The traveling pelvic bullet: a case of retrograde ballistic migration through the venous system.

Migration of a ballistic missile through the vasculature is rare but important to recognize. It can lead to diagnostic confusion and seemingly unexplainable bullet trajectories. We have described the case of a young man with a gunshot wound to the axillary vein and initial embolus to the inferior vena cava. The bullet subsequently migrated to the right common iliac vein, allowing for straightforward retrieval.

Videothoracoscopic approach to the extraction of a cardiac retainer missile.

The presence of foreign bodies (FB) retained in the heart or pericardium secondary to penetrating trauma in stable patients is a very rare event and its management is controversial. We present the case of a 19-year-old patient who was admitted to our trauma center hemodynamically stable because of two gunshot wounds in the lumbar region. A chest x-ray (CXR) revealed a blurred foreign body over the right heart chamber, thoracoabdominal computed tomography (CT) scan showed a free projectile over the left atrial wall, and transesophageal echocardiogram (TEE) showed a hyperrefringent pericardial sac image near the right ventricle. Finally, the patient went to surgery where a missile was removed from the pericardial sac by video-assisted thoracoscopic surgery (VATS).

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin-6 and matrix metalloproteinases.

Systemic embolization has been reported in up to 40% of patients with left atrial myxoma, half of them with cerebral involvement. However, development of intracerebral embolization associated with parenchymal seeding of the myxoma emboli is an extremely rare complication, with only 36 histologically diagnosed cases reported in the published literature. We describe a 69-year-old woman who arrived at the emergency service with hemiparesis associated with drug-resistant epilepsy and a medical history of resection of a left atrial myxoma 10 months previously. Cranial computed tomography revealed multiple large lesions of heterogeneous density and cystic components in the occipital lobes and posterior fossa parenchyma. Histopathological analyses after stereotactic biopsy of the occipital lesion revealed infiltrative myxoma cells with benign histological findings and uniform expression of calretinin similar to that of the primary cardiac myxoma. Additional immunohistochemical studies confirmed brain parenchymal seeding of the myxoma cells with strong expression of interleukin-6 (IL-6) and focal expression of matrix metalloproteinases-2 (MMP-2). Here, we discuss the clinicopathological features of intracerebral embolization of left atrial myxomas associated with progressive parenchymal seeding of the tumor emboli and the potential pathogenic role of IL-6 and MMPs.

Association of Perioperative Red Blood Cell Transfusion With Symptomatic Venous Thromboembolism Following Total Hip and Knee Arthroplasty.

BACKGROUND: Prior registry data suggest that perioperative red blood cell (RBC) transfusion may increase the incidence of venous thromboembolism (VTE) in patients status post surgery. However, there are limited data that explore VTE risk after perioperative transfusion in the setting of primary total joint arthroplasty (TJA). Our aim is to investigate the association between perioperative RBC transfusion and the development of symptomatic VTE after adjusting for confounding variables. METHODS: We retrospectively reviewed all patients undergoing primary TJA at a single institution from 2001 to 2016. The primary outcome was development of symptomatic VTE (deep vein thrombosis or pulmonary embolism) up to 90 days following primary TJA. To identify the association between RBC transfusion and development of VTE, univariate and multivariate analyses were used, as well as a sensitivity analysis using propensity score matching based on patient comorbidities. RESULTS: Of the 29,003 patients who underwent TJA, 2500 (8.62%) received RBC transfusion perioperatively and 302 (1.04%) developed a postoperative VTE within 90 days of surgery. While univariate analysis did suggest a slightly increased incidence of VTE in association with RBC transfusion (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.09-2.16), this difference was eliminated when multivariate analysis (OR, 0.42; 95% CI, 0.12-1.39) and propensity score matching (propensity-matched OR, 1.2; 95% CI, 0.7-1.8) were employed. CONCLUSION: Perioperative RBC transfusion does not significantly increase the incidence of symptomatic VTE following primary TJA in the 90-day postoperative period after adjustment for host VTE risk scores and other confounding variables. Perioperative RBC transfusion may be safely administered if indicated following total hip and knee arthroplasty.

