To find out which conditions can be treated in a minimally invasive way by interventional radiologists, click on the corresponding section below.
To find out which conditions can be treated in a minimally invasive way by interventional radiologists, click on the corresponding section below.
The aorta is the largest vessel in your body, delivering blood from your heart to the rest of your body. An aneurysm is when the aorta enlarges abnormally. The wall of the aorta consists of layers. If the inner layer peels off, this is called a dissection.
Many patients with aneurysms and dissections do not experience any symptoms. When they do cause symptoms, patients usually experience pain between the shoulders, in the abdomen or in the back. If the aneurysm or dissection leaks, patients bleed internally and may feel weak or collapse.
If you have a large aneurysm in your abdomen, your doctor may be able to diagnose you by physically examining you. If you have an aneurysm of the aorta in your chest, your doctor may be able to diagnose you using X-ray. Ultrasound can be used to diagnose aortic aneurysms of the chest or abdomen. CT and MRI will diagnose aneurysms of any part of the aorta.
The treatment you will be given depends on the size of the aneurysm or dissection, the symptoms you experience and the rate of change. The aim of treatment is to prevent the affected area from rupturing or, if it has already ruptured, to treat the rupture.
Small aneurysms can be managed conservatively by imaging follow-up and no treatment. Aneurysms which are large or are still growing may be managed by minimally invasive approaches, which place a prosthetic tube through a small hole inside the aneurysm to protect its weak walls.
Alternatively, a more suitable treatment option for you may be open surgery, in which a doctor will stitch in a prosthetic tube to replace the weakened aorta.
Arterial occlusive disease is a condition in which the arteries throughout the body gradually become narrowed. It can affect arms and legs. Often, patients who suffer from lower extremity arterial occlusive disease also have other conditions, such as carotid artery disease and heart disease. The condition is associated with significant morbidity and mortality.
The major risk factors for arterial occlusive disease are age, high levels of cholesterol and triglycerides (a type of fat found in the blood), high blood pressure, diabetes, smoking and a history of plaque build-up in the arteries. Men are more likely than women to develop arterial occlusive disease.
The symptoms of arterial occlusive disease are caused by the impaired blood flow to the patient’s limbs. Symptoms may occur suddenly or gradually develop over a period of time.
The most common symptoms are intermittent muscle pain and cramps, a continuous burning pain in the leg, numbness and pain caused by nerve damage, chest pain, high blood pressure and symptoms related to stroke.
To be diagnosed, you will undergo a physical examination. In addition, there are imaging techniques that can be used to aid diagnosis, such as CT, MRI and ultrasound. You may also undergo other tests, such as blood tests.
In some cases, patients may have to undergo specific procedures to relieve the narrowing of the artery and restore blood flow. Where feasible, minimally invasive approaches have become the preferred treatment options. These include percutaneous transluminal angioplasty and stenting.
However, if the disease is advanced, surgery may be necessary in order to restore blood flow.
Biliary tract obstruction is a common clinical problem. The biliary tract is the path by which bile is released by the liver and taken to the small intestine. The most common causes of biliary tract obstruction are gallstones and cancerous tumours. Less common causes include inflammation of the pancreas, metastatic disease to the liver and a disease of the bile ducts that causes inflammation and obstruction.
Patients often experience symptoms such as fever, abdominal pain in the upper right side, jaundice and nausea. Less frequent symptoms include itching and vomiting.
Specific blood tests can usually rule out certain conditions, such as an inflammation of the gallbladder, infection of the bile duct and an increased level of waste product from the liver, liver enzymes, and alkaline phosphatase. Any of these may indicate a loss of bile flow.
Several imaging techniques, including ultrasound, MRI and CT, can be used to diagnose biliary duct obstruction.
Treatments for biliary duct obstruction include surgery, imaging and interventional radiology. An interventional radiologist may perform a biliary dilation through the skin and insert a stent, a small mesh tube, which can offer security in the management of biliary obstructions.
A bone tumour is a mass of tissue as resulting from abnormal growth or cell division in the bone. There are two types of bone tumours, primary and secondary. Primary bone tumours develop first in the bone, while secondary bone tumours are tumours which develop elsewhere in the body and then spread to the bone.
Primary bone tumours may be benign (non-cancerous) or malignant (cancerous). Bone cancer can develop in any bone in your body, but most commonly occurs in the long bones in your arms and legs. The most common types of bone cancer include osteosarcoma, chondrosarcoma and Ewing’s sarcoma.
The most common symptoms are pain, reduced functioning in the affected area and an increased risk of fractures.
There are a number of methods your doctor may use to diagnose you, including radiograms (which use X-ray), MRI, CT and bone scintigraphy (a type of diagnostic test which uses radioisotopes which external detectors turn into 2D images). Your doctor may also use these techniques to evaluate the disease during follow-up.
The best method of treatment for bone tumours is a multidisciplinary approach, meaning doctors from different fields work together to decide on the course of treatment which is best suited to you. This can improve any functions that have been affected by the bone tumour, relieve any pain you are experiencing and, if the condition is life-threatening, prolong your survival.
The treatments that you will be offered first are radiotherapy, chemotherapy, bisphosphonates (drugs that prevent the loss of bone mass) and surgery.
In addition, there are a number of systemic and local therapies which can be used to cure or palliate bone tumours. Types of local therapies include interventional treatments such as embolisation, ablation techniques (radiofrequency ablation, cryoablation, microwave ablation, laser ablation and focused ultrasound), vertebroplasty and osteoplasty.
The largest artery in your body is the aorta, which leads from the heart to the abdomen. The carotid arteries extend from the aorta to the brain, and supply blood to the brain. If you press gently on either side of your windpipe, in your neck, you may feel pulsations from the carotid arteries.
Like any artery in the body, the carotid arteries may become diseased and blocked inside, either partly or completely. This is a little like the ‘furring up’ of the inside of washing machines or kettles in hard-water areas. The material that is deposited inside the arteries is called atheroma, from the ancient Greek word for porridge and is essentially a fatty deposit. It forms a mound or plaque. This will eventually cause a narrowing in the carotid artery, which is called stenosis.
As more plaque builds up, the arteries narrow and stiffen. This process is called atherosclerosis and is more likely to happen with aging. Only 1% of adults aged 50-59 have significantly narrowed carotid arteries, but 10% of adults aged 80-89 have this problem.
The build-up of atheroma in a carotid artery can cause a number of problems. Parts of the fatty deposit may break off and travel to the brain in the blood stream. When these particles lodge in a smaller artery in the brain they may cause a mini-stroke (called a transient ischaemic attack or TIA) or a full-blown stroke. The severity of the problem caused is difficult to predict and depends on where these particles go.
If these particles travel to the brain, you may experience loss of speech, weakness or numbness of an arm or perhaps an arm and a leg on one side of the body. The side of the body experiences weakness depends on which carotid artery has caused the problem.
The left-half of the brain controls the right side of the body and the right side of the brain controls the left side of the body, as human beings are ‘cross-wired’. Therefore, if the particles break off from plaque in the right carotid artery and travel to the right side of the brain, the patient may experience weakness in the left arm and/or leg.
For most right-handed people, the speech control centre of the brain is situated on the left, so disease in the left carotid artery may lead to speech problems.
Alternatively, visual problems may occur where it seems as if a curtain has come down over one eye. This happens because the particles have travelled to the artery supplying the eye.
You may experience the following symptoms:
Sometimes the fragments that lodge in the brain or the eye break up and blood flow is restored. In these circumstances, the symptoms are temporary.
If the symptoms clear up within 24 hours then it has been a mini-stroke (TIA).
However, these symptoms should not be ignored and a mini-stroke is a warning that you may be at risk of having more mini-strokes or a full-blown stroke. These symptoms should be reported to your family practitioner immediately, as the highest risk seems to be soon after your first symptoms.
If the symptoms do not improve within 24 hours, you have probably experienced a stroke. It is recommended that you contact your family practitioner, as you may experience further and possibly more disabling strokes without appropriate treatment.
Your doctor will first ask about your general health and medical history, including about risk factors such as whether you smoke and about the frequency and timing of your symptoms. You will have a physical examination and your blood pressure may be measured. You may also have an electrocardiogram (ECG) and chest X-ray.
Your doctor may also use other imaging techniques to diagnose you, such as Doppler, magnetic resonance angiography, angiography and CT.
The first treatment strategy is to address any risk factors you have, such as stopping smoking.
Secondly, you will need to be on the combination of medicines that is most suitable for you to prevent further build-up of plaque and to try to stabilise the plaque that has already built up; this is called ‘best medical therapy’. You may be offered medications such as aspirin, statins or ACE inhibitors.
Alternatively, you may be treated using surgery, in an operation called carotid endarterectomy (CEA). Interventional radiology can also treat carotid artery disease, using a procedure called carotid artery stenting. This involves placing a stent (a metal mesh tube) in the vessel to keep it open, preventing plaque from blocking the vessel.
Cirrhosis is scarring of the liver resulting from chronic (long-term) liver disease. The normal liver tissue is replaced by scar tissue and small lumps. The most common causes of cirrhosis are alcoholism, the hepatitis C virus and fatty liver disease. Patients with cirrhosis face an increased risk of liver cancer.
The symptoms of cirrhosis include jaundice (the skin and whites of the eyes turning yellowish), weakness, itching and fatigue.
Major complications of cirrhosis include excessive build-up of fluid in the abdomen, deteriorating brain function, infection, high blood pressure, progressive kidney failure and veins rupturing and bleeding.
