RESUMO
Lacrosse, a sport of increasing popularity, is played with netted sticks and a firm rubber ball propelled at speeds frequently reaching over 100 miles/hour. While lacrosse injuries have been previously described, little published literature exists on lacrosse balls causing pulmonary contusion. We present a case of a 17-year-old male lacrosse player athlete who suffered a lacrosse ball strike to the left posterolateral chest, leading to a clinical presentation of local bruising, shortness of breath, and hemoptysis. Despite delayed arrival to the emergency room, where imaging revealed pulmonary contusion, multidisciplinary supportive management led to favorable clinical outcome with no residual effect on athletic ability and quality of life. Although pulmonary contusion may be a rare injury in the setting of thoracic trauma from lacrosse ball strikes, prompt evaluation and a high index of suspicion can rule out more life-threatening processes and ensure an excellent clinical prognosis.
RESUMO
To evaluate the utility of integrating a 3D vessel tree co-registration software platform into the stereotactic radiosurgery (SRS) workflow and its time saving for brain arteriovenous malformation (bAVM) treatment in adults compared to the conventional stereotactic head frame workflow. Eight consecutive adult bAVM cases were selected and retrospectively reviewed. Total number of angiograms and SRS procedures were 8. The electronic medical records were analyzed by time stamps to determine the length of time for each component of the set-up, transport, and frame removal. Times were averaged and the start of sedation by anesthesia used as a surrogate for the start of the frame application process. Reductions in workflow times were then modeled assuming cerebral angiography as a separate procedure. There were 8 adult bAVM cases included. Six were female. All patients had a single treatment session. Average age was 51.5 years (Range: 36-71). All patients were treated under monitored anesthesia care. In 6 patients, the AVM was deeply located (basal ganglia, midbrain, brainstem); in 2 cases, the lesion was frontal. Spetzler-Martin grades were 4 (50%) Grade 2 and 4 (50%) Grade 3. The average prescription isodose volume (PIV) and 12 Gy volumes (V12Gy) were 0.85 cc and 1.74 cc, respectively. The mean time from frame application to arrival in the angiography room was 111.5 minutes (range 40 to 171 min; median 107 min; SD 35.3 min); transport from angiography room to SRS was 47.5 minutes (range 15 to 107 min; median 36 min; SD 31.1 min), and frame removal after SRS was 20.5 minutes (range 10 to 47 min; median 16 min; SD 11.6 min). The average total additional time for the entire process of frame application, patient transportation, and frame removal was 132 minutes (range 87 to 181 min; median 127.5 min; SD 28.4 min). Therefore, assuming a non-frame based workflow and with angiography performed ahead of the actual radiosurgical treatment, the total time savings on the day of treatment was estimated at 132 minutes (range 87 to 181 min; median 127.5 min; SD 28.4 min). The ability to perform angiography, image fusion, and treatment planning for the actual day-of-delivery using 3-dimensional vessel tree co-registration could result in significant time savings over traditional workflow practices. Further experience with this system will evaluate its accuracy, reproducibility, and potential broader use in SRS workflow paradigms for the treatment of vascular pathologies. For bAVMs, the benefits of this time savings might allow for streamlined workflows on the day of SRS.
