Dysphagia lusoria is a congenital abnormality characterized by an aberrant right subclavian artery. It often presents as either an incidental finding on imaging or chronic dysphagia. We describe the case of a 66-yearold female who presented with severe chest pain, worse with swallowing, along with an ongoing globus sensation. She was found to have a negative cardiac workup for ischemia with a subsequent computed tomography angiogram (CTA) of the chest showing an abnormal right subclavian artery. We emphasize the unique diagnostic approach of this rare anatomical anomaly and its potential presentation that worsens with deglutition.

BackgroundTechnology can extend Infection Disease Consultants (IDCs) into resource limited small community US hospitals. We compared in-person infectious disease (ID) consults with Tele-ID consults to determine whether length of stay, antibiotic usage, drug cost, or readmission rates will remain the same between both groups over a 3-month period.MethodsUniversity of Maryland Harford Memorial Hospital (UM-HMH) is a 95-bed hospital including a 6-bed ICU. From May to August 2017 (study period) there was no IDC at UM-HMH. During study period, IDCs from a regional UM hospital provided formal Tele-ID consults through an HIPAA compliant secured Skype Business account. Patient history and wound examination were done by the IDC via video monitor while a bedside nurse assisted in performing the physical examination. Laboratory and radiological data were reviewed in real time as both hospitals shared the same electronic medical record and IT infrastructure (Meditech 6.15). A formal consultation was dictated and computer orders were entered by the IDC within 24 hours of the consult request. Daily Tele-ID follow-up rounds were conducted. IDCs had the authority to transfer a patient to the regional hospital for in-person care if deemed necessary. Study period was compared with a baseline period (May–August 2016) when IDCs were providing in-person consults at UM-HMH.ResultsBaseline period had 148 inpatient stays and study period had 148 inpatient stays. Despite similar case mix index in both groups, there was no statistical difference between the clinical outcomes. Results are shown in Table 1.Baseline PeriodStudy Period P valuePatients (n)148148–Average length of stay6.77.10.54Case mix index1.161.230.46Average days on antibiotics5.96.20.47Average drug cost$484$4960.85Readmission %22.217.80.38Deaths331ConclusionTele-ID at our hospitals was noninferior to in-person ID consults. An integrated computer system, nursing support, and daily follow-up are key components of a successful Tele-ID program.Disclosures All authors: No reported disclosures.

No abstract

Silicone implant-induced hypercalcemia is a rather rare pathological entity. There are only a few published reports on the topic. Here, we have reported a case of acute kidney injury in the background of hypercalcemia and elevated vitamin D level in a transgender patient with a history of silicone injections in the breast and buttocks for cosmetic purposes.