If the cirrhosis is at an early stage, the patient may not yet be experiencing any symptoms. In these cases, the condition tends to be diagnosed when the patient is being tested for other conditions. The best method for diagnosing cirrhosis is biopsy.
Treating the causes of the cirrhosis can slow the progression of the condition, as well as reducing the risk of liver cancer. Interventional techniques can help manage complications associated with the disease.
Ultimately, the treatment for cirrhosis is a liver transplant.
Deep vein thrombosis (DVT) results when a blood clot forms in one of your deep veins, most commonly in your legs. This can lead to a pulmonary embolism, meaning the blood clot has travelled to the lungs and blocked an artery, which is a potentially life-threatening complication.
Patients with DVT may not have any noticeable symptoms. You may, however, experience symptoms in the affected area such as pain, swelling, warmth, changes in your skin colour (such as reddening or turning blue), or swelling of veins that are close to the surface of your body. In addition, you may have a raised body temperature.
Symptoms of a pulmonary embolism vary depending on how big the blood clots are, and on how well your heart is functioning. Patients may have difficulty breathing and experience back pain. Other symptoms include life-threatening reactions such as cardiogenic shock (where the heart is no longer able to pump enough blood) and severe hypoxaemia (low levels of oxygen in the blood).
A doctor can diagnose DVT via ultrasound or CT. It may also be necessary for the doctor to carry out other imaging procedures, such as a CT angiography, to rule out or evaluate the risk of a pulmonary embolism. This involves injecting contrast dye into a vein to highlight the blood vessels carrying blood to and from your lungs, and taking X-ray images of the blood flowing through them.
If the doctor diagnoses a DVT, you should immediately be treated with anti-clotting medication to reduce the risk of both a pulmonary embolism and of post-thrombotic syndrome, a chronic (long-term) complication that can develop after experiencing DVT.
In rare cases, a specialist may have to perform a minimally invasive procedure to instantly reduce the amount of clots. This involves inserting a catheter and using it to inject clot-dissolving medication directly in the clots, or to mechanically break up the clots.
Empyema refers to pus gathering within a naturally-existing space in the body.
When this develops in the pleural cavity, meaning the space between the two thin membranes surrounding your lungs, it is called pleural empyema. This is usually caused by an infection that spreads from the lung to the pleural cavity, but can be caused by anything that introduces infectious agents to the area, including chest trauma or surgery and tears to the gullet.
Gallbladder empyema commonly results from advanced gallbladder inflammation, with gallstones blocking the small tube that moves bile from the gallbladder.
Most patients with empyema experience fatigue, fever, chills, sweating and loss of appetite, but elderly patients and those with diabetes may not have specific symptoms.
Other symptoms depend on the site of the infection. If you have pleural empyema, you may experience shortness of breath, coughing and chest pain, whereas if you have gallbladder empyema you are likely to experience nausea, vomiting, constant and severe pain in the right upper or upper middle abdominal area, and pain radiating to the right shoulder blade.
Blood tests can help a doctor determine whether there is an infection. Ultrasound, chest X-ray and CT can be used by doctors to confirm the empyema’s existence and indicate its location, thickness and cause.
Your doctor will first try to control the infection with antibiotics. If this is not enough, you may be advised to undergo a minimally invasive procedure called percutaneous drainage, in which an interventional radiologist uses image guidance to insert a tube and drain the pus.
Endovascular aneurysm repair involves correcting a bulge or widened area in a blood vessel. Endoleaks are a complication that can result after the aneurysm repair procedure, in which blood leaks into the aneurysmal sac. Endoleaks can cause an aneurysm to become larger and even rupture. Endoleaks are classified into five different types, and can occur in up to 25% of patients.
Patients with endoleaks will often not experience any symptoms. If a patient who has undergone endovascular aneurysm repair experiences an expansion of the aneurysm, further investigation is necessary.
Patients who undergo aortic aneurysm repair require lifelong imaging surveillance. Various imaging techniques can be used to diagnose endoleaks.
The specific characteristics of the endoleak and the patient’s ability to tolerate surgical repair determine the selection of the treatment method. Where feasible, minimally invasive treatments have become the preferred approach, and involve repairing the endoleak by preventing blood flow to the aneurysm.
Nosebleeds are a very common medical problem. They generally result when the tissue that lines part of the nose erodes and certain vessels become exposed and break.
Causes include trauma, abnormalities in the structure that separates the nose into two sides (septum), irritation of the tissue lining the nasal cavity, inflammatory diseases, tumours, high blood pressure, vitamin K deficiency, hardening of arteries (arteriosclerosis) and specific blood or blood vessel disorders (such as hereditary haemorrhagic telangiectasia).
There are two types of nose bleeding: posterior and anterior. Anterior bleeds come from the front of the nose, and are more frequent. Posterior bleeds come from the back of the nose. These are usually heavier and more difficult to control. They are more frequently associated with complications such as airway obstruction, breathing blood into the lungs and coughing it up, and abnormally low blood plasma volume.
Most episodes of nosebleeds are self-limited, meaning the bleeding will stop without medical assistance. In rare cases, nosebleeds can be life-threatening, especially in elderly patients and those who suffer from diseases or conditions that occur together with the nosebleeds.
In most cases, blood will flow from a single nostril, but when a nosebleed is particularly heavy, it will spill into the second nostril, and may also run down the throat and into the stomach (in which case the patient will also spit up or vomit blood). In rare cases, where blood loss is especially heavy, the patient may feel light-headed, dizzy and may even faint.
Episodes of nose bleeding are self-evident. Where they are especially severe or recur, it is necessary to see a doctor. Lab tests will allow the doctor to evaluate underlying medical conditions that may be causing the severe bleeding.
Most nosebleeds can be self-treated by directly applying manual pressure to the nostrils, squeezing them between the fingers for 5 to 30 minutes. The head should be elevated, but not pushed too far back (in order to avoid swallowing blood).
If the vessel that is causing the bleeding is one that is easily seen and accessed, the doctor can seal it with a procedure called cauterisation. If the bleeding does not respond to cauterisation, nasal packing is an option. This involves placing an intra-nasal device, such as gauze, a type of balloon or sponge, to apply constant pressure. Nasal saline sprays may be useful for bleeding caused by excessive dryness.
Where bleeding is severe and recurring, medications are available to control the pain and to treat conditions causing the bleeds, such as vitamin K deficiency and high blood pressure. Antibiotics may be necessary to prevent infection.
Where severe nosebleeds keep occurring, surgery may be an option, such as arterial ligation. In this procedure, a doctor will tie up the specific blood veins causing the nosebleeds, preventing them from bleeding. This may require local or general anaesthesia.
Some patients may not qualify for surgery, or surgery may not work. For those patients, embolisation, a minimally invasive procedure that requires local anaesthesia only, may be an alternative. This involves making a small cut, inserting a catheter into a peripheral artery, and using image guidance to move it to the vessels that lead to the point of the bleeding. The specialist will then use one of several materials, such as liquid tissue glue, microcoils, beads or particles, to block the bleeding vessel.
The specialist will also perform an angiography (using contrast material and X-ray to see how the blood is flowing through the arteries) both before and after the procedure.
When patients have chronic kidney disease or experience sudden kidney failure, there is a risk that their kidneys may permanently stop working. As a result, these patients will often receive haemodialysis several times a week. This is a treatment in which a machine is used to filter waste, eliminate excessive fluid and restore proper electrolyte balance in the blood. In order to more easily administer dialysis, a surgeon usually first has to connect an artery to a vein, creating an arteriovenous (AV) fistula.
If it is not possible to create a fistula, the surgeon will instead use an AV graft (a synthetic tube) to create the connection between the artery and vein. If an AV fistula or AV graft do not work properly and need to be re-opened or replaced, the condition is called an AV fistula (or AV graft) malfunction in renal insufficiency.
If you have an AV fistula or AV graft malfunction, your doctor may notice symptoms when clinically examining the fistula or graft, such as a throbbing sensation in the area or swelling of the arm caused by fluid retention.
Modern dialysis machines can identify some problems resulting from malfunctions, such as insufficient blood flow caused by a narrowing of the supplying artery (stenosis), or blood exerting abnormally high levels of pressure on vein walls as a result of the narrowing of a big vein in the chest.
A doctor can diagnose the condition using imaging techniques, such as contrast-enhanced CT, MRI or fluoroscopy.
AV fistula malfunctions usually occur when the narrowing in the veins has caused clots to form (thrombosis). Which treatment option is most suitable for you depends on the cause of the fistula malfunction and its location.
If the fistula malfunction was caused by narrowing in the vessels, an interventional radiologist can carry out a minimally invasive procedure called a percutaneous transluminal angioplasty. In this procedure, a catheter (a thin flexible tube) with a tiny balloon at the tip is inserted into the narrowed area under image guidance, and then the balloon is gently inflated to expand the area.
You may need to take medication to prevent the formation of blood clots, though this depends on your clinical situation.
Gastroduodenal outlet obstruction refers to a blockage in the outlet of the stomach that prevents the stomach from emptying itself. The condition is most commonly caused by cancer affecting the stomach or part of the small intestine, though it can have other causes. The most common cancers affecting these areas are gastric and pancreatic cancers.
Patients with gastroduodenal outlet obstruction may suffer from nausea and vomiting, weight loss and abdominal discomfort. This can severely affect quality of life.
Gastroduodenal outlet obstruction can be difficult to diagnose, as it has similar symptoms to a number of other conditions. However, imaging techniques can be used to help identify a gastroduodenal obstruction, including CT, MRI and endoscopy.
