ABSTRACT
A 27-year-old man with OSA, posttraumatic stress disorder, and chronic mechanical back pain presented with a 3-day history of acute atraumatic worsening of his low back pain as well as right groin numbness that was exacerbated by walking. He also complained of bilateral leg "heaviness," pain, and swelling, all becoming so severe that he rented a wheelchair for mobility.
Subject(s)
Acute Pain/etiology , Collateral Circulation , Edema/etiology , Low Back Pain/etiology , Vascular Malformations/complications , Vena Cava, Inferior/abnormalities , Venous Thrombosis/complications , Adult , Humans , Leg , Male , Mobility Limitation , Tomography, X-Ray Computed , Vascular Malformations/diagnostic imaging , Vena Cava, Inferior/diagnostic imaging , Venous Thrombosis/diagnosis , WheelchairsABSTRACT
Pulmonary and mediastinal masses represent a wide range of pathologic processes with very different treatment options. Although advances in imaging (such as PET and high-resolution CT) help in many cases with the differential diagnosis of thoracic pathology, tissue samples are frequently needed to determine the best management for patients presenting with thoracic masses. There are many options for obtaining tissue samples, each of which has its own set of benefits and drawbacks. The purposes of this report are to present the most current evidence regarding biopsies of thoracic nodules and masses and to present the most appropriate options for select common clinical scenarios. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Subject(s)
Diagnostic Imaging , Lung Neoplasms/diagnosis , Thoracic Diseases/diagnosis , Biopsy/methods , Delphi Technique , Diagnosis, Differential , Evidence-Based Medicine , Humans , Mediastinal Diseases/diagnosis , Radiography, InterventionalABSTRACT
Liver biopsy is a common study performed after hepatic transplantation. Most centers routinely perform a biopsy 1 week after surgery to evaluate for the possibility of acute rejection. Subsequent biopsies are based on clinical symptoms and routine hepatic function laboratory testing. We report the clinical presentation and treatment of a biliary-venous fistula resulting in sepsis and bilhemia (elevated serum bilirubin levels caused by a biliary-venous fistula) in a 2(1/2)-year-old patient 4 months after partial left lateral segment living related liver transplantation. This case is unusual in that the fistula is the reversal of the more common venous-biliary fistula. The fistula developed after a percutaneous liver biopsy was performed.
