Angiography and Embolisation

A 38-year-old man from rural Maharashtra presents with a 3-day history of haemoptysis (approximately 200 mL/day) and a productive cough. Chest X-ray shows a cavitary lesion in the left upper lobe with an air-fluid level. Sputum smear microscopy is positive for acid-fast bacilli. High-resolution CT chest confirms a 4 cm cavity with an aspergilloma within it. The patient is haemodynamically stable, afebrile, and on anti-tuberculous therapy for 2 months. Bronchoscopy is contraindicated due to severe anxiety. Which is the most appropriate next step in management?

A 52-year-old woman from Delhi presents with acute onset severe right upper quadrant pain and jaundice. Laboratory tests show total bilirubin 8.2 mg/dL, direct bilirubin 7.1 mg/dL, ALP 320 U/L, and GGT 280 U/L. Abdominal ultrasound reveals a 1.8 cm stone impacted in the common bile duct (CBD) with proximal CBD dilatation (12 mm) and intrahepatic bile duct dilatation. ERCP is attempted but fails due to duodenal diverticulum at the ampulla of Vater. The patient is haemodynamically stable, afebrile, and has no signs of acute pancreatitis. What is the most appropriate next step in management?

A 52-year-old man from Delhi presents with a 3-day history of haematemesis and melaena. He has a 10-year history of alcohol-related cirrhosis with portal hypertension. On examination, he is tachycardic (HR 110/min), hypotensive (BP 88/56 mmHg), and has clinical signs of hepatic encephalopathy. Upper endoscopy confirms actively bleeding oesophageal varices refractory to two sessions of endoscopic variceal ligation. Urgent CT angiography of the abdomen shows patent portal vein and splenic vein. The interventional radiologist is called for emergency intervention. Which of the following is the most appropriate next step in management?

A 68-year-old woman from Mumbai presents with acute right flank pain and haematuria. She has a history of hypertension and atherosclerotic disease. CT angiography of the abdomen shows a 4 cm right renal artery aneurysm with active extravasation of contrast into the perirenal space. The patient is haemodynamically stable. Renal function is preserved (creatinine 1.0 mg/dL, eGFR 72 mL/min). The interventional radiologist discusses treatment options. Which of the following is the most appropriate management strategy?

A 38-year-old woman from Mumbai presents with a 3-month history of progressive dyspnea and hemoptysis. CT angiography reveals a large pulmonary arteriovenous malformation (AVM) in the right lower lobe measuring 4 cm with a feeding artery and draining vein. The patient has hereditary hemorrhagic telangiectasia (HHT). Pulmonary function tests show mild hypoxemia (SpO₂ 92% on room air). The patient is referred for percutaneous transcatheter embolisation. Which embolic agent is most appropriate for this lesion?