Spontaneous perforation of cervical oesophagus: a rare variant of Boerhaave's syndrome

2009 ◽  
Vol 123 (12) ◽  
pp. 1378-1380 ◽  
Author(s):  
S Mittal ◽  
A Rohatgi ◽  
R P Sutcliffe ◽  
A Botha
Keyword(s):  
Vocal Folds ◽  
Sudden Onset ◽  
Water Soluble ◽  
Uneventful Recovery ◽  
Oesophageal Perforation ◽  
Nasogastric Feeding ◽  
Computed Tomography Scanning ◽  
Difficulty Breathing ◽  
The Right ◽  
False Vocal

AbstractBackground:A 29-year-old man presented with sudden onset of severe pain in his throat, difficulty breathing and a hoarse voice, following an episode of vomiting.Investigations:Initial laboratory tests were normal. The patient underwent fibre-optic nasendoscopy, which demonstrated a haematoma in the piriform fossa. Lateral neck radiography and subsequent computed tomography scanning confirmed a 2 cm, loculated, gas-containing collection at the level of the vallecula in the right posterolateral wall, extending to the false vocal folds and communicating between the right parapharyngeal space and the right carotid sheath. Water-soluble contrast swallow confirmed the diagnosis.Diagnosis:Contained oesophageal perforation.Management:Conservative treatment was adopted involving nil orally, intravenous antibiotics and nasogastric feeding. The patient made an uneventful recovery.

Rhabdomyoma of the Larynx: Case Report and Clinical and Pathologic Review

2005 ◽  
Vol 84 (7) ◽  
pp. 437-440 ◽  
Author(s):  
Agata K. Brys ◽  
Osamu Sakai ◽  
Jaimie DeRosa ◽  
Stanley M. Shapshay
Keyword(s):  
Case Report ◽  
Vocal Folds ◽  
Radiologic Findings ◽  
The Right ◽  
False Vocal

We describe a case involving a 79-year-old man with symptoms of slowly progressive hoarseness resulting from a rhabdomyoma originating deep to the right true and false vocal folds. We also review the pathology and radiologic findings of rhabdomyoma.

scholarly journals 1457 Subcutaneous Emphysema in Adolescents: A Trap for The Unwary

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Sharma ◽  
R Stoner ◽  
N Fazili ◽  
J Watfah
Keyword(s):  
Subcutaneous Emphysema ◽  
Trauma Surgery ◽  
Underlying Mechanism ◽  
Sudden Onset ◽  
Water Soluble ◽  
Oesophageal Perforation ◽  
Management Approach ◽  
Caucasian Girl ◽  
Water Soluble Contrast ◽  
Great Vessels

Abstract A 16-year-old, Caucasian girl presented with sudden-onset pleuritic chest pain (CP), vomiting and shortness of breath. Nil past medical history; nil medications; nil trauma/ surgery. She was tachycardic, tachypnoeic and apyrexial with oxygen saturations >96% on air. There was significant right-sided facial and neck swelling. Chest palpation demonstrated crepitations suggesting subcutaneous emphysema (SE). Urinalysis was negative. Laboratory tests revealed leucocytosis and neutrophilia. Chest X-Ray: SE. CT Thorax: extensive gas within mediastinal cavity tracking along great vessels and within subcutaneous tissues with left, apical pneumothorax. Two air-filled tracts communicating between oesophagus and mediastinal cavity, ∼2cm from gastro-oesophageal junction, indicated oesophageal rupture. Conservative management included IV Fluids, antibiotics and feeding via total parenteral nutrition. After 1-week, oral water-soluble-contrast was administered. Subsequent imaging showed no evidence of extra-luminal extravasation and she was discharged. At 4-week follow-up, normal dietary intake was re-established with no complications. Discussion Boerhaave’s syndrome (BS) (described by Dutch physician Herman Boerhaave in 1724) is the phenomenon of spontaneous oesophageal perforation. The underlying mechanism is due to a sudden rise in intra-luminal pressure against a closed glottis resulting in barotrauma. BS in adolescents remains a rare entity with a paucity of reported cases. Mackler’s triad describes the classical presentation comprising vomiting, CP and SE. Non-specific presentation may delay diagnosis and a high clinical index of suspicion is required. CT thorax and water-soluble-contrast studies are diagnostic. Timing of presentation, complications and haemodynamic status dictate conservative or surgical management approach. BS carries a 20-40% mortality, and must be included in differential diagnoses of adolescents presenting with vomiting and CP.