The condition can be treated using surgery or interventional radiology, depending on the individual patient’s situation. It is often not possible to cure the condition by surgically removing the obstruction, and although a surgical bypass is a possible palliative treatment, it is associated with high morbidity and mortality rates.
Interventional procedures can provide other options. For patients suffering from cancerous obstructions that cannot be surgically removed, stents placed via the gullet are a safe, palliative alternative. These procedures are performed either using fluoroscopic guidance alone or in combination with endoscopic guidance.
Haemoptysis refers to coughing up blood from the vessels in your respiratory tract below your voice box. Massive haemoptysis accounts for approximately 5% of cases of haemoptysis and is a life-threatening condition because it can result in asphyxiation (lack of oxygen). Because of the severity of the consequences, patients with haemoptysis need to be examined and treated as soon as possible.
Massive haemoptysis refers to when a patient coughs up between 100-1,000 ml of blood in 24 hours, but smaller amounts of blood can also be life-threatening, and so require interventional management.
In 90% of cases, the source of the bleeding is in the bronchi, the airways of the respiratory tract which conduct air into the lungs. In 5% of cases, the source of the bleeding is in the pulmonary system, which is the system that carries de-oxygenated blood away from the heart to the lungs and returns oxygenated blood back to the heart. There are a number of causes for haemoptysis, including tuberculosis, bronchitis and trauma.
The first step for evaluating haemoptysis is a chest radiograph, although the findings appear normal in up to 30% of cases. Another useful diagnostic approach is a bronchoscopy, in which an imaging device is inserted into the airway. CT may be used to find the source of the bleeding and to identify the cause.
The treatment of choice for massive haemoptysis is bronchial artery embolisation, a minimally invasive technique performed by an interventional radiologist. The interventional radiologist inserts a catheter into the patient’s femoral vein (in the upper thigh) using fluoroscopy for guidance. The interventional radiologist then directs the catheter to the bronchial artery and inserts embolisation materials into the branch of the bronchial artery responsible for the bleeding to block the area, stopping the bleeding. The patient will have an angiography after the embolisation procedure to confirm if the procedure has been successful.
The treatment has high rates of immediate clinical success. If the bleeding recurs, the embolisation procedure can be repeated. There are a number of possible complications, including chest pain and difficulty swallowing. The most serious complication is inflammation of the spinal cord, but this only occurs in 1.4-6.5% of cases.
There are surgical treatments available, but these are reserved for cases where the embolisation procedure is unsuccessful or if the condition recurs after multiple embolisation procedures. Surgery has a mortality rate of 14-18%.
Other treatments include endobronchial tamponade, which is the use of an absorbent plug to stop the bleeding, and is used in patients who are not suitable candidates for embolisation or surgery. Another option is rigid bronchoscopy, which may be used to treat patients whose blood flow is impaired or who have breathing problems. Bronchoscopy can be used to clear the airways and aid physicians to carry out treatments.
Hypertension is the medical term for chronic high blood pressure. There are two types of hypertension: primary hypertension (also known as essential hypertension) and secondary hypertension. Primary hypertension means that the cause of the high blood pressure is undefined; the majority of hypertension cases (95%) are classified as primary hypertension.
Around 5% of cases of hypertension are cases of secondary hypertension, which is when the patient’s high blood pressure is caused by an underlying disease.
There are a number of forms of hypertension. These include: white coat hypertension, meaning that blood pressure is high in clinical settings but not at other times; malignant hypertension or hypertensive emergency, when the patient’s organs may be damaged as a result of the high blood pressure; and resistant hypertension, which is when the patient’s blood pressure does not respond to therapeutic lifestyle changes and at least two other anti-hypertensive drugs.
In most patients, hypertension does not cause any specific symptoms and so the condition is only identified when a doctor physically examines them.
When hypertension does cause symptoms, the symptoms fall into one of the following categories: related to the high blood pressure itself; caused by hypertensive vascular disease; or caused by the underlying disease, if the patient has secondary hypertension.
Although headaches are often thought of as a symptom of high blood pressure, a headache is in fact a symptom of severe hypertension only, and patients tend to experience headaches upon waking up. Other symptoms include light-headedness, vertigo, tinnitus, altered vision and fainting episodes. You may also experience dizziness, palpitations, easy fatigability and impotence. Malignant hypertension and untreated hypertension may cause acute or chronic damage to the brain, heart, arteries (such as aortic dissection), kidneys and eyes.
In order for your doctor to confirm that you have hypertension, you will need to provide your medical history as well as undergoing a physical examination and laboratory tests. These tests are also used to rule out any of the possible causes of secondary hypertension. Your blood pressure should be measured at least twice and on two separate occasions.
If you have a strong family history of hypertension and have had high blood pressure in the past, you are likely to have primary hypertension. If there is a possibility that you have white coat hypertension, you may be diagnosed using a 24-hour blood pressure device which can be used at home.
Secondary hypertension often develops in patients under 35 years old or over 55 years old. If you do have secondary hypertension, you will need other tests to establish the underlying cause, such as an ultrasound or other imaging tests.
If you have primary hypertension, your first treatment option will include dietary changes, physical exercise and weight loss. If this treatment is ineffective or unsuitable for you, you may be given anti-hypertensive drugs to treat the hypertension.
If you have secondary hypertension, your treatment will depend on the underlying condition which causes the hypertension. If you have an endocrine disease, your treatment will be tailored to the specific condition affecting your hormones.
If the underlying condition is caused by a narrowing of the blood vessels in your kidney, you will undergo an imaging test (called a transarterial angiography) to confirm the location of the narrowed area and a doctor will insert a stent (a tiny metal mesh tube) into the vessel to support it and ensure it stays open. This restores the normal blood flow to the kidney.
If you have resistant hypertension, you may be given medication to lower your blood pressure. New drugs are currently being investigated, so there may be a medication suitable for you. Alternatively, you may undergo a more invasive method, such as renal denervation, a minimally invasive procedure in which a doctor deliberately damages specific nerves in the renal artery to lower the patient’s blood pressure.
Your spine consists of vertebrae, which are separated by intervertebral discs. Disc herniation refers to when the outer layer of the disc ruptures, allowing the jelly-like substance in the middle of the disc to bulge out of the damaged outer rings. The most common causes of disc herniation are trauma and disc degeneration.
Between 60% and 80% of people will experience low back pain at some point in their lives. Disc herniation is one of the most common causes of low back pain and leg pain, and affects mobility, physical function and quality of life.
The symptoms of intervertebral disc herniation depend on the location and the nerves involved. While some patients experience little or no pain, others experience severe and insistent neck or lower back pain. Other symptoms include numbness, tingling, muscular weakness, paralysis, pins and needles and slowed reflexes.
If the herniated disc is in the lower back, the patient may also experience sciatica (pain caused by compressed nerve roots in the sciatic nerve, which extends from the lower back to the back of each leg). Another condition caused by disc herniation is cauda equine syndrome, a serious medical condition which affects the legs and urogenital area.
To diagnose you, your doctor will need your medical history, a list of your symptoms and to physically examine you. Although X-rays cannot be used to diagnose herniated discs, they may be used to rule out other causes of back pain, such as infection, tumours, spinal alignment issues or fracture.
CT can provide useful information to assess bone, degenerative disc disease, loss of disc height and deterioration of the joint cartilage. MRI provides the most information as the herniated area is clearly visualised. Other tests, such as electromyograms and nerve conduction studies, which measure the electrical activity of nerves at rest and moving, may be used to assess nerve damage if the nerve roots are compressed.
You will first be treated with conservative therapies, including rest, physiotherapy, painkillers and anti-inflammatory medication. If these approaches are unsuccessful, however, there are minimally invasive techniques available that can provide effective pain relief for nerve pain caused by disc herniation, such as selective image-guided infiltration with a local anaesthetic and disc decompression techniques.
The aim of disc decompression techniques is to remove a small amount of the jelly-like substance in the centre of the disc, thus reducing pressure between the discs. This can be achieved by using a variety of decompression techniques, such as medication, heat or mechanical devices.
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An intracranial aneurysm is a blood-filled bulge in the wall of a blood vessel in the brain, which occurs at a weak point in the blood vessel.
As a result, intracranial aneurysms are associated with a high risk of bleeding around the brain, known as subarachnoid haemorrhage, and in the brain itself, known as intracerebral haemorrhage, though this is less common. Subarachnoid haemorrhage and intracerebral haemorrhage are types of intracranial haemorrhage and can have catastrophic consequences.
A small intracranial aneurysm usually does not produce many, if any, symptoms until it ruptures, causing subarachnoid haemorrhage. The most frequent symptom of this is a severe headache, but you may also experience nausea and vomiting, neck stiffness, blurred vision, alteration in consciousness and seizures.
However, if you have a large intracranial aneurysm, you are more likely to be aware of it before it ruptures, as it may distort your normal anatomy. There are a number of neurological symptoms that you may experience, depending on the structure affected, including problems with vision, cognition, perception, speech, behaviour, balance, concentration, memory or fatigue.
A CT scan or MRI of your brain can be used to diagnose you. In order to plan the optimal treatment for you, a doctor may need to perform a cerebral angiogram, which uses X-ray-based techniques.
There are a number of possible treatments for intracranial aneurysms. The aneurysm may be treated surgically through an opening in your skull. A clip is then placed on the vessel, which stops blood flow to the aneurysm, making it harmless.
