... 

The radiologic patterns of primary colonic lymphoma, such as intraluminal masses, polyps, stenosis, and polyposis, are often quite similar to those of carcinomatous stenosis, adenomatous polyps, and familial polyposis, and can also be evaluated by CT colonography (Table 13.4). The possibility of lymphoma should be considered when cecal tumors involve the terminal ileum, when tumors do not invade the pericolonic fat or adjacent structures and when there are secondary findings such as splenomegaly or bulky abdominal lymph node enlarge-... 

Follow-up of the location and the lumen of a stent may be feasible with CT colonography. Particularly if endoscopy is incomplete or if stents could not be passed by conventional colonoscopy, CT colonography could be an alternative for contrast enema. CT colonography provides additional information about the location and the lumen of the stent and the proximal colon (Fig. 13.20a-c). In case of re-obstruc-tion because of tumor recurrence, the additional 2D displays demonstrate the morphology of the stent-stenosis, which might be helpful for further treatment. During the same procedure, the extracolonic conditions of the disease (metastases, lymph nodes) can be evaluated. 

---