Sharp Recanalization of a Chronically Occluded Superior Vena Cava in a Patient with Multiple Prior Peripherally Inserted Central Catheters.
Creator
Shwaiki Omar; Khoncarly Sarah; Buchino James J; McDaniel Janice
Publisher
Journal Of The Association For Vascular Access
Date
2019
2019-06
Description
Purpose: To present a unique case in which intravenous medications were administered intermittently through a peripherally inserted central catheter (PICC) line over 2 years in the presence of an occluded superior vena cava (SVC) due to impressive collateral development. However, SVC recanalization was ultimately needed to allow for long-term future access needs. Case Description: This is a 25-year-old female with cystic fibrosis with known chronic occlusion of the SVC requiring multiple ports and PICC lines to maintain venous access. Despite conservative measures, it eventually became impossible to pass the occlusion via guidewire to properly place a PICC line. Sharp recanalization of the SVC occlusion with port placement was scheduled and successfully performed. The SVC was stented due to severe residual stenosis following recanalization and balloon angioplasty. Results: Imaging revealed a significantly enlarged hemiazygos vein and numerous prominent collaterals throughout the mediastinum and chest wall, resulting in the majority of chest venous drainage entering the inferior vena cava. After recanalization, her SVC and port remained patent and functional. Conclusions: For patients with SVC occlusion requiring venous access, a PICC line with the tip placed near the confluence of the brachiocephalic veins may serve as a temporary method for venous access in the presence of extensive collateral flow. However, for long-term access, sharp recanalization of the occlusion should be considered to restore normal laminar blood flow patterns and allow for optimum central venous catheter tip placement at the cavoatrial junction.
Sinus CT Scan Findings in “Sinus Headache” Migraineurs.
Creator
Mehle Mark E; Kremer Patricia S
Publisher
Headache: The Journal of Head & Face Pain
Date
2008
2008-01
Description
Objective.— To evaluate the sinus CT scan findings in “sinus headache” migraineurs, and to compare the findings to nonmigraine “sinus headache” patients. Background.— The majority of patients presenting with “sinus headache” satisfy the International Headache Society (IHS) criteria for migraine headache. Few studies have correlated the rhinologic complaints and computed tomography (CT) findings in these patients. Methods.— Thirty-five patients with “sinus headache” were evaluated prospectively and referred for CT of the paranasal sinuses. The CT scans were assessed for sinus abnormality (recorded as a Lund–Mackay [L-M] score) and were analyzed for concha bullosa and septal deviation. The findings in the migraine cohort were compared with the nonmigraine “sinus headache” patients. Findings.— Twenty-six patients (74.3%) satisfied the IHS criteria for migraine. The mean CT scan L-M score did not differ significantly between the migraine (2.07) and nonmigraine cohort (2.66). Five of the migraine group had substantial sinus disease radiographically (with L-M scores of 5 or above). Concha bullosa of at least 1 middle turbinate was more common in the nonmigraine cohort. An analysis of the sidedness of the headaches, sinus disease, concha bullosa, and/or septal deviation is presented. Conclusions.— The majority of “sinus headache” patients satisfy the IHS criteria for migraine. Surprisingly, these patients often have radiographic sinus disease. This raises the possibility of selection bias in otolaryngology patients, inaccurate diagnosis, or radiographic sinus disease and migraine as comorbid conditions. Positive migraine histories apparently do not obviate the need for a thorough ENT workup, possibly including CT scanning. [ABSTRACT FROM AUTHOR]
Subject
HEADACHE; TOMOGRAPHY; DIAGNOSTIC imaging; MEDICAL radiography; MIGRAINE; PARANASAL sinuses
What do we know about rhinogenic headache? The otolaryngologist's challenge.
Creator
Mehle Mark E
Publisher
Otolaryngologic clinics of North America
Date
2014
2014-04
Description
Sinus headache is a common presenting complaint in the otolaryngology office. Although most patients with this presentation are found to have migraine headache, many do not, and others fail therapy. This review focuses on the current understanding of nonneoplastic rhinogenic headache: headaches that are caused or exacerbated by nasal or paranasal sinus disease or anatomy. The literature regarding this topic is reviewed, along with a review of surgical series seeking to correct these abnormalities and the outcomes obtained with intervention. Suggestions are provided regarding patient diagnosis and management, and options for intervention are reviewed.