Clinical Cases
Title: Radiofrequency Ablation of Renal Mass Complicated by Pseudoaneurysm Treated with Coiling
Author(s): Nannette Alvarado, MD
Preet Kang, MD
Esben Vogelius, MD
Post: 9/2010
A 60-year-old male with multiple medical problems, including T12 paraplegia and nephrolithiasis, was incidentally discovered to have a small enhancing mass of the upper pole of the left kidney by CT.
Author(s): Nannette Alvarado, MD
Preet Kang, MD
Esben Vogelius, MD
Post: 9/2010
A 60-year-old male with multiple medical problems, including T12 paraplegia and nephrolithiasis, was incidentally discovered to have a small enhancing mass of the upper pole of the left kidney by CT.
Title: Acute Rupture of Popliteal Artery Aneurysm: Endovascular Management
Author(s): Sandeep Bagla, MD
Post: 8/2010
An 89-year-old male with mild renal insufficiency and atrial fibrillation (on Coumadin therapy) presented to the Emergency Department after a fall with right knee pain and swelling. Examination of the right knee revealed ecchymosis involving the entire right knee with a palpable bruit over the right popliteal fossa. The patient was referred to Interventional Radiology for further workup and management.
Initial workup was primarily aimed at anticoagulation profile and duplex ultrasound. INR was 4.0. Duplex ultrasound of the right knee was also performed.
Author(s): Sandeep Bagla, MD
Post: 8/2010
An 89-year-old male with mild renal insufficiency and atrial fibrillation (on Coumadin therapy) presented to the Emergency Department after a fall with right knee pain and swelling. Examination of the right knee revealed ecchymosis involving the entire right knee with a palpable bruit over the right popliteal fossa. The patient was referred to Interventional Radiology for further workup and management.
Initial workup was primarily aimed at anticoagulation profile and duplex ultrasound. INR was 4.0. Duplex ultrasound of the right knee was also performed.
Title: External to Internal Iliac Artery Endograft Exclusion of Common Iliac Artery Aneurysms Following Aortobifemoral Bypass
Author(s): Stephen A Grossman, MD
Richard Park, MD
William C Thatcher, MD
Post: 8/2010
The patient is a 70-year-old man who presented in June of 2009 to the emergency room hypotensive with severe abdominal pain, nausea, and vomiting. He neither drank nor smoked. His medications were: aspirin 81 mg daily for cardiovascular risk reduction, levothyroxine 0.125 mg daily, antacids for reflux, thorazine 25 mg prn for hiccups, and magnesium oxide 400 mg supplements. He had a history of uncomplicated thyroidectomy and ventral hernia repair in March 2009. He had no family history of abdominal aortic aneurysm (AAA). CT scan of the abdomen and pelvis was performed for diagnosis.
Author(s): Stephen A Grossman, MD
Richard Park, MD
William C Thatcher, MD
Post: 8/2010
The patient is a 70-year-old man who presented in June of 2009 to the emergency room hypotensive with severe abdominal pain, nausea, and vomiting. He neither drank nor smoked. His medications were: aspirin 81 mg daily for cardiovascular risk reduction, levothyroxine 0.125 mg daily, antacids for reflux, thorazine 25 mg prn for hiccups, and magnesium oxide 400 mg supplements. He had a history of uncomplicated thyroidectomy and ventral hernia repair in March 2009. He had no family history of abdominal aortic aneurysm (AAA). CT scan of the abdomen and pelvis was performed for diagnosis.
Title: Bleeding Gastroduodenal Ulcer in a Patient with Aortoiliac Atherosclerotic Occlusive Disease
Author(s): Jeremy Hogg, MD
Sanjay Misra, MD
Post: 8/2010
A 79-year-old Caucasian man presented to the emergency department by ambulance in hemorrhagic shock. His vital signs were: pulse 130-140, blood pressure 70s/30s, respiratory rate 20, and Glasgow coma scale (GCS) 13. The patient’s medical history was only significant for hypertension and “indigestion.” He did not regularly see a physician. He did not take any medication and had no known allergies. The patient called for emergency medical service at home because of a syncopal episode and was found on the kitchen floor by the ambulance crew with his lower extremities covered in melena. He was also vomiting bright red blood. In the emergency department, he described acute onset of severe abdominal pain (9-10/10) approximately six hours prior to presentation, with subsequent development of melanotic (he describes black) stools and at least one bowel movement with red blood. On further questioning, he admitted to having intermittent melanotic stools over the past month.
