POCUS for Thrombus: Emphasizing the Importance of Initial Point-of-Care Ultrasound in the Management of Pulmonary Thromboembolism.

Pulmonary embolism (PE) constitutes a substantial health burden among individuals in the United States. It ranks as the third most common cause of cardiovascular death aside from stroke and myocardial infarction. Diagnostic errors are common with PE as patients can present with non-specific symptoms or could be completely asymptomatic with PE being an incidental finding. Diagnostic errors can result in missed or late diagnosis of PE, which, in turn, increases health care costs, morbidity, and mortality rates. Hence, early diagnosis is crucial. Computed tomography pulmonary angiography (CTPA) remains the gold standard in PE diagnosis, despite exposure to high doses of radiation. Point-of-care ultrasound (POCUS) is an underutilized, non-invasive technique that aids in the early diagnosis of PE and can safely reduce the radiation from CTPA in cases where contraindication exists. POCUS has been shown to have a high sensitivity and specificity for early diagnosis of PE.

Spinal Cord Ischemia Following Endovascular Abdominal Aortic Aneurysm Repair: An Unpredictable Catastrophe.

Spinal cord ischemia (SCI) following endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is a rare yet catastrophic complication. The underlying pathophysiological mechanism remains incompletely understood. We present the case of a 75-year-old man with a difficult left common iliac artery (CIA) anatomy that necessitated the coiling of his left internal iliac artery (IIA) to ensure proper sealing of his aortic stent graft. The patient complained of bilateral lower extremity weakness immediately following the procedure. The patient was diagnosed with SCI, which was later confirmed by magnetic resonance imaging (MRI). He was treated with cerebrospinal fluid drainage. The patient's neurological status mildly improved on follow-up one year later.

Implantation of a dual-chamber pacemaker in a patient with persistent left superior vena cava using a a steerable stylet.

A persistent left superior vena cava (PLSVC) is a rare abnormality that presents a challenge to the implanter. To our knowledge, this is the first case report of implantation of dual-chamber pacemaker via PLSVC utilizing a steerable stylet (the Locater; St. Jude Medical, Inc., Minnetonka, Minnesota) with chronic follow-up showing stable threshold.