Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Adrenal infarction is a rare event, especially in pregnancy. The diagnosis is challenging because patients present with acute abdomen and initial workup are usually unrevealing. We present a case of unilateral adrenal infarction in a pregnant young woman without any other causes of thrombophilia, who presented with acute abdominal pain and an unremarkable initial workup. MRI and contrast-enhanced CT scan revealed a non-haemorrhagic infarct of the right adrenal gland. Our case highlights the importance of considering this rare diagnosis in the differential for a pregnant woman with acute abdomen without any obvious surgical cause.

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Misdiagnosis of Rectus Abdominis Abscess Owing to Delayed Contrast-Enhanced Computed Tomography

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_003097 ◽

2021 ◽

Author(s):

Yuichiro Nagase ◽

Yukinori Harada

Keyword(s):

Computed Tomography ◽

Laboratory Tests ◽

Rectus Abdominis ◽

Rectus Abdominis Muscle ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

A 77-year-old man, who was on anticoagulation, presented with a painful lump on the right abdominal wall. Laboratory tests showed slight anaemia and elevated inflammatory markers. Abdominal plain computed tomography (CT) revealed a mass in the right rectus abdominis muscle. He was admitted with a diagnosis of primary rectus abdominis haematoma. However, on the next day, the diagnosis was corrected to primary rectus abdominis abscess, following contrast-enhanced CT of the abdomen. This case illustrates the importance of considering primary rectus abdominis abscess in patients with suspected primary rectus abdominis haematoma, and contrast should be used when performing CT.

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Bony cystic lesion with associated submandibular lymphadenopathy on a background of breast carcinoma: an unexpected case of cervicofacial actinomycosis

BMJ Case Reports ◽

10.1136/bcr-2019-232850 ◽

2020 ◽

Vol 13 (4) ◽

pp. e232850

Author(s):

Lwazi Sibanda ◽

Emma Wates ◽

James Higginson

Keyword(s):

Breast Carcinoma ◽

Maxillofacial Surgery ◽

Oral And Maxillofacial Surgery ◽

Incision And Drainage ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Bony Metastases ◽

The Right

Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of Actinomyces israelii and a diagnosis of cervicofacial actinomycosis with mandibular osteomyelitis. The patient was successfully treated with prolonged antibiotics.

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Resolution of grade IV hypertensive retinopathy in an adult with pheochromocytoma: post-tumor resection

BMJ Case Reports ◽

10.1136/bcr-2019-231245 ◽

2020 ◽

Vol 13 (2) ◽

pp. e231245

Author(s):

Aparajita Banerjee ◽

Bhagabat Nayak ◽

Gargi Verma ◽

Sucheta Parija

Keyword(s):

Blood Pressure ◽

Tumor Resection ◽

Hypertensive Retinopathy ◽

Corrected Visual Acuity ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Hypertensive Woman ◽

Systemic Examination ◽

The Right

A 64-year-old hypertensive woman presented with complaints of a painless, progressive decrease in vision, headache, dizziness for the last month. She was a known case of diabetes mellitus on insulin therapy. On examination, best-corrected visual acuity was 6/12 in the right eye and 6/18 in the left eye. The fundus examination in both eyes revealed features of grade IV hypertensive retinopathy. Systemic examination revealed the raised blood pressure of 200/110 mm Hg. Diagnosis of pheochromocytoma was made on the basis of increased urinary norepinephrine (892.8 mg/dL) and mass in the left adrenal gland (measuring 31×28 mm) at contrast-enhanced CT. Medical management to control hypertension was done and ultimately, she underwent left laparoscopic adrenalectomy. After 10 months of surgery, the patient was asymptomatic, blood pressure was within normal limit and her vision improved to 6/6 in both the eyes. The retinal features of hypertensive retinopathy had completely disappeared.

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Unique levoatriocardinal veins in neonates with hypoplastic left heart syndrome and intact atrial septum

Cardiology in the Young ◽

10.1017/s1047951117001445 ◽

2017 ◽

Vol 28 (1) ◽

pp. 150-152 ◽

Cited By ~ 1

Author(s):

Chiaki Iida ◽

Jun Muneuchi ◽

Mamie Watanabe

Keyword(s):

Hypoplastic Left Heart Syndrome ◽

Atrial Septum ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Intact Atrial Septum ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Left Heart Syndrome

AbstractWe had two cases of neonates with hypoplastic left heart syndrome and intact atrial septum who had unique levoatriocardinal veins. Contrast-enhanced CT and angiography revealed that previously unknown communicating vessels ran from the top of the left atrium and drained into the right atrium. We emphasise that transcatheter atrial septostomy should be performed not through these communicating vessels but using the trans-septal approach in neonates with hypoplastic left heart syndrome and an intact atrial septum.

