Research articles

Mesial temporal lobe epilepsy is the most common pharmaco-resistant epilepsy where surgery has an important role. A multidisciplinary team coordination between different neuroscientists including psychiatrists and psychologists is needed to effectively correlate all the clinical, pathological, electrophysiological, and radiological data to better manage patients with refractory epilepsy. Patients with mesial temporal lobe epilepsy usually remain seizure-free after surgical resection. We present a case of mesial temporal lobe epilepsy where 1.5 Tesla magnetic resonance imaging showed no changes in mesial structures. Based on the strong suspicion of temporal lobe asymmetry due to the correlation between the typical ictal semiology and the electrophysiological changes in video electroencephalogram (EEG), a 3.0 Tesla magnetic resonance imaging was performed and evidenced the temporal lobe asymmetry. This case shows the value of high field strength in magnetic resonance imaging for mesial temporal lobe epilepsy for adequate qualitative analysis of mesial structures in typical clinical-electrophysiological cases of mesial temporal lobe epilepsy where 1.5 Tesla magnetic resonance imaging shows no evident lesion.

Eni Reka, Forian Dashi, Arben Rroji, Eugen Enesi, Arsen Seferi, and Mentor Petrela

Routine inferior vena cava filter retrieval is a common procedure that can be accomplished with different techniques. Simple loop-snare retrieval is common; however, snares are single use, and many seemingly routine retrievals require more advanced techniques. Rigid endobronchial forceps retrieval is an effective advanced approach with the ability for the forceps to be sterilized and reused for multiple procedures. The purpose of this study was to compare the cost-effectiveness of snare versus forceps inferior vena cava filter retrieval techniques at a single institution. This study is a cost minimization analysis based on an institutional review board-approved, single-center, retrospective review of all inferior vena cava filter retrievals from January 2019 to April 2021. Routine inferior vena cava filter retrieval techniques were categorized as loop-snare-only retrieval, forceps-assisted after unsuccessful snare retrieval, and forceps-only retrieval. Total equipment cost for each technique was determined. Seventy-seven successful routine inferior vena cava filter retrieval procedures were performed at our institution during the study period (63 loop-snare-only retrieval, 8 forceps-assisted after unsuccessful snare retrieval, and 6 forceps-only retrieval). There were no technical failures. Forceps-only retrieval was the most cost-effective technique with per-procedure equipment cost of loop-snare-only retrieval, forceps-assisted after unsuccessful snare retrieval, and forceps-only retrieval techniques of $434.30, $556.55, and $221.98, respectively. Average equipment cost for the 77 retrievals over the study was $430.46. Had all retrievals been performed using the forceps-only retrieval technique, average equipment cost per retrieval would have decreased by $208.48, for a total cost savings of $16 052.72. Utilization of forceps-only retrieval technique for all routine inferior vena cava filter retrievals would result in a meaningful cost savings compared to standard loop-snare-only retrieval and forceps-assisted after unsuccessful snare retrieval techniques.

John F. Swietlik, Quinn Steiner, Paul F. Laeseke, and Aaron Eifler

The aberrant internal carotid artery is a vascular anomaly of the temporal bone and occurs due to the agenesis of the first and second segments of the primitive internal carotid artery, resulting in dominance of a collateral pathway. The internal carotid artery provides the primitive brain its entire blood supply until the posterior circulation forms later in embryonic development. This condition is present in only 1% of the population and produces very subtle imaging findings potentially only discovered during middle ear surgery. During surgery, surgeons may misinterpret it for a glomus tumor or mass, and injury to the site can result in profuse bleeding and even death. Therefore, it is vital for physicians to have knowledge of this disease. Since radiologists are often the ones who diagnose this condition, we present a case report and detailed embryology and review anomalies of the internal carotid artery development.

Riyaa Rajesh, Benjamin Bosse, Robert Higley, Jay Babu, Karthikram Raghuram, and Rajesh Rangaswamy

Most studies have focused on treatment options and timing without consideration of pathophysiology of stroke pattern in intracranial stenosis. Hypoperfusion stroke has different pathophysiology compared to embolic or perforator patterns of stroke, and the same approach to treatment may not work. Medical management alone may not be the best option for the treatment of hypoperfusion stroke, and these patients may benefit more from early stenting. Higher periprocedural risk in early percutaneous transluminal angioplasty and stenting can be seen in acutely symptomatic intracranial atherosclerotic stenosis as a result of plaque destabilization, while the risk of stroke recurrence may be higher in patients with watershed stroke treated with medical therapy alone. We report 4 patients who presented with symptomatic high-grade intracranial stenosis with imaging features of acute watershed infarction who underwent early percutaneous transluminal angioplasty and stenting. Although few studies have advocated early stenting, larger studies are needed to confirm the role of early angioplasty and stenting in acutely symptomatic patients with intracranial atherosclerotic stenosis presenting with hypoperfusion stroke.