Alternatively, you may have a minimally invasive treatment, in which blood flow to the aneurysm is stopped, but instead of this being carried out through a hole in your skull, the doctor will direct a microcatheter to the aneurysm from an artery in your groin under X-ray guidance, and will then place tiny metal coils into the aneurysm to block it.
If you undergo either of these treatment methods, you will need to stay in hospital.
An arteriovenous malformation (AVM) is an abnormal cluster of blood vessels that can occur anywhere in the brain. Blood flows through them at excessively high pressures, but bypasses the brain tissue without nourishing it.
If you have an AVM, it is likely that you have had it since birth. The abnormal blood vessels which make up an AVM have weak walls. This means that the blood vessels tend to widen over time and then rupture, causing intracranial haemorrhage.
The symptoms you experience depend on the location and size of the AVM. Although you may not have any symptoms at all, it is also possible to experience symptoms such as seizures, a headache that won’t go away, weakness or numbness. You may also experience a buzzing sound in your head. If the AVM begins to bleed, you may develop symptoms of a subarachnoid haemorrhage or, less commonly, of acute stroke.
Your doctor can diagnose you using a CT scan or MRI of your brain. In order to plan the optimal treatment for you, a doctor may need to perform a cerebral angiogram (or DSA) under X-ray guidance with a contrast substance injected directly into your brain.
There are three possible treatments for an AVM: endovascular embolisation, surgical removal and stereotactic radiosurgery. The treatment that is most suitable for you depends on the size and location of the AVM and whether or not it has bled. It is fairly common for patients to have to undergo more than one treatment.
If you undergo endovascular embolisation, an interventional radiologist will direct a microcatheter to the AVM through an artery in your groin, and will then plug the abnormal blood vessels with glue.
Stereotactic radiosurgery is a form of radiotherapy in which the AVM is exposed to focused beams of gamma rays, thereby severely damaging the abnormal blood vessels. This means that blood flow gradually slows to a halt and the AVM shrinks and, over several months or years, turns into a scar.
You will need to stay in hospital for these procedures.
Jaundice is a condition which causes your skin and the whites of your eyes to turn yellow. It occurs when a patient has too much bilirubin, which is a yellow chemical in haemoglobin, the substance that carries oxygen in your blood cells. Patients often develop jaundice in connection with liver disease, an obstruction of the biliary tract or other conditions.
The most common symptom of jaundice is a yellowish pigmentation of the skin and the whites of the eyes.
To diagnose you, your doctor will perform a physical examination and some blood tests. Imaging techniques can also be used to aid the diagnosis, such as ultrasound, CT and MRI.
If a patient also has bile duct obstruction, it may be necessary to perform further diagnostic procedures to examine the affected area.
Treatment depends on the exact underlying cause of the jaundice. If the condition is connected to biliary duct obstruction, several options are available. Surgery may be necessary to relieve the blockage. Imaging techniques may also be used.
Minimally invasive techniques to manage jaundice related to biliary obstruction include percutaneous transhepatic biliary drainage, which involves placing a catheter across the narrowed duct and connecting it to an external bag to allow drainage. The interventional radiologist may also place a stent, which keeps the biliary ducts open without the need for a catheter. In some cases, the physician will perform a separate procedure, called percutaneous biliary dilatation, which involves stretching a section of the bile duct with a balloon, to aid insertion of the stent.
Liver cancer refers to uncontrolled cell growth inside or on the surface of the liver. Liver cancer is the third most common type of cancer worldwide.
Primary liver cancer means that the tumour starts in the liver. The most common type of primary liver cancer is called hepatocellular carcinoma (HCC). Patients who have underlying chronic liver disease (such as chronic hepatitis B or C, or conditions caused by alcohol abuse or a build-up of too much iron) and develop cirrhosis (scarring of the liver) are most likely to suffer from this kind of cancer.
When the cancer results from cancerous cells spreading to the liver from other parts of the body, it is referred to as metastatic liver disease.
Generally, liver tumours are discovered during routine screening or when they cause symptoms because of their size or location. Common symptoms include weakness, fatigue, weight loss and loss of appetite. Other possible symptoms are fever, night sweats and pain in the abdomen, but these occur less frequently.
Patients with chronic liver disease generally have symptoms of advancing cirrhosis, such as jaundice (meaning the skin and whites of their eyes turn yellowish), itching, an enlarged spleen, severe weight loss and weakness, as well as bleeding in the upper gastrointestinal tract, caused when blood is re-routed through blood vessels in the stomach and gullet, which then swell and split.
There are a number of techniques that your doctor can use to diagnose liver cancer and determine its severity (called staging), including imaging procedures like ultrasound, CT and MRI.
In most cases, a biopsy will be necessary to determine the exact type of cancer and to judge its aggressiveness. These are now commonly carried out with image-guided, minimally invasive techniques that involve inserting a needle directly into the liver through the abdominal wall in the stomach area.
Other specific options are available depending on the exact type of liver cancer involved, such as testing blood for tumour markers or using imaging techniques.
Both traditional surgery and interventional techniques play a role in treating liver cancer. If you have HCC, your surgical options include removing all or part of the liver and liver transplantation. However, many patients do not qualify for this treatment for various reasons.
Interventional alternatives include several percutaneous thermal ablation techniques, meaning that a needle is inserted into the liver tumour under image guidance, through which extreme temperatures are delivered to destroy the tumour.
Types of percutaneous thermal ablation techniques include radiofrequency ablation (which uses radiofrequency energy), microwave ablation (using microwave heat), cryoablation (in which a gas is used to freeze the tissue), or electroporation (using a powerful electrical field using high-voltage direct current).
In some cases, the liver tumour has an unusually high number of blood vessels attached to it. This increases the risk of bleeding, making it harder to remove the tumour. A treatment called transarterial chemoembolisation can relieve the pain and suffering caused by these tumours. In this procedure, an interventional radiologist delivers a high dose of a cancer-killing drug directly into the tumour.
Another possible treatment is radioemboliastion, a similar technique to transarterial chemoembolisation that is used to extend and improve the quality of patients’ lives. During this procedure, an interventional radiologist injects radioactive microspheres directly into the tumours, a targeted approach that destroys them or slows down their growth rate.
Low back pain affects up to 40% of the adult population. The most common causes of low back pain are lumbar strain or sprain.
Low back pain may also be caused by degenerative processes, including degenerative disc disease and facet joint syndrome (a type of low back pain characterised by stiffness and pain that increases when turning backwards), disc herniation, vertebral fractures, spinal stenosis (narrowing of the spinal canal) and spondylolisthesis (displacement of a vertebra or the vertebral column).
It is characterised by pain in your lower back which may spread to your hips, buttocks or thighs. Over 90% of low back pain and sciatica (pain caused by an irradiated or inflamed sciatic nerve) spontaneously disappear within 30 days after medical and physical therapy.
The location of your pain depends on the cause of the low back pain. If you have a vertebral compressive fracture, you will experience severe pain in the middle of your lower back which is made worse when pressure is applied.
If you have disc disease, your pain may be associated with sciatica, or if it is caused by facet joint pain your pain may increase when you twist or bend backwards, or if it is due to spinal canal stenosis or instability you may have pain due to the strain.
There are a number of methods that your doctor can use to diagnose you, including taking a medical history, clinically examining you, or using X-ray, CT or MRI. The most common diagnostic tool is an electromyography, which evaluates the electrical activity of your skeletal muscles.
In most cases, the first treatment option for patients is conservative treatment, such as non-steroidal anti-inflammatory drugs, physical therapy, brace support for instability or vertebral fractures, and epidural steroid injections.
There are also minimally invasive treatments available. Minimally invasive therapies include vertebroplasty or vertebral augmentation for VCF, disc decompression for contained disc herniation, radiofrequency denervation for facet joint syndrome and or screws for facet arthrodesis.
Patients report a 93% success rate for vertebroplasty, 79% for disc decompression and 75% for RF neurotomy, as measured by the amount of pain reduction experienced. If these treatments do not work for you, you may be advised to have surgery.
Lung cancer refers to the uncontrolled cell growth in lung tissue. The leading risk factor for lung cancer is exposure to tobacco smoke, with smoking accounting for 80-90% of lung cancer cases. Other causes of lung cancer include genetic factors, asbestos exposure and air pollution.
Primary lung cancer, which starts in the lung, usually originates from cells that help protect or enclose organs. The lungs are the most common site for primary cancer worldwide. Metastatic lung disease, on the other hand, is when cancerous cells spread to the lung from other parts of the body, and is also common.
Lung cancer has a variety of symptoms, including persistent coughing, wheezing and shortness of breath, as well as coughing up blood, especially in smokers. You may also notice weight loss, fever, fatigue and deformities in the fingers and fingernails, which are referred to as clubbing.
Compression and invasion of structures near the tumour can also cause other symptoms, including chest pain, hoarseness, and swelling of the face and neck if there is a blockage preventing blood flowing back to the heart (resulting in a condition called superior vena cava obstruction).
There are a number of tests which can be used to diagnose lung cancer. The first step often involves the doctor taking a chest X-ray, and an imaging technique called CT may be used to provide more details about the type, location and extent of the disease.
In most cases, a specialist will also have to perform a biopsy to obtain and examine a tumour sample. This is usually done by way of a bronchoscopy, where the specialist inserts a narrow tube (scope) through your mouth or nose and windpipe, into your lungs, and then takes small tissue samples using a tiny device. It can also be done with an image-guided needle biopsy, where the specialist uses CT for guidance while moving a needle to the area from which a sample is taken.
