Radiation induced cholecystitis is a known but rare complication of Yttrium90 (Y90) radioembolization of hepatic tumors due to nontarget embolization. Many documented cases of radiation induced cholecystitis have been treated with cholecystectomy, which is significant given the typical patient population undergoing radioembolization tends to be of higher surgical risk. Here, we present a case of a 68 year old male who developed radiation induced cholecystitis status post hepatic radioembolization that resolved with conservative management alone. This case highlights that radiation induced cholecystitis may be successfully and safely treated conservatively.

Catheter-based interventions are relatively rare in the neonate population but serve as an invaluable tool in managing many pathologies. Here we present a case report of a neonate with a vascular hepatic tumor managed by embolization via transumbilical access. In neonates, the small size of the common femoral artery makes cannulation difficult and is thought to increase the risk of catheter-associated thrombosis and ischemia. Often, these patients reside in the neonatal intensive care unit (NICU) and already have an umbilical artery catheter (UAC) in place, which can be used as an effective alternative route of vascular access to carry out life-saving interventions.

Image-guided vertebral augmentation effectively treats pathologic vertebral lesions, though managing pathology in the cervical spine presents unique challenges. Posterolateral approaches, while safer, require prone positioning that may not be feasible for all patients. Open anterolateral and transoral approaches increase infection risk and typically require general anesthesia. We present a novel multimodal anterolateral approach using ultrasound, fluoroscopy, and cone-beam CT for percutaneous C2 vertebral augmentation in a patient with metastatic lesions. A 72-year-old man with multiple myeloma presented with a C2 vertebral body lytic lesion at high risk for dislocation. Due to presence of a stabilizing cervical collar and the risk associated with prone positioning, vertebral augmentation access was limited. With the patient in supine position, we utilized cone-beam CT with overlay guidance to plan a right lateral trajectory. Ultrasound identified vital vasculature, enabling targeted hydrodissection to create a safe access path with real-time image-guidance. An 11G trocar needle was advanced under ultrasound guidance, with intermittent cone-beam CT adjustments to ensure precise placement. After confirming access to the right lateral mass of C2 via fluoroscopy, 3.5cc of PMMA cement was successfully injected without extravasation. The patient experienced no complications or neurologic deficits on follow-up and was cleared to remove the cervical collar 10 days postprocedure. This case demonstrates the feasibility and efficacy of a multimodal anterolateral approach for C2 vertebral augmentation when conventional approaches are contraindicated. By integrating ultrasound-guided hydrodissection with advanced imaging, this technique offers a safe alternative for anatomically constrained patients while avoiding the risks associated with traditional approaches.

Thoracic renal arteries (TRAs), defined as renal arteries originating above the diaphragmatic hiatus from the descending thoracic aorta, represent an exceptionally rare anomaly reported in less than 0.1% of the general population. Traditionally, they are predominantly described as unilateral right-sided variants with origins at the T10-T12 vertebral levels. We report the case of a 29-year-old female with an indeterminate right retroperitoneal mass requiring image-guided biopsy. Upon review of cross-sectional imaging for preprocedural planning, contrast-enhanced CT incidentally revealed bilateral TRAs. On the right, there was a single, dominant thoracic renal artery arising from the aorta at the bottom of T12 vertebral body. The left kidney had a dominant left renal artery in the typical location at the top of L2, with a smaller accessory thoracic renal artery arising from the aorta at the midportion of T11. Embryologically, the presence of TRAs reflects the persistence of cranial mesonephric arterial segments that normally regress as the kidneys ascend. While unilateral TRAs have been sporadically documented, bilateral thoracic origins remain extraordinarily uncommon. Such high-level renal artery origins pose a heightened risk for iatrogenic injury during retroperitoneal procedures and may have implications for thoracic endovascular aortic repair (TEVAR), open thoracoabdominal surgeries, and transplant planning. Recognizing the potential for bilateral TRAs is crucial for interventional radiologists and vascular surgeons. Meticulous imaging review, including arterial-phase reconstructions, serves to avoid complications such as hemorrhage, inadvertent arterial occlusion, or renal ischemia. This case underscores the importance of considering aberrant vascular anatomy in patients undergoing interventions.

Solitary plasmacytoma of bone (SPB) is a rare plasma cell malignancy that most often presents with localized pain. This case describes a 70-year-old female with a pathologic humeral fracture due to a large, hypervascular SPB. The tumor was assumed to be a metastatic lesion, and preoperative embolization was performed to minimize intraoperative blood loss, followed by tumor debulking and total shoulder arthroplasty. The total estimated blood loss was limited to 100cc, and the patient was returned to baseline functional status with full shoulder range of motion at 6 months postop. Literature on embolization of appendicular plasmacytomas is sparse; however, this case supports its efficacy. We recommend considering preoperative embolization as an adjunctive therapy for all hypervascular bone tumors requiring surgical management, regardless of origin.