Comparison of Computed Tomography Pulmonary Angiograms at the University Hospital of the West Indies, Jamaica with Reported Cases in Literature / Comparación de las Angiografías Pulmonares por Tomografía Computarizada en el Hospital Universitario de West Indies, Jamaica, con los Casos Reportados en la Literatura

ABSTRACT Objective: This study was undertaken to determine the positive rate for computed tomography pulmonary angiograms (CTPAs) at the University Hospital of the West Indies (UHWI), to compare the positive rate at the UHWI to that reported in the literature and to compare the rates of positive CTPAs between the genders. Method: Data were obtained from the databases of the Radiology Department of the UHWI. All CTPAs performed to confirm a clinical diagnosis of pulmonary embolism and the results issued during the period January 1st 2013 and December 31st 2013 inclusive were reviewed. Only initial examinations of adequate diagnostic quality were included in the study. Results: Three hundred and thirteenth CTPAs were performed for initial diagnosis of pulmonary embolism. Sixteen examinations were excluded for inadequate diagnostic quality. Two hundred and ninety-seven examinations on 223 females and 74 males were included in the study. The means for age were 49.7 years and 55.1 years, respectively; the difference in the means was significant (p < 0.05). Ninety-four examinations (31.6%) on 22 males (7.4%, mean age 58.4 years) and 72 females (24.2%, mean age 57.5 years) were positive for pulmonary embolism. The difference in the means was not significant (p = 0.8). On Chi-squared test there was no significant difference in the percentage of positive CTPAs between males and females (p = 0.7). Conclusions: The percentage of positive CTPAs at the UHWI is high. There was no significant difference between the genders in the percentage of positive CTPAs or the mean age at which pulmonary emboli were detected.

ABSTRACT Objetivo: Este estudio se llevó a cabo con el propósito de determinar la tasa positiva de las angiografías pulmonares por tomografía computarizada (APTC) en el Hospital Universitario de West Indies (UHWI), comparar la tasa positiva en el UHWI con la que se reporta en la literatura, y comparar las tasas de APTC positivas entre géneros. Método: Se obtuvieron datos de las bases del Departamento de Radiología de UHWI. Se examinaron todas las APTC realizadas para confirmar un diagnóstico clínico de embolia pulmonar y los resultados emitidos durante el período del 1ero de enero de 2013 y 31 de diciembre de 2013 inclusive. En el estudio se incluyeron únicamente exámenes iniciales de calidad diagnóstica adecuada. Resultados: Trecientos trece APTC fueron realizadas para el diagnóstico inicial de embolia pulmonar. Se excluyeron 16 exámenes por poseer una calidad diagnóstica inadecuada. Doscientos noventa y siete exámenes de 223 hembras y 74 varones fueron incluidos en el estudio. Los promedios de edad fueron 49.7 años y 55.1 años respectivamente. La diferencia de los promedios fue significativa (p < 0.05). Noventa y cuatro exámenes (31.6%) de 22 varones (7.4%, edad promedio 58.4 años) y 72 hembras (24.2%, edad promedio 57.5 años) fueron positivos a la embolia pulmonar. La diferencia de los promedios no fue significativa (p = 0.8). En la prueba de Chi-cuadrado no hubo diferencias significativas en el porcentaje de APTC positivas entre varones y hembras (p = 0.7). Conclusiones: El porcentaje de APTC positivas en el UHWI es alto. No hubo diferencias significativas de género en el porcentaje de APTC positivas o la edad promedio a la que se detectaron los émbolos pulmonares.