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

2014 ◽  
Vol 17 (4) ◽  
pp. 196
Author(s):  
Erhan Kaya ◽  
Halit Yerebakan ◽  
Daniel Spielman ◽  
Omer Isik ◽  
Cevat Yakut
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Type A ◽  
Sudden Onset ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
The Right

Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

scholarly journals An incidental finding of testicular seminoma in the context of acute pulmonary embolism: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kaitlin J. Mayne ◽  
Emma Lewis ◽  
Lewis Vickers
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Guidelines ◽  
Acute Pulmonary Embolism ◽  
Incidental Finding ◽  
White Male ◽  
Vena Cava ◽  
Testicular Seminoma ◽  
Computed Tomography Scanning ◽  
The Right

Abstract Background Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient. Case presentation A 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy. Conclusions This case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”

scholarly journals Myopic Simple Hemorrhage Presenting as Radial Hemorrhage in Henle’s Fiber Layer

2021 ◽  
pp. 446-450
Author(s):  
Marco Mazzola ◽  
Laura Premoli ◽  
Cristian Metrangolo ◽  
Jennifer Cattaneo ◽  
Elias Premi ◽  
...  
Keyword(s):  
High Myopia ◽  
Sudden Onset ◽  
Fiber Layer ◽  
Characteristic Finding ◽  
Macular Telangiectasia ◽  
Complete Restoration ◽  
Retinal Capillary ◽  
Capillary Plexus ◽  
Specific Sign ◽  
The Right

This case report describes a simple hemorrhage (SH) presenting as radial hemorrhage in Henle’s fiber layer (HFL) in a patient with high myopia. A 26-year-old girl with high myopia was referred to our center for sudden onset of decreased vision and a central scotoma in the right eye (OD). Best corrected visual acuity (BCVA) was 20/100 OD. Fundus examination showed a stellate intraretinal hemorrhage in the fovea of the OD. The hemorrhage was organized in a peculiar petaloid pattern with feathery distal edges, suggesting localization within the radially oriented HFL. The presence of both choroidal neovascularization and microvascular abnormalities consistent with macular telangiectasia type 2 (MacTel 2) were excluded. Based on these findings, a diagnosis of myopic SH was made. At 4-month follow-up BCVA OD spontaneously improved to 20/40, without any treatment been ever administered to the patient. Spectral-domain optical coherence tomography OD showed reabsorption of the hemorrhage and almost complete restoration of the foveal architecture. The intraretinal location and spread of the hemorrhage into the HFL in our patient are an unusual presentation of SH, which vividly highlights the anatomy of the fovea. Since fibers in HFL are quite delicate and loosely arranged, this layer is very susceptible to deposition of transudates, exudates, hemorrhage, and other products. Radial hemorrhage in HFL has been originally reported in 4 patients as complication of MacTel 2. It has been previously postulated that it may represent a characteristic finding in MacTel 2 that may develop as a result of microvascular abnormalities of the deep retinal capillary plexus. On the contrary, our data suggest that radial hemorrhage in the HFL does not represent a characteristic finding of MacTel 2, but must rather be considered a non-specific sign with multiple possible etiologies.

Jam processing: Effect of pectin replacement by locust bean gum on its characteristics

2020 ◽  
pp. 1-12
Author(s):  
Aida Mekhoukhe ◽  
Nacer Mohellebi ◽  
Tayeb Mohellebi ◽  
Leila Deflaoui-Abdelfettah ◽  
Sonia Medouni-Adrar ◽  
...  
Keyword(s):  
Cold Water ◽  
Physicochemical Characteristics ◽  
Water Soluble ◽  
Sensory Profile ◽  
Locust Bean Gum ◽  
Locust Bean ◽  
Preference Map ◽  
The Right ◽  
High Level ◽  
The Impact

