Early presentation of traumatic pseudoaneurysm of deep lingual artery as a massive oral bleed

Tongue trauma with active bleed is most commonly due to the ruptured lingual artery and its branches, whereas delayed haemorrhage is usually secondary to pseudoaneurysm formation. This case is a unique presentation of traumatic tongue bleeds with early formation of pseudoaneurysm of a lingual artery branch. We present our experience in its management. A contrast-enhanced CT (CECT) with angiography detected right deep lingual artery pseudoaneurysm, which was managed by endovascular gelfoam embolisation followed by tongue laceration repair. Tongue bleed stopped immediately post embolisation; tongue viability and functions restored on postoperative day 1 of repair. No complications like secondary haemorrhage or tongue necrosis were noted at 1-month follow-up. High index of suspicion for lingual artery and/or its branch pseudoaneurysm is crucial in acute and uncontrollable traumatic tongue bleed. A CECT is a minimum norm in early diagnosis. Choice of management is the cornerstone of a successful outcome.

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Forearm Compartment Syndrome Concomitant with Pseudoaneurysm of the Anterior Interosseous Artery after Minor Penetrating Injury

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518720220 ◽

2018 ◽

Vol 23 (03) ◽

pp. 395-398

Author(s):

Shingo Komura ◽

Akihiro Hirakawa ◽

Yasuharu Matsushita ◽

Tomihiro Masuda ◽

Marie Nohara ◽

...

Keyword(s):

Compartment Syndrome ◽

Penetrating Injury ◽

Successful Outcome ◽

Pseudoaneurysm Formation ◽

Anterior Interosseous Artery ◽

Traumatic Pseudoaneurysm ◽

Interosseous Artery ◽

Forearm Compartment Syndrome ◽

A Minor ◽

Type Of Injury

A 16-year-old man sustained a minor penetrating injury to his forearm, resulting in pseudoaneurysm formation that caused acute compartment syndrome with muscle contracture. Surgical treatment, including fasciotomy, evacuation of the hematoma and aneurysmectomy, followed by intensive hand therapy provided a successful outcome. Traumatic pseudoaneurysm after penetrating injury is a rare cause of acute forearm compartment syndrome. Although minor penetrating injuries tend to be underestimated, this type of injury can cause subsequent serious pathological conditions.

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Case Report: Seaweed Bezoar Masquerading as a Malignant Obstruction

Case Reports in Surgery ◽

10.1155/2018/3829271 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

E. C. Abboud ◽

B. Babic

Keyword(s):

Small Bowel ◽

High Sensitivity ◽

Bowel Loop ◽

Asian Woman ◽

Malignant Obstruction ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Risk Patients ◽

High Index Of Suspicion

Bezoars represent a rare cause of small bowel obstruction (SBO). Nonoperative management of bezoars includes use of endoscopy with mechanical or chemical dissolution methods. When obstruction persists, surgical intervention becomes necessary. Here, we present the case of an Asian woman with a SBO secondary to a phytobezoar masquerading as a malignancy. She presented with two days of acute-on-chronic abdominal pain that started after eating seaweed. Initial computed tomography (CT) scan showed a SBO with a jejunal transition point and ill-defined liver lesions, worrisome for a malignant obstruction with liver metastases. Further imaging, however, showed the resolution of these artifacts. Subsequent laparotomy revealed a small bowel loop with copious obstructing seaweed. A distal stricture was palpated, and the involved segment was resected. Intraoperative liver ultrasound was negative, and final pathology revealed benign small intestine with a mild stricture. Given the rarity of bezoar-related obstructions, the diagnosis is often delayed particularly when confounding factors exist such as our patient’s concomitant hepatic findings. Contrast-enhanced CT has a high sensitivity but a lower specificity in identifying bezoars. A high index of suspicion is therefore necessary especially when managing higher risk patients.

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Atypical presentation of catastophric spontaneous mesenteric bleeding

BMJ Case Reports ◽

10.1136/bcr-2021-244051 ◽

2021 ◽

Vol 14 (8) ◽

pp. e244051

Author(s):

May Honey Ohn ◽

Jun Rong Ng ◽

Ng Pey Luen ◽

Khin Maung Ohn

Keyword(s):

Close Monitoring ◽

Atypical Chest Pain ◽

Mortality And Morbidity ◽

Sudden Drop ◽

Abdominal Bleeding ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Profound Hypotension ◽

Early Imaging ◽

High Index Of Suspicion

Spontaneous mesenteric bleeding is an exceptionally rare clinical condition and potentially lethal especially among elderly patients who are taking oral anticoagulant. We present a case of a 79-year-old woman who presented to the emergency department with atypical chest pain which was radiating to the back. She developed profound hypotension with a sudden drop of haemoglobin. Contrast-enhanced CT of the aorta showed active mesenteric bleeding with mesenteric haematoma. The early diagnosis relies solely on a high index of suspicion of occult bleeding in patients with unexplained hypotension with a sudden drop of haemoglobin. Troponin can be falsely positive in mesenteric bleeding. Close monitoring to detect any sign of deterioration and early imaging in diagnosing intra-abdominal bleeding can help to avoid delay in treatment which is essential to prevent mortality and morbidity.