If the cancer is in the very top of a lung and the specialist suspects that it has invaded the network of nerves in your neck and chest (called the brachial plexus) or your vascular system, you may undergo an imaging procedure called MRI.
A further way of detecting some types of cancerous cells is an imaging technique called positron emission tomography (PET), which involves injecting a small amount of a tracer that travels through your blood, collects in organs and tissues, and allows the specialist to see certain areas of concern more clearly.
The treatment options available to the patient depend on the specific characteristics of the cancer, including its cell type, location, whether or not it has metastasised and how well the patient’s heart and respiratory system are working.
Surgery is considered the main curative treatment. If surgery is not an option for a patient, and the disease is limited to the lung, an interventional technique called image-guided ablation can play a major role. This procedure involves an interventional radiologist using image guidance to insert a needle into the tumour. The tumour is destroyed by delivering radiofrequency energy (radiofrequency ablation), microwave heat (microwave ablation) or a gas that freezes the tissue (cryoablation).
Patients who suffer from small cell lung carcinoma or incurable cancer can improve the quality and length of their lives by undergoing chemotherapy and radiotherapy (in which high-energy X-rays are aimed at the site of the cancer).
Multiple myeloma refers to cancer of plasma cells, which are a type of white blood cell that produce antibodies. In patients with multiple myeloma, the cancerous plasma cells gather in the bone marrow, which affects the production of normal blood cells. It accounts for 1% of all cancers and 10% of haematologic cancers, meaning cancers that affect blood, bone marrow and lymph nodes. Multiple myeloma is more common in older patients, with 70% of patients diagnosed aged 50-70 years old, and is twice as common in men as in women.
The condition may develop in one of four ways. Some patients have multiple lesions on the bones in their head and trunk. Others find they have a lower bone density than normal. Multiple myeloma may also present as a single large lesion in the spine or pelvis or as a bone hardening or increasing in density.
Patients with multiple myeloma may experience a range of symptoms. Some patients experience hardly any symptoms, while others have severe symptoms that require emergency treatment.
The main symptom of the condition is bone pain, which at first only occurs intermittently but then becomes constant. The pain tends to be worse during the day, especially after activity or weight bearing. Other symptoms include decreased red blood cell count (anaemia), kidney failure, too much protein in the urine and too much calcium in the blood.
Patients may also experience complications related to the multiple myeloma, such as bone fractures, amyloidosis (the build-up of proteins in tissues and organs), recurrent infections, tumours made up of plasma cells and nerve damage.
Multiple myeloma is often diagnosed after routine blood tests for other conditions, though a bone marrow biopsy or sample of cells is necessary to confirm the diagnosis.
It is essential for patients to have a skeletal survey (a series of X-rays of all the bones in the body), as this can be used not only to diagnose the extent of the disease but also to assess the patient’s response to treatment and predict potential complications such as fractures.
Other imaging techniques can be used to gather further information about the condition. MRI can be used to detect multiple lesions, while CT may be used to evaluate the soft tissue component outside the bone or the risk of fracture in severely affected bones. In order for your doctor to diagnose you as accurately as possible, a number of factors are needed, including physical examination, medical history, symptoms and lab results.
Although multiple myeloma currently remains incurable, there are a number of treatments which may extend the patient’s life. Chemotherapy can be used to slow the progression of the disease and reduce symptoms, and drugs called bisphosphonates prevent the loss of bone mass and promote bone healing. If you experience anaemia, you may be treated with erythropoietin, which is a hormone that stimulates red blood cell production.
A further possible treatment is stem-cell harvest, which can then be used to give you a stem cell transplant after you have undergone bone marrow ablation using chemotherapy or radiotherapy. This approach has had positive results for response and disease-free survival rates.
Multiple myeloma is very sensitive to radiation, which is used to treat lesions that are causing discomfort or pain, stabilising bones at risk of fracture and treating problems with the spinal cord.
There are a number of minimally invasive techniques available, including vertebral and bone augmentation techniques, in which cement is injected into the area surrounding a fracture to stabilise it, reducing pain and improving mobility. Ablation techniques, in which the tumour cells are destroyed under imaging, can be used to control individual tumours.
1. Saba HI, Mufti G. Advances in Malignant Hematology. Wiley-Blackwell (2011).
2. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology. Philadelphia.
3. Dähnert W. Radiology review manual. Lippincott Williams & Wilkins. (2003).
4. Palumbo A, Rajkumar SV. Treatment of newly diagnosed myeloma. Leukemia. Mar 2009;23(3):449-56.
‘Nasolacrimal duct’ is the medical term for your tear duct. Your tear duct system consists of an upper and a lower lacrimal duct, which are tiny channels in your eyelids that join together in an area under your eye called the lacrimal sac. The nasolacrimal sac carries tears from the lacrimal sac into your nasal cavity.
Sometimes the tear duct can become blocked, known as nasolacrimal duct stenosis (narrowing in the duct) or obstruction (blockage in the duct). This condition may be present from birth or could be caused by external factors, such as a growth which blocks the duct or inflammation.
If there is any obstacle inside your tear duct system, it will cause tears to drain from your eye into your nasal cavity. As a result, patients have an excessive amount of tears, known as epiphora. If you have an obstruction in your tear duct system, you may also experience pain, redness or pus.
Your doctor may diagnose you using imaging, which is an out-patient procedure. Depending on the imaging method used, your doctor may also be able to see the cause of the stenosis or obstruction as well as its severity. You will be under local anaesthesia for the procedure.
Two possible routes of treatment for nasolacrimal duct stenosis are surgery and minimally invasive techniques. Both types of treatment are performed as out-patient procedures under local anaesthesia. If you choose to undergo surgery, this means you will have a dacryocystorhinostomy, a surgical procedure in which the surgeon creates a new lacrimal duct.
On the other hand, you may choose to have a minimally invasive procedure, using interventional radiology. One interventional radiology technique is to use a tiny balloon to expand the area (known as balloon dilation), which may be accompanied by a mesh metal tube (a stent) being used to support the structure of the duct. In this procedure, an interventional radiologist inserts a catheter into the edge of the patient’s eye and into the affected tear duct, using imaging for guidance. The interventional radiologist then passes a guidewire and a tiny balloon into the duct and then, once the balloon is dilated, the area is gently expanded.
Your kidneys produce urine, which drains through your ureters to your bladder so that it can leave the body. If there is a blockage of this drainage system, the urine backs up, and if it is under pressure, this could potentially damage the kidneys. This condition is called obstructive uropathy. You may be born with it or it may develop later in life.
You may experience repeated infections, back pain under your ribs and blood in your urine. If your kidneys have stopped working, you may feel nauseous.
Ultrasound is the first test in the majority of cases. If your condition is caused by stones in your bladder or kidneys, your doctor may use X-ray or CT without dye to diagnose you. CT with dye (CTU) can be used to look for other causes of the condition, such as a tumour. MRI and nuclear medicine occasionally play a role in diagnosis.
The treatment you will receive depends on the cause of the obstructive uropathy. If the blockage is severe and the health of your kidney is threatened, the blockage will be drained through the skin by a tube inserted into your ureter (this procedure is called nephrostomy) or an internal tube (double J stent).
Sometimes the blockage can be relieved through the urethra and bladder (cystoscopy). Stones can be removed through the skin, through the bladder and by open surgery. If you have a tumour, you may need surgery or radiation to remove the blockage.
Chronic pelvic pain is a common problem for women and has a number of causes. One cause of pelvic pain that has been identified in recent years is pelvic congestion syndrome. This condition is caused by varicose veins in the ovarian and pelvic veins, meaning that blood pools in the veins and affects the surrounding nerves, causing pain in the uterus, ovaries and vulva.
Pelvic congestion syndrome usually affects women between the ages of 20 and 50, and is unusual in women who have never been pregnant.
The main symptom is pain in the pelvis and lower back that lasts for more than 6 months. The pain usually becomes worse during menstrual periods, while standing, at the end of the day, after intercourse and during pregnancy.
Patients may also experience an irritable bladder, abnormal menstrual bleeding and vaginal discharge. Varicose veins may be present on the vulva, buttocks and thighs. Other symptoms include a lack of energy, depression, rectal discomfort and chronic lower back pain.
If a woman is experiencing chronic pelvic pain, and other abnormalities have been excluded, a doctor must consider pelvic congestion syndrome as a possible cause. A doctor can use pelvic and transvaginal ultrasound to rule out other diagnoses, and Doppler ultrasound to obtain information about the patient’s venous blood flow.
The diagnosis can easily be missed during a regular pelvic exam, as the affected veins become less enlarged when the patient is lying down. An ultrasound carried out while the patient is in a standing position is helpful because it may reveal the dilated pelvic veins.
MR venography, which can depict the entire venous anatomy, is the best non-invasive method for diagnosing pelvic congestion syndrome and determining the extent of the condition.
The most accurate method for diagnosing the syndrome is by pelvic venography. To do this, an interventional radiologist, under fluoroscopic guidance, inserts a catheter into a vein in the groin area (the femoral vein), guides it to the dilated pelvic veins, and injects contrast dye to make the veins more clearly visible under X-ray.
The doctor may prescribe painkillers to reduce the pain associated with pelvic congestion syndrome. Hormonal medications may also reduce congestion.
If these approaches fail, pelvic congestion syndrome can be treated using embolisation, a minimally invasive technique. An interventional radiologist first carries out a pelvic venography, described above, then inserts tiny coils in order to close the varicose veins. The specialist may also inject particular chemicals, called sclerotic agents, into the veins. The procedure does not require general anaesthesia, and is performed on an out-patient basis. Patients can return to normal activities immediately.
