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We report a case of a 77-year-old female with purulent chondritis of the thyroid cartilage who was initially referred for laryngeal neoplasm. Purulent chondritis of the laryngeal cartilage is a rare entity with three reports in the literature. The unique CT imaging features of expansile laryngeal cartilage with peripheral rim enhancement and central fluid-attenuation correlate to the abscess formation between the inner and outer perichondria. The correct imaging assessment prompts surgical management and avoid misdiagnosis.

Background: Collateral flow and early ischemic changes on CT are pivotal determinants of outcome in patients with large artery occlusion (LAO). Evolution of stroke occurs during inter-facility transfer. We sought to evaluate the association between collaterals and stroke evolution measured by ASPECTS decay and the relationship of these imaging findings with patient outcomes. Methods: In a cross-sectional multicenter study, we evaluated 313 transferred patients with AIS and LAO (MCA or ICA) from 01/08-04/14. The collateral score (CS) (Figure 1) and ASPECTS were measured. Good collaterals were defined as scores 2-3 (poor; scores 0-1). ASPECTS decay was defined as dichotomized deterioration in ASPECTS from good (8-10) to bad (0-7) during transfer. ASPECTS was also analyzed as an ordinal variable. Logistic regression and mediation analyses were performed to evaluate the association between the collaterals, ASPECTS and patients good and poor (mRS 0-2 and 4-6, respectively) outcomes. Results: Table 1 depicts baseline characteristics. Patients with poor CS had greater odds of ASPECTS decay during transfer (OR 13.4, 95%CI 7.5-24, p Conclusion: Our cohort shows that stroke evolution is determined by transfer time and collateral flow, which are pivotal determinants of clinical outcome in patients with AIS and LAO.

Background: Intra-arterial therapy (IAT) is an approach to promote recanalization in acute ischemic stroke (AIS) patients. While IAT continues to go through further evaluation in multiple phase III trials using new devices and focusing on time improvement, patients with LAO continue to be treated with IAT. Multiple clinical, radiographic and time factors go into vascular neurologists’ decisions whether to pursue IAT or not. We aimed to evaluate factors affecting determination of IAT for stroke amongst patients transferred to tertiary centers. Methods: A US multicenter retrospective cohort analysis was conducted on 313 consecutive transferred patients who met vessel criteria from 01/08-4/14. Collateral were measured by the collateral score (CS). ASPECTS decay was defined as a change from good (8-10) to poor (0-7) scores between center CT scans. IAT patients were compared with no IAT patients with regard to factors predictive of IAT. Results: Table 1 shows baseline characteristics of the two groups. Age was not a predictor of IAT. NIHSS was associated with IAT, but was not a predictor of IAT. For each escalating point on CS, the odds of IAT increased more than 4 times (OR 4.27, 95% CI 2.86-7.87, p Conclusions: Infarction evolution measured by ASPECTS decay, collaterals status and time from stroke ictus are all major determinants of the vascular neurologist decision whether to proceed with IAT. Our findings further support the time-sensitivity of the process for transferring candidates for IAT.