No abstract

On surveillance imaging of patients with cancer or when metastatic disease is suspected, detection of metastatic disease may be greatly enhanced by an understanding of which primary tumors metastasize to the heart and the most common routes of spread.

Varices are a common cause of gastrointestinal (GI) bleed. When ectopic, there is often a delay in diagnosis as it is difficult to localize these varices. Ectopic small bowel varices usually arise from portal hypertension, which commonly develops in the setting of cirrhosis. This case presents a much rarer cause of bleeding ectopic varices with portal hypertension secondary to chronic superior mesenteric vein (SMV) thrombosis that developed after an episode of hemorrhagic pancreatitis. An 81‐year‐old man with a past medical history of a recent GI bleeds secondary to an arteriovenous malformation presented to the hospital with continued melena after a recent admission at another hospital for the same symptom. Upper endoscopy and colonoscopy showed no evidence of active bleeding. Subsequently computed tomography angiography (CTA) showed bleeding from collaterals in the third part of the duodenum, consistent with ectopic varices. The CTA also showed SMV thrombosis. The patient underwent an ultrasound‐guided transhepatic venogram with coiling and sclerosant embolization of SMV varices and distal SMV balloon angioplasty. Capsule endoscopy after showed no evidence of further bleeding. The patient was discharged 72 h after the intervention with stabilized hemoglobin and resolved melena. Ectopic varices should be on the differential diagnosis for patients presenting with a GI bleed that remains nonlocalized after endoscopy and colonoscopy. EGD or colonoscopy is the first‐line intervention for the treatment of bleeding ectopic varices. If unreachable by these means, percutaneous coil embolization is an alternative way to stabilize the patient. As no general management guidelines exist, treatment of bleeding ectopic varices should continue to be case‐dependent and involve a multidisciplinary team.

No abstract

Segmentation was performed in 3DSlicer (v4.5). For HV and PV segmentation, fiducial seeds were placed and a semiautomated simple region growing algorithm was applied, followed by marching cubes to generate a mesh. For liver segmentation, slices were contoured, followed by a robust statistics segmenter and mesh generation by marching cubes. The final model for 3D printing was generated by performing a boolean subtraction of vasculature, and exported as a stereolithography (.STL) file. The model was then printed on a ProJet 3500 HD Max in VisiJet Crystal, a translucent acrylate polymer. To better visualize HVs and PVs, the interior walls were painted in vibrant colors. Results: The resultant liver model features parenchyma formed with translucent acrylate polymer, enabling visualization of the separately colored HVs and PVs. The HVs and PVs are hollow, allowing evaluation of the geometric relationships between venous systems and "dry run" catheter interrogation. Selection of a post-printing method for coloring the HVs and PVs was important as it greatly reduces the complexity and expense of the 3D print itself, when compared to a multi-color, multi-material approach. Conclusions: As 3D printers become ubiquitous tools of modern medical care, routine 3D printing for TIPS planning is feasible. Using on-site segmentation, a physically transparent liver model may be produced containing hollowed, color coded HVs and PVs to facilitate TIPS planning and potentially decrease morbidity.