A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL.
Background: Intranasal sphenopalatine ganglion (SPG) block has been shown to be an effective
treatment for headaches. Multiple therapeutic agents have been studied, although the wide
availability and low cost of lidocaine and bupivacaine have made them attractive treatment
options. To the authors knowledge, no study has yet demonstrated superiority of one anesthetic
over the other.
Objective: To determine the efficacy of lidocaine versus bupivacaine when performing intranasal
sphenopalatine ganglion (SPG) block for the treatment of headaches.
Study Design: Retrospective cohort study.
Setting: A single tertiary care academic institution
Methods: This retrospective study identified patients who underwent SPG block at a single
institution from January 1, 2014 to December 20, 2017. Patients were included if they were
treated with either lidocaine or bupivacaine and had both pre- and post-procedure pain scores
recorded on a 0-10 scale. Patients were excluded if they were less than 18 years of age.
Results: 386 total procedures were performed. 303 (78.5%) were lidocaine delivered via the
SphenoCath device, and 83 (21.5%) were bupivacaine delivered via the Tx360 device. 90.2% of
treatments (n = 348) decreased the patient’s pain level. Of the treatments performed with lidocaine,
89.1% (n = 270) resulted in improvement of the patient’s pain level with a mean decrease in pain
level of 3.1 (SD ± 2.3). Of the treatments performed with bupivacaine, 94.0% (n = 78) resulted in
improvement of the patient’s pain level, with a mean decrease in pain level of 3.0 (SD ± 1.9). No
statistically significant difference was found between the 2 anesthetics.
Limitations: The retrospective study design may introduce selection bias. Both lidocaine and
bupivacaine were administered by different devices (Sphenocath and Tx360 respectively) which
may account for differences in initial treatment success. There were differences in the size of the
two groups, which may also introduce error.
Conclusions: This study demonstrates similar efficacy of SPG block performed with lidocaine or
bupivacaine. While no difference was found, the particular advantages and disadvantages of the
intranasal delivery device may influence physician choice.
Key words: Sphenopalatine ganglion nerve block, lidocaine, bupivacaine, sphenocath, Tx360,
pain intervetnio, headache, miimally invasive therapy
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