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Adrenal infarction in a healthy pregnant woman

Obstetric Medicine ◽

10.1177/1753495x15627959 ◽

2016 ◽

Vol 9 (2) ◽

pp. 90-92 ◽

Cited By ~ 7

Author(s):

Heidi Sormunen-Harju ◽

Krista Sarvas ◽

Niina Matikainen ◽

Nanna Sarvilinna ◽

E Kalevi Laitinen

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Pregnant Woman ◽

Acute Abdomen ◽

Rare Event ◽

Normal Pregnancy ◽

Healthy Pregnant Woman ◽

Upper Abdominal ◽

Adrenal Infarction ◽

In Pregnancy

Adrenal infarction is a very rare event but occasionally seen in hypercoagulable states. We present a case of a 31-year-old woman at 38 weeks of gestation who developed a severe upper abdominal pain and unilateral adrenal infarction due to thrombosis of the adrenal vein. The only thrombogenic factor found was pregnancy. The case highlights that adrenal infarction may complicate a normal pregnancy and should be included in the differential diagnosis of the acute abdomen in pregnancy.

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Anesthetic management of gigantic pheochromocytoma resection with inferior vena cava and right atrium tumor thrombosis: A case report

10.21203/rs.2.301/v1 ◽

2019 ◽

Author(s):

Jingli Chen ◽

Caihua Liu ◽

Chang Liu ◽

Quanyuan Fu ◽

Dingwei Peng ◽

...

Keyword(s):

Inferior Vena Cava ◽

Surgical Resection ◽

Right Atrium ◽

Inferior Vena ◽

Anesthetic Management ◽

Vena Cava ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right

Abstract Background: This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension into vena cava and right atrium in a patient. Report for anesthetic management is limited in these patients under surgical resection until now. Case presentation: In September 2015, a 24-year-old male presented to the department of cardiology with right flank pain and hypertensive urgency in our hospital. Contrast-enhanced CT abdomen and MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Echocardiography shown no abnormal detection. Finally, this patient gave up the surgical resection of phaeochromocytoma and chose the expectant treatment. In April 2018, this patient once again presented to the emergence department with a persistent cough and intermittent wheezing character for 5 hour. Contrast-enhanced CT and echocardiography shown existing IVC thrombus had extended into the right atrium. After the careful preoperative preparation, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team. After one month post-operation care, the patient healthily leave our hospital. Conclusion: To the best of our knowledge, the occurrence of pheochromocytoma in IVC and right atrium thrombosis has not been reported so far from mainland China. This clinical case may supply a rare reference experience for surgical treatment and anesthetic management in the group of phaeochromocytoma patient with distance vascular extension. Keywords: Adrenal tumor; Malignant phaeochromocytoma; Inferior vena cava; Right atrium; Tumor thrombus.

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The feasibility of deep learning-based synthetic contrast-enhanced CT from nonenhanced CT in emergency department patients with acute abdominal pain

Scientific Reports ◽

10.1038/s41598-021-99896-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Se Woo Kim ◽

Jung Hoon Kim ◽

Suha Kwak ◽

Minkyo Seo ◽

Changhyun Ryoo ◽

...

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Deep Learning ◽

Acute Abdominal Pain ◽

Point Scale ◽

Contrast Enhanced Ct ◽

Underlying Malignancy ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Emergency Department Patients

