Pačinskaitė, Rūta

\Introduction Lymphatic malformations are rare congenital vascular anomalies most commonly affecting the head and neck. Progressive enlargement may cause functional and cosmetic complications. Surgical management is challenging and associated with recurrence, lymphatic leakage, infection, nerve injury, and scarring. Sclerotherapy with Picibanil (OK-432) is a minimally invasive alternative. Case Presentation A 1-year-old child presented with a right-sided cervicofacial mass present since birth and gradually enlarging. Physical examination revealed a soft, non-tender lesion without airway compromise. MRI demonstrated a multiloculated cystic lesion involving supra- and infrahyoid neck spaces, measuring up to 6.7 × 5.8 × 4.7 cm. Cytology of aspirated cyst fluid was negative for malignancy. Between 2022 and 2023, multiple ultrasound-guided procedures were performed with cyst aspiration and intralesional Picibanil injection. Transient post-procedural swelling resolved conservatively. The lesion regressed significantly over the following year. Follow-up ultrasound in 2024–2025 demonstrated two small, stable residual cysts. Discussion Cervicofacial lymphangiomas arise from abnormal lymphatic development and typically present in early childhood. Multicompartment involvement complicates surgical excision and increases recurrence risk. MRI and ultrasound are essential for diagnosis and treatment planning. Meta-analysis data show that OK-432 is an effective alternative to surgery, particularly in macrocystic and mixed lesions, with high response rates and fewer complications. Systematic reviews further support sclerotherapy as a first-line or adjunctive therapy for pediatric head and neck lymphangiomas. Long-term outcomes are generally favorable, although continued surveillance is required. Conclusions Staged Picibanil sclerotherapy achieved sustained regression of a complex cervicofacial lymphatic malformation, avoiding surgery. Long-term imaging follow-up remains essential.

Introduction Treatment of parathyroid adenomas (PA) traditionally relies on open surgery, which may be unsuitable for elderly or comorbid patients [1]. We report the first use of percutaneous cryoablation for PA at Kaunas Clinics, demonstrating its feasibility as a minimally invasive alternative to surgery. Case Presentation A 79-year-old woman was admitted with hypercalcemia. Intravenous (IV) fluids and loop diuretics were initiated, along with correction of hypophosphatemia. The patient had a history of total thyroidectomy 30 years prior. Ultrasound (US) revealed a lesion in the left paratracheal region, measuring 1.1 × 0.5 × 1.4 cm. Fine-needle aspiration with parathyroid hormone (PTH) washout showed markedly elevated PTH (210.6 pmol/L), confirming PA. Despite conservative management, calcium (Ca) levels remained elevated. The patient was referred to an interventional radiologist for planned cryoablation, as the patient was not eligible for surgery. Under US guidance and general anesthesia, hydrodissection (HD) with physiological saline was performed to separate the lesion from the trachea and maintained this safe plane throughout the procedure. A single 17G cryoprobe was inserted into the lesion under US guidance and two freeze-thaw cycles (10-minute and 6-minute freezes) were applied. Iceball formation was monitored using US and computed tomography (CT), confirming complete lesion coverage. Follow-up CT showed no acute post cryoablative complications. Postprocedural laboratory results demonstrated a rapid decline in PTH (34.70 to 2.45 pmol/L) and a progressive decrease in serum Ca to normal levels (3.08 to 2.39 mmol/L) within 24 hours. Discussion The procedure was technically challenging due to the patient’s history of thyroidectomy, which changed the cervical soft-tissue anatomy [2]. Identification of the recurrent laryngeal nerve was crucial and difficult; therefore, HD was used to safely separate the PA from the nerve’s expected location, maintaining a safe distance throughout the procedure [3]. Conclusions This case demonstrates that percutaneous cryoablation may serve as a safe, minimally invasive alternative to surgery for selected patients.

