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State of the Art Pediatric Interventional Radiology Brent Cully, MD

State of the Art Pediatric Interventional Radiology Brent Cully, MD. Doug Rivard , DO Brenton Reading MD. CMH Interventional Radiology. 3 Physicians 2 Nurse Practitioners 3 Technologists 2 IR Rooms 1 CT Fluoro Dedicated Ultrasound. CMH Interventional Radiology.

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State of the Art Pediatric Interventional Radiology Brent Cully, MD

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  1. State of the ArtPediatric Interventional RadiologyBrent Cully, MD • Doug Rivard, DOBrenton Reading MD

  2. CMH Interventional Radiology • 3 Physicians • 2 Nurse Practitioners • 3 Technologists • 2 IR Rooms • 1 CT Fluoro • Dedicated Ultrasound

  3. CMH Interventional Radiology • Full sedation team under supervision of Dept of Anesthesiology

  4. Sedation • 8 Work Up / Recovery rooms • Most patients get sedation • Must be npo 6 hours • 2 hrs clears

  5. CMH Interventional Radiology • Services Provided • Vascular Access • Angiography / Angioplasty • GI Access • Lumbar Puncture • Image-Guided Biopsy / Drainage • Ablation / Embolization • Catheter Stripping • Intravascular Foreign Body Retrieval

  6. CMH Interventional Radiology • Services Provided • Vascular Anomalies Clinic • In Conjunction with Dermatology and Plastic Surgery • Contact Dermatology Clinic • Direct Interventional Consults • Imaging Guided Biopsies, Drainages, Vascular Access • Contact CMH Radiology

  7. Vascular Access • Placed 368 PICCs in 2010 • In addition to dedicated Vascular Access Team of 8 nurses • As small as 2.6 Fr DL 109 Port-A-Caths in 2010

  8. Newborn PICC Placed in NICU

  9. 23 year old w/ cystic fibrosis

  10. CTPort

  11. Angiography / Angioplasty • 15 year old with recurrent dialysis graft issues

  12. Balloon Angioplasty

  13. Post Angioplasty

  14. 4 yo playing with Mom’s BP cuff • 190 /110 mmHg

  15. 6 year old girl s/p liver transplant, now with elevated LFTs and splenomegaly

  16. CT angio shows stenosis at the portal vein anastomosis • Post-stenotic dilation of the intrahepatic portal vein • Dilated intrahepatic bile ducts

  17. Ultrasound-Guided PercutaneousTranshepaticCholangiogram • Internal / External Biliary Drain

  18. Post Angioplasty

  19. GI Access - Cecostomy • Provide easy colon access for patients needing daily enema therapy Constipation

  20. GI Access – Perc GT and GJ • Initial placement of percutaneous GT tubes • Ultrasound liver margin, contrast enema to outline colon, inflate stomach thru NG

  21. New All-In-1 GT Tube

  22. Gastric Port Jejunal Port

  23. Percutaneous Drainage • Percutaneously drained approx 50 periappendiceal abscesses last year • Currently in study of tPA infusion into abscesses to ? decrease hospital stay

  24. Can utilize US or CT-Fluoro guidance

  25. Abscess Drainage • 17 yo female treated with 1 month of steroid therapy for inflammatory bowel disease • Developed chest pain and right shoulder pain, fever Pneumonia

  26. CT chest shows a large liver abscess with diaphragm perforation

  27. Placed percutaneous drain with US guidance • Cultures grew Streptococcus anginosus

  28. Percutaneous Drainage • 15 year old who developed fever and cough after visiting her father in Michigan • Positive Histoplasma titers

  29. MediastinalAbscess

  30. Primary care team requested IR drainage

  31. Primary care team requested IR drainage

  32. Primary care team requested IR drainage

  33. Percutaneous Biopsies

  34. Pulmonary Hamartoma

  35. Sclerotherapy • Imaging – guided injection of lymphatic and venolymphatic malformations for nonsurgical treatment, or size reduction prior to surgery • Irritation of internal lining of the fluid cavity • Resultant scarring, limited re-expansion • Doxycycline, Sotradecol (detergent)

  36. 2 year old girl who developed left neck and axilla swelling following URI • Findings consistent with infected or reactive lymphatic malformation

  37. Access obtained with Ultrasound • Contrast injected to assess communication between cavities and ensure no systemic venous runoff • Sclerosant injected, +/- small drain for next few days

  38. Sclerotherapy • Does not completely resolve lesion • Goal is cosmetic improvement, functionality • Will require multiple treatments

  39. Laser Ablation • 2 year old girl with large venous malformation of right leg

  40. Laser catheter introduced into vein lumen • Saline injected around vein to act as heat sink • Laser “fired” and slowly withdrawn

  41. Laser Ablation

  42. Pre Operative Embolization • 18 year old male with lifelong flank mass, biopsy proven AVM • Requesting excision, surgeon concerned about bleeding

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