fBallons are barely visible if at all without the use of contrast media. One can put air in it and you might see the balloon inflation as a black air like structure. In this case we put gadolinium in the balloon. its slight density is exploitedCece wrote:To use this fine example:
This is not the case of the week but a previous one. Ok, fluoroscopy only is the image on the left. Flouroscopy with the use of contrast is the image on the right. Both are in the jugular but only in the right one can the jugular be seen....
What does a balloon look like when it is not filled with contrast? Can waisting still be seen?
there is fluid in the vein. it is just not opacified. ivus does not require xray dye, it requires fluid.pklittle wrote:Dr Sclafani.. What an experience this woman has been going through! To be in a foreign country and have such a horrible reaction to the dye.
My question, as I usually feel, is so basic. How can you do the work with no liquid in the vein? How does IVUS work with no fluids? Aren't the veins limp and closed up everywhere whether there is stenosis or not?
glad there was a solution for that! Not seeing the balloons would've made things even more challenging.drsclafani wrote:fBallons are barely visible if at all without the use of contrast media. One can put air in it and you might see the balloon inflation as a black air like structure. In this case we put gadolinium in the balloon. its slight density is exploited
This is a very interesting case.drsclafani wrote:The first image that struck me as unusual is #2. Here is a close-up:
This is in the dural sinuses. The bright reflections do you see the tissue with reflections at about "9 o'clock?
i was wondering what this was. I have never seen anything like that before on IVUS. Could it be a clot?
I surmised that it represented Arachnoid granulations. These are SF-filled meningothelial-lined protrusions that are filled with CSF. They
extend into the venous sinuses through openings in the
dura. They filter CSF and drain it into central venous circulation.
it is important to differentiate them from dural sinus thrombosis and tumor. It was in a typical location for arachnoid granulations.
vickiozwannabe wrote:Hi Dr Sclafani,
I had venoplasty five weeks ago. I had complete occlusion of my LIJV and moderate RIJV. The left side had multiple collaterals involving vertebral plexus and the EJV. It was stenosed at the mandible and distal end. It was eventually dilated to 10.1mm. The right was stenosed at the distal end and was dilated to 12mm.
I have had lots of improvements and still getting stronger. Am wondering if these collaterals might affect venous drainage to the arm? The strangest thing is my watch is practically falling off its now so loose. Conversely my right hand has been going numb more than prior to the procedure. Could this be due to nerve irritation or restenoses? My RIJV initially spasmed and had worse flow but improved after additional balloonings.
I have concerns about my azygous as it was declared normal almost immediately after it was catheterised. It was surprisingly uncomfortable too compared to the stenosed veins. Will have to save up and visit New York to check it out properly.
Cheers,
Vicki
Let's review the VUS near the valveCece wrote: If it was an arachnoid granulation, nothing to treat there...what was the next image that struck you as unusual?
Thanks for your reply Dr Sclafani. Looks like maybe I better step up the savings plan.drsclafani wrote:vickiozwannabe wrote:Hi Dr Sclafani,
I had venoplasty five weeks ago. I had complete occlusion of my LIJV and moderate RIJV. The left side had multiple collaterals involving vertebral plexus and the EJV. It was stenosed at the mandible and distal end. It was eventually dilated to 10.1mm. The right was stenosed at the distal end and was dilated to 12mm.
I have had lots of improvements and still getting stronger. Am wondering if these collaterals might affect venous drainage to the arm? The strangest thing is my watch is practically falling off its now so loose. Conversely my right hand has been going numb more than prior to the procedure. Could this be due to nerve irritation or restenoses? My RIJV initially spasmed and had worse flow but improved after additional balloonings.
I have concerns about my azygous as it was declared normal almost immediately after it was catheterised. It was surprisingly uncomfortable too compared to the stenosed veins. Will have to save up and visit New York to check it out properly.
Cheers,
Vicki
only 12 mm? i truly hope that i am incorrect: I am going to guess that your symnptoms will return to baseline within four months. , maybe two. Dont quote me, tho..
ok, if we are standing on the tiny blue arrow, looking forward, we are seeing half of the vein longitudinally. If it is oriented this way, shouldn't the stenosis be on the right in the longitudinal image? But it looks like it is on the left.drsclafani wrote:Let's review the VUS near the valve
on the left is a fluoro picture of the IVUS with a blue arrow pointing to the IVUS device.
In the middle are two images of the valve. See how the blue arrow corresponds to the IVUS probe.follow the blue arrow to a small circle void of echos. If you look closely you will see a small arrow in the center of the echo-less circle. This represents the orientation of the images on the right. That image is a longitudinal view of the vein.
Going from left to right in the right image (got that?) there are several sites of reflections. These reflections represent the valve and the wall of the vein.
The orange arrows show progressive narrowing of the lumen of the vein.
Hi , I'm taking a totally uneducated stab in the dark here. Is it a valve with fused leaflets on the narrow side?Cece wrote:ok, if we are standing on the tiny blue arrow, looking forward, we are seeing half of the vein longitudinally. If it is oriented this way, shouldn't the stenosis be on the right in the longitudinal image? But it looks like it is on the left.drsclafani wrote:Let's review the VUS near the valve
on the left is a fluoro picture of the IVUS with a blue arrow pointing to the IVUS device.
In the middle are two images of the valve. See how the blue arrow corresponds to the IVUS probe.follow the blue arrow to a small circle void of echos. If you look closely you will see a small arrow in the center of the echo-less circle. This represents the orientation of the images on the right. That image is a longitudinal view of the vein.
Going from left to right in the right image (got that?) there are several sites of reflections. These reflections represent the valve and the wall of the vein.
The orange arrows show progressive narrowing of the lumen of the vein.
In the longitudinal image, going from left to right, we are seing the vein wall, then the reflections off the valve, then the other vein wall, which is thicker?
The arrows very clearly show the narrowing.
In the IVUS images, are we seeing a healthy set of valves on the top image and then a second stumpy set of valves in the bottom image that is the stenosis? I originally thought the second image showed a continuation of the same valves in the first image.
And there is the 'bright bump' in the longitudinal image! The arrow showing the greatest narrowing is right at the start of the 'bright bump.' I had my perspective switched, I should've been looking at it as a narrowing, not as the widening below. But it is easier to see with the additional longitudinal image on top, if at the very top with the orange arrows is healthy vein. Always good to know what normal should be, when trying to identify abnormal....
Anyone else see what Dr. Sclafani is trying to show here?
Cece wrote:Happy healthy restful vibes going out to Dr. Sclafani, who judging by his absence here is much too busy right now! How is the symposium coming along?