Background / Objective We describe a case of a 44-year-old male patient with a visible neck mass and discomfort. Thyroid ultrasound examination revealed an oval-shaped heterogeneous nodule in the right lobe with a large central cystic component and smooth margins measuring ~6.2x3.2cm [Fig. 1]. The nodule exhibits no high-risk features and was categorized as EU-TIRADS 3. Two fine needle aspirations with cytological examinations showed no malignancy. Microwave ablation (MWA) was suggested for minimally invasive treatment of this symptomatic nodule. Methods The cystic component of the nodule was aspirated before the ablation. Ultrasound-guided percutaneous MWA was achieved under local anesthesia using an 18 G antenna. In total, 6 MWA sessions were performed using an overlapping technique of 15W power for 5 to 10 minutes. Results No complications occurred during the procedure and the patient was discharged on the same day. Follow-up ultrasound examinations displayed a gradual reduction in nodule volume of 59% within 8 months [Fig.2] Conclusions Benign thyroid nodules are a frequently encountered pathology in the general population. Minimally invasive treatment techniques such as ethanol injection, laser and thermal ablation have been developed as alternatives for partial or total thyroidectomy. A recent meta-analysis (J. Ding et al., Ultrasound Quarterly, 2023) of ultrasound-guided benign thyroid nodule thermal ablation demonstrated that minimally invasive techniques were safer and more efficient in terms of relief of symptoms, cosmetic effect, complication rate, and hospitalization duration compared to surgery.

Clinical history: A 62-year-old woman with a history of hysterectomy and adnexectomy for symptomatic myomatous uterus presented with a large pelvic mass. Ultrasound revealed a heterogeneous mass, measuring ~11.8 x 6.7 cm in size [Fig.1] that was found to be leiomyosarcoma. Further CT imaging showed multiple metastases: in the left lung, right adrenal gland, diaphragm, subcutaneous tissues and muscles of abdominal and pelvic regions, lower extremities. Treatment options: A combined treatment strategy including surgery, cryoablation, and systemic therapy was chosen in this case. Seven metastases were selected for cryoablation and hydro-dissected from adjacent tissue. Under CT or ultrasound guidance, 2-3 17G cryoprobes were placed into each lesion. Each metastasis received 2 subsequent ablation cycles (10-minute freeze and 10-minute thaw per cycle). Follow-up contrast-enhanced CT scans showed devascularization of ablated tumors with little to no tissue volume loss; some ablated areas show calcifications [Fig. 2]. Discussion: Leiomyosarcomas account for up to 20% of newly diagnosed soft tissue sarcomas. Cases with multifocal disease spread are usually deemed unsuitable for surgical management. Thermal ablation techniques provide a minimally invasive and repeatable approach for the local control of primary or metastatic disease, therefore should be considered in combination with other treatment strategies. In the presented case cryoablation alongside surgical and systemic treatment allowed to reduce tumor burden and associated symptoms and to reach stable disease. Take-home points: Cryoablation in combination with systemic and surgical treatment can be effective for local disease control and improvement of quality of life in advanced soft tissue leiomyosarcoma cases.

Purpose To assess the incidence of pneumothorax and potential risk factors in lung tumor microwave ablation (LT-MWA) with tract sealing using patients’ venous blood clot. Materials and methods A study of 19 patients who underwent CT-guided MWA for pulmonary tumors was conducted. All patients underwent MWA with ablation tract sealing by injecting 5-20ml of the patient's venous blood clot while simultaneously withdrawing the coaxial needle sheath. The presence of pneumothorax was assessed by CT 10 minutes and 24 hours following MWA. Pneumothorax and chest tube insertion rate, potential patient, procedure, and lesion related risk factors were evaluated. Results We performed 23 consecutive LT-MWA sessions. Pneumothorax occurred in 5 MWA sessions (21,7%), chest tube was inserted in one case (4,7%). The presence of lung emphysema was more common in patients with pneumothorax compared to complication-free group, 60% and 22,2%, respectively. The single drained patient had lung emphysema. Our data was not inferior compared to radiofrequency ablation with tract sealing where pneumothorax occurred in 34% and drainage was needed in 10% of cases (M. Dassa et al., CardioVasc. Interv. Radiol., 2021). If compared to nonhuman MWA study using gelatin sponge particles for tract sealing (J. Peng et al., Int. J. Hyperthermia, 2023), our incidence of pneumothorax was similar (25% and 21,7%, respectively). Conclusion CT-guided LT-MWA tract sealing with patients’ blood clot is a unique approach to manage pneumothorax ratio. Study results suggest that ablation tract sealing with patients’ blood clot is noninferior to other reported track ablation sealing methods.