In increasingly rare cases, surgical treatment, such as a hysterectomy and vein removal, may be necessary.
1. Pelvic Congestion Syndrome – Chronic Pelvic Pain in Women Sirweb.com [http://www.sirweb.org/patients/chronic-pelvic-pain/]
2. Ignacio E, Dua R, Sarin S, Soltes Harper A, Yim D, Mathur V, Venbrux AC. “Pelvic Congestion Syndrome: Diagnosis and Treatment,” Semin Intervent Radiol. 2008 December; 25(4): 361–368.
Peripheral vascular disease (PVD) typically refers to long-standing narrowing and/or blockage of the vessels delivering blood to your legs (the arteries). Most cases are caused by atherosclerosis, the same condition that affects the blood vessels of the heart and the brain.
The majority of PVD patients experience cramping and pain in the lower leg muscles while walking, which is relieved by stopping (this is known as intermittent claudication). In more severe cases, patients may experience pain whilst resting. The most severe type of PVD causes ulcers in the feet or death of the skin (gangrene).
Your doctor will diagnose you by measuring the blood pressure in your legs and comparing the pressure to that in your arms (known as the ankle/brachial index or ABI). You may need to have a picture taken of the blood vessels to document the site and severity of the blockages. This is called an angiogram and can be done using imaging techniques such as CT or MRI. You may also require a test called a digital subtraction angiography (DSA), which involves putting dye directly into your blood vessels.
The initial treatment you will be given is based on your lifestyle and management of risk factors, such as walking programmes, stopping smoking and controlling diabetes.
If these methods do not help you, the blockages may need to be opened. Minimally invasive approaches (also known as endovascular approaches) use tiny balloons and stents to restore blood flow through a very small hole in the artery. Another possible treatment is surgery, which can either clean out the inside of the artery (a procedure called endarterectomy) or bypass the blockage using a vein or prosthetic material.
Pleural effusion is the collection of excessive amounts of fluid in the envelope-like space that surrounds the lungs (called the pleural cavity). The characteristics and thickness of the effusion depend on the origin of the fluid and the cause of the build-up.
In many cases, there are no obvious symptoms. However, if there is a large amount of fluid or there is an inflammation, you may notice symptoms such as shortness of breath, chest pain, cough and fever.
To diagnose you, a doctor will first physically examine you with a stethoscope, or use a technique called percussion (tapping body parts with fingers, hands or small instruments). The doctor can usually diagnose the condition by taking a chest X-ray, with pleural effusions appearing as a white zone at the base of the lung. Other imaging techniques can be used to provide further information.
The exact treatment will depend on the cause of the effusion, and on whether or not you are experiencing any symptoms. The doctor may remove some of the fluid by inserting a needle attached to a syringe into the area above your rib, in a procedure called aspiration. This is done both to investigate the cause of the effusion and to relieve the symptoms it triggers. If the effusion is large or infected, the doctor may insert a tube into the pleural space to drain it, using image guidance to properly place the tube. This should relieve your symptoms and prevent complications.
If you regularly suffer from effusions, it may be necessary to undergo a procedure called pleurodesis, which can either be carried out using chemicals in the pleural space or through surgery. If pleurodesis fails, you may need a treatment called pleural decortication, which involves surgically removing the problematic layer of fibrous tissue.
Portal hypertension, a major complication of chronic liver disease, refers to abnormally high blood pressure in the portal vein system. The portal vein system transports blood from the stomach, intestines, gallbladder and pancreas to the liver. The most common causes of portal hypertension are liver cirrhosis and blood clots in the surrounding veins.
The main symptoms and complications of portal hypertension include gastrointestinal bleeding, the accumulation of fluids in the abdomen (called ascites), abnormal brain function, infection and kidney failure.
There is no simple test to show if a patient has portal hypertension, so the condition is diagnosed based on the presence of symptoms such as ascites and dilated veins. Common imaging methods for diagnosis include ultrasound, CT and MRI.
There are a number of treatments available for portal hypertension and the complications resulting from the condition, including endoscopic therapy, surgery and interventional radiology. For example, transjugular intrahepatic portosystemic shunt (TIPS) is an interventional procedure in which an interventional radiologist connects the portal and hepatic veins using a stent (a metal mesh tube). The aim of this procedure is to reduce the pressure in the veins, prevent dilated veins from bleeding and to reduce the formation of ascites.
Prostate gland hypertrophy (enlargement) is a common medical problem in men over 50. The prostate begins to grow after the age of 25. As the prostate enlarges, it presses on the bladder and the urethra, obstructing the flow of urine and causing discomfort.
Prostate gland hypertrophy is related to lower urinary tract symptoms, such as a urine stream that is hesitant, interrupted or weak and an urgent need to empty the bladder. Other symptoms include leaking, dribbling, feeling that the bladder is not empty after urinating and more frequent urination, especially at night.
Patients may also experience symptoms related to bacteria in the urine remaining in the bladder, such as frequent urinary tract infections and the development of bladder stones. In more severe cases, prostate gland hypertrophy may lead to urinary retention (being unable to urinate) and kidney failure, though this is less common.
During the initial evaluation your doctor will ask you questions about your medical history and your urinary problems. The diagnostic work-up includes a digital rectal examination and testing your urine and blood.
You may have an ultrasound through your abdomen or rectum to calculate the size of your prostate and evaluate its structure. Ultrasound may also be used to calculate the residual urinary volume after urinating.
Conservative treatment for prostate gland hypertrophy includes making changes to your lifestyle, such as reducing stress and avoiding drinking fluids in the evening. There are also several medications that may alleviate your urinary symptoms.
If conservative treatment does not relieve your symptoms, you may be advised to have a prostatectomy (the surgical removal of the prostate). This may be performed via open surgery or via transurethral resection. Transurethral resection is considered the treatment of choice and involves removing part of the prostate gland through the urethra. It is widely performed in patients not responding to conservative treatment. Complications of surgical treatments include urinary tract infections, narrowing in the affected area, post-operative pain, incontinence, sexual dysfunction and blood loss. There are also risks associated with the anaesthesia used during the procedure.
Alternatively, you may undergo a minimally invasive technique called prostate artery embolisation, which has been used to treat prostate gland hypertrophy with promising results. Prostatic artery embolisation can be used in cases where the prostate is too large for transurethral prostatectomy.
Prostatic artery embolisation is performed under local anaesthesia. During the procedure, an interventional radiologist inserts a catheter into the patient’s femoral vein (in the upper thigh). Under fluoroscopic guidance, they will direct the catheter to the prostatic artery and insert microspheres to block the artery that feeds the gland. This will cause the prostate gland to shrink. The success of the procedure can be confirmed using imaging after the procedure. The procedure is performed on an out-patient basis and patients can resume normal activities immediately.
1. Pisco JM, Pinheiro LC, Bilhim T, et al. Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia. Journal of Vascular and Interventional Radiology 2011; 22:11–19. PMID: 21195898.
2. Carnevale FC, Antunes AA, da Motta Leal Filho JM, et al. Prostatic Artery Embolization as a Primary Treatment for Benign Prostatic Hyperplasia: Preliminary Results in Two Patients. Cardiovascular Interventional Radiology 2010; 33:355–61. PMID: 19908092.
Renal cell carcinoma is the most common type of kidney cancer. It occurs when cancerous cells grow in the tubules, which are small tubes in the kidney that filter and clean blood. Renal cell carcinoma is a collection of different types of tumours, each with their own identifying factors, rather than one single entity.
In general, tumours in the kidney are discovered either during routine screening or when patients experience symptoms due to the size or location of the renal cell carcinoma. Common symptoms include blood in the urine, pain between the upper abdomen and back and anaemia. Less commonly, patients experience weight loss, high blood pressure, or recurring fever.
A number of tests can help doctors diagnose renal cell cancer and assess the stage of the cancer. Imaging techniques include ultrasound, CT, MRI and PET.
In most cases, a biopsy is necessary to determine the type of cancer and its aggressiveness. The tissue samples are commonly obtained by way of image-guided interventional techniques.
There are a number of possible treatment options, including the surgical removal of all or part of the affected kidney. Traditionally, this involved removing the whole kidney, but removing part of the kidney has recently been shown to be effective in some patients.
There are also interventional techniques which can be used to treat renal cell carcinoma, such as thermal ablation. In this procedure, an interventional radiologist uses image guidance to insert a needle directly into the tumour and then destroys cancerous cells by delivering radiofrequency energy, microwave heat, extremely cold gas or a high-voltage direct current.
Some tumours are hypervascular, meaning that the amount of blood vessels in the tumour is higher than average. These tumours are especially hard to remove. For patients suffering from a hypervascular tumour, a procedure called transarterial chemoembolisation (TACE) may relieve pain and suffering. This procedure involves delivering a cancer-killing drug directly to a tumour whilst also depriving it of its blood supply, thus destroying the tumour.
Salivary duct stenosis or obstruction refers to a narrowing (stenosis) or blockage (obstruction) in your salivary glands. The blockage may occur spontaneously or it may be caused by the presence of calcified stones in one of your salivary glands or ducts, or by an autoimmune disease. Salivary stones occur in 1.2% of the population and patients are usually between 30-60 years old.
If there is an obstacle in one of your salivary ducts, the saliva created in the duct will stagnate in the duct and form small calcified stones. Symptoms of a salivary duct stenosis or blockage include pain, tenderness, swelling, redness and swollen lymph nodes.
