Sabah Butty

Migration of a distal shunt catheter into the heart and pulmonary artery: report of a case and review of the literature

IntroductionA rare complication of ventriculoperitoneal shunt placement is the proximal migration of the distal catheter into the heart and pulmonary artery. There have been 12 reported cases regarding intracardiac migration. In five of the cases, the catheter traveled further into the pulmonary vasculature.Case reportThe authors report another case regarding the latter situation where the catheter tip localized in a right upper lobe pulmonary arterial branch. Removal of the catheter was complicated by redundancy of the catheter and a knot along the catheter. Nevertheless, extraction was successful via endovascular retrieval using interventional radiology and loop snares. Catheter migration likely began where the right internal jugular vein was penetrated during the initial shunt placement. Subsequent venous flow and negative intrathoracic pressure coordinated the proximal migration of the catheter. The authors provide a literature review to provide information regarding management of this rare complication.

Magnetic resonance urography for the assessment of potential renal donors: Comparison of the RARE technique with a low-dose gadolinium-enhanced magnetic resonance urography technique in the absence of pharmacological and mechanical intervention

The aim of this study was to determine whether magnetic resonance urography without pharmacological (diuretic) stimulation and mechanical compression allows conclusive evaluation of the urinary system in potential renal donors. In 28 consecutive patients magnetic resonance urography (MRU) was performed on a 1.5-T system. Two techniques, rapid acquisition with relaxation enhancement (RARE) and a gadolinium (Gd)-enhanced 3D fast low angle shot (FLASH) sequence were compared in the absence of adjunctive measures. Two reviewers assessed image quality, presence of artifacts and completeness of visualization of the collecting systems and ureters. Among the 53 MR urograms, there was no difference in image quality and presence of artifacts between RARE and Gd-MRU. Despite high image quality, visualization of the urinary collecting system was insufficient. Continuous visualization from the collecting system to the distal ureter was demonstrated bilaterally in only 14% of the RARE and 26% of Gd-enhanced MR urograms, respectively. Overall, Gd-enhanced MRU was superior to the RARE technique in displaying the segments of the urinary collecting system, but this difference was not found to be statistically significant. Neither the RARE technique nor the gadolinium-enhanced MRU technique is accurate enough to allow the evaluation of the collecting system and ureters in potential renal donors in the absence of pharmacological intervention and compression.

Haploidentical related donor hematopoietic stem cell transplantation with post-transplantation cyclophosphamide for DOCK8 deficiency

Haploidentical related donor hematopoietic stem cell transplantation with post-transplantation cyclophos phamide for DOCK8 deficiency Alexandra F. Freeman, MD, Nirali N. Shah, MD, Mark Parta, MD, Helen C. Su, MD, PhD, Alessandra Brofferio, MD, Irma Gradus-Pizlo, MD, Sabah Butty, MD, Thomas E. Hughes, PharmD, David E. Kleiner, MD, Daniele Avila, CRNP, Theo Heller, MD, Heidi H. Kong, MD, Steven M. Holland, MD, and Dennis D. Hickstein, MD

Life-threatening post-thrombectomy hypotension due to residual complications from a translumbar catheter.

Translumbar catheters offer an alternative life-saving option in patients without conventional dialysis access, though their use and complication rates are poorly understood. We report the first case in the medical literature of a translumbar catheter inducing a central venous stenosis. This occult sequela converted what is usually a subclinical complication from an arteriovenous graft thrombectomy into a life-threatening one. This unusual clinical presentation highlights the need for clinicians to recognize the potential serious implications of translumbar catheter-induced occult central venous stenosis.