Catheter-Directed Fibrinolysis of Submassive Pulmonary Embolism After IVC Filter Migration to Renal Veins

A 76-year-old male presented with a submassive pulmonary embolism despite having an inferior vena cava (IVC) filter. Imaging demonstrated pulmonary artery emboli and a deep vein thrombosis in the left common femoral vein. Venography revealed the IVC filter with struts extending into the left and right renal veins. A new IVC filter was deployed below the prior filter. This case demonstrates IVC filter migration complicated by a submassive pulmonary embolism.

Delayed onset nodules from liquid injectable silicone: report of a case, evaluation of associated histopathology and results of treatment with minocycline and celocoxib

Although liquid injectable silicone is safe for the majority of patients treated, there are a few individuals for whom this treatment has been problematic. The problems that arise include migration and granuloma formation. In some instances the granulomas may arise years after the injections. Treatment of these granulomas typically involves the use of steroids. However, the complications associated with long-term steroid usage, as well as the limited efficacy in some patients, have prompted clinicians to seek alternative treatments. This article presents the case of a woman who had delayed granuloma formation to liquid injectable silicone treated with a combination of minocycline and celocoxib. The histology of this case, as well as potential mechanisms of action for the treatment, are also presented.

Komplikationen nach Faltenunterspritzung und ihre Behandlung

All dermal fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of these risks and be prepared to accept them. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., the implantation of a long-lasting filler substance was too superficial). Such adverse events can be treated with intradermal 5-fluorouracil and steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunological phenomena such as late-onset allergy and non-allergic foreign body granulomas. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions should remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granulomas in the subcutaneous fat.

Fungal Keratitis Caused by Paecilomyces lilacinus Associated With a Retained Intracorneal Hair

OBJECTIVE

To report a case of fungal keratitis caused by Paecilomyces lilacinus (P. lilacinus) associated with a retained intracorneal hair.

METHODS

A 61-year-old man developed pain, decreased vision, hyperemia, and corneal infiltrates in his right eye without any predisposing factor. An intracorneal hair had migrated superiorly in the corneal stroma, giving rise to 3 separate stromal infiltrates. The patient demonstrated a waxing and waning course over several months despite antimicrobial and steroid therapy.

RESULTS

Histopathologic examination of a corneal biopsy specimen disclosed the presence of fungal elements, and intensive antifungal therapy was initiated. Verticillium sp. was initially identified as the causative organism, but after failure to improve on topical natamycin, subsequent investigations demonstrated the pathogen to be P. lilacinus that was resistant to routine antifungal agents. The patient was then initiated on systemic voriconazole and terbinafine. He responded well to treatment and ultimately recovered a best-corrected visual acuity of 6/15 in the affected eye.

CONCLUSION

This is the first case of P. lilacinus keratitis associated with a retained intracorneal hair. Hair in the cornea could be a predisposing factor for this infection. Early corneal biopsy should be considered to properly diagnose and manage atypical keratitis and to prevent further complications.

BB embolus causing monocular blindness in a 9-year-old boy

PURPOSE

To report a case of monocular blindness resulting from intravascular bullet migration.

DESIGN

Observational case report.

METHODS

A 9-year-old boy presented to the emergency room with a penetrating BB gun injury to the chest.

RESULTS

Carotid angiography localized the bullet to the right internal carotid artery. He subsequently suffered blindness in the right eye, a right pupil-involving third nerve palsy, left hemiparesis, and a probable left homonymous hemianopia.

CONCLUSION

BB gun injuries may result in devastating ophthalmologic as well as systemic consequences due to bullet embolization.

Chromatic visual phenomenon caused by a subluxed intraocular lens

A 74-year-old man developed an unusual chromatic aberration as a complication of cataract extraction surgery with posterior chamber intraocular lens implantation. The patient could see the location and color of one of the haptics of the dislocated lens. His symptoms resolved with miotic therapy.