Applied Interventional Radiology

03/09/2026

What a spectacular day. This one was full of great personal and professional experiences, camaraderie, and feelings of achievement and belonging. We started with a trip to our favorite coffee shop then on to King Faisal hospital where we saw several consults and worked in a lovely woman with a recurrent post parting breast abscess for a drain (had to search the pharmacy warehouse for the parts we needed to assemble a suction bulb), a baby with a venous malformation over her right eye, and a happy and curious but cool 14 year old son of an oncologist with a recurrent pleural effusion after recovering from an undetermined pulmonary infection. Luke connected really well with this kid and it was a blast watching them interact. Audrey spent some quality time with the IR nurses here, Christine and Robert, and has really endeared herself to them. Dr Alsayed and I had many good conversations about IR, Egypt, Rwanda, Harleys, exercise and his vision for the program here. I did my best to add value when the opportunity arose and I think I contributed something meaningful. Once the day was done Luke, Audrey and I went downtown for some shopping and a cultural immersion experience which was fun and fascinating. The place and the pace are both so different but the people are all essentially the same. Rwandans are all so very kind and polite even amidst the chaos of a busy city center. Then we met up with Robert and Mbanza to experience the Sundowner restaurant where the highlight was full fish Tilapia that you pull apart and eat with your hands. So delicate and soft and so delicious!! I’d definitely say this day left its mark on us!

Peace and remain blessed!

03/09/2026

Slept well last night, for the first time since we’ve been here. A much needed realignment for my body. This morning is much like the last - bright, vibrant and full of anticipation. Our day yesterday was spent alongside Dr. Dieudonne and Dr. Alsayed at the Military hospital. This hospital is open to the entire community, not just military and family members. It too has undergone major renovations and expansion in the last fee years with more expansion planned. It’s busier than King Faisal. We saw several patients, including multiple ultrasound guided biopsies and cyst aspirations as well as consults for additional biopsies, nephrostomy tube placements and chemobolization procedures. We met with a nephrologist to review several dialysis access cases. Lunch always late and slow but delightful. Dieudonne and Juliet, one of our nurses took us to a nearby restaurant that had many good options. I chose a picture of a sandwich topped with an egg, but I got instead a steak quesadilla which was really a delicious mistake 😀. I spent the late afternoon doing consults with Dr Dieudonne. Audrey and Luke had a nice time with Frank exploring the Rwandan art museum. In the evening we met with our tour provider ‘Kali’ who came to the apartment to have a beer and discuss the Gorilla excursion for the weekend. He is part of an NGO that is building a large wetland sanctuary for Cranes around here, and they are doing a feasibility analysis to determine whether their sanctuary can be converted to a National Park. We are hoping to have the opportunity to tour the sanctuary while we are here.

Today was rich, informative and filled primarily with joy and satisfaction. There were a few moments of somber reality - the kind that typify being in healthcare. Young patients with advanced diseases, old patients whose lifetime of accomplishments, hardships, love and pain is evident in their eyes, their smile, their wrinkles, and their shuffle as their time draws near, and family members battling their despair with optimism and gratitude for the care they are receiving. There are institutional impediments to care which are foreign to us, but also many which are familiar.

With much gratitude myself and until tomorrow!

Peace

02/09/2026

A beautiful morning in Kigali. A thin layer of smog blankets the valley creating a hint of haziness over the vital town center. Construction sounds begin to rise from the valley floor, some distant and some near. Yesterday was a good day. We met Dr Alsayed and his team including the Dr. Choi who recently completed his fellowship in Tanzania, two fellows Drs. Mbanza and Dieudonne, and a variety of friendly and professional nurses and technologists. We were stationed at King Faisal Hospital which is undergoing a dramatic transformation with its expansion from 150 beds to over 700 beds! The radiology department is clean and sufficient with one CT, one MRI, multiple ultrasounds and the Cathlab is spacious and sharp, though light on supplies. We did two venous malformation cases - one a 9 year old with an extraarticular malformation over the left knee and one a 5 year old boy with a disfiguring malformation of the left lip. Both patients were treated with bleomycin injections which I’ve not used here in the US. That led to a nice learning point for me - bleomycin should be diluted with albumin rather than saline or contrast if it is to be foamed with air because its bubbles are too unstable to be sustained unless mixed with a protein like albumin. This is because unlike STS or polidocanol it is not a detergent and lacks any surfactant properties. We were served a nice lunch of traditional African fare. When the day was done we asked our driver Frank to take us to the local supermarket which turned out to be a gas station store. When we explained we were looking for something bigger he smiled and said “ah, ok!” And drove us to a Simba which was more to our expectations. We grabbed some bread, fruit, beer and snacks and headed back to the apartment for a bit before walking ourselves down the hill to a Korean/Japanese restaurant which proved to be delicious! I did not sleep well last night, however, for reasons unknown. Spent some wee hours researching various IR topics and reading for pleasure but simply couldn’t sleep.

