Acute Pancreatitis Following Percutaneous Mechanical Thrombectomy of Left Common Iliac Vein.

While parental or oral anticoagulation remains a mainstay of therapy for thrombosis, in sporadic clinical situations, percutaneous mechanical thrombectomy is favored. Percutaneous mechanical thrombectomy is a well-tolerated subtype of catheter-directed intervention resulting in thrombus breakdown and removal. This procedure combines endovascular mechanical thrombectomy in combination with pharmacologic thrombolysis allowing for a significant reduction in procedure time. Similar to other catheter-based procedures, common complications include hemorrhage, dissection, pseudoaneurysm, and perforations. Acute pancreatitis, in contrast, is a rare complication of percutaneous mechanical thrombectomy with only limited cases reported and is hypothesized to occur secondary to release of heme byproducts. Here, we present a case of acute pancreatitis following outpatient percutaneous mechanical thrombectomy of the left common iliac vein that ultimately required hospitalization, intensive care unit (ICU) admission, and standard medical management for pancreatitis.

Dorsal arachnoid web: A rare clinical entity.

A dorsal arachnoid web is a rare entity involving abnormal formation of arachnoid mater into a dense web which may result in ventral herniation of the spinal cord and significant neurologic symptoms. Back pain or a compressive myelopathy are two of the most common presenting symptoms. CT myelogram or MRI can aid in the diagnosis of arachnoid web, and management of includes surgical and conservative approaches. Herein, we describe two interesting cases of arachnoid webs highlighting the diagnostic approach and differences in the approach to management of each case.

Incidental Cryptococcal lung mass in an immunocompetent patient.

Cryptococcus is an encapsulated fungal organism often implicated in central nervous system and pulmonary disease in patients with AIDS or other immunocompromising diseases. However, immunocompetent hosts can also be infected. In these cases, symptoms are generally mild and common radiographic findings include small, well-defined, smoothly marginated pulmonary nodules. We present a case of a 31-year-old man without any immunocompromising factors found to have pulmonary Cryptococcal infection presenting as a large lung mass.

Clinical and biochemical profiles suggest fibromuscular dysplasia is a systemic disease with altered TGF-ß expression and connective tissue features.

Fibromuscular dysplasia (FMD) is a rare, nonatherosclerotic arterial disease for which the molecular basis is unknown. We comprehensively studied 47 subjects with FMD, including physical examination, spine magnetic resonance imaging, bone densitometry, and brain magnetic resonance angiography. Inflammatory biomarkers in plasma and transforming growth factor ß (TGF-ß) cytokines in patient-derived dermal fibroblasts were measured by ELISA. Arterial pathology other than medial fibrodysplasia with multifocal stenosis included cerebral aneurysm, found in 12.8% of subjects. Extra-arterial pathology included low bone density (P<0.001); early onset degenerative spine disease (95.7%); increased incidence of Chiari I malformation (6.4%) and dural ectasia (42.6%); and physical examination findings of a mild connective tissue dysplasia (95.7%). Screening for mutations causing known genetically mediated arteriopathies was unrevealing. We found elevated plasma TGF-ß1 (P=0.009), TGF-ß2 (P=0.004) and additional inflammatory markers, and increased TGF-ß1 (P=0.0009) and TGF-ß2 (P=0.0001) secretion in dermal fibroblast cell lines from subjects with FMD compared to age- and gender-matched controls. Detailed phenotyping of patients with FMD allowed us to demonstrate that FMD is a systemic disease with alterations in common with the spectrum of genetic syndromes that involve altered TGF-ß signaling and offers TGF-ß as a marker of FMD.

Diagnostic and therapeutic difficulties in retroperitoneal abscess.

Abscesses developing within the retroperitoneal spaces are complicated and serious infections. These abscesses present insidiously, leading to considerable mortality and morbidity. A high clinical suspicion can help diagnose and treat this potentially fatal illness. Computed axial tomography is the best diagnostic modality for retroperitoneal abscess. Computed tomographic scan is useful, not only for diagnosing the retroperitoneal abscess, but can be used for therapeutic drainage of abscesses in high-surgical-risk patients. We present an illustrative case of retroperitoneal abscess and discuss the pathogenesis of retroperitoneal abscess, diagnosis, and treatment.