Elderly patient with dural sinus thrombosis leading to abnormal medullary veins and cerebral venous infarctions.

We present a patient affected by a rapid neurological decline that was connected to subacute partial thrombosis of the straight sinus and associated with dilated superficial and deep medullary veins. An MRI scan confirmed signal alterations compatible with vascular disease and partial thrombosis of the straight sinus associated with dilated superficial and deep medullary veins of the cerebral white matter. Later, another MRI scan showed a replacement of the extensive white matter signal abnormalities, on FSE T2 and FLAIR sequences, by chronic vascular lesions.

Multidetector computed tomography aspects of tracheal mucosal leishmaniasis localization.

Tracheal mucosal localization of Leishmania is considered a rare and dangerous event. A single case of leishmaniasis of the trachea has been described in literature. Our work describes multidetector computed tomography features of leishmaniasis localized in the tracheal mucosa that occurred in a 68-year-old patient who lived in an endemic zone. Our patient underwent biopsy that established the diagnosis of leishmaniasis.

Atypical placement of hemodialysis catheters in patients with complete and irreversible obstruction of central venous vessels.

PURPOSE: This article describes the approach to atypical placement of central venous catheters (CVC) in dialysis patients with complete untreatable obstruction of central venous vessels. METHODS: Five patients with complete obstruction of central venous vessels underwent CT venography and digital venous angiography. After ultrasound-guided and radioscopic-assisted cannulation of the internal jugular vein, permanent CVCs were placed in atypical locations: in two patients a preliminary venous angioplasty was performed to facilitate the catheter positioning in a mediastinal enlarged collateral vein and in a persistent left superior vena cava; in three patients the CVC was placed in the azygos vein, enlarged because of the obstruction of the superior vena cava. RESULTS: In all cases, we achieved satisfactory morphological and functional immediate results. Hemodialysis (HD) was carried out long term in all patients except one who presented a non-functioning CVC after 4 months. In one case the catheter, still functioning well after 9 months, was removed due to kidney transplantation. The CVC in the left superior vena cava was replaced with a longer one after 12 months, and it is still functioning well 3 months after replacement. The patency of the other two catheters has to date been kept for 9 and 18 months. CONCLUSIONS: The placement of CVC for HD in atypical sites can be considered a viable option in extreme cases; adequate imaging support is paramount in order to facilitate the procedure and to avoid complications.