Right anterior caudocranial oblique (RACCO) projections were evaluated for transarterial portography with digital subtraction angiography. For RACCO projection, the image intensifier was tilted 25° caudally and 30° to the patient's right with the patient in the supine position. The abnormal findings imaged in 20 patients were analyzed by types of abnormalities and their locations in the portal venous systems by comparing RACCO and PA projections. The RACCO view was superior to the PA projection for demonstrating either encasements or tumor thrombi in relatively proximal segments of the portal venous branches. Two encasement lesions and a tumor thrombus were imaged only on the RACCO projection. However, the RACCO projection had no definite advantage over the PA view for showing encasements or tumor thrombi in the distal segmental branches. The RACCO projection was superior to the PA view for demonstrating defects in the hepatograms of some hepatic segments (S5 and S8). We concluded that the RACCO view is extremely useful and is indicated for angiographic work-ups of hepatic or biliary lesions when abnormalities are suspected in proximal portal venous branches.

Chronic pancreatitis is known to cause vascular disorders including pseudoaneurysm of peripancreatic arteries. Although the incidence of pseudoaneurysms due to pancreatitis detected by angiography has been reported as high as 10% in western literature, they are still considered rare in Japan. We reported two cases of pseudoaneurysm caused by chronic pancreatitis, one in splenic artery and the other in gastroduodenal artery, successfully treated by embolization. The embolizations were performed by occluding proximal splenic artery for splenic arterial aneurysm and gastroduodenal artery distal and proximal to the orifice for the aneurysm of gastroduodenal artery with stainless steel coils. Since the surgical therapy has high mortality rate, we consider transcatheter embolization is the treatment of choice for pseudoaneurysms caused by chronic pancreatitis.

The right caudocranial oblique (RACCO) view which is obtained by tilting the image intensifier 25 degrees caudally and 30 degrees to the right while the patients lie in supine position is proposed for improved depiction of the portal venous system. Transarterial portography with digital subtraction angiography was performed in the RACCO and posteroanterior (PA) views in 32 patients. Comparison of the two views revealed that the RACCO view was superior to the PA view of the left main branch in 25 patients (78%) and of the right posterior lobe branch in 24 (75%) patients. Visibility of more distal portal branches, however, did not always improve by RACCO view. RACCO view will be useful for the evaluation of portal systems of primary and secondary hepatic neoplasms as a special view following portogram in PA projection when more detailed information is necessary on proximal portal branches.

A case of acute pulmonary complication following intra-arterial infusion of Lipiodol-Adriamycin emulsion for hepatocellular carcinoma was reported. Intra-arterial infusion chemotherapy was performed on a 75-year-old male with Lipiodol-Adriamycin emulsion (Lipiodol 8 ml + Adriamycin 40 mg). Severe dyspnea and cyanosis started about 30 minutes after the infusion, and blood gas analysis revealed hypoxemia and hypocapnia. Chest X-ray revealed diffuse infiltrative shadow throughout the both lungs. He was on positive end-expiratory pressure breathing for 4 days. Clinical symptoms and chest X-ray improved rapidly in the course of two weeks, he became almost asymptomatic. We concluded that the nature of this pulmonary damage was pulmonary edema due to the large amount of Adriamycin that flowed into pulmonary artery via arterio-venous shunt present in the hepatocellular carcinoma.

The right anterior caudocranial oblique (RACCO) view is proposed for improved depiction of the portal venous system. It is achieved by tilting the image intensifier 25 degrees caudal and 25 degrees-30 degrees to the right and maintaining the patient in the supine position. Transarterial portography with digital subtraction angiography was performed in the RACCO and posteroanterior (PA) views in 22 patients. Comparison of the two views revealed that the RACCO view was superior to the PA view of the left main branch in 15 patients (68%) and of the right posterior lobe branch in 19 patients (86%). The RACCO view will be useful for the evaluation of the portal system in patients with primary and secondary hepatic neoplasms in whom detailed images are important for diagnosis treatment planning.

Forty six patients with follow up angiography after hepatic arterial embolization using gelatin sponge particles were analysed to evaluate the factors affecting development of intra- and extrahepatic collaterals. Significant correlation was demonstrated between the grade of embolization and the development of collaterals (p less than 0.001). Also there was significant correlation between development of collaterals and combined use of anticancer drugs with emboli (p less than 0.001). This suggests the possibility of endothelial damages of the arteries caused by anticancer drugs, which may enhance the permanent arterial occlusion and subsequent development of collaterals. No significant correlation was demonstrated between the numbers of embolization therapy and development of collaterals in this study.