An abscess is a collection of pus in any part of the body. There are two different types of abscesses: skin abscesses and internal abscesses. Skin abscesses (cutaneous abscesses) develop under the skin. They are common and typically easy to treat. Internal abscesses develop inside an organ or in the spaces between organs and can be more difficult to identify than skin abscesses. The symptoms can be vague and there may be no obvious external signs of a problem. This book provides a comprehensive review of the different types of abscesses along with their causes and treatments.
Traumatic injury of the posterior communicating artery causing arteriovenous fistula is rare. Here, we present a complicated case in which a patient presented with a traumatic carotid-cavernous fistula and subsequently developed recurrence. Recurrence was complicated by shunting of the posterior communicating artery to the sphenoparietal sinus post-treatment that was successfully treated endovascularly.
Method
A 53-year-old male with a remote history of head trauma complicated by posttraumatic right cavernous carotid fistula presented with progressive headaches. He was treated at another facility via trans-superior ophthalmic vein coil embolization several years prior.CT angiography demonstrated recurrence with a complex fistula. Further investigation via cerebral angiogram demonstrated a type A direct high flow cavernous-carotid fistula with cortical venous drainage and multiple venous aneurysms.
Result
The fistula was treated by R ICA deconstruction with coil and Onyx embolization after a balloon occlusion test. Follow up MRI after one year suggested a continued low-pressure fistula. He subsequently underwent cerebral angiogram which showed an indirect fistula, with feeders from ethmoidal arteries and branches of the internal maxillary artery. Outflow was through the sphenoparietal sinus. There was a direct fistula communication in between the posterior communicating artery and fistula outflow. Via the R PCommA, the fistula outflow was embolized using coils and Onyx with almost complete obliteration of the fistula and minimal to no reflux into the right posterior communicating artery. The patient did well postoperatively with complete resolution of headaches and was seen recently in clinic for 6 months follow up visit.
Conclusion
We present a patient with carotid-cavernous arteriovenous fistula complicated by subsequent fistula between the posterior communicating artery and sphenoparietal sinus successfully endovascularly treated with complete obliteration of the fistula without reflux. To our knowledge, this is the first such report. We present this case to review the multiple challenges of managing complicated traumatic carotid cavernous arteriovenous fistula and to highlight the utility of endovascular intervention in their treatment.
Disclosures
M. Mathkour: None. J. Berry: None. E. McCormack: None. E. Valle-Giler: None.
Few studies have examined the basilar venous plexus (BVP) and to our knowledge, no previous study has described its histology. The present anatomical study was performed to better elucidate these structures. In ten cadavers, the BVP was dissected. The anatomical and histological evaluation of the intraluminal trabeculae within this sinus were evaluated. Once all gross measurements were made, the clivus and overlying BVP were harvested and submitted for histological analysis. A BVP was identified in all specimens and in each of these, intraluminal trabeculae were identified. The mean number of trabeculae per plexus was five. These were most concentrated in the upper half of the clivus and were more often centrally located. These septations traveled in a posterior to anterior direction and usually, from inferiorly to superiorly however some were noted to travel horizontally. In a few specimens the trabeculae had wider bases, especially on the posterior attachment to the meningeal layer of dura mater. More commonly, the trabeculae ended in a denticulate form at their two terminal ends. The trabeculae were on average were 0.85 mm in length. The mean width of the trabeculae was 0.35 mm. These septations were consistent with the cords of Willis as are found in the lumen of some of the other intradural venous sinuses. An understanding of the internal anatomy of the BVP can aid in our understanding of venous pathology. Furthermore, this knowledge will benefit patients undergoing interventional treatments that involve the BVP.
6523 Background. Obesity is associated with an increased risk of breast cancer in postmenopausal women. In previous studies, obesity has been associated with decreased utilization of screening mammography (SM). We examined the association between Body Mass Index (BMI) and compliance with recommended SM using data from the 2004 Behavioral Risk Factor Surveillance Survey (BRFSS). Patients and Methods. The BRFSS included 130,185 female participants, aged 40 and older, who were randomly selected to participate in the world's largest telephone survey. After weighted analysis, this is believed to be representative of 56,226,220 non-institutionalized US women in this age group. The primary endpoint was the proportion of women who underwent SM within the two years preceding the survey. Utilization of SM in normal weight women (BMI 18.5–24.99) was compared with underweight (<18.5), overweight (25–29.99) and women with obesity class I (30–34.99), class II (35–39.99) and class III (≥40) using logistic regression analysis. Results. The sample included 1.91% underweight, 37.91% normal weight, 30.15% overweight and 14.36%, 5.44% and 3.49% women in obesity classes I, II, and III, respectively. Adjusting for age, race, smoking status, general health perception, level of education, and income level, underweight women were less likely to comply with regular SM than normal weight women (OR 0.57; 95% CI, 0.48–0.68). In contrast, overweight women had a significantly higher rate of appropriate SM utilization (OR 1.08; 95% CI 1.01–1.15). Women with class I and class II obesity showed a statistically non- significant trend towards a higher utilization of SM (OR 1.08; 95% CI 0.99–1.18) and (OR 1.10; 95% CI 0.98–1.25), respectively, while women with class III obesity showed a non-significant trend (OR 0.97; 95% CI, 0.84–1.13) towards under-utilization of SM. Conclusion. We present a weighted analysis of the BRFSS, evaluating the association of BMI and compliance with recommended SM among women 40 years and older. These results may be generalized to the US population of women in this age range. Previous studies reporting under-utilization of SM in higher risk, overweight and obese women were not confirmed in this large population-based analysis. No significant financial relationships to disclose.
Abstract Aim Wire localization (WL) for nonpalpable tumours has been the gold standard localization technique in breast conserving surgery. However, issues such as patient discomfort, schedule inflexibility, and dislodgement can be encountered. SAVI SCOUT® (SSL), uses radar localization and can be inserted up to a month pre-operatively and was introduced in this institution in February 2023. This study aims to assess oncological outcomes as well user reported outcomes using WL vs SSL in a tertiary referral centre. Method A retrospective analysis was performed of all patients undergoing SSL wide local excision (WLE) and those undergoing WL WLE, for biopsy confirmed breast cancer, over 18 months. Primary outcomes were positive resection margin rate and re-excision rate. Results Eighty-two patients were included. Thirty-eight SSL and thirty-nine WL. Successful lesion excision was achieved in 100% of cases. Positive margin rate and re-excision rate was 15.8% for SSL (n=6) and 7.7% in WL (n=3) (p=0.45). 100% of breast radiologists agreed that SSL easier to place and schedule than WL, and believed it was more comfortable for patients than WL. Surgeon outcomes: 50% agreed tumours were easier to identify with SSL and probes were more accurately placed. 100% agreed that SSL led to less operation delays. Conclusions Positive outcomes were reported for SSL amongst users. However, a higher positive margin rate was seen in SSL when compared to WL (15.8% vs 7.7%) but was not statistically significant. A larger cohort of patients and increased operator experience is necessary to assess long term outcomes.
Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The patient's pre-operative evaluation was significant for pseudotumor cerebri, hyponatremia, obesity, and a history of smoking; post-operative course was significant for neurogenic diabetes insipidus.
Phyllodes tumours (PTs) are rare neoplasms accounting for <1% of breast lesions. With increased breast awareness and screening programmes, smaller PTs are being detected. The purpose of this study was to determine the clinical, radiological and pathological presentation of PTs and to evaluate the role of imaging follow-up, for which there are no specific guidelines.A retrospective study of all patients diagnosed with PT in a symptomatic unit between January 2006 and March 2013 was carried out. Patients were identified using breast care and electronic patient record databases.53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs.Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology.We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.
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