This morning we will set off for coffee and then meet at the military hospital where we are scheduled for a full day of cases. There is no cath lab there - yet at least. They are expecting the installation of a Biplane room in the next year which will be a tremendous accomplishment for this country!

29/08/2026

What a privilege to be bound for Rwanda to help educate and support the incredible Interventional Radiology fellows there. This IR program under the talented leadership of Dr. Abdelhay Alsayed is poised to transform healthcare for this magnificent country! Applied Interventional Radiology Audrey Johnson Road to IR

12/11/2021

A day in the life of this

24/01/2020

29 yo female presents to ER with anemia, profound hypotension and vaginal bleeding. She is s/p cesarean section one month ago which complicated by two episodes of heavy post-partum bleeding that led to treatment one week ago with a D & C (dilation and curettage). Hg at presentation is 6.3. CT in the arterial phase (image 1) shows subtle abnormality on the left in the lower uterine segment. This persists on the venous phase (image 2). Angiogram was performed and demonstrates extravasation from a right uterine artery pseudoaneurysm (image 3 and 4). 6cc of Gelfoam slurry embolization of the uterine artery appeared to achieve stasis (image 5), but a five minute delayed internal iliac angiogram surprised me by revealing persistent hemorrhage (image 6). The microcatheter was advanced to the pseudoaneurysm but could not be advanced beyond it (image 7). Coil embolization was performed and follow up internal iliac angiogram showed cessation of bleeing and thrombosis of the uterine artery (image 8). A contralateral internal iliac artery angiogram was performed to interrogate for cross pelvic collateral flow which is absent (image 9).

Have any of you been surprised by the failure of a gelfoam slurry to achieve embolization of pelvic arteries?

Peace.

23/01/2020

76 yo male with sepsis and right renal stones on CT (image 1). Patient underwent a percutaneous nephrostomy placement. Usually, for patients with renal stones, I obtain access via direct puncture under fluoroscopy. However in this case I was surprised to see that the stones which were so apparent on CT were radiolucent at fluoroscopy (image 2). US showed the echogenic shadowing calculi nicely (image 3), and was used for uncomplicated access to the inferior pole. Contrast nephrostogram (image 4) shows large filling defects at the ureteropelvic junction and within the calyx representing the large stones.

In IR it always pays to expect the unexpected.

Peace.

,

29/11/2019

Trainees in Interventional Radiology -

Always ask yourself the following four questions:

1. Does the potential benefit to the patient from the procedure outweigh the risk?
2. Is there a lower risk alternative which can achieve the same benefit?
3. What could go wrong?
4. How will I manage any complication?

Remember, nothing is ever routine.

13/10/2019

Interventional Radiology Tutorial: Gelfoam Pledgets for Hemostasis after Solid Organ Biopsy

How to use Gelfoam Pledgets to achieve hemostasis after a percutaneous biopsy of the liver or kidney

11/10/2019

Image 1 is from a routine CT guided random biopsy of the liver for abnormal liver function tests in a middle aged woman who did well and was discharged pain free after three hours of observation. Patient then returned to the ER approximately 12 hours later tachycardiac, hypotensive and obtunded. CT with contrast was obtained (image 2) showing extensive parenchymal and subcapsular hemorrhage grossly disproportionate to the routine biopsy. Angiogram (not shown) revealed at least three small left hepatic artery pseudoaneurysms which were embolized and the patient recovered. Take home point - there are no “routine” biopsies.