Aortic penetration by temporary inferior vena cava filters: report of an interesting case and review of the literature.

We report a patient who received a retrievable G2 filter and developed inferior vena cava perforations in multiple locations, including penetration of one of the prongs inside the aortic lumen. Furthermore, we conducted an extensive literature review of similar cases to describe the clinical presentation, aortic pathology, radiologic findings, treatment, and outcomes related to this complication.

The axillary/subclavian artery access route for transcatheter aortic valve replacement: a systematic review of the literature.

A primary predictor for success with catheter-based treatment of structural heart disease is having safe remote access to the heart. The devices for transcatheter aortic valve replacement require large-bore access, but many patients with severe aortic stenosis also have iliofemoral disease or relative contraindications to transapical access. In such situations, the leading alternative vascular access site has been the axillary or subclavian artery. This approach has been used with increasing frequency, and as these new devices become more readily available, it is anticipated that the experience will grow. Literature on the use of this access site for transcatheter aortic valve replacement is reviewed to highlight the current understanding about safety of this approach.

A short history of the Society of Thoracic Surgeons national cardiac database: perceptions of a practicing surgeon.

The Society of Thoracic Surgeons database was developed as an initiative to standardize nationwide outcomes in adult cardiac surgery, and it has currently expanded into general thoracic and congenital cardiac surgery databases. For more than 19 years since its inception, the Society of Thoracic Surgeons database has grown as a powerful source of risk-adjusted outcomes, large scale scientific contributions, and invaluable information for healthcare policy making. This review article provides a snapshot of the genesis, history, growth, and scientific contributions of the Society of Thoracic Surgeons database to stimulate the participation of thoracic surgery programs and maximize its future use for investigational purposes.

Secondary pneumomediastinum: a retrospective comparative analysis.

Pneumomediastinum is an uncommon radiographic finding of potential clinical significance. Secondary pneumomediastinum (SPM) has a variety of etiologies that can lead to potentially morbid outcomes. There are limited data regarding the etiologies, diagnosis, and outcomes of this entity. A retrospective comparative study was conducted over an 11-year period of patients developing pneumomediastinum secondary to a specific pathologic or traumatic event. Forty-five patients were identified with an underlying condition resulting in SPM. Demographic data, radiologic findings, length of hospital stay, and mortality were recorded. Statistical comparison was conducted between patients with blunt thoracic trauma- and barotrauma-induced pneumomediastinum. Logistic and multiple linear regression analyses were performed to discover factors predictive of mortality and length of hospital stay. Median age of the patients was 40 years and 69% were men. Subcutaneous emphysema was identified in 44%, pneumothorax in 47%, and pleural effusion in 11%. Pneumomediastinum was identified by plain radiograph (CXR) in only 47% compared to 100% by computed tomogram (CT scan). Average length of hospital stay was 19 days and mortality was 38%. Patients with blunt thoracic trauma had a lower sensitivity for CXR to discover pneumomediastinum, were more likely to develop subcutaneous emphysema or pneumothorax, and had lower mortality and length of hospital stay compared with those with barotrauma-induced pneumomediastinum. Barotrauma was an independent predictor for hospital mortality. Secondary pneumomediastinum is a morbid condition with distinctive etiologies, radiologic findings, and outcomes. Barotrauma-induced pneumomediastinum is associated with a prolonged recovery and high mortality rate.

An unusual presentation of spontaneous pneumothorax secondary to talc-induced pulmonary granulomatosis.

Talc-induced pulmonary granulomatosis is an unusual condition resulting from the intravenous administration of medications intended for oral use. A patient with this condition who presented with a spontaneous tension pneumothorax is reported. Although the radiographic findings of a diffuse reticulonodular pattern are typical, this patient was found to have diffuse, small cavitary pulmonary nodules. Surgeons should be aware of this rare condition and should have a low threshold for performing a thoracoscopic lung biopsy.

Spontaneous pneumomediastinum: a comparative study and review of the literature.

BACKGROUND: Spontaneous pneumomediastinum (SPM) is an unusual occurrence with few cases reported. It is seen after intrathoracic pressure changes leading to alveolar rupture and dissection of air along the tracheobronchial tree. This study was undertaken to provide a thorough clinical and radiologic analysis of this patient population. METHODS: A retrospective comparative analysis was performed on patients with SPM over 12 years. Patient demographics, clinical presentation, and radiographic and diagnostic studies were recorded. A clinical and radiologic comparison was performed with secondary pneumomediastinum. RESULTS: Seventy-four patients were identified with a diagnosis of pneumomediastinum. A total of 28 patients with SPM were identified. The major initial complaints were chest pain (54%), shortness of breath (39%), and subcutaneous emphysema (32%). The main triggering events were emesis (36%) and asthma flare-ups (21%). No apparent triggering event was noted in 21% of patients. Chest radiograph was diagnostic in 69%; computed tomography was required in 31%. Esophagram, esophagoscopy, and bronchoscopy were performed on an individual basis and were invariably negative. When compared with secondary pneumomediastinum, SPM is more likely to be discovered by chest radiography, has a lower incidence of pneumothorax and pleural effusion, requires a shorter hospital stay, and has no associated mortality. CONCLUSIONS: Spontaneous pneumomediastinum is a benign condition that often presents with chest pain or dyspnea. It can develop without a triggering event and with no findings on chest radiography. Treatment is expectant and recurrence is low. Secondary causes must be ruled out to avoid an unfavorable outcome.

Pancreatic sarcoidosis: unusual presentation resembling a periampullary malignancy.

Sarcoidosis involving the pancreas is a rare occurrence. Isolated cases of localized or diffuse involvement of the pancreas have been reported in the literature. The preoperative diagnosis of this entity is a clinical challenge, and surgical intervention is usually needed to make a definitive diagnosis. We report a patient that presents with a preoperative evaluation suggestive of cholangiocarcinoma. Surgical management involved pancreaticoduodenectomy, which revealed pancreatic sarcoidosis with regional lymph node involvement. An extensive literature review of sarcoidosis of the pancreas is provided, which cites all reported cases in which the presentation warranted surgical intervention.