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Interventional Radiology Cases
Published and forthcoming books in the Cases in Radiology series:
Body MRI Cases, William Brant and Eduard de Lange
Breast Imaging Cases, Catherine Appleton and Kimberly Wiele
Cardiac Imaging Cases, Charles White and Joseph Jen-Sho Chen
Chest Imaging Cases, Sanjeev Bhalla, Cylen Javidan-Nejad, Kristopher
W.Cummings, and Andrew Bierhals
Emergency Radiology Cases, Hani Abujudeh
Gastrointestinal Imaging Cases, Angela Levy, Koenraad Mortele,
and Benjamin Yeh
Genitourinary Imaging Cases, Mark Lockhart and Rupan Sanyal
Interventional Radiology Cases, Anne M.Covey, Bradley B. Pua, Allison Aguado,
and David C. Madoff
Musculoskeletal Imaging Cases, Mark Anderson and Stacy Smith
Neuroradiology Cases, Clifford Eskey, Clifford Belden, David Pastel, Arastoo
Vossough, and Albert Yoo
Nuclear Medicine Cases, Chun Kim
Pediatric Imaging Cases, Ellen Chung
Ultrasound Cases, Leslie Scoutt, Ulrike Hamper, and Teresita Angtuaco
Interventional Radiology Cases
Anne M.Covey, MD
Associate Professor of Radiology
Memorial Sloan-Kettering Cancer Center
Weill Cornell Medical College
NewYork, NewYork
Bradley B. Pua, MD
Assistant Professor of Radiology
Weill Cornell Medical College
NewYork Presbyterian Hospital
NewYork, NewYork
Allison Aguado, MD
Assistant Professor of Radiology
Memorial Sloan-Kettering Cancer Center
Weill Cornell Medical College
NewYork, NewYork
David C. Madoff, MD
Chief of Interventional Radiology
Professor of Radiology
Weill Cornell Medical College
NewYork Presbyterian Hospital
NewYork, NewYork
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https://t.me/med1917
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Oxford is a registered trademark of Oxford University Press
in the UK and certain other countries.
Published in the United States of America by
Oxford University Press
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© Oxford University Press 2015
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means, without the prior
permission in writing of Oxford University Press, or as expressly permitted by law,
by license, or under terms agreed with the appropriate reproduction rights organization.
Inquiries concerning reproduction outside the scope of the above should be sent to the
Rights Department, Oxford University Press, at the address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Covey, Anne M., author.
Interventional radiology cases / Anne M.Covey, Bradley B. Pua, Allison Aguado, David C. Mado.
p.; cm.—(Cases in radiology)
Includes bibliographical references and indexes.
ISBN 978–0–19–933127–7 (alk. paper)
I. Pua, Bradley B., author. II. Aguado, Allison, author. III. Mado, David C., author. IV. Title.
V. Series:Cases in radiology.
[DNLM:1. Radiology, Interventional—methods—Case Reports. WN180]
RC78
616.07′57—dc23 2014005736
is material is not intended to be, and should not be considered, a substitute for medical or other
professional advice. Treatment for the conditions described in this material is highly dependent on
the individual circumstances. And, while this material is designed to oer accurate information with
respect to the subject matter covered and to be current as of the time it was written, research and
knowledge about medical and health issues is constantly evolving and dose schedules for medications
are being revised continually, with new side eects recognized and accounted for regularly. Readers
must therefore always check the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers and the most recent
codes of conduct and safety regulation. e publisher and the authors make no representations or
warranties to readers, express or implied, as to the accuracy or completeness of this material. Without
limiting the foregoing, the publisher and the authors make no representations or warranties as to the
accuracy or ecacy of the drug dosages mentioned in the material. e authors and the publisher do
not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed
or incurred as a consequence of the use and/or application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
To my incredible daughters, Emma and Olivia (Rainy), who mean the world tome
https://t.me/med1917
—Anne M. Covey
To my parents, wife, and sister for their continued love and support
—Bradley B. Pua
Special thanks to my wife Esa, and my children Emma, Benjamin and Samuel
for whom without their support, this work would not have been possible.
—David C. Mado
https://t.me/med1917
Acknowledgments
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e publisher thanks the following for their time and advice:
Mark Anderson, University of Virginia
Sanjeev Bhalla, Mallinckrodt Institute of Radiology, Washington University
Michael Bruno, Penn State Hershey Medical Center
Melissa Rosado de Christenson, St. Luke’s Hospital of Kansas City
Rihan Khan, University of ArizonaAngela Levy, Georgetown University
Alexander Mamourian, University of Pennsylvania
Stacy Smith, Brigham and Women’s Hospital
Case 62:Images courtesy of Neil M.Khilnani, MD, Weill Cornell Medical
College, NewYork, NY
Case 64:Images courtesy of Rotimi O.Johnson, MD, St. Louis University School
of Medicine, St Louis, MO
Case 77:Images courtesy of George G.Vatakencherry, MD, Kaiser Permanente
Medical Group, Rancho Cucamonga, CA
Cases 47 and 103:Case submitted by Bedros Taslakian, MD, American
University of Beirut Medical Center, Beirut, Lebanon
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Preface
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e world of interventional radiology is changing. Over the next several years we
will transition to a residency in interventional radiology to provide a more clinically based experience for trainees with time dedicated to critical care, surgery, and
medicine. And over the past decade, the focus of many practices has shied from
peripheral vascular intervention to interventional oncology. One thing that has not
changed, however, is the importance of case review and self-assessment in developing the breadth and depth of knowledge required to become a skilled interventional
radiologist.
We are absolutely amazed when welook over the impressive CVs of fellow and
junior attending applicants. If being a good doctor could simply be achieved by dedication, research, and community service, they would all be outstanding at the start.
But the fact is that experience counts—and as it turns out, it counts for quite a lot.
Experience can be gained in many ways. Being directly involved in the workup,
case, and follow-up management is the best way to learn. Doing cases alone, however, is not enough. Knowledge can be supplemented with lectures, conferences, and
ongoing review of cases, and particularly unknown cases. is book is written with
that in mind. e cases that follow are presented as unknowns, some with direct
questions posed to the reader and many without. It is our intention that this book
will be used in dierent ways by readers at dierent levels.
e structure of each case—images and short clinical history on one page and
detailed annotated images, teaching points, and management outlined on the following page(s)—allows it to be used by residents early in their training, and they will
benet by using it as a complement to a more thorough text and as a quick reference
for upcoming cases. More advanced residents and fellows will use it as an opportunity for self-assessment and to supplement their knowledge. Practicing radiologists
can keep it handy to use as a quick refresher for cases they do infrequently, such as
adrenal vein sampling.
Of course, the experience of studying these cases is not intended to substitute for hands-on experience. Unlike other casebooks, the focus is on radiographic ndings and diagnosis; we have key teaching points and management
issues that are so critical in taking good care of patients. Interventional radiologists
today are active clinicians, no longer proceduralists, with many seeing patients in
clinic and with hospital admitting privileges. In years past, questions once posed
to referring doctors, such as “When can my abscess catheter be removed?” and
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