HISTORY: Metastatic thymic cancer with liver metastases. Status post
radioembolization and cryoablation. Small amount of residual cancer remaining
along the inferior aspect of the cryoablations site.
• DESCRIPTION: Procedure was performed under general anesthesia. Time‐out
performed in the ...
HISTORY: Metastatic thymic cancer with liver metastases. Status post
radioembolization and cryoablation. Small amount of residual cancer remaining
along the inferior aspect of the cryoablations site.
• DESCRIPTION: Procedure was performed under general anesthesia. Time‐out
performed in the room. Preliminary CT scan was used to identify the target along the
inferior aspect of the cryoablation site. Using CT guidance, 2 Neuwave Certus PR15
ablation probes were placed into the mass in parallel fashion. Limited CT of was
performed to assess relationship to adjacent structures. Microwave ablation was
performed at 65 watts for 10 minutes. CT during the procedure demonstrated gas to
fill the tumor volume consistent with adequate ablation zone. Both probes were then
removed with tract ablation. Limited CT with 100 ml Ultravist 300 intravenous contrast
was performed which demonstrated that the ablation cavity seemed to have a -
ANSWER Codes: 47382, 77013 or 47399, 77013
INDICATION: Right groin lymphocele following abdominal aortic aneurysm repair.
TECHNIQUE: Initial contrast injection was made through the indwelling lymphocele drain.
This showed the residual cavity to be morphologically similar to previous studies with a
residual volume of approximately 20 mL. Aspiration of injected contrast showed complete
collapse of the collection fluoroscopically. Given the limited response of the lymphocele to
alcohol sclerotherapy in the past, it was decided to use a different sclerosant. 300 mg of
doxycycline hyclate was reconstituted in 15 mL of normal saline
,+5 mL of 1% lidocaine. This was administered through the drain. The doxycycline was
left to dwell for one hour. The patient was discharged home with instructions to place
the drain back to gravity bag drainage after 1 hour dwell time. A new sterile dressing
was applied at the drain site.
FINDINGS: Approximately 20 mL residual cavity siz - ANSWER Code: 49185
INDICATION: Postoperative lumbar spine seroma/lymphocele
TECHNIQUE: Through the existing catheter contrast was injected showing an
irregular lumbar seroma spanning from approximately the top of L5 lower aspect of L2.
This is smaller than the previous exams. Approximately 20 mL of contrast was injected
frontal and lateral views were obtained showing no communication with the spinal sac.
At this time 2 aliquots of 15 mL of absolute ethanol was injected with the contact time
of 15 minutes in each.
FINDINGS: Lumbar seroma with no communication to the cerebral spinal. The cavity appeared less well‐defined.
It does appear that the capsule is less distinct. The cavity was collapsed. Output was very small and low from the
cavity.
IMPRESSION: Smaller lumbar seroma with additional alcohol sclerotherapy on today's
procedure. The drain was removed. - ANSWER Code: 49185
INDICATION: Back pain and non healing fracture. New acute fracture at T6.
TECHNIQUE: The procedure and its risks (including hemorrhage; infection; nerve
damage including paralysis, extraosseous leakage of cement into the spinal canal,
neural foramen,
paravertebral space, or blood vessels) were discussed with the patient and family, and
written informed consent was obtained.
MATERIALS EMPLOYED: Depuy Confidence
SEDATION: Levaquin 500 mg IV was administered intravenously before the start of the
procedure. Conscious sedation with intravenous Versed and fentanyl was administered
during the procedure for anxiety and pain control. The patient was continuously
monitored by a nurse and myself during the procedure (blood pressure, heart rate,
,pulse oximetry and level of sedation). The patient received conscious sedation for
30 minutes.
PROCEDURE: The needle site and periosteum were anesthetized by lidocaine
injection. The T6 - ANSWER Code: 22510, 99152, 99153
INDICATION: Multilevel vertebral body compression fractures with pain refractory to
conservative management.
TECHNIQUE: The procedure and its risks were discussed with the patient and
family, and written informed consent was obtained. MATERIALS EMPLOYED:
Confidence vertebroplasty kit.
SEDATION: This procedure was performed with the patient under deep sedation
as provided
by anesthesia service.
PROCEDURE: The needle site and periosteum were anesthetized by lidocaine
injection. The
T8 vertebral body was accessed with a diamond tip introducer coaxial needle via a left
transpedicular approach. Appropriate needle positioning was seen by multi planar
fluoroscopy. In a similar fashion, a single diamond tip needle was approached via left
transpedicular approach to the T6 vertebral body. Thickened polymethylmethacrylate
was instilled under direct fluoroscopic visualization at both levels. No vascular
intravasation was seen. I - ANSWER Codes: 22510, 22512
INDICATION/DIAGNOSIS: Back pain
TECHNIQUE: The patient was placed in the prone position on the examination
table and an
appropriate window for injection identified at T6/T7 for a translaminar injection. The
overlying skin was prepped and draped in a sterile fashion. Buffered 1% lidocaine used for
local anesthesia. An attempt was made to advance a 22‐gauge needle into the epidural
space via a translaminar approach. However, due to shadowing of the lamina, the epidural
space was difficult to access at this level. Next, a T7/T8 right transforaminal approach was
selected for injection. The overlying skin was anesthetized using 1%
, lidocaine. A 22‐gauge needle was advanced via a transvenous foraminal approach on the right at the T7/T8 level. Needle tip
position was confirmed by injecting approximately 1 mL Isovue‐M 200 demonstrating central epidural flow of contrast. The patient
experienced radicular discomfort with needle - ANSWER Code: 64479
Access is gained at the right common femoral artery, The physician advances
the catheter
to the aorta, injects contrast and provides an interpretation for an abdominal aortogram.
The catheter is withdrawn and access is gained at the left common femoral artery. The
physician advances the catheter in an ipsilateral antegrade fashion to the left
superficial femoral, injects contrast and provides an interpretation for an extremity
angiogram. - ANSWER Catheterization Codes: 36200-59, 36245
Access is gained at the left common femoral artery. The physician advances the
catheter
into the superior mesenteric artery (SMA) for injection and imaging. - ANSWER Imaging
Code: 75726
INDICATION: Back pain and non healing fracture. The patient had acute fractures
identified at the T7, T8, T10, and T12 levels. The vertebral bodies were examined
under fluoroscopy.MATERIALS EMPLOYED: Kyphon kyphoplasty kit.
PROCEDURE: The patient is brought the angiography table and placed in a prone
position. Therefore the decision was made to proceed with kyphoplasty at T10 and T12.
The needle site and periosteum were anesthetized by lidocaine injection. The T12
vertebral body was accessed with a diamond tip introducer coaxial needle via a right
transpedicular approach. The stylet was removed leaving the outer cannula in place.
The kyphoplasty balloon was then inserted and inflated under fluoroscopic guidance.
The balloon was then removed and the inner cannula was inserted for cement
instillation. A second needle was then inserted through the contralateral pedicle under
fluoroscopic guidance. After needle advanceme - ANSWER Codes: 22513, 22515
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