Paget-Schroetter Syndrome (PSS) and Adjunctive Treatment With Mechanical Aspiration Thrombectomy and Catheter Directed Thrombolysis: A Case Report and Review of Literature.

Paget-Schroetter syndrome, also known as venous thoracic outlet syndrome, is primarily an effort-induced thrombosis of the subclavian and axillary veins. Treatment modalities involve systemic anticoagulation, catheter-directed thrombolysis (CDT), and surgical decompression. Early endovascular intervention is noted to improve outcomes and result in symptomatic relief. Here we implore the usage of the novel mechanical aspiration thrombectomy device as an adjunct to CDT for the management of peripheral venous thrombosis and highlight it as a treatment option resulting in substantial radiological and symptomatic improvement.

Massive Pulmonary Embolism and Deep Vein Thrombosis in COVID-19 Pneumonia: Two Case Reports.

Coronavirus disease 2019 (COVID-19) is known to cause a severe acute respiratory syndrome with increased morbidity and mortality due to multiorgan involvement. COVID-19 is associated with an increased risk of venous thromboembolism (VTE), ranging from asymptomatic to potentially fatal presentations. Predictors of VTE in COVID-19 are not fully defined, and the role of anticoagulation in these patients is debatable. Here we discuss two cases of COVID-19, who initially presented with mild COVID-19 symptoms and later with potentially fatal VTE within 30 days of initial presentation. The first case is of a 42-year-old gentleman with a history of sarcoidosis and a recent diagnosis of COVID-19 pneumonia who was in isolation at home and presented with syncope and worsening shortness of breath. He was hemodynamically unstable and resuscitated with fluid management in the emergency department. The chest angiogram imaging studies showed massive pulmonary embolism with right heart strain, which was confirmed with bedside point-of-care ultrasound. The patient deteriorated clinically and received an intravenous tissue plasminogen activator in the emergency. He was discharged home under stable condition on oral anticoagulation. The second patient is a 63-year-old gentleman with chronic obstructive pulmonary disease, obesity, sleep apnea, and a recent diagnosis of COVID-19 pneumonia, which was complicated with an ischemic stroke, who presented with worsening complaints of shortness of breath and palpitation. The chest angiogram imaging showed bilateral pulmonary embolism. An echocardiogram showed mild right heart strain. The lower extremity duplex ultrasound showed bilateral deep vein thrombosis. The patient underwent catheter-directed thrombolysis and discharged on oral anticoagulation. There is a need to develop stronger predictors to provide thromboprophylaxis in COVID-19 pneumonia to prevent life-threatening VTE.

Spinal Cord Compression as Initial Presentation in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and aggressive neoplasms with high metastatic potential to the lung, regional lymph nodes, and bone. Metastatic spinal cord compression due to HCC is a rare, unusual initial presentation and is a neurosurgical emergency. We present two cases of HCC where spinal cord compression was the initial presentation before the diagnosis of HCC. Our first patient presented with bilateral flank pain. The biopsy of the chest wall showed HCC. However, a CT scan of the abdomen showed metastatic involvement of the T11 vertebra. He was found to have severe spinal canal stenosis on MRI of the back without neurological deficit. He underwent an emergent tumor decompression of the T11 vertebra with kyphoplasty. Our second patient was a young man who presented with cord compression symptoms, which included bilateral leg weakness and an inability to void. An urgent laminectomy with decompression of the lumbar spine was performed. He received radiotherapy for spinal metastasis and started systemic therapy for HCC. Unfortunately, he failed multiple lines of systemic therapy, and the progression of the disease complicated his clinical course with spinal cord compression for the second time.

Idiopathic pyometra in a postmenopausal patient.

Pyometra is a rare gynecological condition most commonly seen in elderly, postmenopausal women. Malignancy should always be considered as the primary etiology until proven otherwise in the investigation of an intrauterine infection. Clinical signs and symptoms can be vague or nonexistent, and thorough investigation with ultrasound and cross-sectional imaging may be necessary to understand the extent of the disease and best course of treatment. We describe a case of idiopathic pyometra in a postmenopausal woman, as well as review the pathophysiology, investigation, and management of pyometra.

Spilled stones following pyelolithotomy: An unusual mimic of peritoneal carcinomatosis.

While spillage of intraperitoneal gallstones has been reported frequently in the literature, spilled renal stones after urologic intervention is rare. The dropped renal stones may mimic peritoneal carcinomatosis (PC) on imaging, causing concern and potentially leading to unnecessary diagnostic workup. Additionally, these dropped stones may cause surrounding inflammation, potentially leading to the formation of adhesions or an intra-abdominal abscess. Calcifications along the peritoneal lining are generally interpreted as peritoneal carcinomatosis until proven otherwise. However, this case highlights the importance of a detailed history and comparison with prior imaging. We describe a rare case of intraperitoneal spilled renal stones after pyelolithotomy initially mistaken for PC, in addition to a review of diagnostic pitfalls and radiologic mimics of PC.