scholarly journals Traumatic pseudoaneurysm of the cavernous carotid: a lethal complication of craniofacial trauma

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Omar Ahmed ◽  
Sara Mahmood ◽  
Youssef Aladham ◽  
Moustafa Mohamed Abdelnaby
Keyword(s):  
Early Recognition ◽  
Endovascular Coiling ◽  
Carotid Angiography ◽  
Oculomotor Palsy ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Traumatic Pseudoaneurysm ◽  
Craniofacial Trauma ◽  
Cavernous Carotid Artery

Abstract Pseudoaneurysm of the cavernous carotid artery is a rare, yet life-threatening complication of craniofacial trauma. It may well present itself with delayed massive epistaxis up to several months after the initial insult. Early recognition and prompt treatment are the key in management and a high index of clinical suspicion is always required. In this article, we report a patient with a penetrating head injury who developed delayed epistaxis along with unilateral abducent and partial oculomotor palsy. Urgent diagnostic carotid angiography was undertaken, followed by endovascular coiling that resulted in no recurrence for a year of follow-up.

Postpartum ovarian vein thrombosis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kelly Ribeiro ◽  
Samir Mahboobani ◽  
Katherine Van Ree ◽  
Katy Clifford ◽  
TG Teoh
Keyword(s):  
Abdominal Pain ◽  
Complete Resolution ◽  
Early Recognition ◽  
Ovarian Vein ◽  
Transabdominal Ultrasound ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Ovarian Vein Thrombosis

Abstract Objectives Postpartum ovarian vein thrombosis (POVT) is a rare pathology that can lead to severe complications such as sepsis, extension of the thrombus leading to organ failure, and pulmonary embolism. It therefore requires early recognition and prompt treatment. Case presentation A patient with right POVT presented four days after delivery with acute right-sided abdominal pain and fever. Appendicitis was initially considered, before an abdominal-pelvic computed tomography raised the suspicion of POVT, subsequently confirmed through transabdominal ultrasound. Antibiotics and anticoagulation were initiated, with rapid clinical improvement and complete resolution of the thrombus three months later. Conclusions Diagnosing POVT is challenging as it clinically mimics other more frequent conditions. It is rare but life-threatening and should be considered in all females presenting with abdominal pain and fever in the postpartum period.

scholarly journals Thromboembolic complications of thyroid storm

2014 ◽  
Vol 2014 ◽  
Author(s):  
T Min ◽  
S Benjamin ◽  
L Cozma
Keyword(s):  
Atrial Fibrillation ◽  
Early Recognition ◽  
Massive Pulmonary Embolism ◽  
Clinical Findings ◽  
Favourable Outcome ◽  
Thyroid Storm ◽  
List Type ◽  
Chads2 Score ◽  
Prompt Treatment ◽  
Life Threatening

Summary Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. Early recognition and prompt treatment are essential. Atrial fibrillation can occur in up to 40% of patients with thyroid storm. Studies have shown that hyperthyroidism increases the risk of thromboembolic events. There is no consensus with regard to the initiation of anticoagulation for atrial fibrillation in severe thyrotoxicosis. Anticoagulation is not routinely initiated if the risk is low on a CHADS2 score; however, this should be considered in patients with thyroid storm or severe thyrotoxicosis with impending storm irrespective of the CHADS2 risk, as it appears to increase the risk of thromboembolic episodes. Herein, we describe a case of thyroid storm complicated by massive pulmonary embolism. Learning points Diagnosis of thyroid storm is based on clinical findings. Early recognition and prompt treatment could lead to a favourable outcome. Hypercoagulable state is a recognised complication of thyrotoxicosis. Atrial fibrillation is strongly associated with hyperthyroidism and thyroid storm. Anticoagulation should be considered for patients with severe thyrotoxicosis and atrial fibrillation irrespective of the CHADS2 score. Patients with severe thyrotoxicosis and clinical evidence of thrombosis should be immediately anticoagulated until hyperthyroidism is under control.

