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State of the Art Pediatric Interventional Radiology Brent Cully, MD

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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. - PowerPoint PPT Presentation

Text of State of the Art Pediatric Interventional Radiology Brent Cully, MD

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State of the ArtPediatric Interventional Radiology

Brent Cully, MD Doug Rivard, DO Brenton Reading MD

CMH Interventional Radiology3 Physicians2 Nurse Practitioners3 Technologists2 IR Rooms 1 CT FluoroDedicated Ultrasound

CMH Interventional RadiologyFull sedation team under supervision of Dept of Anesthesiology

Sedation8 Work Up / Recovery roomsMost patients get sedationMust be npo 6 hours2 hrs clears

CMH Interventional RadiologyServices ProvidedVascular AccessAngiography / AngioplastyGI AccessLumbar PunctureImage-Guided Biopsy / DrainageAblation / Embolization Catheter StrippingIntravascular Foreign Body RetrievalCMH Interventional RadiologyServices Provided

Vascular Anomalies ClinicIn Conjunction with Dermatology and Plastic SurgeryContact Dermatology Clinic

Direct Interventional ConsultsImaging Guided Biopsies, Drainages, Vascular AccessContact CMH RadiologyVascular Access109 Port-A-Caths in 2010

Placed 368 PICCs in 2010In addition to dedicated Vascular Access Team of 8 nursesAs small as 2.6 Fr DL

Newborn PICC Placed in NICU

23 year old w/ cystic fibrosis

CT PortAngiography / Angioplasty15 year old with recurrent dialysis graft issues

Balloon Angioplasty

Post Angioplasty

4 yo playing with Moms BP cuff190 /110 mmHg

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

CT angio shows stenosis at the portal vein anastomosisPost-stenotic dilation of the intrahepatic portal veinDilated intrahepatic bile ducts

Ultrasound-Guided Percutaneous Transhepatic Cholangiogram

Internal / External Biliary Drain

Post Angioplasty

GI Access - CecostomyProvide easy colon access for patients needing daily enema therapy


GI Access Perc GT and GJInitial placement of percutaneous GT tubesUltrasound liver margin, contrast enema to outline colon, inflate stomach thru NG

New All-In-1 GT Tube

Jejunal PortGastric Port

Percutaneous DrainagePercutaneously drained approx 50 periappendiceal abscesses last yearCurrently in study of tPA infusion into abscesses to ? decrease hospital stay

Can utilize US or CT-Fluoro guidance

Abscess Drainage17 yo female treated with 1 month of steroid therapy for inflammatory bowel disease

Developed chest pain and right shoulder pain, fever


CT chest shows a large liver abscess with diaphragm perforation

Placed percutaneous drain with US guidanceCultures grew Streptococcus anginosus

Percutaneous Drainage

15 year old who developed fever and cough after visiting her father in Michigan

Positive Histoplasma titers

Mediastinal Abscess

Primary care team requested IR drainage

Primary care team requested IR drainage

Primary care team requested IR drainage

Percutaneous Biopsies

Pulmonary Hamartoma

Sclerotherapy Imaging guided injection of lymphatic and venolymphatic malformations for nonsurgical treatment, or size reduction prior to surgeryIrritation of internal lining of the fluid cavityResultant scarring, limited re-expansionDoxycycline, Sotradecol (detergent)

2 year old girl who developed left neck and axilla swelling following URIFindings consistent with infected or reactive lymphatic malformation

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

SclerotherapyDoes not completely resolve lesionGoal is cosmetic improvement, functionalityWill require multiple treatments

Laser Ablation2 year old girl with large venous malformation of right leg

Laser catheter introduced into vein lumenSaline injected around vein to act as heat sinkLaser fired and slowly withdrawn

Laser Ablation

Pre Operative Embolization18 year old male with lifelong flank mass, biopsy proven AVMRequesting excision, surgeon concerned about bleeding

Pre Operative EmbolizationFeeding arteries occluded by nBCA glue injected thru microcatheter

Blood loss at surgery = 100 mL

Pre Operative Embolization

BEFORE AFTERRadiofrequency Ablation of Osteoid OsteomaThermal ablation of osteoid osteoma nidusIf successful, can avoid more invasive excision

Radiofrequency Ablation of Osteoid Osteoma

Pediatric Interventional Radiology - SummaryMost Procedures are Less Invasive than SurgeryLow Radiation Doses, or No Radiation w/ USOften Performed with Sedation Rather than General AnesthesiaHappier, Healthier Patients and Families