Author(s): Jeremy Hogg, MD
Sanjay Misra, MD
Post: 8/2010
A 79-year-old Caucasian man presented to the emergency department by ambulance in hemorrhagic shock. His vital signs were: pulse 130-140, blood pressure 70s/30s, respiratory rate 20, and Glasgow coma scale (GCS) 13. The patient’s medical history was only significant for hypertension and “indigestion.” He did not regularly see a physician. He did not take any medication and had no known allergies. The patient called for emergency medical service at home because of a syncopal episode and was found on the kitchen floor by the ambulance crew with his lower extremities covered in melena. He was also vomiting bright red blood. In the emergency department, he described acute onset of severe abdominal pain (9-10/10) approximately six hours prior to presentation, with subsequent development of melanotic (he describes black) stools and at least one bowel movement with red blood. On further questioning, he admitted to having intermittent melanotic stools over the past month.
Title: Iatrogenic Pseudoaneurysm after Fine Needle Aspiration Biopsy of a Lung Mass
Author(s): Hector Ferral, MD
Post: 8/2010
The patient was a 59-year-old African-American woman with past surgical history of aortic, tricuspid, and mitral valve replacements. She was taking anticoagulation (Coumadin). She was known to have severe pulmonary hypertension and enlargement of all four heart chambers. A contrast-enhanced CT scan was performed and showed a right lung mass.
Author(s): Hector Ferral, MD
Post: 8/2010
The patient was a 59-year-old African-American woman with past surgical history of aortic, tricuspid, and mitral valve replacements. She was taking anticoagulation (Coumadin). She was known to have severe pulmonary hypertension and enlargement of all four heart chambers. A contrast-enhanced CT scan was performed and showed a right lung mass.
Title: Endovascular Treatment of Lériche Syndrome
Author(s): Nicolas Diehm, MD
Post: 8/2010
A 52-year-old otherwise healthy female presented with chronic lifestyle limiting claudication of both lower limbs after pain-free walking distance of 50 m. Cardiovascular risk factors were cigarette smoking (40 pack years) and hyperlipidemia. Noninvasive arterial workup revealed the presence of noncritical ischemia in both lower limbs. Of note, all lower limb pulses were absent.
Author(s): Nicolas Diehm, MD
Post: 8/2010
A 52-year-old otherwise healthy female presented with chronic lifestyle limiting claudication of both lower limbs after pain-free walking distance of 50 m. Cardiovascular risk factors were cigarette smoking (40 pack years) and hyperlipidemia. Noninvasive arterial workup revealed the presence of noncritical ischemia in both lower limbs. Of note, all lower limb pulses were absent.
Title: Management of Complex Polyvascular Peripheral Arterial Disease
Author(s): Mallik Thatipelli, MD, FACC, FSVM, FACPh, RVT
Post: 7/2010
A 78-year-old Asian female was referred by her primary care physician for painful blue discoloration and small ulcer at the tip of right big toe since 1 month. She had never seen a doctor in her life up until the prior month. Her only cardiovascular risk factor was recently diagnosed poorly controlled hypertension (HTN); she was taking ACE and calcium channel blockers. She complained of relentless rest pain in the right foot, needing round the clock narcotics. Her serum creatinine was 1.1 mg/dL on the first office visit.
Author(s): Mallik Thatipelli, MD, FACC, FSVM, FACPh, RVT
Post: 7/2010
A 78-year-old Asian female was referred by her primary care physician for painful blue discoloration and small ulcer at the tip of right big toe since 1 month. She had never seen a doctor in her life up until the prior month. Her only cardiovascular risk factor was recently diagnosed poorly controlled hypertension (HTN); she was taking ACE and calcium channel blockers. She complained of relentless rest pain in the right foot, needing round the clock narcotics. Her serum creatinine was 1.1 mg/dL on the first office visit.
