Large-Bore Mechanical Thrombectomy of Acute Pulmonary Embolism at a Community-Based Hospital: A Case Series.

Acute pulmonary embolism (PE) is a common, and sometimes fatal, diagnosis that results in over 11,000 deaths in hospitalized patients in the USA annually. In patients with high-risk or high-intermediate-risk PE and especially in whom thrombolytic therapy is contraindicated, mechanical thrombectomy can be an effective treatment option. This case series outlines three patients with PE who were successfully treated with large bore aspiration thrombectomy by Interventional Radiology at a community-based military treatment facility (MTF). Two patients had presented to the emergency department with acute PE and a third of patients with acute PE were transferred from an outside hospital specifically for mechanical thrombectomy due to a complication from systemic anticoagulation. The patients were categorized as good candidates for immediate large-bore aspiration thrombectomy, a recently added capability at the MTF. The patients showed immediate improvement post-procedure and required only one night admission for observation to the intensive care unit. Implementation of this new capability for patients with acute high-risk or high-intermediate-risk PE or with contraindications to thrombolysis provides an alternative treatment with immediate, life-saving capability.

Femoral Neck Fracture with Avascular Necrosis.

Hip fractures are common in the aging population, with complications such as avascular necrosis. We describe a case of an 85-y-old woman with early avascular necrosis as a complication from femoral neck fracture discovered on routine bone densitometry screening.

Digital fluoroscopic video assessment of glenohumeral migration: Static vs. Dynamic conditions.

The purpose was to compare glenohumeral (GH) migration, during dynamic shoulder elevation and statically held positions using digital fluoroscopic videos (DFV). Thirty male volunteers (25+/-4 years) without right shoulder pathology were analyzed using DFV (30Hz) during arm elevation in the scapular plane. DFV were obtained at the arm at side position, 45 degrees , 90 degrees , and 135 degrees for static and dynamic conditions. GH migration was measured as the distance from the center of the humeral head migrated superiorly or inferiorly relative to the center of the glenoid fossa. Inter-rater reliability was considered good; ICC (2,3) ranged from 0.83 to 0.92. A main effect was revealed for contraction type (p=0.031), in which post-hoc t-tests revealed that humeral head was significantly more superior on the glenoid fossa during dynamic contraction. A main effect was also revealed for arm angle (p<0.001), in which post-hoc t-tests revealed significantly more superior humeral head positioning at 45 degrees , 90 degrees , and 135 degrees when compared to arm at side (p<0.001), as well as at 90 degrees compared to 45 degrees (p=0.024). There was no interaction effect between angle and contraction type (p=0.400). Research utilizing static imaging may underestimate the amount of superior GH migration that occurs dynamically.

Anterior cruciate ligament injury and bucket handle tear of the medial meniscus.

The patient was a 27-year-old man with an acute onset of right knee pain, subsequent to a twisting injury that occurred while playing soccer earlier in the day. He was evaluated via direct-access physical therapy 5 hours after the injury. He did not report giving way and locking, but did report feeling a "pop" upon injury. Based on the patient's history and physical examination findings, the therapist was concerned about the possibility of anterior cruciate ligament disruption and medial meniscus tear. The physical therapist ordered conventional radiographs to rule out bony pathology and magnetic resonance imaging of the right knee to assess for internal derangement. The conventional radiographs of the knee were interpreted as normal, while the radiologist's report from the magnetic resonance imaging was significant for an anterior cruciate ligament tear and bucket handle tear of the medial meniscus. The patient was referred to an orthopaedic surgeon and subsequently underwent surgical reconstruction of the anterior cruciate ligament.