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Pseudoaneurysm of the splenic artery mimicking a solid lesion

Emergency Care Journal ◽

10.4081/ecj.2016.5880 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Raffaele Pezzilli ◽

Monica Cevenini ◽

Cristina Mosconi ◽

Nico Pagano ◽

Matteo Renzulli ◽

...

Keyword(s):

Splenic Artery ◽

Abdominal Distension ◽

Inflammatory Cells ◽

Endoscopic Examination ◽

The Body ◽

Artery Pseudoaneurysm ◽

Pancreatic Function Tests ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Multiple Biopsies

A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL); liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT) revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils.

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Mid-term outcome of transarterial embolization of renal artery pseudoaneurysm and arteriovenous fistula after partial nephrectomy screened by early postoperative contrast-enhanced CT

CVIR Endovascular ◽

10.1186/s42155-020-00160-z ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Satoru Morita ◽

Yuka Matsuzaki ◽

Takahiro Yamamoto ◽

Kumi Kamoshida ◽

Hiroshi Yamazaki ◽

...

Keyword(s):

Renal Artery ◽

Partial Nephrectomy ◽

Transarterial Embolization ◽

Term Outcome ◽

Artery Pseudoaneurysm ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Renal Artery Pseudoaneurysm

Abstract Purpose To retrospectively evaluate the mid-term outcome of transarterial embolization (TAE) of renal artery pseudoaneurysm (RAP) including arteriovenous fistula (AVF) after partial nephrectomy screened by early postoperative contrast-enhanced CT (CE-CT). Materials and methods Eighty-two patients (7.0%) who underwent TAE after partial nephrectomy were reviewed, from 1166 partial nephrectomies performed over 6 years. In 18 patients (22.0%), TAE was performed emergently on the median postoperative day (POD) seven. In the remaining patients, elective TAE was performed on the median POD six for RAP detected by early postoperative CE-CT or that emerged on follow-up CE-CT. Results In one patient (1.2%), TAE was performed twice because one of two RAPs could not be embolized during the first TAE, being successfully embolized at the second TAE after readmission with hematuria. Otherwise, no bleeding recurrence or RAPs were observed during the median 1354 follow-up days. Thus, the primary and secondary success rates of TAE were 98.8% (81 of 82 patients) and 100% (82 of 82 patients), respectively. On angiography, the average number of lesions was 1.7 ± 0.9 and the average RAP size was 12.8 ± 6.0 mm. The shapes of the lesions varied: oval-round 60, oval-round + AVF 36, irregular + AVF 14, AVF 12, irregular 10, disruption 4, and extravasation 3. No major complications were observed. The median inpatient days after TAE were two. No estimated glomerular filtration rate deterioration was observed (64.6 ± 18.6 vs. 64.2 ± 18.4 mL/min/1.73 m2, p = 0.902). Conclusion TAE is largely effective and safe for treating bleedings or RAPs, including AVFs, after partial nephrectomy, as screened by early postoperative CE-CT.

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Rasmussen’s aneurysm masquerading as mass lesion

BMJ Case Reports ◽

10.1136/bcr-2019-232669 ◽

2020 ◽

Vol 13 (2) ◽

pp. e232669

Author(s):

Satyajeet Sahoo ◽

Manoj Kumar Panigrahi ◽

Suprava Naik ◽

Prasanta Raghab Mohapatra

Keyword(s):

Mass Lesion ◽

Male Smoker ◽

Adequate Treatment ◽

Artery Pseudoaneurysm ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Pulmonary Disorder ◽

Life Threatening ◽

Pulmonary Artery Pseudoaneurysm

Haemoptysis is an often encountered respiratory symptom. The amount of haemoptysis varies from mild to life-threatening severity and may indicate the underlying pulmonary disorder. Herein, we report a 50-year-old male smoker who presented with occasional streaky to mild haemoptysis for last 1 year. He had pulmonary tuberculosis 10 years ago and had received adequate treatment. Chest radiograph was suspicious of a mass lesion in left upper lung. Contrast-enhanced CT scan of thorax revealed pulmonary artery pseudoaneurysm suggestive of Rasmussen’s aneurysm. Unlike this case, Rasmussen’s aneurysm usually manifests as life-threatening haemoptysis and portends a high mortality.

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Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula

BMJ Case Reports ◽

10.1136/bcr-2018-228587 ◽

2019 ◽

Vol 12 (6) ◽

pp. e228587

Author(s):

Pranav Mohan Singhal ◽

Manu Vats ◽

Sushanto Neogi ◽

Mehul Agarwal

Keyword(s):

Asymptomatic Patient ◽

Exploratory Laparotomy ◽

Surgical Sponge ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Complication Of Surgery ◽

High Index Of Suspicion ◽

Upper Abdomen ◽

Resection And Anastomosis

Retained gossypiboma is a rare and under-reported complication of surgery, which can present in a variety of ways. Thus, a very high index of suspicion is required by the clinician to clinch the diagnosis in a postoperative patient. A 45-year-old woman, who was otherwise asymptomatic, presented to the General Surgery outpatient department (OPD) with a contrast-enhanced CT suggestive of a retained intra-abdominal foreign body from previous surgery. An exploratory laparotomy was planned on elective basis. Intraoperatively, dense inter-bowel adhesions were found in the upper abdomen. After a meticulous adhesiolysis, an ileoileal fistula and an intraluminal surgical sponge were discovered. Resection and anastomosis of the involved ileal segment was done. An asymptomatic patient with a migrated intramural gossypiboma with an ileoileal fistula is an extremely rare occurrence. In these circumstances, it becomes almost impossible for the surgeon to clinch the diagnosis of a gossypiboma in an otherwise asymptomatic patient, without the aid of radiological investigations.

