Chronic tophaceous gout is a common disease but rarely found in the head and neck region. Here we report a case of a middle aged male who presented with a mass over the right side of the nasal bridge. CT of the paranasal sinuses revealed a tophi lesion in the right nasal bridge with erosion of the underlying nasal bone. The mass was excised and histologically confirmed to be a gouty tophus. This case report illustrates how a common disease presented in an uncommon location could pose a diagnostic challenge.
The aim of this report is to describe our experience in managing cases of difficult inferior vena cava (IVC) filter retrieval with emphasis on different advanced retrieval techniques. We report three cases of difficult IVC filter retrieval at our institution. We included three patients age ranging from 42 to 72 years. Two of the cases were presenting with the lower limb deep vein thrombosis and one of the cases had pulmonary embolism and they all had Retrievable Celect Platinum IVC filter (Cook Medical, Bloomington, Ind.) inserted preoperatively. One case was managed conservatively after failing IVC filter retrieval using standard retrieval set, meaning the filter was left in place, one was successfully removed with advanced endovascular retrieval techniques, and one failing advanced endovascular retrieval and finally had it removed with open surgery. We reviewed the risk factors contributing to difficult IVC filter retrieval and discussed the different options for managing these cases including conservative management, endovascular treatment, and open surgery for retrievable type of IVC filter which can be placed permanently. Knowledge of these options will help us better understand conditions, leading to difficult IVC retrieval on insertion, hopefully to minimize the occurrence of these cases, and to better manage cases with difficult IVC filter retrieval to decide the best option for each patient after careful consideration and multidisciplinary discussion with surgeons and patients.
Central venous catheter is a commonly performed procedure in which inadvertent arterial puncture is a known complication. Inadvertent arterial injury with a large-bore catheter is associated with significant morbidity and there are a few endovascular techniques to repair the injury, including the use of a percutaneous closure device and a covered stent placement. We report a case of a patient with complex medical history complicated by inadvertent right subclavian artery injury during central venous catheter insertion. The catheter was immediately removed. The right subclavian arterial injury was repaired with a stent-graft.
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