Purpose Percutaneous transthoracic lung biopsy (PTLB) is an acknowledged and widely used practice for obtaining lung lesion samples for histological examination. CT-guided PTLB is a fast and safe procedure allowing high diagnostic value for many parenchymal abnormalities and, thus, is imperative in current-day interventional radiology. Pulmonary hemorrhage and pneumothorax are the most frequent and potentially life-threatening complications following a PTLB. Studies estimate that pulmonary hemorrhage occurs roughly in 31-41% of cases of CT-guided PTLB and occasionally necessitates specified treatment or intervention [1, 2]. Procedure-related pneumothorax is observed in around 26% and requires pleural drainage in approximately 7% of the cases [3]. Through the last few decades, several techniques have been explored and suggested to reduce the incidence of biopsy-related complications, e.g. immediate post-procedure patient placement in dependent lateral decubitus position as well as various tract sealant materials, such as normal saline, collagen foam, hydrogel plug, gelatin sponge slurry, fibrin glue, hemostat gelatin powder [4-13]. Autologous blood is perhaps the most researched sealant, first described in the 1970‘s [14]. Even though the so-called “blood patch technique” showed promising results in several studies [15-17], no general agreement or guidelines were established for CT-guided PTLB using blood as a biopsy tract sealant.

We hypothesize that bleeding occurring around the intervention site has a preventative effect on the incidence of procedure-related pneumothorax [18], therefore, biopsy tract sealing by injecting patient's venous blood clot should result in reduced procedure-related complication rates. Since PTLB is an everyday procedure in our hospital, we aimed to test our hypothesis and introduce the methodology for biopsy tract sealing using autologous venous blood clot. [...].

Background: Traumatic brain injury is a complication of motor vehicle accidents that causes physical, cognitive and social issues. Coordinated efforts of the rehabilitation team are especially significant to achieve maximum functional activity of the patient. Case description: We present a female patient who experienced a severe traumatic brain injury in a car accident. Early rehabilitation was started right away, the main method being physical therapy. The patient was experiencing feelings of anger and hopelessness towards her situation. A month after the accident the patient‘s Barthel index was 5 points. Three months later, the score has increased to 20 points and continued to increase to 40 points over the following month. By the end of this phase, the patient was able to eat served food and walk with the help of a walker or other people. Significant changes in the patient's independence and autonomy were observed over 5 years when the patient was attending repeated rehabilitation. The patient‘s emotional state has significantly improved: anger and resentment were much less common. Due to applied repeated rehabilitation episodes over the period of 5 years, the Barthel index has increased from 40 to 100 points, indicating complete independence of the patient. The most adverse factors influencing the life of the subject were general health disorders and reduced circle of friends, which lead to psychological stress. Marriage and birth of a child, support from loved ones, positive thinking, enjoyable activities motivated the subject to follow through with rehabilitation treatment and improve her state of autonomy. Conclusions: During five years of rehabilitation after a motor vehicle accident, major changes were observed in our patient‘s autonomy and independence. This case report outlines the significance of both early rehabilitation in the acute phase and repeated rehabilitation in the later phase of a [...].

DAI is a frequent and detrimental type of traumatic brain injury that may lead to death and disability. DAI is classified into 3 grades based on the anatomic distribution of the injury: grade I involves grey-white matter interfaces, grade II involves fibers of the corpus callosum in addition to grade I locations, grade III involves brainstem in addition to grade I and II locations. Due to the microscopic and delicate nature of axonal damage, DAI may pose difficulties in diagnosis and coexisting brain injuries only complicate the diagnostic process. Thus, this article aims to evaluate the role of radiologic imaging in the diagnosis of DAI and its characteristic findings. Many researchers agree that CT scan is not a sensitive technique for the detection of DAI, however, in the acute setting CT may identify life-threatening injuries that may require surgical intervention. MRI is a rational second-line imaging tool following urgent CT, especially when urgent CT fails to reveal the possible cause of the patient’s symptoms and clinical signs. Yet, conventional MRI sensitivity in detecting DAI is questionable. Advanced MRI sequences could contribute to more accurate diagnosis by depicting microscopic hemorrhagic lesions (SWI), changes in diffusion properties of water (DTI, DWI) or changes in fiber tract connectivity (DTT), alterations in the functional architecture of the brain (fMRI). Location and volume of DAI lesions are important in predicting functional outcomes. In this article, we present a case of a 9-year-old boy who suffered a brain injury due to a traffic accident.