If the blockage is caused by an infection, the infected area will produce pus and redness in the floor of your mouth. If there is an obstruction in a salivary duct, you may find that no saliva is released from the duct.
Your doctor will diagnose you based on your medical history and a physical examination. Imaging methods can detect the presence of calcified stones in around 80% of cases. One possible imaging method is a sialogram, in which X-rays are used to show the whole length of the duct so that any problems can be revealed. A sialogram is performed under local anaesthesia and is an out-patient procedure.
There are a number of treatments available. Conservative treatments include citrus fruits (which increase the amount of saliva you produce, which may dislodge the stone), hydration, moist heat therapy, medication, massage or shock wave therapy.
Alternatively, you may undergo a sialendoscopy, a minimally invasive treatment in which the narrowing or obstruction is treated using an endoscope (an imaging tool). Another possible treatment option is to have a surgical procedure, such as cannulation (surgically inserting a tube into the affected duct to keep the area clear) or removal of the duct.
Degenerative spinal canal stenosis is a disease which usually affects people over 50 and causes disabling pain and neurogenic intermittent claudication, meaning that you regularly have leg pain that is caused by inflamed nerves.
This condition involves the narrowing of one of the canals in your lower back. It may be caused by progressive hypertrophy (increase in volume) of the surrounding bone, cartilage or ligaments, and may compress nerves or vessels in your spinal canal.
Spinal canal stenosis is a degenerative disease that causes disabling pain and neurogenic intermittent claudication. You may find that the pain gets worse when you stand upright and that it is relieved by sitting down.
There are a number of methods that your doctor can use to diagnose you, including taking a medical history, clinically examining you, or using X-ray, CT or MRI. The most common diagnostic tool is an electromyography, which evaluates the electrical activity of your skeletal muscles.
In most cases, the first treatment option for patients is conservative treatment, such as non-steroidal anti-inflammatory drugs, physical therapy, brace support for instability or vertebral fractures, and epidural steroid injections.
There are also a number of minimally invasive therapies to treat spinal canal stenosis, including, for example, the implanting of percutaneous interspinous spacers that expand the affected area. Patients report a success rate of 75%, measured by the amount of pain reduction experienced. If conservative and minimally invasive therapies are unsuccessful, you may be advised to have surgery.
If you experience a stroke, this means that the blood flow in an important artery which supplies your brain has stopped, leading to the sudden development of neurological symptoms such as paralysis and slurring of speech.
As a prolonged lack of oxygenated blood has a massive effect on nerve cells, it is vital to minimise the time span between the onset of symptoms and starting treatment as much as possible.
The most common symptoms of stroke are muscle weakness, paralysis, drooping of the mouth on one side and slurred speech. These symptoms form the basis of the slogan Stroke – act F.A.S.T. that is being used by public awareness campaigns about early treatment of acute stroke.
F for face: is one side of the patient’s face drooping? Is her smile uneven?
A for arms: can she raise both her arms and hold them there?
S for speech: can she speak? Is her speech slurred or otherwise difficult to understand?
T for time: time is critical – ring for an ambulance immediately (the telephone number to call is 112 in most European countries).
The doctor can diagnose you after a quick neurologic examination. Imaging techniques such as CT and MRI are used to rule out intracranial haemorrhage as a possible cause of the symptoms.
In most cases, the first type of treatment for patients is a dose of a drug which can dissolve blood clots that is given directly into the veins. This is known as fibrinolytic therapy. If your symptoms are caused by a blood clot in a relatively large blood vessel and you are unsuitable for or do not respond to fibrinolytic therapy, you may undergo endovascular treatment. This involves an interventional radiologist removing the blood clot under X-ray guidance, with the help of devices placed through microcatheters.
If you have acute stroke, you will be admitted to hospital for treatment and it is likely that you will stay in hospital for at least a few days.
The superior vena cava (SVC) is the second largest vein in your body, carrying deoxygenated blood from the upper half of your body to the right atrium, which is one of the four chambers in your heart. SVC obstruction occurs when the vein becomes narrowed or blocked. The obstruction may be a chronic condition, meaning it lasts for a long time, or it may be acute, meaning the condition starts suddenly and lasts for a short time.
In most cases, the cause of the obstruction is cancer, particularly lung cancer, although not all of the possible causes are cancerous.
The main symptom is shortness of breath. Other symptoms include a cough, headaches, swelling of the face, neck or arms, and swelling of veins in the neck, chest or arms.
A doctor can diagnose the condition using imaging techniques, such as contrast-enhanced CT, MRI or a technique called a digital subtraction angiography.
If the obstruction in the vein is caused by cancer, it is usually treated with radiation therapy and chemotherapy. However, it may take several weeks for the patient to respond to these treatments.
SVC stenting, in which an interventional radiologist places a metal stent into the narrowed or blocked vein to hold it open, is a minimally invasive option which can be carried out as a stand-alone procedure or in addition to other treatments. The interventional radiologist will use fluoroscopy for guidance while inserting a catheter into a large vein, leading it to the affected area, and placing a stent there to provide relief. In most cases, symptoms will clear up quickly following the stent placement, usually within 24 to 48 hours.
A tracheoesophageal fistula (TEF) is an abnormal connection between the oesophagus (gullet) and the windpipe, which are two tubes in the throat and chest that are usually separate from one another. Some patients are born with this disorder, but it can also develop later in life. In cases where it is present at birth, the condition usually occurs alongside oesophageal atresia, an obstruction of the gullet.
The most common cause of acquired TEF is cancer, such as tumours in the gullet. Other causes include injury resulting from medical treatment or previous surgery, blunt or penetrating chest or neck trauma, certain types of infection, ingesting corrosive fluid and inhalation burns. TEF can also develop as a result of prolonged mechanical ventilation using a tube such as a tracheostomy tube.
A congenital (present at birth) TEF may be suspected based on symptoms found during prenatal ultrasounds, such as excess amniotic fluid in the amniotic sac, the absence of fluid in the stomach, a small abdomen or enlarged areas in the gullet. Infants born with a TEF may vomit, gag, cough, emit large amounts of oral secretions, have bluish skin, and possibly respiratory distress. They may also develop abdominal swelling. The first feeding can cause sudden arrest and death.
Patients with an acquired TEF who have been ventilated may experience unexplained weight loss, recurrent chest infections and repeated failures to wean. In non-ventilated patients, symptoms include chest pain, shortness of breath, difficulty swallowing, coughing up blood, hoarseness, fever, repeated respiratory tract infections and pneumonia. Patients with cancer will have the same symptoms, in addition to experiencing symptoms associated with the tumour.
Imaging techniques can be used to diagnose a TEF. If your doctor thinks your unborn baby may have a TEF, a foetal MRI is the test of choice. For infants born with a TEF, the condition is usually diagnosed by chest radiography.
When a nasogastric tube is inserted into the mouth of a patient with a TEF, it is not possible to pass the tube to the stomach; instead, the tube will coil in the middle section of the chest cavity. TEFs can also be diagnosed by way of CT radiography, but these are not commonly used. Contrast-enhanced studies are sometimes required to confirm the diagnosis of a TEF, and to identify its location, size and direction. Acquired TEFs can also be diagnosed by direct visualisation using a flexible metal tube with a camera.
TEF is treated with surgery. If an infant is healthy and has no pulmonary complications, primary repair is performed within the first few days of life. Repair may be delayed in patients with low birth weight, pneumonia or other conditions. These patients should first be treated conservatively, with intravenous feeding, inserting a feeding tube through the skin and directly into the stomach, and upper pouch suction, until they are considered to be low risk enough to undergo the procedure.
Precautions must be taken before the procedure to prevent leakage and damage in the gullet. These include placing an endotracheal or tracheostomy tube. A draining gastrostomy tube may also be applied to reduce reflux.
TEFs that are a result of cancer are often inoperable. In such cases, a stent may be placed in the gullet to isolate the TEF and prevent food and other material from entering into the windpipe or lungs.
1. Bluestone CD. Pediatric otolaryngology. Saunders (2003) ISBN: 0721691978.
2. Engum SA, Grosfeld JL, West KW, “Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades,” Arch Surg. May 1995; 130(5): 502-8; discussion 508-9.
Uterine fibroids are the most common tumours of the female genital tract. You might hear them referred to as “fibroids” or by several other names, including leiomyoma, myoma or fibromyoma. Fibroids are non-cancerous (benign) growths that develop in the muscular wall of the uterus. Fibroids do not always cause symptoms. Nevertheless their size and location can lead to problems for some women, including heavy bleeding, pelvic pain, and pressure symptoms (bloating, swelling, urinary frequency). Fibroids may also be associated with infertility.
Uterine fibroids are very common, although often they are very small and cause no problems. From 20-40% of women aged 35 and over have uterine fibroids of a significant size. African-American women are at a higher risk: as many as 50% have fibroids of a significant size.
Fibroids range greatly in size, from very tiny to the size of a cantaloupe melon or larger. In some cases, they can cause the uterus to grow to the size of a five-month pregnancy or more. Fibroids may be located in various parts of the uterus. In most cases, there is more than one fibroid in the uterus. There are three primary types of uterine fibroids.
Most fibroids do not cause symptoms — only 10-20% of women with fibroids ever require treatment. Depending on location, size and number of fibroids, a woman might experience the following:
• Pelvic pain
• Pelvic pressure or heaviness caused by the bulk or weight of the fibroids pressing on nearby structures
• Pain in the back or legs as the fibroids press on nerves that supply the pelvis and legs
• Pain during sexual intercourse
• Bladder pressure leading to a constant urge to urinate
• Pressure on the bowel, leading to constipation and bloating
• Abnormally enlarged abdomen
• Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes clots. This often leads to anaemia.