Karthikram Raghuram and Ranjit Kumar Chaudhary

Pulmonary arteriovenous malformations are abnormal vascular communications between the pulmonary arteries and veins, resulting in an extracardiac right-to-left shunt. Pulmonary arteriovenous malformations are most commonly hereditary and associated with hereditary hemorrhagic telangiectasia. In the current literature, pulmonary arteriovenous malformations have been found to cause hypoxia, ischemic stroke, brain abscess, and hemothorax. Due to these potential complications, transcathether embolization is recommended as a treatment of pulmonary arteriovenous malformations. Here we describe a case of a 25-year-old male with multiple bilateral pulmonary arteriovenous malformations presenting with stroke due to right-to-left shunting.

Seung Ah Lee, Laura Ocasio, and Cihan Duran

Fishbone ingestion is a common complaint in the otolaryngology clinic. Fishbone mimickers are important to recognize to obtain the correct diagnosis. We present rare cases of stylohyoid complex calcification as a fishbone mimicker. Three cases presented with unilateral pain after swallowing a fishbone. After a negative fiberoptic endoscopic exam, a computed tomography scan was performed and demonstrated positive findings. The first case underwent evaluation under anesthesia with no fishbone detected. After further investigation, we concluded that this was an incidental finding of calcifications of the stylohyoid complex, most probably stylopharyngeus muscle and not a foreign body. Thus, the following 2 patients were managed conservatively. Differential diagnosis of stylohyoid complex calcification should be considered when examining a computed tomography scan with positive findings in a patient after fishbone swallowing. Awareness of this entity may help to avoid unnecessary procedures under general anesthesia.

Itay Chen, Aleeza Rubin, Gustavo Rajz, Sichel Jean-Yves, and Eliel Ben-David

Current literature lacks analysis of the interventional radiology workforce’s distribution in the United States. To characterize the geographic distribution of the interventional radiology workforce in the United States and to determine if there is a disparity in the geographic distribution of interventional radiologists in the rural–urban–metropolitan continuum. This project also resulted in the creation of an interactive map that may be utilized by interventional radiologists to screen for underserved areas to practice. This retrospective study identified all interventional radiologists participating in Medicare’s Fee-for-Service program. Each interventional radiologist’s practice location was then matched to its respective county. Each county was classified as either rural, urban, or metropolitan based on a standardized classification system provided by the United States Department of Agriculture Economic Research Service known as Rural–Urban Continuum Codes. All counties were linked to population-level metrics provided by the Census Bureau. Finally, predetermined metrics were calculated: interventional radiologist density per 100 000, total population, and the total number of interventional radiologists in each county type. There are a total of 3142 counties in the United States. Among them, 1165 are metropolitan counties, 1332 are urban counties, and 644 are rural counties. Interventional radiologists are absent from 485 metropolitan counties, 957 urban counties, and 587 rural counties. There are 1.37 interventional radiologists per 100 000 people in metropolitan counties, 0.81 interventional radiologists per 100 000 in urban counties, and 0.57 interventional radiologists per 100 000 in rural counties. The data suggest a disparity in the geographic distribution of interventional radiologists across the rural–urban continuum in the United States. The interactive map may serve as a tool to help normalize the distribution of interventional radiologists.

