Inferior vena cava filter migration to the right ventricle.

Inferior vena cava (IVC) filter placement is recommended for acute proximal deep venous thrombosis if anticoagulation is contraindicated. A 52-year-old man presented with weakness, dyspnea, syncope, and renal failure 8 months after IVC filter placement. Imaging revealed migration of the IVC filter to the right ventricle. Endovascular retrieval was not feasible, thus surgical extraction and tricuspid valve repair was performed. IVC filter migration to the heart is a rare, but a potentially life-threatening complication. Retrieval can be accomplished using endovascular or open surgical technique.

[(18)F]Fluorodeoxyglucose positron emission tomography-computerized tomography and lung cancer: a significant referral bias exists.

OBJECTIVE: [(18)F]Fluorodeoxyglucose positron emission tomography-computerized tomography (PET-CT) scan is a tool widely used in the diagnosis and staging of lung cancer. Referral bias is present when the results of a diagnostic study affect the decision to proceed with definitive testing. This bias artificially increases the sensitivity and decreases the specificity, and may inappropriately alter the decision to undergo definitive testing. The accuracy of PET-CT scan in suspected lung cancer and the role of referral bias were investigated. METHODS: From January 2005 through June 2007, 584 consecutive patients undergoing PET-CT scan for suspected lung cancer were studied. Endpoints measured included qualitative and quantitative results of PET-CT scans and pathologic results from patients, who underwent invasive procedures for diagnosis, staging and/or therapy. A positive PET scan was defined as one in which the standard uptake value (SUV) was greater than 2.5. A standard mathematical model, based on overall results of PET-CT scan in all patients, was used to create adjustments to account for the effect of referral bias. RESULTS: A total of 414 (71%) of PET-CT scans were reported as positive, while 170 (29%) were negative. Attempt at tissue diagnosis occurred in 417 patients (71%); surgical intervention was performed in 246 (42%). Whereas 86% (355/414) of patients with a positive PET-CT scan underwent tissue sampling, only 36% (62/170) with a negative PET-CT scan had an attempt (p<.001). In patients with a positive study, a higher SUV was associated with an attempt at tissue diagnosis (p<.001). Before adjustment, the sensitivity and specificity of the PET-CT scan for any cancer were 87% and 43%. After adjustment, sensitivity fell to 75%, while specificity rose to 64%. The unadjusted sensitivity of PET-CT scan for detecting mediastinal disease was only 79%. CONCLUSIONS: The estimate of the accuracy of PET-CT scan is significantly influenced by referral bias, and a strong reliance is placed on its results. Furthermore, patients with a positive PET-CT scan are more likely to undergo tissue sampling as the SUV increases. Given the relatively low sensitivity of the PET-CT scan in detecting disease and its poor performance in the mediastinum, the PET-CT scan may have too high an impact on the decision to undergo further invasive diagnostic procedures. Patients should not be deferred from tissue sampling based solely on a negative PET-CT scan.

Special situations: air leak after lung volume reduction surgery and in ventilated patients.

Patients undergoing lung volume reduction surgery and those supported by mechanical ventilation are among our most vulnerable patients. Prolonged air leak in these fragile patients can have dire, even fatal, consequences. This article describes the incidence of prolonged air leak in these populations, the causes ascribed to their development, and strategies that may be applied to their prevention and treatment.

Bronchopulmonary carcinoid tumor presenting with polymyositis.

We present a patient with a typical bronchopulmonary carcinoid tumor who presented with proximal muscle weakness. Laboratory analysis and a muscle biopsy specimen led to the diagnosis of polymyositis. Chest imaging revealed a bronchopulmonary carcinoid tumor. Symptoms and laboratory derangements remitted after removal of the tumor. This case represents a rare report of a typical carcinoid tumor presenting with the paraneoplastic syndrome of polymyositis.

Standard uptake value predicts survival in non-small cell lung cancer.

BACKGROUND: Integrated [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan is a widely used modality in the evaluation of lung cancer. Our goal was to determine the ability of the standard uptake value (SUV) of the primary tumor (SUV-T) and regional lymph nodes (SUV-N) to predict survival. METHODS: From January 2005 through June 2007, 584 consecutive patients undergoing integrated PET-CT scan for suspected lung cancer were studied. Results of integrated PET-CT scans, including the maximum SUV-T and SUV-N, were recorded. A patient was defined as having a positive PET scan if the maximum SUV (T or N) was greater than 2.5. Overall survival was documented from clinical records and the Social Security Death Index. Cox regression analysis was used to evaluate the correlation between SUV and survival. RESULTS: Among patients with a positive PET scan (n = 329), both SUV-T and SUV-N were predictors of survival. As maximum SUV of the primary mass increased, survival decreased (hazard ratio, 1.05; p < 0.001). As maximum SUV of locoregional lymph nodes increased, survival also decreased (hazard ratio, 1.06; p < 0.001). Furthermore, among patients with no mediastinal disease identified by PET-CT scan, increased SUV-T continued to predict poor survival (hazard ratio, 1.06; p = 0.001). CONCLUSIONS: Local and regional maximum SUVs defined by integrated PET-CT scanning have a strong correlation with survival in patients with non-small cell lung cancer. An elevated SUV is known preoperatively and may assist clinicians in stratifying patients at increased overall risk preoperatively.

Postoperative outcomes in intimal aortic angiosarcoma: a case report and review of the literature.

Intimal angiosarcoma is a most unexpected cause of aortic occlusion. We present the case of a 74-year-old woman with intimal angiosarcoma that manifested with the triad of congestive heart failure, acute renal failure, and abdominal angina. A review of the literature and discussion of postoperative outcomes follows.