Radiologic Evaluation and Management of Metastatic Renal Cell Carcinoma with Tumor Thrombus Extension into Right Atrium

This case report discusses the radiologic evaluation, histopathology, and management of a 67-year-old female with metastatic renal cell carcinoma (RCC) extending as a tumor thrombus into the right atrium. The patient had newly developed hematuria that was not followed up with the recommended imaging modality. Months later, the patient presented to the emergency department with progressive hematuria in addition to symptoms of dyspnea and significant weight loss. Initial CT imaging revealed a large renal mass with metastasis to the liver and lungs, along with tumor thrombus invading the inferior vena cava and right atrium. Histopathologic evaluation confirmed metastatic RCC and utilized in conjunction with the imaging studies to verify cancer staging. Combination immunotherapy with pembrolizumab and lenvatinib was initiated by the oncologist. This case emphasizes the importance of a comprehensive radiologic and clinical evaluation of hematuria as well as adequate workup to verify and stage RCC

Recent Advances in Nephrology

Recent Advances in Nephrology. Sheharyar Khokhar, MD Objectives: Describe current and emerging application of Artificial Intelligence in Nephrology including risk prediction, imaging, and dialysis management Analyze the potential benefits and limitations of AI based decision support tools Summarize the key findings of recent landmark clinical trials in Nephrology including FLOW, CONFIDENCE, and PROTECT trial

Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis and Central Anomalous Retinoschisis with mid-PEripheral Traction

PURPOSE: To report the clinical and multimodal imaging (MMI) findings and long-term follow-up of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) contiguous with midperipheral retinoschisis (MPRS) and to describe a severe SNIFR variant termed CARPET (Central Anomalous Retinoschisis with mid-PEripheral Traction). DESIGN: Retrospective case series. SUBJECTS: Eleven patients (15 eyes) with SNIFR contiguous with MPRS in at least 1 eye at baseline or final follow-up. METHODS: Multimodal imaging features, including cross-sectional and en face macular and peripheral spectral-domain OCT and OCT angiography, were reviewed in all cases at baseline and at the final follow-up visit. MAIN OUTCOME MEASURES: Various courses (including progression, regression, or stability) of MPRS or SNIFR over time were evaluated. RESULTS: Midperipheral retinoschisis exhibited centripetal progression to SNIFR in 5 eyes of 3 patients with follow-up of 67, 60, and 27 months, respectively, with maintenance of excellent visual acuity (range: 20/25-20/20) in 4 of these 5 eyes. In 2 eyes of 2 patients (including 1 eye with initial centripetal progression of MPRS to SNIFR), MPRS contiguous with SNIFR spontaneously resolved with long-term follow-up (77 and 25 months, respectively). Stellate nonhereditary idiopathic foveomacular retinoschisis contiguous with MPRS partially regressed after 48 months in 1 patient, and was stable after 54 months in another. A distinctive midperipheral microvasculopathy, associated with MPRS that was contiguous with SNIFR, was identified in 7 eyes of 4 patients. Finally, 3 eyes of 3 patients exhibited additional unique features, including central neurosensory detachment and outer lamellar macular hole, which were associated with significant midperipheral traction, representing a severe variant subtype of SNIFR that we refer to as CARPET. Two of these 3 eyes progressed with short-term follow-up of 6 and 2 months, respectively, whereas the schisis resolved and vision improved after pars plana vitrectomy in the third case. CONCLUSIONS: Midperipheral retinoschisis can progress to SNIFR over multiple years of follow-up. Stellate nonhereditary idiopathic foveomacular retinoschisis with MPRS can also spontaneously resolve or remain stable. Midperipheral retinoschisis can additionally be complicated by a midperipheral inner retinal microvasculopathy. Finally, CARPET may represent a unique and severe variant form of SNIFR driven by midperipheral vitreoretinal traction and associated with significant vision loss. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article

Efficacy of negative pressure wound therapy blowhole placement in alleviating severe subcutaneous emphysema and associated transient blindness following video-assisted thorascopic surgery: a case series

Video-assisted thorascopic surgery (VATS) lobectomy is widely used for treating lung cancer, but severe subcutaneous emphysema can be a rare complication, leading to distressing symptoms such as pain, temporary blindness, and voice changes. Traditional management strategies often require prolonged treatment, and blowhole incisions can result in infection and discomfort. This case series explores the use of negative pressure wound therapy (NPWT) applied via a unilateral blowhole incision to treat severe subcutaneous emphysema post-VATS lobectomy. In three cases, NPWT facilitated rapid resolution of pain, restored vision, and resolved voice changes within 8 h. No infection-related complications occurred. This approach not only accelerates recovery and alleviates patient discomfort but also reduces the burden on caregivers and healthcare teams. NPWT should be considered a valuable addition to the management of severe subcutaneous emphysema, improving patient outcomes and enhancing postoperative care

Critical Care Wrapped/Rewind 2024: Taylor\u27s Version

Critical Care Wrapped/Rewind 2024: Taylor\u27s Version. Jason Lyons, MD, Critical Care Medicine Objectives: Update on recent data and studies in critical care medicin

Emerging Risk Factors for Invasive Pulmonary Aspergillosis: A Narrative Review

Aspergillus can cause a spectrum of diseases depending on the immune status and predisposing conditions. Invasive pulmonary aspergillosis (IPA) is classically seen in patients with severe immunocompromise, such as patients with hematologic malignancies, transplant recipients, and chronic corticosteroid use at high doses. Recently, IPA cases in patients without these classic risk factors, including those associated with severe respiratory viral infections, chronic obstructive pulmonary disease, liver failure, and critical illness, are being increasingly recognized. Delayed recognition and missed diagnoses contribute to increased mortality in these patient populations. Maintaining a high index of suspicion and implementation of systematic screening protocols in high-risk patients may help reduce missed or delayed diagnoses and improve patient outcomes. This review describes the pathophysiology, incidence, risk factors, outcomes, and diagnostic and treatment considerations in IPA in patients with emerging risk factors