Vamsi K. Potluri, Shaunak G. Patel, Josh L. Bilello, Gunvir S. Gill, Arsalan Saleem, and Arya N. Bagherpour

Reverse transcription-polymerase chain reaction tests are currently used to diagnose COVID-19. However, they have sensitivity rates as low as 60%-70%. There is now growing interest in the role and appropriateness of chest radiographs and computed tomography for both the diagnosis and management of patients with suspected or known COVID-19. This study aimed to retrospectively identify the correlation between chest x-ray findings on admission and clinical outcome and mortality in COVID-19 patients. A retrospective study was carried out across 2 district general hospitals involving a cohort of 40 patients, with confirmed COVID-19 via reverse transcription-polymerase chain reaction testing over a period of 1 month. Clinical findings, severity of symptoms, outcomes, and mortality in these patients were correlated with chest radiograph findings on admission and throughout their hospital stay. Our study revealed that patients presenting with a normal chest radiograph on admission had a more favorable outcome when compared to those with panlobar involvement, who were shown to have a worsened prognosis with an increased mortality rate. In summary, our study has highlighted parallels between the baseline chest radiographic features seen in patients with confirmed COVID-19 compared to their clinical outcome.

Serena Virdi, Zereda Zulkeefli, Josiah Damisa, Imroz Sachdev, and Sarath Bethapudi

A 58-year-old man presented with acute onset of neurological deficits. Magnetic resonance imaging showed bilateral cerebellar infarctions. Computed tomography angiogram, and T1 SPACE magnetic resonance imaging showed occlusion of the dominant left vertebral artery. Catheter angiography showed near occlusion of left vertebral artery with luminal thrombus. Angiography performed after 3 weeks of medical therapy showed recanalization of the left vertebral artery but with high-grade stenosis which was successfully treated by percutaneous transluminal angioplasty and stenting. Our case report demonstrates that lesion characterization is important to identify candidates for aggressive medical management with interval percutaneous transluminal angioplasty and stenting, especially when the mechanism of stroke is due to acute plaque destabilization.

Karthikram Raghuram and Ranjit Kumar Chaudhary

Both patent ductus arteriosus and postductal coarctation of the aorta are among the most common congenital heart defects. However, it is extremely rare to have both conditions occur simultaneously. In this report, we present an interesting case in which both patent ductus arteriosus and postductal coarctation occur simultaneously. Other aspects such as embryological background, epidemiology, and clinical complications are also discussed.

Kelly Trinh and Daniel Ocazionez

Although most thyroid nodules with indeterminate cytology (Bethesda III/IV) are benign, they represent a management dilemma possibly leading to unnecessary surgery. This study aims to evaluate the role of magnetic resonance imaging in the risk stratification of thyroid nodules with indeterminate cytology. Patients scheduled for thyroidectomy for thyroid nodules with indeterminate cytology were prospectively enrolled. Diffusion-weighted images and T2-weighted images were obtained. Apparent diffusion coefficient values and T2-weighted signal intensities of thyroid nodules, normal thyroid parenchyma, muscle tissue, and spinal cord were recorded. In the final analysis, 17 nodules (5 malignant and 12 benign) were included. Apparent diffusion coefficient values, noduleto-spinal cord apparent diffusion coefficient ratio, and nodule-to-muscle T2 signal intensity ratio were significantly lower in malignant nodules (P = .019, P = .019 and P = .037, respectively). Using a threshold of 1.570 ×10−3 mm2/s, nodule apparent diffusion coefficient value had a sensitivity of 100%, specificity of 75%, positive predictive value of 62.5%, negative predictive value of 100%, and an accuracy of 82.4%. At a threshold of 3.831, nodule-to-muscle T2-weighted signal intensity ratio had a sensitivity of 100%, specificity of 50%, positive predictive value of 45.5%, and negative predictive value of 100%. If falling under both of these threshold values was required for the diagnosis of malignancy, then the sensitivity and negative predictive value would remain unchanged at 100%, but there would be an increase in specificity, positive predictive value, and accuracy to 83.3%, 71.4%, and 88.2%, respectively. Furthermore, 83.3% (10/12) of benign nodules could have been spared from unnecessary surgery. Magnetic resonance imaging is a very sensitive tool for discriminating benign from malignant thyroid nodules with indeterminate cytology and it may spare patients from unnecessary surgery.

