Christopher Scott Morris

Ehlers-Danlos syndrome (EDS) refers to a rare group of genetic disorders that makeup part of the connective tissue disorders consortium. It is characterized by clinical features such as skin hyperextensibility, joint hypermobility, and tissue fragility. A vascular subtype (EDS IV) exists, that predisposes affected patients to vascular injury and is well-known and documented. However, other manifestations of EDS IV are less commonly understood and reported. Though spontaneous pneumothorax has been described in several cases, formation of traumatic air cysts/pneumatoceles with little to no inciting factors has not. This can eventually lead to pulmonary hemorrhage or hemopneumothorax. We present a case of spontaneous formation of a traumatic air cyst with ensuing large-volume hemopneumothorax occurring in a time period of under 3 minutes, between pre- and post-contrast-media administration during CT angiography of the chest.

Interventional radiology departments are well qualified to place and maintain tunneled peritoneal dialysis catheters, and image-guided peritoneal dialysis catheter techniques are cost-effective, ex... Interventional radiology (IR) is an underutilized resource for the placement and management of tunneled peritoneal dialysis (PD) catheters, as only about 5% of PD catheters are placed by using IR. ...

Purpose Peritoneal dialysis (PD) catheters function best when residing within the retrovesical space of the peritoneal cavity, but they frequently migrate and fail. A novel variable length and conforming PD catheter weighted anchor to prevent migration has been evaluated.Methods Test devices were placed in normal saline for 21 months. The effluent was periodically measured for heavy metals, including tungsten. The water-tight property of the device was also tested separately. Four cadavers were subjected to three-dimensional imaging and maneuvering to evaluate percutaneous insertion, function, stability within the retrovesical space, and percutaneous retrievability in 10 test devices.Results Liquid leakage was low, with a mean absorbance of the test device effluent saline of 0.015. Mean methylene blue absorbance of the test device was significantly lower than the positive control (p-value = 0.01). Leakage of tungsten from devices made with medical grade Silastic tubing was also low, with a mean of 0.362 mg/L in the effluent saline, compared to a background concentration of 0.166 mg/L. Each test device was successfully inserted into the retrovesical space and retrieved percutaneously and remained completely intact following placement and insertion. No test device migrated as shown on axial cone beam CT imaging. Mean flow times and volumes were satisfactory at 3 minutes and 0.92L, respectively, for all test devices. For all catheters, the mean flow rate was 312 cc/min. No significant difference was found between the pre-roll and post-roll mean flow rates of the test devices (p-value = 0.35).Conclusion This PD catheter weighted anchor showed stability, with minimal leakage of tungsten. All test devices were successfully inserted and retrieved percutaneously, with no damage or migration, and mean flow rates were satisfactory. Further investigation is warranted.

Purpose: To evaluate the use of a dual-chambered venous access port for extracorporeal apheresis therapy. Methods: This was a single-center retrospective analysis of all patients who received a dual-chambered venous access port for apheresis therapy over a 36-month period. Clinical success was defined as successful completion of at least one round of apheresis via the venous access port. Major complications were defined as any event requiring elevation of patient care and/or venous access port removal or repositioning. Minor complications were defined as venous access port issues resolved with clinical intervention. Results: Forty-four patients had a venous access port placed at the time of this study. Patients underwent red cell exchange (n = 33), therapeutic plasma exchange (n = 6) or extracorporeal photopheresis (n = 5). Forty (90%) patients had autoimmune diseases and four (10%) had neoplastic processes. Clinical success was achieved in 42 (95.5%) patients. Average venous access port dwell time was 632 days (range = 42–1191 days). All therapies through the venous access ports were well tolerated and no patients reported pain or discomfort. Major complications were seen in nine (20.5%) patients–the majority (n = 7) of which were due to venous access port malfunction–and resolved with catheter revision. One (2.27%) major complication involved an infected venous access port, and one involved a large hematoma at the venous access port site. Minor complications were seen in eight (18.2%) patients, where simple flushing of the catheter with saline or tissue plasminogen activator resolved the issue. Conclusion: The dual-chambered venous access port was successfully used for sustained blood flow in apheresis therapy with a moderate, yet correctable complication rate.