Title: Life-Saving Endovascular Management of Ruptured Hepatic Mass at the Cost of Definitive Pathologic Diagnosis
Author(s): Virendersingh K Sheorain, MD
Anthony C Venbrux, MD
Post: 7/2010
A 65-year-old male presented to the Emergency Department with a 10-hour history of left upper quadrant, sudden-onset, dull-aching, intermittent, nonradiating abdominal pain. On examination, the abdomen was distended with diffuse tenderness in the epigastric area. On admission, the vital signs were: BP 98/67 mm Hg, pulse 71, respiration 14, temperature 97.4 degrees F, pain 5, and O2 Sat 100. Routine laboratory tests were unremarkable, with baseline hematocrit of 40.9%, with a range of 42.0-52.0%.
Author(s): Virendersingh K Sheorain, MD
Anthony C Venbrux, MD
Post: 7/2010
A 65-year-old male presented to the Emergency Department with a 10-hour history of left upper quadrant, sudden-onset, dull-aching, intermittent, nonradiating abdominal pain. On examination, the abdomen was distended with diffuse tenderness in the epigastric area. On admission, the vital signs were: BP 98/67 mm Hg, pulse 71, respiration 14, temperature 97.4 degrees F, pain 5, and O2 Sat 100. Routine laboratory tests were unremarkable, with baseline hematocrit of 40.9%, with a range of 42.0-52.0%.
Title: Collateralized Flow Simulating a Carotid-Cavernous Sinus Fistula in Patient with Right Brachiocephalic Vein Occlusion but Patent Right Upper Extremity AV Fistula
Author(s): Moonjohn Kim, MD
Rahul S Patel, MD
Kamran A Shah, MD
Post: 7/2010
A 50-year-old African-American woman with end stage renal disease secondary to hypertensive and diabetic nephropathy was admitted to the hospital for a cadaveric renal transplant. She had been maintained on hemodialysis via a right upper extremity AV fistula. Following transplantation, she acutely developed right hemifacial swelling. On physical exam, there was a bruit over her right eye. Significantly, she did not complain of altered visual acuity.
Author(s): Moonjohn Kim, MD
Rahul S Patel, MD
Kamran A Shah, MD
Post: 7/2010
A 50-year-old African-American woman with end stage renal disease secondary to hypertensive and diabetic nephropathy was admitted to the hospital for a cadaveric renal transplant. She had been maintained on hemodialysis via a right upper extremity AV fistula. Following transplantation, she acutely developed right hemifacial swelling. On physical exam, there was a bruit over her right eye. Significantly, she did not complain of altered visual acuity.
Title: Patient with Critical Limb Ischemia and Failed Antegrade Popliteal Revascularization
Author(s): Dai-Do Do, MD
Torsten Willenberg, MD
Post: 7/2010
A 75-year-old male patient was referred from the department of nephrology for evaluation of a chronic critical limb ischemia of the right leg. An infection of a chronic ischemic lesion on the great toe was jeopardizing preservation of the lower limb.
One year prior, interventional recanalization of a 12 cm complete occlusion from the distal popliteal artery to the fibular artery (the only remaining calf vessel) was attempted. However, there was no improvement of arterial leg perfusion. Vascular surgery was not considered because of the compromised general condition of the patient, who was suffering from severe renal insufficiency and chronic heart failure (NYHA Class III).
Author(s): Dai-Do Do, MD
Torsten Willenberg, MD
Post: 7/2010
A 75-year-old male patient was referred from the department of nephrology for evaluation of a chronic critical limb ischemia of the right leg. An infection of a chronic ischemic lesion on the great toe was jeopardizing preservation of the lower limb.
One year prior, interventional recanalization of a 12 cm complete occlusion from the distal popliteal artery to the fibular artery (the only remaining calf vessel) was attempted. However, there was no improvement of arterial leg perfusion. Vascular surgery was not considered because of the compromised general condition of the patient, who was suffering from severe renal insufficiency and chronic heart failure (NYHA Class III).