scholarly journals Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

2021 ◽  
Vol 18 (21) ◽  
pp. 11051
Author(s):  
Fang-Yu Hsu ◽  
Shih-Hsuan Mao ◽  
Andy Deng-Chi Chuang ◽  
Yon-Cheong Wong ◽  
Chih-Hao Chen
Keyword(s):  
Motor Vehicle ◽  
Early Recognition ◽  
Arterial Embolization ◽  
Maxillary Artery ◽  
Trauma Patients ◽  
Shock Index ◽  
Packed Red Blood Cells ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Craniofacial Trauma

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

scholarly journals Colonic Volvulus in Children: Surgical Management of a Challenging Condition

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 982
Author(s):  
Francesca Destro ◽  
Luciano Maestri ◽  
Milena Meroni ◽  
Alessandro Campari ◽  
Federica Pederiva ◽  
...  
Keyword(s):  
Early Recognition ◽  
Significant Risk ◽  
Intestinal Resection ◽  
Significant Risk Factor ◽  
Colonic Volvulus ◽  
Presenting Symptoms ◽  
Threatening Condition ◽  
Life Threatening ◽  
Intestinal Pseudo Obstruction

Colonic volvulus (CV) is a rare but potentially life-threatening condition with unclear etiopathogenesis. To date, less than 80 pediatric cases have been described. Hirschsprung’s disease (HD) is associated with CV in 17% of cases, representing a significant risk factor. Non-HD CV is an even more complex entity. The aim of this study is to describe a series of patients with CV to accentuate some peculiar aspects of this disease. We performed a retrospective study (period: 2012–2021) collecting information of patients with CV. Data analyzed included: demographics, medical history, presenting symptoms and radiological and surgical details. Eleven patients (12.5 ± 2.8 years; 7F/4M) had CV (eight sigmoid, two transverse colon, one total colon). Five patients had associated anomalies and three had HD. A two-step approach with volvulus endoscopic/radiological detorsion followed by intestinal resection was attempted in eight cases (one endoscopic approach failed). Three patients required surgery at admission. At follow-up, two patients developed recurrent intestinal obstruction, one of whom also had anastomotic stenosis. Colonic volvulus is a challenging condition that requires prompt patient care. A missed diagnosis could lead to severe complications. The evaluation of the patient should include a careful histological examination (searching for HD and alpha-actin deficiency), immunologic and metabolic screening, neurological tests and detection of chronic intestinal pseudo-obstruction (CIPO). Lifelong follow-up is mandatory for the early recognition and treatment of progressive diseases involving the proximal gastrointestinal tract.

Cerebellar hemorrhage and subsequent venous infarction followed by incomplete transvenous embolization of dural carotid cavernous fistulas: a rare complication

2008 ◽  
Vol 108 (6) ◽  
pp. 1245-1248 ◽  
Author(s):  
Reng-Jye Lee ◽  
Chih-Feng Chen ◽  
Shih-Wei Hsu ◽  
Chun-Chung Lui ◽  
Yeh-Lin Kuo
Keyword(s):  
Early Recognition ◽  
Rare Complication ◽  
Vascular Complications ◽  
Transvenous Embolization ◽  
Blurred Vision ◽  
Cerebellar Hemorrhage ◽  
Life Threatening ◽  
Venous Infarcts ◽  
Carotid Cavernous Fistulas

✓ Endovascular therapy for dural carotid cavernous fistulas (CCFs) is generally accepted to be safe and effective. The authors report a rare complication of hemorrhage and subsequent venous infarcts of the pons and cerebellum after transvenous embolization. This 41-year-old man presented with a severe left frontal headache, congestion of the left conjunctiva, blurred vision, and photophobia. Cerebral angiography demonstrated a right dural CCF. The patient underwent transvenous embolization of the cavernous sinus but had the initial complication of cerebellar hemorrhage. One month later, he developed progressive dizziness, ataxia, and right-sided weakness. Magnetic resonance imaging revealed severe cerebellar and pontine edema. The cause was a residual fistula combined with delayed occlusion of the inferior petrosal sinus. The fistula was obliterated after repeated embolizations. The patient's symptoms gradually resolved, and there was no evidence of recurrence during the 4-year follow-up period. Incomplete transvenous embolization of a dural CCF can result in life-threatening vascular complications due to redistribution of shunt flow. Early recognition of redistributed drainage and preventive placement of coils at the origin of draining veins during the procedure could avert this rare complication.

scholarly journals ENDOCRINOLOGY IN THE TIME OF COVID-19: Clinical management of neuroendocrine neoplasms (NENs)