Muhammad O. Awiwi, Serkan Teksöz, Serkan Akbaş, Migena Gjoni, and Osman Kızılkılıç

Vertebral fractures affect many people, especially in countries with an aging population like the United States. Vertebral augmentation procedures such as vertebroplasty or kyphoplasty can be effective treatment options that increase life expectancy. However, in the late 2000s, randomized control trials and guideline recommendations questioned the efficacy of these procedures. This study aims to evaluate current utilization trends of vertebral augmentation procedures. Data were collected from the United States Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary from 2010 to 2018. Data were stratified using current procedural terminology (CPT) codes for vertebral augmentation procedures and then sub-analyzed by type of intervention, specialty performing the intervention, and location the intervention was performed. The number of vertebral augmentation procedures performed decreased from 228.4 per 100 000 in 2010 to 180.8 per 100 000 in 2018—a decrease of 20.9%. By specialty, spine surgeons saw the biggest decrease from 102.75 per 100 000 to 79.29 per 100 000. Finally, by location, procedures were approximately constant except for office-based procedures which saw an increase of 256%. The number of vertebral augmentation procedures performed per 100 000 people declined. Specifically, vertebroplasties decreased while kyphoplasty remained approximately the same. By specialty, spine surgeons saw the largest decrease followed by radiologists. Finally, when analyzed by location, all locations were approximately the same except for office-based procedures which saw an increase. The stagnant trends in vertebral augmentation procedures could potentially be explained by the controversy among randomized control trials and guidelines in the late 2000s.

Shaunak G. Patel, Vamsi K. Potluri, Raveena D. Patel, Josh L. Bilello, Gunvir S. Gill, Arsalan Saleem, and Arya N. Bagherpour

Laser ablation has become a rising minimally invasive method in place of surgical resection for the removal of tumors related to a range of problems from prostate and pulmonary cancers to high-grade gliomas and refractory epilepsy. Robotic and nonrobotic approaches to laser ablation are compared. Research articles were collected from Google Scholar by topics of interest based on more recent findings, and only articles that contained accuracy measurements were included in this review. There are two pathways in the field of laser ablation: robotic and non-robotic approaches. The accuracy of robotic devices is 0.3-3 mm. The accuracy of non-robotic devices is 0.02-5.86 mm. Both types of devices generate similar targeting accuracy towards tumor removal. In addition, the patient safety of operating the laser ablation devices has also been summarized. It is concluded that robotic laser ablation is feasible and more accurate and efficient compared to other methods; however, further clinical testing is needed to establish the safety and accuracy in real-life scenarios as most results were extracted from non-respiratory environments.

Aaron Asael Smith, Rui Li, and Zion Tsz Ho Tse

The cross-sectional imaging appearance of the abdominal vasculature during acquisition with Valsalva maneuvers can have unfamiliar appearances mimicking pathologic processes resulting in incorrect diagnosis risking unnecessary additional imaging and follow-ups. Herein, we report a case of unique arterial findings generated by the Valsalva maneuver during computed tomography acquisition in a patient undergoing evaluation for inguinal hernia.

Irfan Masood and Hasan Khan

A meandering pulmonary vein is a rare congenital pulmonary vascular variant. This usually presents as a unilateral pulmonary vein that takes an abnormal and tortuous course within the lungs, eventually draining into the heart. In our case, the patient presents with a finding of a left meandering pulmonary vein which eventually drains into the left atrium on cross-sectional imaging of the chest.

Shadan Alwan and Emma Ferguson

Percutaneous radiologic gastrostomy is a common procedure performed by interventional radiologists for patients needing nutritional support or gastric decompression. Major bleeding is an uncommon complication of the procedure, occurring in less than 2% of cases. Bleeding related to a pseudoaneurysm of the superior epigastric artery is a rare entity with a few reported cases in the literature. A wide range of treatment options are available, but it requires timely diagnosis and intervention to avoid hemorrhagic shock and associated morbidity and mortality.

Irfan Masood, Obadah Ezzeldin, Hasan Khan, Sam Postma, and Alexander Shestopalov

Transcatheter aortic valve replacement has become a standard of care treatment for many patients with severe symptomatic aortic stenosis over the course of the past decade. While transcatheter aortic valve replacement has many advantages compared to surgical aortic valve repair, one disadvantage is the increased risk of vascular complications seen with transcatheter aortic valve replacement. In this case report, we present a rare post-transcatheter aortic valve replacement vascular complication of ascending aorta pseudoaneurysm formation.

Ferzana Hossain, Cihan Duran, and Mina F. Hanna

Initially recognized as a rare condition, uretero-arterial fistulas are increasing in incidence. In this report, we present a case of uretero-arterial fistula arising from chronic ureteral stenting followed by surgical repair. Patient presentation, clinical considerations, treatment approach, and complications unique to our case are discussed.

