Tracheoesophageal fistula due to Candida and Actinomyces co-infection: A case report and comprehensive review of the literature.

Acquired benign tracheoesophageal fistulas and bronchoesophageal fistulas (TEF) are typically associated with granulomatous mediastinal infections, 75% of which are iatrogenic. Candida albicans and Actinomyces are commonly occurring organisms, but are uncommon etiologies of TEF. Normal colonization and the slow growth characteristics of some species of these agents rarely result in infection, mycetoma, and broncholithiasis, and thus, delays in diagnosis and treatment are likely. Few reports describe C. albicans or Actinomyces spp. as the etiology of TEF or broncholithiasis. Herein, we report a case of benign acquired TEF secondary to coinfection of Candida and Actinomyces complicated by the formation of an actinomycetoma and broncholithiasis and a comprehensive literature review to highlight the unique nature of this presentation and offer a diagnostic algorithm for diagnosis and treatment of TEFs. Following a presentation of three months of productive cough, choking sensation, night sweats, and weight loss, a bronchoscopy revealed a fistulous connection between the esophagus and the posterior right middle lobe. Pathology identified a calcified fungus ball and a broncholith secondary to the co-infection of Candida and Actinomyces. This unique presentation of Candida and Actinomyces co-infection and the associated diagnostic algorithm are presented as education and a useful tool for clinicians.

Peritoneal loose bodies and the differentiation of fatty abdominal and pelvic lesions.

Peritoneal loose bodies (PLBs) have been sparingly documented within the surgical and radiologic literature, with 38 cases reported to date. A 67-year-old male presented to urology for the management of an asymmetric prostatic nodule. Imaging incidentally identified a well-circumscribed mass of low T2 signal intensity with a small fatty core in the left lower quadrant close to the sigmoid colon; malignancy was in the differential. The mass grew slightly over the next year. A diagnostic laparoscopy retrieved a free floating 4 × 4 cm benign mass from the pelvis, identified as necrotic fat with areas of dystrophic calcifications. PLBs are often a diagnostic dilemma without surgical intervention. Here we present a diagnostic algorithm based on a comprehensive literature review and our case to help better identify unknown abdominal and pelvic fatty masses and to avoid surgery strictly for diagnosis, especially for patients that are not ideal surgical candidates. Using this algorithm, the mass in the patient presented here could have been accurately characterized without invasive diagnostic measures.

Examination of renal donors as outpatients using intraarterial digital subtraction angiography and a pigtail catheter.

OBJECTIVE: We performed this study to assess the safety and efficacy of outpatient angiographic renal donor examination using a 3-French pigtail catheter, intraarterial digital subtraction angiography, and a progressively shortened examination time after the procedure. CONCLUSION: For 45 consecutive procedures performed, no complications were reported, and no diagnostic discrepancies were found in patients who proceeded to surgery. Using this method we were also able to eliminate the excretory urogram as well as reduce the total amount of contrast per procedure.