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Lingual Artery Pseudoaneurysm after Severe Facial Trauma

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603454 ◽

2018 ◽

Vol 11 (3) ◽

pp. 219-223

Author(s):

Leyre Margallo ◽

Estibaliz Ortiz de Zárate ◽

Maria Franco ◽

Maria Garcia-Iruretagoyena ◽

Rosa Cherro ◽

...

Keyword(s):

Emergency Surgery ◽

Late Complication ◽

High Energy ◽

Facial Trauma ◽

Lingual Artery ◽

Surgical Trauma ◽

Trauma Patients ◽

Management Options ◽

Artery Pseudoaneurysm ◽

Pseudoaneurysm Formation

The mortality associated with high-energy trauma has several time peaks and variable prognosis. In the particular case of isolated head and neck trauma, management initially includes stabilizing the patient, especially the airway and circulation, and then proceeding to treat injured structures with debridement and often fracture fixation and coverage. We present a case of a male patient who suffered a severe facial trauma at his workplace. He underwent an initial uneventful emergency surgery for control of bleeding and mandibular osteosynthesis. At 2 weeks postoperatively, a second emergency surgery was required to treat a previously undiagnosed lingual pseudoaneurysm that ruptured spontaneously, with massive oral bleeding. The case highlights the clinical significance and timing of pseudoaneurysm formation, and the surveillance and high index of suspicion required for potentially life-threatening bleeding at later time peaks. Diagnostic and therapeutic angiography effectively treated the late complication. Multidisciplinary management options are reviewed, emphasizing the need for rapid decision making and collaboration to improve outcomes in such significant surgical trauma patients.

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Long-Term Incidence and Timing of Splenic Pseudoaneurysm Formation After Blunt Splenic Injury: A Retrospective, Observational, Descriptive Study

10.21203/rs.3.rs-806027/v1 ◽

2021 ◽

Author(s):

Takaki Hirano ◽

Yudai Iwasaki ◽

Yuko Ono ◽

Tokiya Ishida ◽

Kazuaki Shinohara

Keyword(s):

Splenic Injury ◽

Descriptive Study ◽

Blunt Splenic Injury ◽

Pseudoaneurysm Formation ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Observational Descriptive Study

Abstract Background Nonoperative management (NOM) has become a standard strategy for hemodynamically stable patients with blunt splenic injury; however, delayed rupture of splenic pseudoaneurysm (SPA) is a serious complication of NOM. In medical literature, data regarding the long-term incidence of SPA are scarce, and the appropriate timing for performing follow-up contrast-enhanced computed tomography (CT) has not yet been reported. The present study aimed to elucidate the long-term incidence and timing of SPA formation after blunt splenic injury in patients treated with NOM. Methods This retrospective, observational, descriptive study was conducted at a tertiary medical center in Japan. Patients with blunt splenic injury who were treated with NOM in the study setting, between April 2014 and August 2020, were included for the analysis. We performed follow-up contrast-enhanced CT for more than 2 weeks in 65% cases to detect SPA formation. The primary outcome was the cumulative incidence of delayed formation of SPA. We also evaluated differences in SPA formation between patients who received transcatheter arterial embolization (TAE; TAE group) and those who did not receive it (non-TAE group) on the admission day. Results Among 49 patients with blunt splenic injury who were treated with NOM, 32 underwent follow-up contrast-enhanced CT for over 2 weeks, and 5 of the 32 patients (10.2%) had delayed formation of SPA. All cases of SPA formation occurred within 15 days of injury. The incidence of SPA formation was not significantly different between the TAE and non-TAE groups (5.3% vs. 13.3%, p = 0.67). Conclusions SPA developed in approximately 10% of patients within 2 weeks after blunt splenic injury. Therefore, performing follow-up contrast-enhanced CT around this period after injury may be useful to evaluate delayed formation of SPA. Although our findings are novel, they should be confirmed through future studies with a larger sample size.

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Sinonasal polyposis complicated with extradural abscess and lateral rectus palsy

BMJ Case Reports ◽

10.1136/bcr-2021-242667 ◽

2021 ◽

Vol 14 (5) ◽

pp. e242667

Author(s):

Aswin Chandran ◽

Harithraa Cheniappangoundar Baskar ◽

Anup Singh ◽

Rajeev Kumar

Keyword(s):

Nasal Polyposis ◽

Early Recognition ◽

Clinical Findings ◽

Acute Onset ◽

Mortality And Morbidity ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

High Index Of Suspicion ◽

Orbital Complications

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.

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