technetium-tc-99m-sulfur-colloid and Arteriovenous-Malformations

Polyvinyl alcohol sponge (PVA) radiolabeled with 99mTc-sulfur colloid was used to evaluate a large hepatic arteriovenous malformation (AVM) in a 71-yr-old white female prior to embolization. The patient had hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu) with severe left-to-right shunting through the hepatic AVM which resulted in high-output congestive heart failure. The patient also had severe pulmonary hypertension. Scintigraphic imaging of the embolized radiolabeled PVA particles allowed us to be certain that the particles did not flow through the liver and inadvertently embolize the lungs; with the patient's already poor pulmonary status, embolization could have been fatal.

Topics: Aged; Arteriovenous Malformations; Cardiac Output, High; Embolization, Therapeutic; Female; Heart Failure; Hepatic Artery; Humans; Hypertension, Pulmonary; Polyvinyls; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Telangiectasia, Hereditary Hemorrhagic

Radiolabeling of Ivalon (polyvinyl alcohol sponge) particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization. A more efficient technique of labeling Ivalon particles with technetium-99m sulfur colloid was developed. An increase in labeling efficiency allowed more accurate determination of the distribution of injected Ivalon particles. Scanning electron microscopy demonstrated the stability of the Ivalon particles during this new labeling process. Two patients with arteriovenous malformations underwent therapeutic embolization with radiolabeled Ivalon particles; gamma camera imaging of the lesion and chest was performed throughout the procedure.

Topics: Adult; Arteriovenous Malformations; Child; Embolization, Therapeutic; Female; Humans; Isotope Labeling; Leg; Male; Microscopy, Electron, Scanning; Polyvinyls; Pulmonary Embolism; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Arteriovenous Malformations; Brain Abscess; Child; Female; Humans; Lung; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Transcatheter embolization by Ivalon particles for treatment of arteriovenous malformations has been an accepted therapeutic technique for many years. We describe a new and efficient radiolabeling technique of Ivalon particles using [99mTc]sulfur colloid. Continuous and dynamic monitoring of injected radiolabeled Ivalon particles is made possible by viewing the persistence scope of a portable gamma camera whose head is positioned over the patient undergoing therapeutic embolization. Therefore, if inadvertent pulmonary embolism or reflux migration of radiolabeled Ivalon particles has occurred, the angiographer is immediately aware of this potentially serious or fatal complication and can take corrective action. We describe two patients, each with an arteriovenous malformation, who had therapeutic embolization with radiolabeled Ivalon particles, one resulting in reflux migration and the other resulting in inadvertent pulmonary embolism.

Topics: Adult; Arteriovenous Malformations; Embolization, Therapeutic; Female; Humans; Isotope Labeling; Middle Aged; Polyvinyls; Technetium Tc 99m Sulfur Colloid

Colonic angiodysplasia is now recognized as a frequent cause of gastrointestinal bleeding in patients over age 55. These microvascular arteriovenous malformations may be as common a cause of colonic bleeding as diverticular disease. The lesions are not evident on barium studies. Even colonoscopy and selective colonic angiography can give false-negative results. Therefore, repeated studies for recurrent episodes of bleeding are often necessary before the diagnosis is made. Methods of treatment include coagulation biopsy, segmental colon resection and right hemicolectomy.

Topics: Angiography; Arteriovenous Malformations; Colectomy; Colon; Colonoscopy; Diagnosis, Differential; Diverticulitis, Colonic; Gastrointestinal Hemorrhage; Humans; Middle Aged; Technetium Tc 99m Sulfur Colloid

We report a case of hepatic portal venous hypertension secondary to a small-bowel vascular malformation in a 24-year-old man with anemia. Preoperative diagnostic evaluation included gastrointestinal barium studies and endoscopy (showing esophageal varices), hepatic panangiography, peroral small-bowel biopsy, percutaneous transhepatic portal venography, and manometry. Preoperative injection of methylene blue dye into the jejunal arteries supplying the malformation resulted in easy localization of the lesion at surgery. Direct manometry at the time of segmental jejunal resection yielded a portal pressure of 35 mmHg, with subsequent reduction to 21 mmHg.

Topics: Adult; Angiography; Arteriovenous Malformations; Endoscopy; Humans; Hypertension, Portal; Jejunum; Male; Manometry; Methylene Blue; Microspheres; Phlebography; Preoperative Care; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

99mTc sulfur colloid scintigraphy is a technique which can be used to localize sites of lower gastrointestinal hemorrhage. Two reports of patients illustrate its use clinically. This procedure is non-invasive, relatively inexpensive, easily performed and has a high degree of sensitivity. The technique may, in some instances, replace angiography or endoscopy as the initial procedure used to diagnose the site of lower gastrointestinal bleeding or, more likely, serve as a complementary diagnostic modality.

Topics: Aged; Arteriovenous Malformations; Colloids; Colonic Neoplasms; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileum; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid