Retrospective Comparative Analysis of Fluoroscopic-Guided Lumbar Puncture in the Routine Prone Versus Lateral Decubitus Position.

OBJECTIVE: We sought to investigate patient outcomes such as success rate, fluoroscopy time, and radiation dose for fluoroscopic-guided lumbar puncture procedures performed in the prone position versus the lateral decubitus (LD) position. METHODS: Retrospective chart analysis was performed at a single institution from 2013 to 2019. Cases were separated by performance in the prone or lateral decubitus positions. Data collected include patient characteristics, fluoroscopy time, radiation dose (DAP), puncture level, indication, opening pressure, and success rate. Exclusion criteria include trainee participation and procedures where positioning was unspecified. Mean fluoroscopy time, DAP, and procedure success rate were calculated and compared between groups. RESULTS: Mean fluoroscopy time (min) was 0.97 and 1.07 in the LD and prone groups respectively (p = 0.21). Mean DAP (mGy) was 43.18 and 42.06 in the LD and prone groups respectively (p = 0.38). Success rate was 98.3% and 89.1% in the LD and prone groups respectively (p = 0.04). Room time (minutes) was 64.46 and 77.77 in the LD and prone groups respectively (p = 0.04). CONCLUSION: Our study found no statistically significant difference in terms of fluoroscopic time or radiation dose when comparing fluoroscopic-guided lumbar punctures in the prone versus lateral decubitus positions. Further analysis did show a statistically significant increased success rate and a shorter room time for the lateral decubitus position.

Pediatric fibrocartilaginous spine embolism induced by trauma.

Fibrocartilaginous embolic infarction of the spinal cord is a rare cause of acute back pain and motor weakness. Most symptoms start after minor trauma that is often considered harmless and forgotten, however these minor injuries can result in lethal consequences. It is quite rare to diagnose fibrocartilaginous embolism in a timely manner and start treatment to prevent poor outcomes. We present the case of a previously healthy eight-year-old female with sudden onset neck pain and progressive bilateral upper extremity weakness following an injury while playing with her younger sister. Magnetic resonance imaging of the cervical spinal cord without contrast revealed a posterior disc protrusion suggestive of post-traumatic spinal cord infarction due to fibrocartilaginous embolism. In young, otherwise healthy, patients with acute motor deficits, radiographic imaging can help identify rare presentations like fibrocartilaginous embolism in order to rapidly diagnose and efficiently treat such patients.

Intussusception secondary to signet ring cell adenocarcinoma in adolescent.

Despite the overall decrease in incidence and mortality rates for older adults, colorectal cancer in young adults is increasing. We present a case of a 15-year-old male who presented with 1.5 weeks of intermittent, sharp, severe right-sided abdominal pain. Abdominal radiograph demonstrated an air-fluid level within the right hemiabdomen. Computed tomography demonstrated marked wall thickening and a mass at the junction of the ascending colon and hepatic flexure causing obliteration of the lumen with a fluid-filled, dilated ascending colon. Follow-up ultrasonography demonstrated a 5.9 × 3.9 cm targetoid lesion in the right upper quadrant concerning for intussusception. Contrast enema revealed failure of contrast filling beyond the hepatic flexure due to a lobulated central filling defect surrounded by a claw-like contrast extension. Pathology of the polypoid lesion revealed poorly differentiated signet ring cell adenocarcinoma of the colon at the hepatic flexure. Despite its rarity, this case elucidates the need to consider colorectal carcinoma in adolescent and young adult patients who present with recurrent abdominal signs and symptoms.

Systemic Embolization as the Initial Presentation of a Rare Cause of Infective Endocarditis.

Infective endocarditis is a rare disease and is associated with a high mortality rate. The following case describes a 56-year-old gentleman who presented to our hospital with a pulseless left leg concerning for acute limb ischemia, which was managed with emergent revascularization. His subsequent workup revealed IE due to a rare organism known as Streptococcus dysgalactiae. Through this case, we want to showcase this rare cause of IE and also highlight systemic embolization as its possible initial presentation.