OBJECTIVE: the present work proposed to extract Locust Bean Gum (LBG) from Algerian carob fruits, evaluate physicochemical and rheological properties (solubility). It aimed also to develop different formulations of strawberry jams with a mixture of LBG and pectin in order to obtain a product with a high sensory acceptance. METHODS: the physicochemical characteristics of LBG were assessed. The impact of temperature on solubility was also studied. The physical and the sensory profile and acceptance of five Jams were evaluated. RESULTS: composition results revealed that LBG presented a high level of carbohydrate but low concentrations of fat and ash. The LBG was partially cold-water-soluble (∼62% at 25°C) and needed heating to reach a higher solubility value (∼89% at 80 °C). Overall, the sensorial acceptances decreased in jams J3 which was formulated with 100% pectin and commercial one (J5). The external preference map explained that most consumers were located to the right side of the map providing evidence that most samples appreciated were J4 and J2 (rate of 80–100%). CONCLUSION: In this investigation, the LBG was used successfully in the strawberry jam’s formulation.

Kawasaki disease complicated by cerebral infarction

2003 ◽  
Vol 13 (1) ◽  
pp. 103-105 ◽  
Author(s):  
Kenji Suda ◽  
Masahiko Matsumura ◽  
Shigeru Ohta
Keyword(s):  
Kawasaki Disease ◽  
Cerebral Infarction ◽  
Clinical Situation ◽  
Sudden Onset ◽  
X Ray ◽  
Coronary Aneurysms ◽  
Intracoronary Thrombolysis ◽  
Tissue Plasminogen ◽  
X Ray Computed ◽  
The Right

An 8-month-old boy presented with right hemiplegia of sudden onset after 20 days of Kawasaki disease, which was not initially treated by gamma globulin. Cranial X-ray computed tomography confirmed cerebral infarction as the cause of the right hemiplegia. In subsequent weeks, he developed multiple thromboses in coronary aneurysms. He successfully underwent intracoronary thrombolysis using tissue plasminogen activator without haemorrhagic complications. Cerebral infarction as a complication of Kawasaki disease is rare, and is a difficult clinical situation to manage.

Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Open Medicine ◽  
2011 ◽  
Vol 6 (5) ◽  
pp. 631-633
Author(s):  
Yoshiro Horai ◽  
Tomoya Miyamura ◽  
Karin Shimada ◽  
Soichiro Takahama ◽  
Rumi Minami ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Microscopic Polyangiitis ◽  
Oral Prednisolone ◽  
Sudden Onset ◽  
High Dose ◽  
Pulse Steroid Therapy ◽  
Ocular Manifestations ◽  
Dose Oral ◽  
The Right ◽  
Pulse Steroid

AbstractWe report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur.

Difficulty removing dialysis cuff catheter after its adhesion to the right atrium

2021 ◽  
pp. 112972982199398
Author(s):  
Tomonari Ogawa ◽  
Megumi Inamura ◽  
Yuichiro Kawai ◽  
Ryo Yamamoto ◽  
Kunihiko Yasuda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Right Atrium ◽  
Interventional Therapy ◽  
Dialysis Treatment ◽  
Japanese Female ◽  
Difficulty Breathing ◽  
Elderly Japanese ◽  
One Year ◽  
The Right ◽  
Clinic Hospital

We describe the case of an elderly Japanese female who had experienced diabetic nephropathy since the year 20xx and had been undergoing dialysis treatment while receiving vascular access interventional therapy (VAIVT) for arteriovenous fistula (AVF) occlusion. The patient visited the clinic/hospital in 20xx+10 with the AVF occlusion; emergency VAIVT was performed but blood flow could not be resumed. The patient was not admitted and was treated as an outpatient, and thus a cuff catheter (Split stream catheter: SST28 cm, Medcomp) was inserted. An infection developed and was successfully treated with antibiotics. The dialysis treatment continued without issue. One year after the cuff catheter’s insertion, the patient was admitted due difficulty breathing. Despite continued dialysis treatment with the catheter, the patient died 15 days post-admission. The removal of the catheter proved to be difficult. An autopsy was approved, and the area around the catheter was examined. The adhesion of the catheter to the right atrium was observed, but no infection was detected in the bloodstream. This case illustrates that dialysis with the use of a cuff catheter can be effective.

HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

2021 ◽  
pp. 58-59
Author(s):  
Jayanta Sarkar ◽  
Mini Sengupta
Keyword(s):  
Ectopic Pregnancy ◽  
Abdominal Cavity ◽  
Lower Abdominal Pain ◽  
Cardiac Activity ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Short Period ◽  
The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

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