Pseudoaneurysms are uncommon vascular abnormalities contained by surrounding adventitial and perivascular tissues, often caused by a disruption of the arterial wall secondary to arterial injury or inflammation. Post-traumatic and iatrogenic pseudoaneurysms in children are especially rare, contributing to the insufficient literature regarding their care. Traditional treatment in adults for these lesions include surgical repair and angiography with embolization. Recently, minimally invasive endovascular techniques, such as percutaneous ultrasound-guided thrombin injection (UGTI), have become the first-line therapeutic choice for certain types of pseudoaneurysm. We present 3 patients with pseudoaneurysms treated with UGTI in uncommon locations. Cases: Case 1: 6-year-old female with trauma to the spleen from a bike accident who later developed a 1.6cm pseudoaneurysm of the spleen, which was treated with an injection of thrombin using ultrasound guidance. Case 2: 9-year-old female with trauma to the lower leg after falling through a glass table who developed a 3.8cm pseudoaneurysm off the anterior tibial artery, which was treated with an injection of thrombin using ultrasound guidance. Case 3: 13-year-old female with a 2.3cm iatrogenic pseudoaneurysm off the gluteal artery related to percutaneous transgluteal abscess drain placement, which was treated with an injection of thrombin using ultrasound guidance. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Foo Madeline, Mcdaniel Janice

Keywords: Pseudoaneurysms, Ultrasound-Guided Thrombin Injection, Pediatric IR

Chondroblastomas (CBs) are rare benign bone tumors that usually present within the first two decades of life, are more common in males, and originate within the epiphysis of long bones. In this same age group, Aneurysmal Bone Cysts (ABCs) commonly occur. ABCs are benign expansile osteolytic lesions which can be primary, occurring in isolation, or they can occur alongside other bone tumors such as CBs. CBs are one of the most common tumors to present with associated ABC-like changes. CBs and ABCs are often difficult to treat because of their locations. To minimize operative morbidity, especially in hard-to-reach lesions, percutaneous approaches for both lesions have been individually described. We present a skull base CB with associated ABC-like changes treated by combining two different previously described percutaneous modalities. A 17-year-old healthy male presented with neck and shoulder pain. Imaging revealed an expansile lytic bone tumor replacing the clivus and left occipital condyle. The lesion was predominantly cystic with blood-fluid levels on T2W images but also had a 1 cm diameter dark nodular area in the left side of the clivus that was initially felt to be blood products rather than a solid tumor nodule. Pathology later revealed that this nodular area was a CB and the adjacent cystic portions were ABC-like changes. The CB was treated with Radiofrequency Ablation (RFA) and the adjacent ABC areas with doxycycline sclerotherapy. After 3 years of follow-up, there has been no clinical or radiological evidence of recurrence. RFA was complicated by a hypoglossal nerve injury. Otherwise, he had complete resolution of all symptoms and has returned to all activities including collegiate athletics. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Foo Madeline, Nicol Kathleen, Murakami James

Keywords: Chondroblastoma, ABC, Tumor Ablation