AbstractOur objective was to investigate the feasibility of deep learning-based synthetic contrast-enhanced CT (DL-SCE-CT) from nonenhanced CT (NECT) in patients who visited the emergency department (ED) with acute abdominal pain (AAP). We trained an algorithm generating DL-SCE-CT using NECT with paired precontrast/postcontrast images. For clinical application, 353 patients from three institutions who visited the ED with AAP were included. Six reviewers (experienced radiologists, ER1-3; training radiologists, TR1-3) made diagnostic and disposition decisions using NECT alone and then with NECT and DL-SCE-CT together. The radiologists’ confidence in decisions was graded using a 5-point scale. The diagnostic accuracy using DL-SCE-CT improved in three radiologists (50%, P = 0.023, 0.012, < 0.001, especially in 2/3 of TRs). The confidence of diagnosis and disposition improved significantly in five radiologists (83.3%, P < 0.001). Particularly, in subgroups with underlying malignancy and miscellaneous medical conditions (MMCs) and in CT-negative cases, more radiologists reported increased confidence in diagnosis (83.3% [5/6], 100.0% [6/6], and 83.3% [5/6], respectively) and disposition (66.7% [4/6], 83.3% [5/6] and 100% [6/6], respectively). In conclusion, DL-SCE-CT enhances the accuracy and confidence of diagnosis and disposition regarding patients with AAP in the ED, especially for less experienced radiologists, in CT-negative cases, and in certain disease subgroups with underlying malignancy and MMCs.

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Takayasu’s Arteritis Diagnosed in an Adolescent Patient with Crohn’s Disease: Management of Biologicals

Life ◽

10.3390/life11101019 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1019

Author(s):

Kazuya Kishimoto ◽

Yuji Nozaki ◽

Toshiharu Sakurai ◽

Koji Kinoshita ◽

Masanori Funauchi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis ◽

Arm Pain ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Necrosis Factor

We report a 14-year-old man with Crohn’s disease (CD) who developed right upper arm pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. There were no symptoms suggestive of active CD, but the inflammatory response was high, and a contrast-enhanced CT showed the occlusion of the right brachial artery. We diagnosed the patient as having Takayasu’s arteritis (TA) and started treatment with corticosteroids, then tapered off the steroids as the symptoms of TA resolved. Later, TA flared up, and his treatment was changed from infliximab to an anti-IL-6 receptor antibody, tocilizumab. The change to TCZ stabilized TA, but exacerbated CD. It is difficult to control both diseases at the same time, and the choice of biologics for treatment must be carefully considered.

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A surgical case of mediastinal hematoma caused by a minor traffic injury

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-1065-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Katsuyuki Suzuki ◽

Satoshi Shiono ◽

Kazuki Hayasaka ◽

Makoto Endoh

Keyword(s):

Inferior Thyroid Artery ◽

Case Presentation ◽

Mediastinal Hematoma ◽

Traffic Injury ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

A Minor

Abstract Background Mediastinal hematoma rarely occurs after a minor traffic injury. Case presentation A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery. Conclusions It is possible that mediastinal hematoma might be caused by a minor traffic injury.

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Anesthetic management of gigantic pheochromocytoma resection with inferior vena cava and right atrium tumor thrombosis: A case report

10.21203/rs.2.301/v2 ◽

2019 ◽

Author(s):

Jingli Chen ◽

Caihua Liu ◽

Chang Liu ◽

Quanyuan Fu ◽

Dingwei Peng ◽

...

Keyword(s):

Inferior Vena Cava ◽

Surgical Resection ◽

Right Atrium ◽

Inferior Vena ◽

Anesthetic Management ◽

Vena Cava ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right

Abstract Background: This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension into vena cava and right atrium in a patient. Report for anesthetic management is limited in these patients under surgical resection until now. Case presentation: In September 2015, a 24-year-old male presented to the department of cardiology with right flank pain and hypertensive urgency in our hospital. Contrast-enhanced CT abdomen and MRI abdomen revealed a mass phaeochromocytoma in right adrenal, which invaded the right inferior vena cava（IVC）wall along with IVC thrombus. Echocardiography shown no abnormal detection. Finally, this patient gave up the surgical resection of phaeochromocytoma and chose the expectant treatment. In April 2018, this patient once again presented to the emergence department in our hospital, he had experienced persistent cough and intermittent wheezing for 5 hour. Contrast-enhanced CT and echocardiography shown existing IVC thrombus had extended into the right atrium. After the careful preoperative preparation, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team. After one month post-operation care, this patient healthily left our hospital. Conclusion: To the best of our knowledge, the occurrence of pheochromocytoma with IVC and right atrium thrombosis has not been reported in mainland China so far. This clinical case may supply a rare reference experience for surgical treatment and anesthetic management in the group of phaeochromocytoma patient with distance vascular extension.

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