Davide Giuseppe Castiglione

Shear wave elastography can be a promising tool in the non-invasive evaluation of portal hypertension in patients with hepatic cirrhosis. In this case, Mindray's Resona I9 ultrasound diagnostic system and 2D shear wave elastography (2D-SWE) were used to assess splenic stiffness and correlate it with the degree of portal hypertension. Learn more at: https://lnkd.in/ezPNUwRP #UltrasoundCases #ShearWaveElastography #HepaticCirrhosis

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Identifying a Normal Appendix on Ultrasound: A Comprehensive Guide Ultrasound is a valuable, non-invasive diagnostic tool for visualizing the appendix, particularly in pediatric and thin adult patients. Accurate identification of a normal appendix is essential for distinguishing it from pathological conditions like acute appendicitis. Normal Appendix Ultrasound Features: 1. Size and Appearance: The appendix appears as a blind-ended, compressible, tubular structure. It is typically less than 6 mm in diameter when measured from outer wall to outer wall. The walls are thin, uniform, and without signs of thickening. 2. Compressibility: A normal appendix is easily compressible with gentle pressure from the ultrasound probe. Lack of compressibility may suggest inflammation or obstruction. 3. Wall Layers: The wall of the appendix demonstrates the classic five-layered appearance similar to bowel walls: Mucosa Submucosa Muscularis Serosa Subserosa 4. Absence of Pathological Signs: No periappendiceal fluid collection or abscess formation. No increased echogenicity of the surrounding fat. No hyperemia or increased blood flow on Doppler imaging. ⚠️ Common Pitfalls in Appendix Ultrasound: Obesity or Overlying Gas: These can obscure the appendix, leading to non-visualization. Misidentification of Cecum or Terminal Ileum: Proper technique and knowledge of anatomical landmarks are crucial to avoid false diagnoses. Inexperienced Operator: Accurate identification requires skill in applying graded compression and differentiating normal bowel loops from the appendix. #Ultrasound #Radiology #Appendix #MedicalImaging #Sonography #ClinicalEducation #Healthcare #Radiologist #Appendicitis #MedicalLearning #DiagnosticImaging #EmergencyMedicine #AbdominalUltrasound #RadiologyEducation

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Route cause analysis for Embolization Mistakes 🔴 1. Inadequate Pre-procedure Planning • Lack of cross-sectional imaging (e.g., missing CTA or MRI) to map vascular anatomy. • Failure to identify arterial variants (e.g., replaced hepatic artery, uterine–ovarian collaterals, etc.). • Poor assessment of contraindications (e.g., renal failure, infection, coagulopathy). • Incomplete discussion with referring team about goals (e.g., curative vs palliative). 🔹 Impact: Non-target embolization, incomplete treatment, increased morbidity. 🔴 2. Poor Vascular Access Technique • Using inappropriate sheath size or site (e.g., femoral vs radial vs brachial). • Traumatic multiple access attempts. • Not securing hemostasis post-procedure (leads to pseudoaneurysm, hematoma). • Not using ultrasound guidance in difficult access cases. 🔹 Impact: Access site complications like bleeding, hematoma, AV fistula, thrombosis. 🔴 3. Non-target Embolization • Inadequate superselective catheterization. • Inappropriate embolization material size or type (e.g., small particles migrating distally). • Backflow due to overinjection or lack of flow control. • Failure to identify dangerous collaterals (e.g., spinal artery, vasa recta, ophthalmic branch). 🔹 Impact: Ischemia of bowel, spinal cord, skin, or other vital organs. 🔴 4. Wrong Embolic Agent Selection • Using coils in high-flow AVM without flow reduction → risk of migration. • Using small particles in hypervascular organs → risk of infarction. • Lack of understanding the hemodynamics of the lesion. 🔹 Impact: Incomplete embolization or distal tissue necrosis. 🔴 5. Incomplete Embolization • Not embolizing all feeders or collaterals. • Premature termination due to radiation/time pressure. • Not repeating post-embolization angiographic check for residual blush. 🔹 Impact: Persistent bleeding, recurrence of symptoms or lesion. 🔴 6. Over-embolization or Embolizing Healthy Tissue • Overestimating required volume of embolic material. • Misidentifying vessels due to poor roadmap planning. • Not stopping once endpoint is achieved. 🔹 Impact: Unnecessary infarction, abscess formation, pain, or organ failure. 🔴 7. Inappropriate Anticoagulation Management • Embolizing while patient is fully anticoagulated → risk of bleeding. • Not restarting anticoagulation in stent-assisted cases → thrombosis. 🔹 Impact: Post-procedural bleeding or thromboembolic events. 🔴 8. Poor Documentation and Communication • Failure to document embolized arteries, embolic used, access site, and complications. • No clear instructions for post-procedure care (pain, antibiotics, follow-up imaging). • Lack of communication with ICU or surgical team. 🔹 Impact: Delayed recognition of complications, medico-legal risks. 🔴 9. No Post-embolization Syndrome Management • No prophylactic anti-emetics, analgesics, or antipyretics. • Underestimating patient’s pain or inflammatory response.

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🎯 The Presidential Session at ESGE Days 2025 spotlighted Endoscopic Ultrasound (EUS) as a transformative tool in managing malignant biliary obstruction: 🔹 EUS-CDS vs ERCP in Malignant Distal Biliary Obstruction A randomized controlled trial by Marco Spadaccini (Italy) presented new evidence suggesting that EUS-guided choledochoduodenostomy (EUS-CDS) may be superior to ERCP in preventing post-procedural pancreatitis — a critical clinical outcome. 🔹 PUMa Trial: PTBD vs EUS-BD with Primary Metal Stent Daniel Schmitz (Germany) shared results from a European multicenter prospective trial comparing percutaneous transhepatic biliary drainage (PTBD) and EUS-BD, reinforcing the value of EUS as a frontline option in selected patients. 🔹 State of the Art Review: The Rise of Therapeutic EUS Schalk Van der Merwe (Belgium) delivered a forward-looking talk on the expanding role of therapeutic EUS, bridging diagnostics and intervention with precision and safety. 📌 Clinical Application – Drain or Pain? Our recent GastroCloud Case of the Month March 2025 reflects this evolution: After failed ERCP in a patient with obstructive jaundice due to a malignant pancreatic head tumor, EUS-CDS using a Hotaxios stent allowed for tissue acquisition and ensured effective biliary drainage: minimally invasive, maximally effective! 🔬 EUS is not just an alternative. It's the future of minimally invasive therapy in GI oncology! #TherapeuticEUS #BiliaryDrainage #Endoscopy #ESGEDays2025 #PancreaticCancer #InnovationInEndoscopy #MinimallyInvasive https://lnkd.in/dbWCtVe6 https://lnkd.in/d7cGhYRD

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