CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis.

A 79-year-old man was admitted to our hospital with C6-C7 pyogenic spondylodiscitis with an epidural abscess. Since the cervical intervertebral space is narrower than the thoracolumbar intervertebral space, drain insertion into the cervical intervertebral space requires a more accurate procedure. Moreover, the specific anatomy of cervical vertebrae, which includes the transverse foramen through which the vertebral artery passes and the uncinate process on the side edges of the top surface of the bodies, makes it impossible to perform computed tomography (CT)-guided percutaneous intervertebral drain insertion through the posterolateral approach. Therefore, CT fluoroscopy-guided percutaneous cervical intervertebral drain insertion using a lateral approach, in which the needle is advanced between the carotid sheath and scalene muscle, and simultaneous intravenous contrast enhancement might be a safe and useful technique. There have been no papers on CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis, while successful CT fluoroscopy-guided percutaneous intervertebral drain insertion for thoracolumbar pyogenic spondylodiscitis has been reported. Here, we successfully performed CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis.

Development of Pulmonary Edema Despite Negative Fluid Balance with Diuretics in a Patient with Heart Failure and Sigmoid Septum.

An 87-year-old man was hospitalized due to dyspnea and leg edema. He was diagnosed with heart failure due to anemia with a hemoglobin (Hb) concentration of 6.0 g/dL. Chest X-ray on admission revealed pleural effusion. He was transfused with 400 mL packed red blood cells, which elevated the Hb concentration to 8.6 g/dL. Spironolactone (25 mg/day) and furosemide (20 mg/day, intravenously) were initiated. Despite the negative fluid balance, the patient's dyspnea worsened. Chest X-ray on day 8 revealed pulmonary edema despite decreased pleural effusion. Transthoracic echocardiography (TTE) revealed a sigmoid-shaped interventricular septum and systolic anterior motion of the mitral valve, causing left ventricular outflow tract obstruction (LVOTO; peak pressure gradient, 96 mmHg). Pilsicainide (75 mg/day) was administered to reduce the LVOTO. In addition, furosemide administration was changed to continuous infusion with increased dose of 48 mg/day (2 mg/h). The patient's dyspnea finally abated, with X-ray on day 12 revealing marked reduction in pulmonary congestion. TTE on day 17 revealed marked reduction in LVOTO (peak pressure gradient, 21 mmHg). Hemodynamic change by diuretics in the setting of right-sided heart failure due to anemia and in the presence of LVOTO due to sigmoid septum could be the cause of pulmonary edema.

CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction.

PURPOSE: To retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques-CT-guided bone biopsy and abscess drainage. MATERIALS AND METHODS: Three patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment. RESULTS: Successful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17-33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment. CONCLUSIONS: CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques-CT fluoroscopy-guided bone biopsy and abscess drainage.

A case of polyarteritis nodosa associated with cytomegalovirus infection.

A 77-year-old man suffering from prolonged fever of unknown origin and bilateral leg edema was referred to our hospital. On physical examination, he had fever, general fatigue, bilateral lower leg edema, and muscle weakness of the right upper extremity and left lower extremity. Neurological examination indicated motor and sensory disturbance. Electromyography revealed mononeuritis multiplex and myopathy. A biopsy of the left biceps muscle indicated necrotizing vasculitis with fibrinoid necrosis. Considering all the data together, he was diagnosed as having polyarteritis nodosa (PAN) and concurrent active cytomegalovirus (CMV) infection. His symptoms improved promptly on treatment with 50 mg of prednisolone. This case emphasizes the importance of CMV infection as one of possible etiologies of PAN and reports a therapeutic strategy for this syndrome.

A case of pulmonary varix associated with superior pulmonary vein occlusion.

A pulmonary varix is a localized dilatation of a pulmonary vein, which is usually asymptomatic presented as a mass on a chest roentgenogram, and diagnosed with pulmonary angiography. We encountered a case of 55 year-old man, in whom incidentally identified was a dilated blood vessel that passed through the minor fissure and returned to the inferior pulmonary vein, which we diagnosed as pulmonary varix. This vascular anomaly was accompanied by the occluded superior pulmonary vein, highly suggestive of the developmental mechanism of this disease.