Background Management of thoracic vascular injury predominantly focuses on the aorta and its tributaries while reports of venous injury are less frequent. Although rare, traumatic azygous vein injuries are associated with high mortality. Prompt treatment is required and has traditionally been open surgery. We present a case of an endovascular repair of an azygous vein injury. Case presentation A female patient presented to our trauma center following ejection after a motor vehicle collision (MVC). CT imaging workup revealed mediastinal and periaortic hematoma with active contrast extravasation adjacent to the azygos vein. She was referred to interventional radiology for vascular evaluation and potential endovascular intervention. The patient met criteria for class III hypovolemic shock upon arrival in the endovascular suite. Aortography demonstrated no arterial injury. Venography revealed a pseudoaneurysm on the superior aspect of the azygos arch and contrast extravasation from the inferior margin of the azygous arch. A stent-graft was deployed and post-deployment venogram showed no extravasation and successful exclusion of the injuries. The patient did not have further signs of bleeding. She left the interventional suite with improved vital signs, yet her condition remained guarded. Follow-up CT chest confirmed continued patency of the stent-graft at 8 days and 2 years post-procedure. Conclusion Historically, azygos vein injuries are a rare occurrence and managed with open surgery. Swift management is necessary to prevent the increased morbidity and mortality associated with azygous vein injury, particularly in polytrauma patients such as the one presented here. We believe endovascular stent-graft treatment offers an innovative alternative to the current standard of operative management of azygos vein injury.

No abstract

No abstract

Cylindromas are a rare benign pathology that can manifest as multiple lesions on a patient’s scalp. Standard of care is resection of lesions. We report a case of a 74-year-old man with a known diagnosis of Brooke-Spiegler syndrome which is a genetic syndrome that results in multiple recurrent cylindromas. He had approximately 70 prior resections to remove recurrent lesions with multiple grafts. After a large scalp recurrence, with multiple satellite areas, he preferred radiation to the largest site for no-surgical management. After an excellent clinical response, this led to him electing for total scalp irradiation to the remaining sites. He now has a complete response to all remaining sites.

No abstract