If you have large fibroids, your doctor may suspect this after physically examining you, but most fibroids are diagnosed by ultrasound. In some cases, when planning treatment, the doctor will use MRI to characterise the fibroids and assess their response to therapy.
There are a number of treatments available, some of which will preserve your uterus and some of which will not. The treatment you will be prescribed depends on your age and if you are planning to have a baby.
Techniques which preserve your uterus include blocking the blood supply to the uterus through a small artery hole (uterine fibroid embolisation) or removing the fibroid (myomectomy). You may be given hormonal treatments for the fibroids.
Choosing the most appropriate treatment depends on what symptoms you have, the impact of these symptoms on your quality of life, and whether you are trying to have a baby now or in the future.
A varicocele is an enlargement of the veins in your scrotum. To ensure that blood flows in only one direction, these veins have valves which prevent blood from flowing backwards. If you have a varicocele, this means that these valves are not working, causing blood to remain stagnant in the scrotum. It is similar to a varicose vein, which can occur in legs.
If you have a varicocele, this may affect your fertility, as varicoceles can cause low sperm production, decreased sperm quality and testicular atrophy.
Generally, varicoceles are asymptomatic, meaning that patients do not experience any symptoms, but in some cases they can cause pain, which can vary from a dull, heavy discomfort to a sharp pain.
If you do experience pain, you may find that the pain increases with exercise and movement, and that it gets worse over time, as symptoms often get worse over the course of the day. You may experience relief from the pain when you lie on your back.
Your doctor can diagnose you using ultrasound or after a physical examination. The varicocele will look like a mass in the scrotum.
If you have a clinical examination, you will be asked to take a deep breath and hold it while your doctor feels the scrotum above your testicle. Alternatively, your doctor may use ultrasound to examine the dilation of the veins or to measure the blood flow. These methods allow your doctor to diagnose your varicocele.
If you experience pain, infertility or testicular atrophy caused by a varicocele, you may undergo treatment for it. There are two main options for treatment of a varicocele.
Surgical repair of a varicocele involves a surgeon cutting the veins which supply blood to the varicocele, meaning no blood can reach it. It may be performed under local or general anaesthetic.
Minimally invasive percutaneous embolisation is a procedure in which an interventional radiologist will insert a special catheter (tube) into your groin or arm and guide this under imaging to the affected vein. The interventional radiologist will then use a liquid agent or tiny metal coils to block blood flow to the vein with the varicocele. This treatment is as effective as surgery, but has less risk, pain and recovery time.
Veins carry blood back to the heart. Blood is pushed along relatively slowly by muscle activity and prevented from sliding back by cup-shaped valves. As people get older, these valves can stop functioning properly, causing blood to pool and veins to turn into lumpy knots. When these veins become swollen and congested, they are referred to as varicose veins.
Varicose veins are often painful and can be unsightly, but are usually not life-threatening. However, if left untreated, they may get worse over time and can lead to more serious conditions, including inflammation and leg ulcers.
Varicose veins are not the same thing as so-called ‘thread’ or ‘spider’ veins. These can also be unsightly, but are smaller and develop more closely to the surface of the skin.
Varicose veins are often dark blue or red, and appear swollen and twisted. While some patients do not have any symptoms, it is common to experience swelling, itching, burning, pain and a sense of heaviness. These symptoms tend to be made worse by prolonged standing or sitting. Patients with more serious cases may experience skin changes, including dryness, thinning, scaling, colour changes, inflammation and sores.
To diagnose you, your doctor will perform a physical examination and take your medical history. In addition, your doctor may use Duplex Doppler ultrasound, a non-invasive diagnostic test, to further evaluate the veins.
The pain and swelling caused by varicose veins can usually be reduced by applying bandages or support stockings. When these efforts do not improve the condition or the condition is more severe, other treatments may be necessary. Options include surgical removal and using laser or high-frequency sound waves in a minimally invasive procedure.
Vascular malformations are abnormal clusters of blood vessels that develop while the foetus is in the womb. There are a number of different types of vascular malformations. Venous malformations are veins which have developed abnormally, and are the most common form of vascular malformations. Lymphatic malformations are sponge-like collections of abnormal growths that contain clear fluid. Venolymphatic malformations are vascular malformations that affect both veins and lymph vessels, resulting in cysts or varicose veins. Arteriovenous malformations are abnormal connections between veins and arteries.
While all forms of vascular malformation are congenital (present at birth), it may take weeks or even years for them to become noticeable.
The most common symptom is pain. Depending on the location of the vascular malformation, patients may experience other symptoms such as birthmarks and swelling of the limbs. If the patient has a lymphatic malformation, infection may cause complications. In some cases, arteriovenous malformations are stressful on the heart or cause bleeding complications. Patients with pulmonary arteriovenous malformations may experience symptoms such as low oxygen supply, shortness of breath, fatigue and coughing.
Often, vascular malformations are visible in a physical examination. If you have superficial vascular lesions, these can be evaluated with ultrasound, but for deeper lesions ultrasound is limited in the information it can provide. Ultrasound with Doppler sonography can be used to show the flow and speed of the blood.
MRI is the most useful diagnostic tool for evaluating vascular malformations. MRI can show the exact location of the core of the vascular malformation (known as the nidus), how far the malformation extends and how it is connected with the surrounding vessels. MRI can also be used to gain information on the blood flow in these lesions, and is useful for assessing the success of the treatment during follow-up.
Minimally invasive procedures include phlebography and angiography, which are performed under fluoroscopy. Contrast material is injected to aid visualisation of the vascular malformation. These techniques are usually performed before treatments such as sclerotherapy and embolisation.
Conservative treatment is a good option for patients with mild symptoms. It is not always feasible to surgically remove vascular malformations, and this treatment has a high rate of recurrence.
Minimally invasive image-guided interventions, performed by interventional radiologists, are the treatment of choice for vascular malformations. These techniques include embolisation and sclerotherapy, and are carried out under fluoroscopy. During these procedures, the interventional radiologist will guide a catheter to the vascular malformation and will then insert alcohol, glue or small beads into the surrounding vessels to block blood or lymph flow to the malformation. The aim of this is to destroy the core of the malformation, and the success of the procedure will be confirmed using angiography. Patients have a local anaesthesia for these procedures and tend to be hospitalised for one day. Patients may experience minimal discomfort for a couple of days.
1. Peripheral Vascular Diagnosis and Interventions, Peripheral Vascular Malformations: Imaging, Treatment Approaches, and Therapeutic Issues. Hideki Hyodoh, Masakazu Hori, Hidenari Akiba, Mitsuharu Tamakawa, Kazusa Hyodoh, Masato Hareyama, Rdiographics, October 2005, Volume 25, Issue suppl_1.
2. Vascular Malformations and Hemangiomas. A Practical Approach in a Multidisciplinary Clinic. L. Donnelly, D. Adams, G Bisset, American Journal of Roentgenology, March 2000, Volume 174, Number 3.
Your spine consists of individual bones called vertebrae. Fractures in the spine most commonly occur in the middle and lower back. These fractures tend to be caused by high-energy trauma, such as a car crash, falling from a height, sports accidents or violence such as gunshot wounds. Fractures in these areas can cause damage to the spinal cord which can affect the function of nerves, the spinal cord or brain.
Other possible causes of spinal fractures are osteoporosis (progressive bone disease), tumours and other underlying conditions that weaken the bone and can cause vertebrae to be fractured during normal daily activities.
Vertebral fractures are most common in older patients, who are at risk due to weakened bones from osteoporosis. How the fractures are classified is based on the pattern of injury, which helps determine the proper treatment. The three major types of spine fracture patterns are flexion, extension and rotation.
If you have a vertebral fracture, the primary symptom you will experience is moderate to severe back pain that is made worse by movement. If the fracture affects your spinal cord, you may experience numbness, tingling, weakness, bowel or bladder dysfunction and shock in the affected area. Injuries to the middle and lower spinal cord are likely to affect the function of nerves, the spinal cord and brain as well as the genital area and lower extremities.
Your doctor will diagnose you based on a full physical examination, including using laboratory tests, imaging and testing your reflexes. If the fracture is a result of major trauma, you will need repeated blood tests to check blood circulation. If you have metastatic bone disease, you will need a calcium test to check the level of calcium in your blood.
Imaging techniques are useful for diagnosis. Plain radiographs can be used to screen for spinal fractures. It is sometimes difficult to detect hairline fractures and non-displaced fractures (meaning pieces of the fractured bone are still aligned) using spinal X-rays alone, so CT can be used to detect vertebral fractures and assess the extent of the fractures.
MRI is usually the method of choice for determining the extent of damage to the spinal cord and if the bone has become enlarged. MRI is the most sensitive tool for detecting lesions in bones and the spinal cord.
If you have a minor vertebral fracture, you may be treated non-surgically, such as with a spinal orthotic vest, which is a firm vest that can be worn to stabilise the spine.
If you have a major or unstable fracture or your spinal cord is affected, however, you will need surgical treatment and stabilisation of your spine to prevent spinal deformity. You may also need to have steroids administered intravenously, depending on the nature of the fracture.
There are also minimally invasive treatments available, such as vertebroplasty and kyphoplasty, in which cement is injected into the area surrounding the fracture. The cement stabilises the fracture, reducing pain.
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