Adapting a Dialysis Service for Delivery of Percutaneous Arteriovenous Fistulas.

The percutaneous arteriovenous fistula (pAVF) is an exciting and novel addition to the vascular access options available to patients with end-stage kidney disease who require dialysis. Early clinical results have been promising, with high rates of maturation and low rates of reintervention. To successfully adapt an existing hemodialysis service to include the provision of pAVF formation, it is essential to identify and align the interests of key clinical and nonclinical stakeholders. Only through strong collaboration can the service be supported. The authors provide a comprehensive overview of the planning fundamentals required, including the referral pathway, screening and clinical assessment, and practical procedural elements and considerations, as well as follow-up requirements such as cannulation, fistula surveillance, and maintenance. Key staffing requirements are highlighted, including those pertaining to vascular US screening and dialysis nurse training. A broad and structured planning approach ensures that the entire network of key stakeholder interests is included and provides a strong foundation for a compelling business plan to attract the necessary funding and managerial support for the service. The authors present a systematic framework of the essential considerations necessary to facilitate the planning, funding, and ultimately delivery of a successful pAVF service. Online supplemental material is available for this article. ©RSNA, 2022.

What's that smell? A pictorial review of the olfactory pathways and imaging assessment of the myriad pathologies that can affect them.

The olfactory pathway is composed of peripheral sinonasal and central sensorineural components. The wide variety of different pathologies that can affect the olfactory pathway reflect this complex anatomical relationship. Localising olfactory pathology can present a challenge to the reporting radiologist. This imaging review will illustrate the normal anatomy of the olfactory system and describe a systematic approach to considering olfactory dysfunction. Key concepts in image interpretation will be demonstrated using examples of olfactory pathway pathologies.

Metastatic adenocarcinoma of the oesophagus to the submandibular gland-the imaging and pathological features of a rare phenomenon.

Metastatic disease affecting the submandibular gland is a rare entity, with just over a 100 cases documented. We present the case of a 55-year-old female with an apparently operable oesophageal primary adenocarcinoma, who was identified on staging PET scan and confirmed on ultrasound-guided biopsy to have metastatic disease in her left submandibular gland. The imaging and pathological findings are presented and compared with the current body of literature. Previously recognized primary sites of metastasis include the breast, thyroid, lung and genitourinary organs. We believe this to be the first documented case of oesophageal adenocarcinoma metastasising to the submandibular gland.

Paraneoplastic cerebellar degeneration as a marker of endometrial cancer recurrence.

An 84-year-old woman developed a cerebellar syndrome having undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer 1 year previously. She was found to be anti-Yo antibody positive and was diagnosed with paraneoplastic cerebellar degeneration (PCD). A subsequent positron emission tomography scan and lymph node biopsy identified recurrence of her endometrial cancer. This case illustrates how PCD can be an indicator of cancer recurrence, underlines the significance of PCD as a prompt to search for underlying malignancy, and highlights the difficulties PCD poses to the clinician in terms of diagnosis and management.