Hamzah Saleem, Yuen-Joyce Liu, Mithil Pandhi, and Taylor D. Hicks

To evaluate the ability of superb microvascular imaging to differentiate benign from malignant liver tumors and to compare it with color and power Doppler ultrasonography. Patients scheduled for core biopsy of a liver mass were evaluated with superb microvascular imaging, color, and power Doppler, and their vascularity grades were determined. Vascularity grades of malignant and benign tumors were compared. Vascularity grades were significantly higher in superb microvascular imaging compared to color and power Doppler in both benign and malignant liver lesions (P < .001). However, no statistical difference in vascularity grades between benign and malignant tumors on superb microvascular imaging, power, and color Doppler was found. The area under the ROC curve was 0.642 for SMI (P = .127), 0.514 for color Doppler (P = .153), and 0.653 for power Doppler (P = .144). Superb microvascular imaging is superior to color and power Doppler techniques in terms of depiction of liver tumor vascularity. However, superb microvascular imaging vascularity grade is not reliable at identification of malignant from benign tumors.

Muhammad O. Awiwi, Omer Bagcilar, Migena Gjoni, and Serkan Akbas

The most common coronary artery termination anomaly is coronary artery fistula (CAF), but other variations or abnormalities of termination are increasingly recognized. The purpose of this article is to describe the spectrum of these termination variations and anomalies with the emphasis on coronary computed tomographic angiography (CCTA) illustration.

Hale Ersoy, Woongsoon J. Choi, Tiffiny Hunsaker, Brian S. Wong, and Cihan Duran

Patellar tendinopathy is a frequent cause of pain in athletes, especially in those sports that involve jumping. It is a predominantly degenerative process (tendinosis) with little involvement of inflammatory components. In the diagnosis approach, ultrasound offers some advantages, such as better spatial resolution, real-time evaluation, assessment of hypervascularization by color Doppler, which allow for the categorization of each patient according to the ultrasound findings. Therapeutic management includes several alternatives, such as physical therapy, tendon fenestration, platelet-rich plasma infiltration, percutaneous electrolysis, shock waves, among others, which, according to the ultrasound characteristics of the lesion, will have specific recommendations.

Julio Rosales, Nicolás García Álvarez, Sebastián Butrón, Roberto Yáñez, Guillermo Droppelmann, and Marco A. Verdugo

Calcifying epithelioma of Malherbe or better known as pilomatrixoma is a benign skin/subcutaneous neoplasm originating from the hair matrix cells. It is mostly diagnosed in the head, neck, and upper and lower extremities. Only few cases in the breast have been reported in the literature. Also, it is more common in women and young patients. Imaging findings of pilomatrixoma of the breast can overlap with those of malign lesions. Here, we report a very rare case of pilomatrixoma of the male breast and its clinical, mammographic, and sonographic features.

Oğuzhan Tokur, Sonay Aydın, Pelin Seher Öztekin, Marlen Süleyman, Serap Erel, and Pınar Celepli

Aberrant origination of the vertebral arteries is a rare phenomenon, and those involving the right vertebral artery are exceedingly rare. In this case report, we present the third documented case of an aberrant right vertebral artery originating directly from the descending thoracic aorta, and the first case where there is a simultaneous aberrant left vertebral artery arising from the aortic arch. Anatomical background, embryological development, and potential pathological presentations in addition to clinical considerations unique to our case are discussed as well.

Yang Qiao, Pejman Rabiei, Laura Ocasio, and Emma Ferguson

Vamsi K. Potluri, Khuong Nguyen, and Shangir Siddique

Both human laterality and the COVID-19 pandemic are popular subjects for scientific research studies. Diverse studies are still being performed in both areas. Imaging, especially computerized tomography (CT), plays an important role in the diagnosis and follow-up of COVID-19 pneumonia cases, as well as defining the disease severity. In the current study, we mainly aim to define the distribution of the laterality among COVID-19 cases. Also, we intend to investigate the possible effect of laterality on disease severity and the relation of the laterality with the tracheal anatomy. Patients who had been diagnosed with COVID-19 and who accepted to participate in the study between January 2020 and December 2020 were included. Handedness of the patients was defined using an adapted version of the Edinburg Handedness Inventory. CT images were used to define disease severity and measure bronchial angles. The mean age of the study population was 59.69 ± 16.92 years (19-98 years). Seventy-seven patients were male (43.70%) and 99 patients were female (56.30%). Of the group, 161 patients were right-handed (91.50%) and 15 patients were left-handed (8.50%). Mean bronchial angles did not differ significantly according to handedness. No significant correlation was detected between severity scores (for each lobe and total scores) and bronchial angles. The handedness ratio of COVID-19 pneumonia patients was similar to that of the general population. We could not define a significant relation between handedness and pneumonia severity, either. Branching angles of the bronchus did not differ significantly with the handedness, and pneumonia severity was not related to the bronchial branching angles.

