A rare case of tumor-to-tumor metastasis of esophageal adenocarcinoma into meningioma.

Tumor-to-tumor metastasis is a known but rare occurrence and is characterized as 2 distinct tumor types in same anatomic location. We present a rare case of intracranial tumor-to-tumor metastasis of esophageal adenocarcinoma into meningioma. Our case emphasizes the rare occurrence of intracranial tumor-to-tumor metastasis and importance of histology and immunohistochemical analysis in distinguishing between metastasis and meningioma, especially when faced with ambiguous demarcation. Awareness of this occurrence is crucial, given that metastases might be the initial indication of an underlying tumor and it can impact the clinical management decisions.

Thrombolysis of incidental pulmonary embolism in a stroke patient.

Both acute ischemic stroke (AIS) and pulmonary embolism (PE) are major causes of morbidity and mortality, with overlapping risk factors. Incidental or silent PE therefore may be discovered during an AIS work-up. Thrombolytic therapy is considered first-line therapy for eligible patients with AIS. We present the case of an 88-year-old man with an AIS, who was incidentally found to have a PE, and then received thrombolytic therapy leading to favorable outcomes in both conditions.

Event Documentation and Transfer of Care After Severe Contrast Reactions.

PURPOSE: Radiology residencies are increasingly using clinical simulation to teach contrast reaction management. The aim of this study was to evaluate resident documentation of management and transfer of care in severe contrast reactions after a clinical simulation. METHODS: After a high-fidelity mannequin simulation of contrast-induced anaphylactic shock, residents (n = 18) were asked to document the event in a progress note and transfer care to a receiving medical team. A total of 22 prospectively determined criteria were selected, and notes were analyzed by a blinded reviewer. RESULTS: Notes contained between 12 and 21 of the prospectively determined 22 criteria (54%-95%). The median number of criteria contained in a note was 16. None of the notes fulfilled all 22 criteria. However, consistent deficiencies were found in documenting prior reaction to contrast (28%) and transfer-of-care criteria (22%-44%). CONCLUSIONS: Although standards for the documentation of advanced cardiovascular life support codes and other emergencies have been devised, no such standards exist for documentation in the management of contrast reactions. The results of this study suggest the need to develop a standardized documentation system for severe contrast-induced reactions. Education regarding transfer of care and documentation should be emphasized during clinical simulation.