RESUMEN
Pneumocystis jirovecii pneumonia (PCP) is a life-threatening condition found in immunocompromised individuals, especially in human immunodeficiency virus (HIV) positive patients. Here, we report a case of PCP in a presumably immunocompetent 25-year-old male patient who presented with a one-month history of chest pain, dyspnea, and a nonproductive cough with recent development of night sweats. The patient recently immigrated to the United States without any known medical or family history. A chest radiograph revealed moderate pneumothorax for which a chest tube was placed. A chest computed tomography (CT) scan revealed diffuse lung disease with multiple thin- and thick-walled cystic lesions on a background of diffuse ground-glass opacities. Based on these radiologic findings and subsequent positive HIV serology, there was a high suspicion of PCP. Bronchoalveolar lavage was performed, and PCR for Pneumocystis jirovecii was positive. Appropriate treatment was initiated, and the patient recovered well. Through this report, we aim to highlight the importance of recognizing the various clinical and radiologic findings of PCP even in patients with no overt risk factors. Prompt and targeted treatment could mitigate morbidity and mortality associated with this opportunistic pathogen.
RESUMEN
Pulmonary embolism (PE) is a feared complication of deep venous thrombosis (DVT) that can lead to respiratory distress and even death. The mainstay of preventing PE is anticoagulation, but other strategies exist. Inferior vena cava (IVC) filters are an alternative strategy for PE prophylaxis in individuals who may have contraindications to receiving anticoagulation. Although the placement of an IVC filter is a minimally invasive and typically uncomplicated procedure, all procedures have their risks. We present a case of a 35-year-old woman who experienced a rare complication of IVC filter placement and suffered a retroperitoneal hemorrhage. The patient underwent placement of an IVC filter for PE prophylaxis before a scheduled sleeve gastrectomy. Hours after placement, she returned with new symptoms and signs of blood loss. She was found to have a retroperitoneal hematoma due to bleeding from a lumbar artery that was penetrated by a strut of the filter. Arterial hemorrhage from a lumbar artery is a rare complication of IVC filter placement, and it can result in poor outcomes for the patient. We aim to increase awareness of this rare but dangerous complication to improve recognition and patient outcomes in cases of delayed arterial hemorrhage following IVC filter placement.
RESUMEN
This case report describes a 56-year-old female who presented to the emergency department with diffuse facial and bilateral upper extremity swelling. The patient has a past medical history of Superior vena cava (SVC) syndrome secondary to a clot around her port-a-cath, adenocarcinoma of the lungs status post chemotherapy and radiation, hyperlipidemia, rheumatoid arthritis, diverticulitis status post colon resection, and hypothyroidism. Imaging confirmed the presence of a thrombus obstructing the SVC, likely due to her hypercoagulable state. This case report details the successful removal of a thrombus using the FlowTriever device by INARI in a patient with SVC syndrome. Although indicated for treatment of PE, FlowTriever has shown success in other conditions and nearly eliminates the risk of bleeding without the need for administering thrombolytics, as explained below in the setting of SVC syndrome.
RESUMEN
The authors report a case of a 75-year-old male with pulmonary embolism (PE) successfully treated using the INARI FlowTriever System, a mechanical thrombectomy device. Imaging confirmed deep vein thrombosis and PE presented after two days of left lower extremity (LLE) pain and dyspnea on exertion with history of peripheral vascular disease, coronary artery disease, insulin dependent diabetes mellitus, hyperlipidemia and LLE percutaneous coronary intervention with coronary stent placement. PE treatment with single session clot burden reduction resulted in immediate improvement in oxygenation and echocardiogram confirmed relief of right heart strain. The patient's immediate hemodynamic improvement without thrombolytic therapy, which can take hours for morbidity reduction, supports the expansion of the use of thrombectomy devices for the treatment of submassive symptomatic PE in clinical practice, with further research indicated.
RESUMEN
Pulmonary embolism is most feared sequela of a proximal deep vein thrombosis (DVT). Currently, first-line DVT treatment is anticoagulation to prevent post-thrombotic sequelae like pedal edema as well as a life threatening pulmonary embolism . Advanced therapy considerations for limb- or life-threatening DVT include catheter-directed thrombolysis and thrombectomy. Thrombectomy is necessary when thrombolytics are contraindicated secondary to increased bleeding risk. The authors present a DVT case treated with the mechanical thrombectomy device, ClotTriever (Inari Medical, Irvine, CA), resulting in the efficient and effective removal of thrombus with near-complete resolution of venous symptoms and prompt hospital discharge.