Introduction. X-linked adrenoleukodystrophy (X-ALD) is a rare genetic disorder that manifests in extensive involvement of adrenal glands and white matter of the central nervous system (CNS). The cerebral form of X-ALD predominantly affects boys between ages four and eight years and includes progressive impairment of cognitive functions, behavior, motor skills, hearing, and vision. Case Description. In January of 2021, a 7-year-old boy was admitted to the hospital for investigation of suspected CNS disease. Boy’s mother reported noticing changes in her son’s behavior and appearance: he was not responding to questions and verbal commands, stopped communicating and developed a squint. Clinical examination revealed exotropia, hypermetropia, an increase in muscle tone and deep tendon reflexes in lower extremities, and a positive Babinski sign in the right leg. Laboratory tests ruled out autoimmune encephalitis and diagnosed adrenal insufficiency. Head computed tomography scans exhibited hypodensity in the periventricular white matter of the parietal and temporal lobes. Brain magnetic resonance imaging scans showed confluent and extensive impairment of the white matter bilaterally. Metabolite abnormalities in the demyelination-affected white matter on MR spectroscopy were detected. Positive family history was established and the patient was diagnosed with X-ALD. Summary. X-linked adrenoleukodystrophy is a rare genetic disorder that manifests in extensive involvement of adrenal glands and white matter of CNS. This case report presents a 7-year-old boy with typical clinical and imaging findings of adrenoleukodystrophy. Conclusion. The progressive nature and lack of pathophysiological treatment options in the advanced stage of the disease lead to a poor prognosis of X-ALD patients. Newborn screening and identification of X-ALD patients aids in timely introduction of adrenal hormone replacement therapy and allows hematopoietic cell transplantation to be [...].

Introduction. Stomach cancer is the fifth most common oncological disease in the world and poses a diagnostic difficulty due to its often asymptomatic course. Usually, the first clinical signs are associated with lesions of abundant metastasis in the liver, peritoneum, and lungs. In rare cases, pulmonary metastases may resemble granulomatous disease, such as sarcoidosis. Case Description. In September of 2020 a 30-year-old man with a 2-month history of dyspnea, wheezing, and pain in the chest was admitted to the hospital. There were no gastrointestinal complaints nor abnormal findings in the physical examination. Initial chest radiograph showed pulmonary infiltrates, predominantly in upper and middle lobes bilaterally – 3rd stage sarcoidosis was suspected. Subsequent chest computer tomography (CT) exhibited additional findings: lymphostasis, hilar and mediastinal lymphadenopathy, interlobular septal thickening, and diffuse perilymphatic nodules, and supported the primary hypothesis. However, surprisingly, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) revealed adenocarcinoma with a signet-ring morphology, and the spread of oncoprocess from the gastrointestinal tract was suspected. Chest, abdomen, and pelvic CT exhibited additional findings of ascites, multiple liver, and peritoneal metastases, and highlighted the primary focus of the tumor - gastric cardiac carcinoma. Finally, esophagogastroduodenoscopy with biopsy was performed and confirmed an infiltrative tumor of the gastric body. Summary. Stomach cancer is a common oncological disease. In rare cases, its pulmonary metastases may resemble granulomatous disease, such as sarcoidosis. This report demonstrates a case of a 30-year-old male with an atypical radiological appearance of pulmonary metastases from gastric adenocarcinoma. Conclusion. While lung metastases typically appear as well-defined, rounded lesions, the presence o[...].