A full-term infant with an uncomplicated vaginal delivery presented with absent cry on routine newborn heelstick testing. Neurologic examination revealed paraplegia, absent reflexes, and a T4 sensory level. Spinal MRI showed an expansive, gadolinium-enhancing intramedullary mass from T2 to the thecal sac (figure, A and B). Biopsy confirmed a diagnosis of cellular schwannoma, WHO grade 1 (figure, C). Genetic and immunohistochemical testing for NF-2 and schwannomatosis were negative. Cases of focal intramedullary schwannoma have been rarely reported. 1,2 This congenital, extensive intramedullary schwannoma highlights the diversity of low-grade neonatal spinal neoplasms, obviating initiation of therapy until pathologic diagnosis is achieved.

We describe the inadvertent cannulation of the proximal descending thoracic aortic stent with a five French sheath during attempted pacemaker placement in an 88- year-old male. The injury was managed successfully by the percutaneous placement of a thoracic aortic stent graft with good outcome. Our case highlights the feasibility of managing this uncommon injury with this technique.

Objectives The increase in endovascular aortic aneurysm repair has led to increasing incidence of aortic endograft infections. Additionally, more atypical organisms are being identified as pathogens. We report on a rare aortic endograft infection to further characterize and understand these infections. Methods We report a Clostridium difficile culture–positive aortic endograft infection in an 82-year-old male 3 years after endovascular abdominal aortic aneurysm repair. Results The patient underwent successful open, complete explant of his endograft and in-situ repair using a rifampin-soaked Dacron graft. He continues to do well. Conclusions Aortic endograft infections are a complex problem further complicated by rare and virulent infections. Unless the patient is at prohibitive risk, the management of infected aortic endografts is surgical graft explant and in-situ or extra-anatomic reconstruction due to the exceedingly high mortality rate with non-operative management.

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