Catheter-directed interventions for pulmonary embolism.

Pulmonary embolism (PE), a potentially life-threatening entity, can be treated medically, surgically, and percutaneously. In patients with right ventricular dysfunction (RVD), anticoagulation alone may be insufficient to restore cardiac function. Because of the morbidity and mortality associated with surgical embolectomy, clinical interest in catheter-directed interventions (CDI) has resurged. We describe specific catheter-directed techniques and the evidence supporting percutaneous treatments.

Imaging manifestations of a dreaded obstetric complication in the immediate postpartum period.

HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome is a dreaded complication that may develop during pregnancy or in the immediate postpartum period. Rarely this syndrome manifests itself with imaging findings. We report a case of HELLP syndrome in which the diagnosis was reaffirmed via imaging findings.

Unusual dermal pleomorphic calcifications in a case of inflammatory breast carcinoma.

Inflammatory breast carcinoma is a rare and aggressive type of breast cancer that is definitively diagnosed by histologic evaluation showing invasive tumor cells in the dermal lymphatic system. Associated dermal calcifications are not typically identified. We report an unusual case in which inflammatory breast carcinoma led to the presence of pleomorphic dermal calcifications identified on the initial mammographic examination.

Validation of clinical prediction scores in patients with primary intracerebral hemorrhage.

BACKGROUND: Initial reports of the FUNC score suggest that it may accurately identify those patients suffering from intracerebral hemorrhage (ICH) with an ultra low chance of functional neurologic recovery. This study's aim is to validate the FUNC score and determine if it accurately identifies the cohort of patients with an ultra low chance of survival with good neurologic recovery. METHODS: Retrospective review of 501 consecutive primary ICH patients admitted from the Emergency Department to a large healthcare system. Performance of the FUNC, ICH-GS, and oICH scores was determined by calculating areas under the receiver-operator-characteristic curves. Patients with a predicted 100 % chance of poor neurologic outcome (PNO) (FUNC <4 and ICH-GS >10) scores were evaluated to determine if DNR impacted 90 day survival or rate of survival with a Glasgow Outcome Score of <3. RESULTS: In 366 cases of primary ICH who presented during the study period, 222(61 %) survived to discharge. Both the FUNC (AUC: 0.873) and ICH-GS (AUC: 0.888) outperformed the oICH (AUC: 0.743) in predicting 90-day mortality (p = <0.001). Of 68 patients with a FUNC score <4, 67 (98.5 %) had PNO at discharge. The presence of DNR was not associated with a significant difference in the rate of PNO at discharge (40/40 = 100 % vs. 27/28 = 96.4 % p = 0.42) or 90-day mortality (40/40 = 100 % vs. 21/28 = 75 %, p = 0.06). CONCLUSION: The FUNC and ICH-GS appear superior to the oICH in predicting outcome in patients with primary ICH. In addition, the FUNC score appears to accurately identify patients with low chance of functional neurologic recovery at discharge.

Endolymphatic sac tumor and otalgia.

Otalgia is a common complaint seen by general practitioners, but its etiology is vast. Rarely, otalgia could be secondary to a neoplasm. We describe a case of otalgia and ear discharge in which the imaging revealed a rare neoplasm, an endolymphatic sac tumor, which contributed to the patient's symptoms. The primary diagnosis was made via characteristic imaging features that were later confirmed by histology.

Persistent bilateral proatlantal type II artery.

Vascular anomalies and variants are common in patients undergoing imaging studies, and patients with these anomalies are generally asymptomatic. Remnants of fetal carotid-basilar circulation are rarely identified. We report a rare case of persistent type 2 bilateral proatlantal arteries, in which the patient presented with dizziness.

Dementia caused by dural arteriovenous fistulas reversed following endovascular therapy.

We describe two patients who presented with dementia as the primary neurological manifestation of their dural arteriovenous fistula (dAVF). Although dementia is not the most common presentation for a dAVF, these cases show that obliterating the fistula can eliminate this dreadful manifestation. This awareness may facilitate the diagnosis of dementia in cases caused by dAVF and allow for a minimally invasive treatment that restores cognitive function back to baseline.

Benign endobronchial granular cell tumor resulting in right middle lobe collapse.

Granular cell tumors (GCTs) are generally benign neoplastic tumors of neural origin that have little malignant potential. These tumors may occur in any location, including the tracheobronchial tree. Although an endobronchial location is believed to represent a small percentage of cases, GCTs should be included in the differential considerations of any endobronchial lesions leading to airway collapse.

Intracranial Nocardia in the setting of AIDS.

Nocardia intracranial abscesses occur almost exclusively in patients who are immunocompromised due to diabetes, transplantation, or HIV/AIDS. Patients usually present with seizures, headaches, fevers, and menin-gismus. Laboratory evaluation is nonspecific but may reveal an elevated erythrocyte sedimentation rate and white blood cell count. An important task in the workup of intracranial infection is searching for local causes such as sinusitis, otitis media, or mastoiditis.