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The purpose of this report is to describe via a case example an efficient mechanical thrombectomy technique for hemodialysis access thrombosis using the InThrill Thrombectomy System (Inari Medical, Irvine, CA). A man in his late 60s with end-stage renal disease and a thrombosed femoral arteriovenous graft (AVG) underwent a thrombectomy procedure to remove all thrombotic material including the arterial plug and restore use of the graft for hemodialysis. The InThrill Thrombectomy System used in this procedure consists of a mechanical thrombectomy catheter with a wall-apposing coring element and a sheath with a retractable funnel and aspiration port. The technique starts with gaining wire and sheath access towards the venous outflow. The InThrill Thrombectomy catheter is deployed proximal to the sheath to sequentially remove small segments of thrombus thus avoiding sheath obstruction. A locking syringe is used for rapid aspiration, reducing or eliminating the need to remove the InThrill sheath with every mechanical thrombectomy pass. Finally, the arterial plug is pulled using a Fogarty balloon sheath (Edwards Lifesciences, Irvine, CA) and extracted using the InThrill catheter, removing what may be the nidus for recurrent AV access thrombosis. The technique described here provided a means to remove all thrombotic material including the arterial plug in a planned, sequential manner, without the need for thrombolytics. Patency was restored to the patient's femoral AVG within 60 minutes, and hemodialysis resumed shortly thereafter. Further studies are needed to support long-term efficacy of this thrombolytic-free treatment option.

Tumor-to-tumor metastasis is a rare event with meningioma as the recipient tumor accounting for 20% of the reported cases. The most common primary cancers showing this phenomenon are lung and breast cancer. Most lung cancers metastasizing to a meningioma are due to lung adenocarcinoma with the literature containing only 3 prior reports of small-cell lung cancer showing this pattern of spread. Herein, we present the case of a 67-year-old-patient with small-cell lung cancer that developed a metastasis to a meningioma.

Pulmonary arterial dissection (PAD) is a rare and often lethal complication of chronic pulmonary arterial hypertension (PAH), which may occurs in patients with idiopathic pulmonary arterial hypertension (IPAH) and potentially in those with connective tissue disorders. While rare, sudden death often occurs secondary to acute cardiac tamponade, as the pulmonary artery dissects into the pericardium; this diagnosis is often made postmortem. Nevertheless, with the proliferation of multidetector computed tomography (MDCT) as a diagnostic test, patients may be identified very early after symptom onset, prompting rapid intervention with decreased morbidity and mortality. We report a case of IPAH complicated by pulmonary artery aneurysm (PAA) and PAD, diagnosed by CT pulmonary angiogram (CTPA), and treated with bilateral lung transplantation, pulmonic valve replacement, and re-anastomosis of the donor main PA to a pulmonary valve conduit.

Primary esophageal lymphoma is extremely rare, with fewer than 30 cases reported in the literature. Presentation is nonspecific with multiple radiological and endoscopic appearances, posing its diagnosis a challenge. We report a case of a primary esophageal lymphoma diagnosed by endoscopic ultrasound-fine needle aspiration in a 68-year-old woman referred to our hospital for evaluation of a submucosal tumor spreading all over the esophageal wall. We describe its clinical and imaging features and stand out the importance of having a specific preoperatory diagnosis in order to avoid a major surgery.

Small bowel obstruction secondary to adhesions is a recognized complication of Caesarian section. However, obstruction due to small bowel volvulus caused by adhesions at the Caesarian-section scar has not been reported. We report such a case identified on computed tomography. We review the literature on small bowel volvulus in pregnant patients and discuss the computed tomography findings.