2020 ◽  
Vol 183 (2) ◽  
pp. G79-G88 ◽  
Author(s):  
Ruth T Casey ◽  
Gerlof D Valk ◽  
Camilla Schalin-Jäntti ◽  
Ashley B Grossman ◽  
Rajesh V Thakker
Keyword(s):  
Targeted Therapy ◽  
Genetic Disorder ◽  
Severe Form ◽  
Neuroendocrine Neoplasms ◽  
Tumour Grade ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Indolent Disease

In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.

scholarly journals A case of panitumumab containing chemotherapy causing interstitial lung disease: early recognition and treatment resulting in a good outcome

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-227785 ◽  
Author(s):  
Kamal Naguib Makar Rezkallah ◽  
Adnan Ahmed ◽  
Sabah Patel ◽  
Kelly Kozma
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Early Recognition ◽  
Wild Type ◽  
Serious Adverse Event ◽  
Systemic Corticosteroids ◽  
Life Threatening ◽  
Systemic Antibiotics ◽  
New Onset

Panitumumab is a recombinant human IgG2 monoclonal antibody which is used for the treatment of patients with metastatic colorectal cancer (mCRC) with disease progression on or following FOLFIRI (fluoropyrimidine, oxaliplatin and irinotecan) containing chemotherapy regimen. We report a case of an 83-year-old Hispanic man, non-smoker, with KRAS/NRAS wild-type mCRC of the liver who was treated with 9 cycles of FOLFOX4 (fluorouracil, leucovorin and oxaliplatin) and cetuximab. Follow-up abdominal imaging showed progression of CRC, requiring initiation of panitumumab in addition to FOLFIRI. After 2 cycles of this combination chemotherapy, he presented with acute hypoxaemic respiratory failure. Pulmonary imaging showed new onset of interstitial lung disease (ILD). He was treated with systemic corticosteroids with marked improvement of ILD. We aim to highlight the risk of severe life-threatening ILD associated with panitumumab. Early recognition of this serious adverse event helps avoid unnecessary administration of systemic antibiotics and prevent mortality.

scholarly journals Life-threatening retroperitoneal hematoma after percutaneous vertebroplasty for lumbar fracture

2020 ◽  
Vol 6 (4) ◽  
pp. 840
Author(s):  
Catarina Aleixo ◽  
Jose Marinhas ◽  
Filipe Santos ◽  
Rolando Freitas ◽  
Ricardo Santos Pereira
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Early Recognition ◽  
Invasive Procedure ◽  
Retroperitoneal Hematoma ◽  
Minimally Invasive Procedure ◽  
Prompt Treatment ◽  
Support Measures ◽  
Life Threatening ◽  
Lumbar Fracture ◽  
Specific Potential

<p>Percutaneous vertebroplasty is a safe and effective minimally invasive procedure with specific potential complications. Among these, vascular injuries have seldomly been reported. We present a rare case of retroperitoneal hematoma, presumably from injury to one of the lumbar arteries following percutaneous vertebroplasty in a patient treated for lumbar fracture. Even though the situation was life-threatening, conservative treatment and support measures sufficed in controlling the bleeding and the patient recovered fully. Spine surgeons should be especially aware of this specific and often late-presenting complication, as early recognition and prompt treatment are fundamental to decrease its morbidity and mortality.</p>

Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

2020 ◽  
Vol 8 (1) ◽  
pp. 9-15
Author(s):  
Petrov Nikolay ◽  
◽  
Marinova R. ◽  
Odiseeva Ev.
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Endovascular Coiling ◽  
Published Data ◽  
Military Medical Academy ◽  
Life Threatening ◽  
Arachnoid Hemorrhage ◽  
The Right ◽  
Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

scholarly journals Early recognition of PIMS-TS: a single centre retrospective review

2021 ◽  
Vol 5 (1) ◽  
pp. e001011
Author(s):  
Roshni Mistry ◽  
Nicola Scanlon ◽  
James Hibberd ◽  
Fionnghuala Fuller
Keyword(s):  
Early Recognition ◽  
Febrile Illness ◽  
Final Diagnosis ◽  
University Hospital ◽  
Single Centre ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Review Reports ◽  
Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

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