Aims Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients. Cite this article: Bone Jt Open 2022;3(11):859–866.

A primary aortic mural thrombus (PAMT) is defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysmal disease of the aorta or any cardiac source of embolus. It is a rare entity that has high morbidity and mortality. There is no consensus on the ideal treatment of PAMT. The objective of this paper is to review the possibilities for treatment of mobile abdominal aortic mural thrombus. Endovascular therapy and open surgery appear to be the best options for treatment of mobile abdominal aortic mural thrombus. Thus, in patients with favorable anatomy, endovascular therapy is probably the treatment choice, while in those with unfavorable anatomy, open surgery is probably the best option for treatment of a mobile abdominal aortic thrombus. It is important to emphasize that anticoagulation alone can be used as a non-aggressive option and, if this fails, endovascular or surgical methods can then be employed.

Primary aortic mural thrombus (PAMT) is defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysmal disease in the aorta and a cardiac source of embolus. There is no consensus on the ideal treatment of PAMT. There are a few reports of thromboaspiration of aortic thrombus in literature. The objective of this article is to report a new endovascular approach of abdominal aortic mural thrombus. The use of Penumbra Thromboaspiration System is a feasible procedure to treat abdominal aortic thrombus and may be an option for patients unsuitable for open repair or conservative treatment.

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Myiasis is a dermatosis resulting from flies’ larvae infestation in animal and human tissues. More prevalent in subtropical and tropical countries, it is related to lower social and economic levels. The fly species that can cause this pathology are Cordylobia anthropophaga, Cochliomyia hominivorax, and Dermatobia hominis. The infestation happens after eggs are deposited in a disrupted tissue or by an orifice caused by a fly sting and attacks cutaneous and mucous membranes in many body regions, including the breast. There is no person-to-person transmission. The larvae feed on the injured tissue, leading to pain and tissue destruction. The abscesses, tuberculosis, and inflammatory sebaceous cysts are clinical conditions to be ruled out in differential diagnosis. An abscess is the most common inflammatory breast condition, presenting with pain, erythema, and local heating. A cold abscess may lead to the suspicion of mycobacteria infection, mostly in lactating women. Otherwise, sebaceous cysts when inflamed may look like an abscess, but will not have fluctuation signs, and an ultrasound (US) image will help the diagnosis. The diagnosis is clinical and done by observing moving larvae or by US showing a well-defined lesion, with high echogenicity, and the presence of larvae. The best treatment option is manual larvae extraction, associated or not with paste vaseline or mineral oil covering the affected area, which causes larvae immobilization and asphyxia. The ideal treatment is to remove the larvae intact, because maceration leads to the release of irritating substances into the surrounding tissue. Surgery is not a good option. It is useful to prescribe an antibiotic regimen to treat or prevent infections. This case report allows the conclusion that myiasis is an uncommon breast pathology and sometimes may be ignored in the clinical setting. For this reason, its presence must always be taken into consideration in the differential diagnosis of breast diseases in certain groups of patients coming from at-risk areas. A 56-yearold white female, obese, with low social and economic conditions, came to a public health outpatient clinic complaining of increasing volume, hardening, and skin alterations in the right breast (hyperemia and skin thickening) in the past 10 years. No investigation was done during this long period, but the symptoms worsened in the past 6 months and severe pain was reported by the patient. She was referred to a specialized center and a bilateral mammogram revealed an extensive asymmetry in the upper outer quadrant of the right breast with architectural distortion associated with uncountable atypical calcifications and diffuse dermal thickening, classified as BIRADS 5. Physical examination revealed the presence of bilateral, enlarged, suspected axillary lymph nodes. The patient underwent breast core biopsy that resulted in invasive breast cancer of nonspecial histologic type, Nottingham grade 3, molecular type luminal B (RE 20%, RP 30%, negative HER-2, and KI-67 60%/cells). After being staged with radiologic examinations, she was found with multiple bone metastases in the thoracic and lumbar bodies, as well as a lytic lesion in the left iliac wing. She started treatment with the oncology team using hormone therapy plus Zoledronic Acid plus chemotherapy. One month after beginning therapy, she went to an emergency unit presenting cavitations and dimpling in the right breast, associated with bullous lesions, necrosis, and bad smell. Physical examination demonstrated live moving larvae over the necrotic tissue, confirming the diagnosis of breast myiasis associated with a stage IV breast carcinoma.