Sonay Aydın, Mecit Kantarcı, Erdem Fatihoğlu, Hakkı Yeşilyurt, and Erdal Karavaş

Applicants for radiology residency programs consider various factors when completing their ranking lists of programs. However, in making their decision, there is usually minimal objective data that can guide applicants in creating their rank list. The goal of the study is to determine which factors in order of importance lead to the decision to rank one residency program over the other. This study was an anonymous, cross-sectional study conducted through an online survey in March of 2019. Emails were sent out to applicants who had interviewed at the University of Texas Medical Branch’s Diagnostic Radiology department after match day. The survey consisted of a single open-ended question asking the respondents to list 4 factors in order of importance that guided their program rank list. Of the 73 surveys sent out, a total of 30 applicants responded, a response rate of 41%. The most common “first preference” factors were “Reputation,” “Location,” and “Work Environment,” with 23.33%, 20%, and 20% of applicants considering these the most important factors in ranking a program. Despite reputation being the most common “first preference” factor, “Work Environment” was more commonly mentioned overall, being mentioned in 23.35% of all answers compared to “Reputation” at 12.5%. These results, combined with the difficulty in changing a program’s location and reputation, make it clear that programs should focus on building and highlighting a healthy work environment to attract applicants.

Florentino Saenz, Shadan Alwan, and Quan Nguyen

Bronchial artery aneurysm (BAA) is a rare finding often found in patients with underlying diseases such as cystic fibrosis. We present a case of two BAAs in a 55-year-old male patient with a diagnosis of cystic fibrosis, which had been misdiagnosed as lymph nodes in a prior non-contrast computed tomography study, as enlarged lymph nodes are much more commonly seen than BAAs. High mortality is associated with BAA ruptures; thus, accurate and timely diagnosis along with treatment is especially crucial.

Elif S. Duran and Mina F. Hanna

A patient diagnosed with inoperable retroperitoneal lymphatic malformation presented with progressive abdominal distention secondary to chylous ascites. This was believed to be secondary to lymphatic leakage from the lymphatic malformation into the peritoneal cavity. The chylous ascites was refractory to conservative management and drainage by a peritoneal catheter. Intra-nodal embolization with lipiodol reduced the amount of daily drainage from 4 to 2 L/day. Two weeks later, the most inferior parts of the lymphatic malformation were punctured, and a 1:6 mixture of n-butyl cyanoacrylate (glue) and lipiodol was directly injected into the lesion. Subsequently, the daily drainage decreased to less than 10 mL/day and the patient’s symptoms resolved.

Muhammad O. Awiwi, Ahmet Baş, Rahşan Özcan, and Gonca Tekant

Information on magnetic resonance imaging (MRI) features of renal small cell carcinoma (SCC) is very limited in the literature due to reasons such as the very low incidence of SCCs of kidney origin and the recent development of modern imaging methods. Renal SCCs often appear as large tissue masses on imaging studies. With its very high potential for malignancy, this tumor may demonstrate extension to adjacent vascular structures, metastasis to surrounding lymph nodes, and/or distant sites at the time of diagnosis. In a 51-year-old male diagnosed with renal SCC, we present the MRI features of the brain and bone distant metastases of this tumor, as well as the mass in the kidney with pathological findings.

Mustafa Bozdağ and Sümeyye Ekmekçi

We report an unusual case of a 31-year-old woman who presented to the emergency room with acute chest pain. Computed tomography angiography revealed a lingular pulmonary infarction. Pulmonary embolism was due to a non-cruoric subsegmental pulmonary artery emboli. It corresponded to the distal migration of a contraceptive implant inserted subdermally in the left arm a few months ago (Nexplanon®). Endovascular retrieval was performed successfully with no complications.

Virginie Bliah, Amandine Laporte, Dominique Cabral, Marc Sirol, and Mostafa El Hajjam