Interventional Radiology

Question 1

Anterograde pyelography

Answer 1

• renal pelvis punctured under ultrasound
• contrast injected to demonstrate anatomy and level of obstruction
• can aspirate urine for culture

Question 2

Percutaneous nephrostomy

Answer 2

• insertion of pigtail into collecting system of kidney
• external drainage bag

Question 3

Biliary drains

Answer 3

• ERCP with stent
  
  • CBD stent
  • risk of cholangitis
  • improves QOL
  • internal
• Percutaneous transhepatic biliary drains
  
  • used if level of obstruction is high
  • proximal to common bile duct
  • distorted anatomy
  • external drain
  • internal-external drain

Question 4

Thoracentesis

Answer 4

• diagnostic and therapeutic
• pleurdodesis or tunnelled catheter

Question 5

Tunneled pleural catheter

Answer 5

• drain every day / every other day
• eventually pleurodesis happens 70%

Question 6

Chemical pleurodesis

Answer 6

• tube thoracostomy
• infuse sclerosing agent:
  
  • doxycycline
  • talc
  • bleomycin
• second line compared to Pleurex

Question 7

Tunnelled peritoneal catheter

Answer 7

• for home
  *

Question 8

Esophageal stents

Answer 8

• dysphagia / obstruction
• seld expanding metal stent
• done under fluoro or endo
• can be used for esophageal fistula to provide a seal

Question 9

Gastroduodenal stents

Answer 9

• GOO
• prognosis 2-6 months most appropriate
• goal is symptom control and po intake
• uncovered stents
• migrate, perforation, re-obstruction
• can re-do

Question 10

Colorectal stents

Answer 10

• self expanding metal stents
• indications:
  
  • no surgical options
  • bridge to surgery
  • some patients with extra colonic pelvis tumours
• contraindications
  
  • systemic toxicity
  • intraabdominal abscess
  • coagulopathy
  • bevacizumab
• AVOID in distal rectal lesions
  
  • tenesmus, pain, bleeding
  • incontinence

Question 11

Tracheobronchial stents

Answer 11

• self expanding metal stent
• malignant airwary obstruction
• Bronchoscopy and fluoro placement
• goal : symptomatic improvement, prevent collapse
  *

Question 12

Intravenous thrombolysis for SVC syndrome

Answer 12

• superior venocavography
• IVC obstruction
• General anesthetic
• selective thrombolysis
• percutaneous transfemoral dilatation of narrowed SVC
• self expanding metal stent

Question 13

IVC filter

Answer 13

• VTE with absolute CI to anticoagulation
  
  • ICH, severe active bleeding
  • recent brain / spinal cord surgery
  • pregnancy
  • malignant hypertension
• Failure of coagulation (progression of VTE on anticoagulation)
• Complications of coagulation (bleeding)
• not benign, high mortality and failure
• end point?

Question 14

Percutaneous gastrostomy tubes

Answer 14

• Avoidance of NG
• for nutrition
• placed under fluoro or endoscopy
• for MBO
• Gastrojejunostomy beyond GOO may be necessary

Question 15

Extraction of lost indwelling cannulas and catheters

Answer 15

• typically lodge in R heart or pulmonary arteries
• broken catheters
• remove with fluoro

Question 16

Palliative Embolization

Answer 16

• used to control pain, hemorrhage, hormone production
• can reduce tumour bulk
• TACE
  
  • transcatheter arterial chemoembolization
  • HCC

Question 17

Post embolization syndrome

Answer 17

• pain
• fever
• WBC elevation
• typically following embo of large tumours
• necrotic tissue
• if fever sustained –> abscess? clot?

Question 18

Radiofrequency ablation of HCC and hepatic metastases

Answer 18

• alternating current induces ionic agitation
• frictional heat
• cell death
• Complications:
  
  • transient elevation of liver enzymes
  • abscess
  • intraperitoneal hemorrhage
• Monitor response with CT, AFP and CEA

Question 19

RFA of renal masses

Answer 19

• Nephrectomy is standard of care
• useful if poor OR candidate
• preserves kidney function
• best for peripheral massess
• Complications:
  
  • hemorrhage
  • urinoma
  • asbcess
  • paresthesias
  • hematuria
  • pain

Question 20

RFA adrenal masses

Answer 20

• may imrpove survival if not surgical candidate
• endocrine consultation
• hormonal blockage prior to treatment

Question 21

RFA lung tumorus

Answer 21

• useful for palliation for pain
• small NSCLC if not a surgical candidate
• Complications:
  
  • pneumothorax
  • bleeding
  • pain
  • abscess/infection
  • fistula
  • effusion
  • fever

Question 22

RFA of soft tissue masses

Answer 22

• for painful soft tissue mets
• resistant to radiation
• short term local control