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In burned patients, inhalation injury can result in progressive pulmonary dysfunction, infection, and death. Although bronchoscopy is the standard for diagnosis, it only assesses the proximal airway and does not provide a comprehensive analysis of pulmonary insult. Chest radiographs have not been proven helpful in diagnosis of inhalation injury. Our hypothesis is that a CT scan alone or in conjunction with bronchoscopy can be used as a prognostic tool for critically ill burn patients, especially those with inhalation injury. The authors performed a retrospective study of all patients admitted to the U.S. Army Institute of Surgical Research Burn Center between 2002 and 2008 with chest CT within 24 hours of admission. They divided subjects into two groups, those with evidence of inhalation injury on bronchoscopy and those without. They used a radiologist's score to assess the degree of damage to the pulmonary parenchyma. The primary endpoint was a composite of pneumonia, acute lung injury/acute respiratory distress syndrome, and death. The inhalation injury group consisted of 25 patients and the noninhalation injury group of 19 patients. Groups were not different in age, TBSA burned, and percentage full-thickness burn. By multiple logistic regression, detection of inhalation injury on bronchoscopy was associated with an 8.3-fold increase in the composite endpoint. The combination of inhalation injury on bronchoscopy and a high radiologist's score was associated with a 12.7-fold increase in the incidence of the composite endpoint. Admission CT assists in predicting future lung dysfunction in burn patients.

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We report a 36-year-old man who presented with unilateral flank pain caused by renal artery occlusion with ischemia and infarction from septic emboli secondary to bacterial endocarditis. We treated the occlusion with a novel rinsing and aspiration device, the Rinspirator Thrombus Removal System (ev3, The presentation of flank pain in younger patients may be secondary to a variety of etiologies such as renal, musculoskeletal, or dermatologic processes, with common causes being renal colic from infection or urolithiasis. Renal ischemia and infarction due to emboli is a rare cause of flank pain. Treatment of acute embolic events to the kidney must proceed rapidly to prevent loss of renal tissue. We present a case of a young man who presented with acute flank pain secondary to septic emboli from bacterial endocarditis with infarction and ischemia of a unilateral kidney. The affected renal artery was revascularized using the Rinspirator Thrombus Removal System (ev3, Plymouth, Minn) device and suction thrombectomy. Institutional Review Board approval was not required for this report.Plymouth CASE REPORTA 36-year-old man presented to a local emergency department complaining of extremity pain and paresthesias, abdominal pain localizing to his right flank, fever, chills, night sweats, nausea, and vomiting. An abdominal computed tomography (CT) scan with contrast demonstrated a striated nephrogram appearance of the right kidney and a normal left kidney (Fig 1). The differential diagnosis included ischemia, infection, or obstruction. The next morning, the patient was transferred to our institution for further evaluation.Laboratory data on admission demonstrated a white blood cell count of 22,100 (reference range, 3.4-9.8ϫ [10] 3 ), creatinine level of 1.5 mg/dL (reference range, 0.7-1.3 mg/dL), measured glomerular filtration rate of 61.9 mL/min (reference range, Ͼ60 mL/min), and a lactate dehydrogenase (LDH) level of 1799 U/L (reference range, 110-213 U/L). A urinalysis demonstrated large amounts of blood, proteinuria, and 1ϩ bacteria per high-power field. Results of blood cultures were negative. Physical examination revealed right flank pain and splinter hemorrhages of the nail beds. Gadolinium-enhanced renal magnetic resonance imaging demonstrated apparent occlusion of the right renal artery and multiple renal infarcts. Heparin therapy was started, and an arteriogram was requested approximately 48 hours after admission.Standard arteriogram risks and treatment options to include thrombectomy and thrombolysis, and alternative surgical options were discussed, and a signed consent was obtained. A nonselective renal arteriogram was performed to delineate the extent of narrowing or occlusion of the right renal artery and possible therapeutic options. The arteriogram demonstrated multiple filling defects in the right renal artery, with antegrade flow and areas of hypoperfusion. The left renal artery appeared normal.The findings were consistent with an embolic source, and treatment was instituted to prevent possible migration an...