No abstract

A 72-year-old male with a past medical history of prostate cancer presented with progressive deterioration of vision involving the left eye. He noted a complete loss of vision in the left eye over a 3-month period. CT examination revealed a large mass encroaching on the optic nerve within the left orbital apex. This expansile, lytic lesion involved the greater wing of the sphenoid bone and was associated with a moderately enhancing soft-tissue component.The patient was referred for CT-guided biopsy of the lesion. The patient was placed in the supine position in the CT scanner. The head was stabilized with a head-holder, and the patient was given intravenous sedation and analgesia (25 mg promethazine, 3 mg diazepam, and 25 mcg fentanyl). Contrast-enhanced CT of the orbits was performed utilizing continuous 3-mm thick axial slices at 3-mm intervals to localize the lesion. In addition to showing the enhancing portions of the lesion, the use of contrast outlines all superficial and deep vascular structures that are to be avoided during the biopsy procedure; in particular, the superficial temporal artery. We then placed markers on the left temporal side of the patient's head. The markers consisted of three 18 gauge needles taped 1 inch apart prior to obtaining axial images (Fig. IA). We chose the marker closest to the lesion and positioned the table above the level of the zygoma. The skin biopsy site was marked with ink prior to sterile prepping and draping.One percent lidocaine local anesthesia was placed at the skin site. A 22-ga 3.5-inch-long spinal needle was placed initially as a reference mark and to generate a tract. Appropriate positioning of this needle was verified with CT.

A 31-year-old woman with Cogan syndrome (a rare form of systemic vasculitis) was evaluated for a cold, painful left foot with diminished pulses. Arteriography demonstrated thrombosis of the left popliteal artery with evidence of vasculitis. Thrombolytic therapy was begun with initial success but eventual rethrombosis. After reinitiating thrombolytic therapy combined with intraarterial vasodilator therapy, successful angioplasty was performed with sustained results at 6-month follow-up.