Asploro Open Access Publications

The COVID-19 Vaccines Can Lead to False Positive Mammograms and Breast MRI. How Can we Decrease the Impact Caused by Post-Vaccination Lymphadenopathy in Breast Cancer and Oncology Patients?

Author(s): Rasha A. Al-Khafaji^*

Abstract

There has been an increase in reporting clinical or radiological axillary lymphadenopathy after the coronavirus disease (COVID-19) vaccination. Cancer care is complex and multidisciplinary, which requires care events to be orchestrated promptly; radiology often serves a key role in diagnosis, post-diagnosis and is sometimes the patient’s first step in cancer care initiation, especially in breast cancer. Radiologists are also a key role in other Multidisciplinary Teams (MDT) dealing with different departments. Therefore, identifying unnecessary management within the health system can generally enhance the patient’s experience, reduce the pressure from providing extra health services, and reduce health costs.

Based on personal observation and previous literature, the author concludes that patients having breast cancer or recent breast cancer diagnosis in the pre- or peri-treatment setting could benefit from receiving a vaccination, if possible, in the anterolateral thigh or contralateral arm regardless if this vaccine is for influenza, HPV, etc. Whether this is applicable for the COVID-19 vaccine remains unanswered. This approach will potentially reduce the patient anxiety from having a recurrence or failure of treatment and decrease the strain of the health care system both functionally and economically. In addition, this approach can potentially reduce or eliminate cancellations, delays, and rescheduling of relevant imaging modalities. Also, the author suggests adding a history of vaccinations to all the imaging request forms; countries with digital health services can reap the benefit of generating extensive epidemiological data of post-vaccination lymphadenopathy. Thus, creating new base-evidence guidelines for managing reactive post-vaccination lymphadenopathy, and potentially avoiding duplicating unnecessary imaging and patient over-treatment.

Palliative Modified Radical Mastectomy to Improve Quality of Life by Decreasing Disease Burden: A Case Report

Author(s): Sohayla Rostami^*, Seth B. Ladd, Linda Stewart, Jackie Battista

Abstract

In cases of advanced pathology, palliative medicine is able to confer a great deal of relief to the patient. In the same light, surgical intervention is able to provide increased quality of life in cases of extensive disease burden, providing palliation where curative measures cannot be achieved. In the case study therein, a patient presents with metastatic breast cancer with a localized fungating mass contributing to severe local and systemic symptomatology. In this setting, invasive management of her disease allowed for clinical improvement of the patient when medical management alone was not sufficient. The patient quickly demonstrated recovery of her symptoms in the post-operative phase when the local disease was resected. The utilization of invasive measures, as seen in this case, further proves the importance of multidisciplinary palliative care where surgical measures are included in patient care.

Renal Infarction and Decreased Splenic Perfusion Secondary to a Left Ventricular Thrombus: A Case Report

Author(s): Sahib Bhatia, Salim Chamoun, Ashwin Sidhu, Muhammad Zafar, Nalin Ranasinghe, Leonard Ranasinghe^*

Abstract

We report a case of a 67-year-old man who presented to urgent care with a one-week history of left-sided abdominal pain and oliguria. Over the past month, he reported feeling fatigued as well as noticed decreased urine output. The patient does have a significant cardiac medical history that includes coronary artery disease with a previous myocardial infarction, reduced ejection fraction, and hypertension. Imaging studies were conducted which revealed the likely etiology of his current symptoms. A transthoracic echocardiogram (TTE) revealed the presence of a large non-mobile apical thrombus occupying most of the apex of the left ventricle. Computed Tomography (CT) confirmed an apical left ventricular thrombus and showed decreased perfusion to the spleen and ischemia/infarction of the left kidney. The patient was initially treated with heparin but subsequently given enoxaparin with bridging to warfarin. He began to feel better with less left flank pain. Although this presentation of an LV thrombus is a rare occurrence, it is important for physicians to consider abdominal pain as a presenting complaint.

A Novel Approach for Removal of an Impacted Extraction Balloon Catheter in Common Bile Duct During ERCP- A Case Report

Author(s): Nauman Idrees^*, Srisha Hebbar, Rakesh Sringeri

Abstract

We describe the case of a 75-year-old female who underwent ERCP for choledocholithiasis. The extraction balloon catheter got impacted at the distal end of a common bile duct (CBD) during attempted stone extraction. Multiple attempts by 2 different ERCP experts to remove the balloon catheter proved unsuccessful. At the time the procedure was carried out, Spyglass Cholangioscopy was not available in the hospital. The balloon catheter was cut outside the channel of scope and used as a nasobiliary drain after an oro-nasal conversion. On repeat ERCP, a few days later, the extraction balloon catheter had fallen out spontaneously into the duodenum. The common bile duct was re-cannulated and stone was successfully removed. This is only the second case report of an impacted extraction balloon catheter in CBD.