Chapter 2: Embolization

Questions From the 2008 Case-Based Review Monograph

Please circle the best answer for each question and return to your VIR fellowship
director.

Name __________________________________________

Case 13: Flank Pain in a Young Female, Michael D. Darcy, MD

Question: What is the most likely diagnosis for the right renal mass, and how should
it be treated?

A) Simple cyst, no treatment needed

B) Renal cell carcinoma, embolization with gelfoam
C) Angiomyolipoma, embolization with alcohol
D) Arteriovenous malformation with AV fistula, embolization with coils

Case 14: Young Male With Scrotal Pain, Michael D. Darcy, MD

Question: What are the diagnoses from the original and the 2 mo. venograms?

A) Normal spermatic vein/normal retroperitoneal vein

B) Aneurysm of spermatic vein/normal retroperitoneal vein
C) Aneurysm of spermatic vein/collateral from renal hilum
D) Spasm of spermatic vein/collateral from renal hilum

Case 15: Female With Cramping Pain and Heavy Menses, Michael D. Darcy, MD
Question: Given these images, what would be the most appropriate therapy?

A) Counseling only, the fibroids are hypovascular and will regress

B) Uterine artery embolization
C) Uterine artery embolization and possible ovarian artery embolization
D) Hysterectomy

Case 16: Pregnant Patient with Hemoptysis, Daniel B. Brown, MD, and Paolo G.
Marciano, MD
Question: The most likely cause of this finding is:

A) Takayasus arteritis
B) Chronic pulmonary embolus
C) Hereditary hemorrhagic telangiectasia
 D) Sarcoidosis
E) Inhalational pneumoconiosis

Case 17: Hematuria Following Laparoscopic Partial Nephrectomy, Daniel B.

Brown, MD
Question: The optimal embolic agent and delivery is:

A) Alcohol embolization via a diagnostic catheter

B) Glue infusion of the upper pole artery
C) Coil embolization at the level of the vascular injury
D) Coil embolization of the proximal upper pole artery

Case 18: Cervical Cancer With Hematuria, Daniel B. Brown, MD

Question: The most likely cause of this patients bleeding is:

A) Arterial injury at the time of percutaneous nephrostomy placement

B) Hemorrhagic cystitis
C) Ureteral-iliac artery fistula
D) Ureteral injury during double J stent change

Case 19: Abdominal Pain Following Discectomy, Jafar Golzarian, MD

Question: At this point, what is the next best step?

A) Remove the sheaths and send the patient home

B) Suture the sheath in place and send the patient to the ICU for surveillance
C) Remove the sheaths and send the patient to the regular floor for surveillance
D) Remove the sheath and schedule a CT angio for the following day
E) None of the above

Case 20: Endoleak Following AAA Repair, Jafar Golzarian, MD

Question: How would you treat this patient?

A) Embolization of the sac

B) Placement of additional stent grafts within the aorta
C) Embolization of the channels within the sac and the origin of the IMA
D) Embolization of the origin of IMA alone

Case 21: GI Bleed, Jafar Golzarian, MD

Question: What would be the best next step as the patient continues to bleed?

A) Red Blood Cell Scan

B) Prophylactic embolization
C) Endoscopy with clipping of the bleeding site
D) Provocative angio with tPA or Heparin
E) A and C
Case 22: Radioembolization Planning, Michael Wallace, MD, FSIR
Question: Regarding the right gastric artery:

A) It always arises from the right hepatic artery

B) It can be a pathway for non-target complications related to radioembolization,
chemoembolization and hepatic arterial infusion chemotherapy.
C) Is unimportant and does not need to be identified or embolized prior to
radioembolization
D) Adequate embolization of the right gastric artery reduces the incidence of
non-target gastric mucosal injury.
E) B and D are correct.

Case 23: Inoperable Hepatocellular Carcinoma Following Portal Vein Embolization

Michael Wallace, MD, FSIR
Question: What are the major concerns or risks associated with performing
chemoembolization after portal vein embolization?

A) There is no increased risk compared to routine chemoembolization

B) Increased risk of sepsis
C) Liver failure
D) Development of portal hypertension and variceal hemorrhage

Case 24: GI Bleed Following Pancreatectomy, Michael Wallace, MD, FSIR

Question: Which of the following is not an acceptable therapeutic option for treating
a pseudoaneurysm arising directly from the main trunk of the superior mesenteric
artery?

A) Percutaneous thrombin injection

B) Occlusion of the SMA proximal and distal to the neck of the pseudoaneurysm
C) Coil embolization of the pseudoaneurysm
D) Stent graft insertion