Multidisciplinary Approach to Venous Disease: Enhancing Patient Care and Trainee Education Through Collaboration.

The full spectrum of venous disease poses a significant burden on individuals and health-care systems globally. Venous disease can lead to a wide range of symptoms based on the level of disease and underlying pathology. In general, underlying pathologies are due to nonthrombotic (reflux/obstructive) and thrombotic causes. Most conditions are a sequela of the long-term effects of chronic venous insufficiency, deep vein thrombosis (DVT), or nonthrombotic deep vein obstruction. The prevalence of venous disease is substantial, impacting the quality of life of a considerable proportion of the adult population. Untreated and progressive lower extremity venous disease can lead to venous ulceration and other complications. Additionally, poorly recognized and poorly understood venous conditions of the abdomen and pelvis leave many patients "orphaned" in health-care systems that lack expertise in complex venous conditions. Addressing the burden and breadth of venous disease requires comprehensive management approaches, early diagnosis, appropriate treatment interventions, and provider and patient education. Multidisciplinary collaborations and further research are essential to enhance our understanding, develop innovative therapies, and improve patient outcomes in the field of venous disease. In this paper, we highlight the importance of multidisciplinary collaboration and our journey to building an institutional venous team, as well as lessons learned.

Endovascular Rerouting the Errant Aortic Endoprosthesis.

The anatomic complexity of aortic dissection remains a challenge in endovascular treatment. The dissection flap may contain defects allowing accidental guidewire passage from one lumen into the other, and inadvertent device placement into the false lumen can occur. The description of this complication and its bailout maneuvers are sparse in the literature. Herein, we describe 7 patients with errant endoprosthesis rerouted with minimally invasive intervention into the true lumen.

Congenital portosystemic shunt occlusion with an Amplatzer PFO occlusion device: a case report.

BACKGROUND: Congenital portosystemic shunts are embryological malformations in which portal venous flow is diverted to the systemic circulation. High morbidity and mortality are seen in patients with concurrent hepatic encephalopathy, hepatopulmonary syndrome, and pulmonary hypertension. Endovascular therapy, in the correct patient population, offers a less invasive method of treatment with rapid relief of symptoms. CASE PRESENTATION: In this report, we discuss the treatment of a two-year-old male with abnormal chorea-like movements, altered mental status, anisocoria and hyperammonemia diagnosed with an intrahepatic congenital portosystemic shunt between the inferior vena cava and right portal vein. Given the patient's amenable anatomy and shunt type, embolization was performed with an 18 mm Amplatzer patent foramen ovale occlusion device. CONCLUSIONS: Portosystemic shunts are a rare congenital abnormality without universal treatment guidelines. An Amplatzer PFO occlusion device can provide a novel method of shunt closure given appropriate shunt type, size and anatomy.

Uremic Leontiasis Ossea in a Patient With End-Stage Renal Disease in Hemodialysis.

Uremic leontiasis ossea is a rare condition, reported in patients with severe renal disease. Patients present with progressive enlargement of facial bones - in particular, the maxillary and mandibular bones. Rarity of this condition leaves clinicians puzzled on initial evaluation and management. Herein, we present a 31-year-old man diagnosed with uremic leontiasis ossea. The report aims to review the pathophysiology of the condition as described in the literature, the patient presentation and imaging modalities used to investigate, and classical findings seen in patients with uremic leontiasis ossea. Finally, we briefly touch base on the reported regimens used to prevent and manage this condition.

Methicillin-Resistant Staphylococcus aureus (MRSA)-Positive Pericardial Abscess Presenting in a Hemodialysis Patient.

Purulent pericarditis is an uncommon infection of the pericardial space that can very rarely present as a pericardial abscess. Infection by hematogenous spread in dialysis patients is among the predisposing risk factors that can lead to purulent pericarditis. Herein, we present a pericardial abscess case due to methicillin-resistant Staphylococcus aureus (MRSA) infection in a male patient with end-stage renal disease (ESRD) on hemodialysis. The patient has a past surgical history of two prior pericardial effusions due to uremic pericarditis.

Hot Aortic Nodules.

Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Morbidity of the dreaded thrombotic complications of atherosclerosis such as cerebrovascular accident and myocardial infarction may be severe. Early detection of fulminant disease is therefore important for risk stratification and selecting a treatment strategy. In this report we present four patients in which 18-fluorodeoxyglucose uptake was identified in atherosclerotic plaques at positron emission tomography, performed for other indications. The study aims to showcase the potential implications of 18-fluorodeoxyglucose avid plaques, which may be otherwise overlooked at positron emission tomography. Early detection may aid in prevention of complications of atherosclerotic cardiovascular disease through aggressive lifestyle modification, as well as pharmacologic or other intervention, such as endovascular atherectomy.

A Rare Case of Creutzfeldt-Jakob Disease in an 80-Year-Old Male.

Creutzfeldt-Jakob disease (CJD) is a rare, rapid and fatal human prion disease that causes neurodegeneration. Rapidly progressive dementia, quick involuntary muscle jerking and specific radiographic and laboratory findings are characteristic of the disease. CJD should not be ruled even if the clinical presentation is outside the common age range. Herein we present a case of an 80-year-old man with probable diagnosis of CJD. The absolute diagnosis of CJD can only be confirmed post-mortem with a brain biopsy.

Mycoplasma Mucositis: A Case of Extrapulmonary Manifestation of Mycoplasma Pneumoniae.

We report the case of an 18-year-old male patient who presented for the evaluation of bilateral conjunctivitis, blurry vision of the left eye, penile lesions, and dysuria. The patient was admitted to the hospital due to widespread mucosal lesions and signs of disseminated infection. Laboratory studies revealed a leukocytosis of 17.41K/µL (normal: 4K/µL - 11K/µL) with a neutrophilic predominance of 82.7%. Chlamydia trachomatis, Neisseria gonorrhoeae, human immunodeficiency virus (HIV), antinuclear antibody (ANA), hepatitis, human leukocyte antigen B27 (HLA-B27), and pathergy test for Behcet's were all negative. Mycoplasma pneumoniae IgM and IgG, herpes simplex virus-1 (HSV-1) IgG and IgM, and HSV-2 IgG were all positive. It was determined that the cause for his lesions was likely Mycoplasma mucositis. He was treated with ceftriaxone, azithromycin, acyclovir, and methylprednisolone. After five days of treatment, complete resolution of symptoms was achieved and he was discharged home.