Tromboembolismo pulmonar bilateral masivo puerperal, secundario a trombosis venosa profunda intraparto. A propósito de un caso / Postpartum massive bilateral pulmonary thromboembolism secondary to deep intrapartum venous thrombosis. A case report

Resumen ANTECEDENTES: la enfermedad tromboembólica es un cuadro clínico que puede manifestarse durante el embarazo, como un episodio aislado de trombosis venosa profunda en los miembros inferiores, o como tromboembolismo pulmonar. La prevalencia se considera baja: 1 caso por cada 1600 embarazos. El solapamiento de los síntomas de la enfermedad tromboembólica con el embarazo puede retrasar la sospecha clínica y complicar el establecimiento del diagnóstico. CASO CLÍNICO: paciente primigesta, de 37 años de edad, con un episodio de tromboembolismo pulmonar con inicio en el puerperio, asociado con trombosis venosa profunda intraparto como factor desencadenante que evolucionó favorablemente gracias al diagnóstico y tratamiento oportunos. CONCLUSIÓN: la importancia de este caso radica en la necesidad de actuar con rapidez para establecer el diagnóstico e indicar inmediatamente el tratamiento.

Abstract BACKGROUND: Venous thromboembolism (VTE) is a combination of pathologies, which can manifest during pregnancy as an isolated lower extremity deep vein thrombosis (DVT) or as a pulmonary embolus (PE). The global prevalence is low, which occurs in 1 to 1600 pregnancies. CLINICAL CASE: A 37-year-old primigravid patient with an episode of pulmonary thromboembolism with onset in the puerperium associated with intrapartum deep venous thrombosis as a triggering factor that evolved favorably due to timely diagnosis and treatment. CONCLUSION: The importance of this case lies in the need to act quickly to establish the diagnosis and immediately indicate the treatment.

Trombosis venosa profunda causando embolia pulmonar aguda e infarto cerebral isquémico / Deep vein thrombosis causing pulmonary embolism and ischemic cerebral infarct

En este artículo presentamos el caso de un paciente femenino de 59 años de edad que ingreso al hospital por insuficiencia respiratoria aguda; diagnosticada con trombosis venosa profunda (TVP) y tromboembolia pulmonar (TEP) masiva. Al cuarto día de admisión desarrolló afasia global y hemiplejia derecha. Imagen de resonancia magnética (IRM) del cerebro demuestra un infarto cerebral agudo en el territorio de la arteria cerebral media izquierda. La Ecografía trans-esofágica evidencia un foramen ovale permeable de 1.8 cm de diámetro con una derivación de flujo arterio-venosa de derecha a izquierda significativo. La paciente fue sometida al cierre del defecto cardiaco por cateterismo con resultados favorables sin recurrencia de infartos cerebrales posteriores. También revisamos la literatura sobre embolia paradójica como causa de infartos cerebrales y brindamos algunas recomendaciones para el manejo y prevención de infartos cerebrales criptogénicos.

Herein, we present a case of a 59 years old woman who was admitted to the hospital due to respiratory failure. She was diagnosed with deep vein thrombosis and massive pulmonary embolism. At the fourth day of admission she developed acute onset of global aphasia and dense acute right hemiplegia. Magnetic resonance imaging demonstrates an acute infarct in the left medial cerebral artery territory. Transesophageal echocardiogram found a large patent foramen ovale of 1.8 cm of diameter with a large right to left shunting. Patient underwent to successful closure of the defect via cardiac catheterization with no recurrence of embolic events. We also review the literature of paradoxical embolus as a cause of cerebral infarcts and provide some recommendations for treatment and prevention of cryptogenic infarcts.

Redescription of "Nesticus" citrinus (Taczanowski, 1874) (Araneae, Araneoidea) from French Guyana.

"Nesticus" citrinus, a species originally placed in Theridion is redescribed based on the syntype series composed by 7 females and a lectotype is designated. All syntypes have broken emboli in their epigynes. Taxonomic position of "Nesticus" citrinus is briefly discussed and its belonging to Nesticidae is doubted.