Uterine arteriovenous malformations are uncommon. The authors report a case of traumatic arteriovenous fistula treated by selective uterine arteries embolization. Selective artery embolization has been effectively used to control postpartum hemorrhage and hemorrhage resulting from pelvic malignancy. A discussion on the consequences of uterine perforation and the control of hemorrhage without sacrificing fertility is presented.

Keywords: Uterus, Selective embolization, Arteriovenous malformation, Postabortal hemorrhage

OBJECTIVE: The aim of this study is to obtain an alternative angiographic diagnostic method which can be used in patients at a high risk for the use of iodine contrast medium. MATERIALS AND METHODS: Twenty-six patients with chronic renal failure whose fistulas were assessed by digital angiography were first evaluated using iodine contrast medium. Subsequently, carbon dioxide was used as contrast medium, and the images were printed in angiographic film. The angiographic studies were evaluated for opacification, radiological diagnosis and vessel diameter by two independent vascular surgeons; the author performed a comparative analysis of the measurement of the artery and the vein, and respiratory frequency before and after contrast injection. RESULTS: The results obtained with the statistical analysis using kappa coefficient showed agreement between the two doctors and were 0.3217 for opacification, 0.5583 for radiological diagnosis and of 0.4298 for the analysis of vessel diameter. For the carbon dioxide technique, no significant difference was seen in the comparative analysis of the measures of the artery (p = 0.3657) and vein (p = 0.2041), in the position measurements and dispersion; the analysis of the position measurements and dispersion for respiratory frequency showed no significant difference. CONCLUSION: We concluded that this method can be used as an alternative for angiographic study in patients with history of allergy or risk of nephrotoxicity.

Keywords: Angiography using carbon dioxide, Renal failure, Arteriovenous fistula

OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in the management of crisoid aneurysms. Although this technique can be used as an adjuvant or complement to surgery, particularly in cases where deep afferents are involved, complete resolution can be achieved only with endovascular treatment. The choice of treatment method should be based on a range of typical characteristics of the lesion, including angioarchitecture, size and clinical presentation.

Keywords: Arteriovenous fistula; Cirsoid aneurysm; Cerebral angiography; Embolization.

Dengue virus infection is endemic in tropical and subtropical areas. Symptomatic dengue infection is classified into dengue fever or dengue hemorrhagic fever with a tendency to develop shock syndrome. Dengue hemorrhagic fever is characterized by hemorrhagic manifestations, thrombocytopenia and increased capillary permeability. Dengue shock syndrome presents findings of dengue hemorrhagic fever with hypotension. Many sonographic findings have been described, including pleural effusion, ascites, gallbladder wall thickening and pericardial effusion. The aim of the present review is to describe sonographic findings and to demonstrate the role of ultrasonography in the assessment of children with suspected dengue hemorrhagic fever.

Keywords: Dengue; Dengue hemorrhagic fever; Dengue shock syndrome; Pleural effusion; Ultrasonography.

Gastrointestinal bleeding is a common cause of admission to emergency services. Hemorrhages originated from arteriovenous malformations in the stomach have been rarely described in the literature. Embolization offers a good chance for the control of bleeding. We describe the case of a patient with recurrent hematemesis and melena whose angiography identified arteriovenous malformations in the greater curvature of the stomach. The bleeding was treated by arterial embolization.

Keywords: Arteriovenous malformation; Gastrointestinal hemorrhage; Embolization.

Rendu-Osler-Weber syndrome or hereditary hemorrhagic telangiectasia is an autosomal dominant vascular disease involving multiple systems whose main pathological change is the presence of abnormal arteriovenous communications. Most common symptoms include skin and mucosal telangiectasias, epistaxis, gastrointestinal, pulmonary and intracerebral bleeding. The key imaging finding is the presence of visceral arteriovenous malformations. The diagnosis is based on clinical criteria and can be confirmed by molecular biology techniques. Treatment includes measures for management of epistaxis, as well as surgical excision, radiotherapy and embolization of arteriovenous malformations, with emphasis on endovascular treatment. The present pictorial essay includes a report of three typical cases of this entity and a literature review.

Keywords: Rendu-Osler-Weber; Hereditary hemorrhagic telangiectasia; Arteriovenous fistula; Epistaxis.

Uterine arteriovenous malformations may cause life-threatening abnormal genital bleeding in women at childbearing age. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method. The authors report the case of a patient with history of gestational trophoblastic disease and multiple curettage procedures who developed uterine arteriovenous malformations, with remission of the lesions after treatment with methotrexate.

Keywords: Arteriovenous malformations; Doppler; Abnormal genital bleeding.

Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae.

Keywords: Arteriovenous fistula; Cavernous sinus; Ultrasonography; Computed tomography; Magnetic resonance imaging; Angiography.

Abdominal vascular syndromes are rare diseases. Although such syndromes vary widely in terms of symptoms and etiologies, certain imaging findings are characteristic. Depending on their etiology, they can be categorized as congenital—including blue rubber bleb nevus syndrome, Klippel-Trenaunay syndrome, and hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)—or compressive—including "nutcracker" syndrome, median arcuate ligament syndrome, Cockett syndrome (also known as May-Thurner syndrome), and superior mesenteric artery syndrome. In this article, we aimed to illustrate imaging findings that are characteristic of these syndromes, through studies conducted at our institution, as well as to perform a brief review of the literature on this topic.

Keywords: Gastrointestinal tract; Venous thrombosis; Arteriovenous fistula; Hemangioma.

OBJECTIVE: To describe the spectrum of magnetic resonance imaging (MRI) findings in patients with neurological manifestations of dengue. MATERIALS AND METHODS: We included nine patients with dengue fever (three females and six males; age range, 9–30 years), all of whom presented with neurological manifestations. The MRI examinations, performed in 1.5 T or 3 T scanners, included T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences. Diffusion-weighted imaging with apparent diffusion coefficient mapping was also employed. Fast low-angle shot and susceptibility-weighted gradient-recalled echo sequences, as well as contrast-enhanced T1-weighted scans, were also obtained in order to assess parenchymal enhancement. MRI scans were analyzed for lesion distribution and imaging features. RESULTS: All patients showed areas of altered signal intensity that appeared as hyperintensity on T2-weighted and FLAIR sequences. The most commonly affected site was the basal ganglia-thalamus complex. Other affected sites were the cerebellum, cerebral cortex, white matter, and brainstem. In all cases, we observed patchy areas of restricted diffusion and focal areas of hemorrhage. CONCLUSION: Dengue encephalitis commonly affects the basal ganglia, thalamus, cerebellum, cerebral cortex, and white matter. Therefore, MRI should be an indispensable part of the evaluation of patients with neurological complications of dengue fever.

Keywords: Dengue; Encephalitis; Magnetic resonance imaging; Leukoencephalitis, acute hemorrhagic; Cerebellar diseases/diagnosis.

OBJECTIVE: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. MATERIALS AND METHODS: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). RESULTS: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. CONCLUSION: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

Keywords: Nephrolithotomy, percutaneous; Aneurysm, false; Arteriovenous fistula; Embolization, therapeutic/methods; Radiology, interventional; Computed tomography angiography.