No abstract

We developed a seven-analyte plasma biomarker panel able to identify benign nodules, otherwise deemed indeterminate, with a high degree of accuracy. This panel may have clinical utility in risk-stratifying screen-detected lung nodules, decrease unnecessary follow-up imaging or invasive procedures, and potentially avoid unnecessary morbidity, mortality, and health care costs.

No abstract

Hydrothorax as a complication of peritoneal dialysis (PD) is a rare but recognized event. Proposed mechanisms for the development of a pleuro-peritoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. Nearly 50% of patients with this diagnosis have resolution of hydrothorax after temporary cessation of PD with interim hemodialysis for 2-6 weeks. Historically, other treatment options have included conventional pleurodesis and open thoracotomy with direct repair, producing variable results. With the advent of video-assisted thoracoscopy (VATS), surgical repairs and pleurodesis are now frequently performed under direct visualization with minimal invasiveness. We report a case of hydrothorax in a patient after recent introduction to peritoneal dialysis. Pleuro-peritoneal communication was documented with thoracentesis and radionuclide scanning. VATS pleurodesis with talc was performed. Repeat scintigraphy performed 1 week after the procedure revealed no residual communication, and patient was able to resume PD without further complications.

The Impella (Abiomed, Danvers, MA) is a minimally invasive transvalvular left ventricular assist device (LVAD) that effectively unloads the left ventricle (LV), especially in patients with ventricular arrhythmias in the setting of a venous-arterial extracorporeal membrane oxygenator (VA ECMO). 1,2 Utilization of the Impella device has increased significantly in the last few years for high-risk percutaneous coronary intervention and cardiogenic shock because of its relatively easy implantation in the catheterization lab and the operating room. Although rare, iatrogenic injury of the aortic valve (AV) can be caused by placement of the device across the AV.3 This can lead to aortic regurgitation (AR) with significant clinical consequences in the setting of cardiogenic shock. This AR can be challenging to diagnose echocardiographically because of the artifacts generated by the device when using color-flow Doppler. In this E-challenge, the authors emphasize the importance of recognizing these findings for accurate interpretation of the echocardiogram in the management of cardiogenic shock refractory to the Impella LVAD and the utility of transesophageal echocardiography (TEE).