Schwannomas are benign tumors arising from the peripheral nerve sheath, commonly occurring in the head, neck, and extensor surfaces of the extremities. They can be associated with neurofibromatosis type II. Our case describes a 48-year-old woman with a 2-week history of a left-sided palpable breast mass. She was referred to radiology, where additional imaging revealed a 1.1-cm mass. A biopsy was performed; histology revealed an intramammary schwannoma. Mammography findings include a well-defined mass without calcification. Ultrasound images have shown hypoechoic, encapsulated, and well-defined lesions without calcification. Histologically, schwannomas reveal alternating Antoni A and Antoni B cellular areas. Schwannomas are also S100-positive on immunohistochemistry. This case is best categorized as a BI-RADS 4A lesions. This case report highlights the importance of both imaging and pathology in the diagnosis of breast neoplasms. Although breast schwannomas are not a common entity, they are an important consideration when evaluating a breast mass.

Extracranial internal carotid artery (EICA) aneurysms make up 1% of peripheral aneurysms and less than 1% of patients who have relapsing polychondritis develop aneurysms. A 39-year-old man with relapsing polychondritis presented with right neck pain. Initial computed tomography angiography demonstrated a 16-mm right EICA aneurysm with growth to 25 mm after 2 months. A right EICA aneurysmectomy, external carotid artery to ICA transposition, and internal jugular vein patch of the common carotid artery was performed with symptom resolution. The inflammatory nature of the underlying disease, aggressive expansion, and symptomatic state warranted open repair and we recommend life-long monitoring given the rarity of this case.

Objective: Critical limb-threatening ischemia (CLTI) of the lower extremity is associated with high rates of morbidity, including amputation and death. Unfortunately, there is a paucity of data related to how periprocedural metrics affect the success of these interventions for CLTI. Perioperative anemia has been shown to affect outcomes in patients suffering from myocardial ischemia. It can be postulated that the same physiologic principles can be applied to CLTI. We hypothesize that perioperative anemia may contribute to a higher risk for amputation in patients receiving interventions for CLTI.Methods: We performed a single-center, retrospective cohort study of patients undergoing procedures for CLTI at The Ohio State University Wexner Medical Center. Patients aged 18 to 100 years with International Classification of Diseases, Ninth Revision or Tenth Revision coding for CLTI of the lower extremities were included. Patients with interventions for claudication or acute limb ischemia were excluded. Demographic data and hemoglobin levels before intervention were obtained. The primary outcome was amputation of the affected limb after intervention. Secondary outcomes included the need for reintervention, 30-day mortality, and 30-day major complication rate. Statistical analyses using univariate and multivariate analysis with logistic regression models were performed to compare amputation rates with these variables.Results: We identified 258 patients undergoing interventions for CLTI between 2006 and 2018. Fifty-nine (22.9%) went on to amputation. Multivariate analysis revealed that patients with hemoglobin levels of <12 g/dL had increased risk of amputation (odds ratio [OR], 2.57; confidence interval [CI], 1.12-5.85; P ¼ .0003). In addition, age >80 years (OR, 0.228; CI, 0.060-0.871; P ¼ .031), nonwhite race (OR, 2.83; CI, 1.32-6.05; P ¼ .007), and male sex (OR, 3.4; CI, 1.61-7.24; P ¼ .001) were identified as risk factors for amputation. Patients without preoperative antiplatelet therapy also had increased risk (OR, 0.31; CI, 0.133-0.697; P ¼ .005).Conclusions: In this study, we showed that periprocedural hemoglobin levels below normal were an independent risk factor for amputation in our cohort of patients. Further prospective studies are indicated to identify whether hemoglobin should be a targeted, adjustable risk factor in patients undergoing interventions for CLTI.

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