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COVID-19 is one of the greatest global public health challenges in history. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is estimated to have an cumulative global case-fatality rate as high as 7.2%[ 1 ]. As the SARS-CoV-2 spread across the globe it catalyzed new urgency in building systems to allow rapid sharing and dissemination of data between international healthcare infrastructures and governments in a worldwide effort focused on case tracking/tracing, identifying effective therapeutic protocols, securing healthcare resources, and in drug and vaccine research. In addition to the worldwide efforts to share clinical and routine population health data, there are many large-scale efforts to collect and disseminate medical imaging data, owing to the critical role that imaging has played in diagnosis and management around the world. Given reported false negative rates of the reverse transcriptase polymerase chain reaction (RT-PCR) of up to 61%[ 2 , 3 ], imaging can be used as an important adjunct or alternative. Furthermore, there has been a shortage of test-kits worldwide and laboratories in many testing sites have struggled to process the available tests within a reasonable time frame. Given these issues surrounding COVID-19, many groups began to explore the benefits of 'big data' processing and algorithms to assist with the diagnosis and therapeutic development of COVID-19.

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May-Thurner syndrome (MTS) predisposes individuals to develop lower extremity deep venous thrombosis (DVT) because of compression of the left common iliac vein. Diagnosis of the anatomic obstruction is critical for effective therapy, as treatment by interventional radiology is often required in addition to anticoagulation to prevent thrombus progression and recurrence. The authors performed a retrospective review of adolescent patients who presented with MTS-associated DVT at a pediatric tertiary care center from 2009 to 2018 to assess for delays in MTS diagnosis after the presentation. Fourteen patients (median age 16.5 y, range, 13.8 to 17.9 y) were included, no DVTs were provoked by a central venous catheter. The median time from DVT to MTS diagnosis was 0.65 months (range, 0 to 21.5 mo). The initial imaging modalities used for DVT diagnosis were not able to diagnosis MTS. All patients were treated with anticoagulation and 13 underwent interventional therapy. Four patients had thrombus progression or recurrence, whereas 6 had complete thrombus resolution on follow-up imaging. Three patients who had a delayed MTS diagnosis had clinical worsening despite therapeutic anticoagulation requiring rehospitalization. Adolescent patients with “unprovoked” left lower extremity DVT should undergo appropriate imaging to diagnose MTS to allow for adequate medical and interventional therapy.

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Objective The management of spinal aneurysmal bone cysts (ABCs) is complex and often requires multimodality therapy, including surgical intervention to stabilize the axial skeleton, and avoid neurologic injury or death. With en bloc resection, ABCs have a recurrence rate of 12%, which increases to >50% with subtotal resection. The use of doxycycline sclerotherapy has been reported to reduce the recurrence rate of non-spinal ABCs to 5% at >24 month follow-up. We retrospectively reviewed our institutional results for sodium tetradecyl sulfate (STS)/doxycycline sclerotherapy and surgical intervention for spinal ABCs, to assess our treatment paradigm for these tumors and inform our future approach to these lesions. Methods Three cervical, two thoracic and two lumbar spine ABCs were treated in seven patients with spine-exclusive disease at our institution from 2011 to the present. The most common presenting complaint was pain. Each patient was retrospectively reviewed for clinical symptomology, number of treatments, technique and clinical follow-up. Qualitative assessment of improvement was based on the most recent clinical evaluation. Results The cohort underwent a mean of three treatment sessions (range 2–15). All were treated with STS and/or doxycycline. Five patients underwent surgical intervention at some point, either before or following sclerotherapy. After the last sclerotherapy session, four patients reported stable or improved pain symptoms, while two reported progressive pain that required surgical intervention for that indication. One patient, who underwent both multiple rounds of sclerotherapy and surgical resection, died due to acute on chronic cervical spine collapse with cord compression and inability to control disease. Conclusion We report our experience in the treatment of spinal column ABCs. Stabilization or improvement in pain was seen in four patients, while the remainder had progressive disease. Our multidisciplinary approach allows patients to receive the most appropriate treatment at presentation and thereafter, for symptom amelioration or spinal stability. Important future goals are to quantitatively assess changes in symptoms over time and to incorporate a reproducible radiographic endpoint for the assessment of treatment efficacy.