scholarly journals A rare case of COVID-19 vaccine-induced thrombotic thrombocytopaenia (VITT) involving the veno-splanchnic and pulmonary arterial circulation, from a UK district general hospital

2021 ◽  
Vol 14 (9) ◽  
pp. e244223
Author(s):  
Huma Asmat ◽  
Folusho Fayeye ◽  
Hameed Alshakaty ◽  
Jay Patel
Keyword(s):  
District General Hospital ◽  
Liver Function Tests ◽  
Intravenous Immunoglobulins ◽  
Cross Sectional ◽  
Vein Thrombosis ◽  
Arterial Circulation ◽  
Acute Medical Unit ◽  
Cross Sectional Imaging ◽  
Low Platelet Count ◽  
Spread Of Infection

A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins. In a time where there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalisation, this particular clinical scenario emphasises the need of all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.

Systemic arteriopulmonary venous fistula (APVF): case presentation of an asymptomatic individual and a review of the literature

2021 ◽  
Vol 14 (7) ◽  
pp. e241644
Author(s):  
Paul Jenkins ◽  
Prageeth Dissanayake ◽  
Richard Riordan
Keyword(s):  
Chest Radiograph ◽  
Cardiovascular Health ◽  
Incidental Finding ◽  
Chest Radiographs ◽  
Cross Sectional ◽  
Arterial Circulation ◽  
Cross Sectional Imaging ◽  
Venous Fistula ◽  
The Right

Abnormal communications between the systemic and pulmonary venous systems are rare but can present as a opacity on chest radiograph. A solitary vessel communicating as a fistula directly between the systemic arterial circulation and the pulmonary venous system is not widely described. These may have significant implications in the long-term cardiovascular health of an individual acting as a left to right shunt. There is no clear consensus as to the management, but surgical management and endovascular embolisation have been successfully used. We present a case where a systemic arteriaopulmonary fistula originating from the abdominal aorta and connecting to the right inferior pulmonary vein manifested as an incidental finding on a chest radiograph and was further evaluated on cross-sectional imaging in a young patient. Chest radiographs are non-specific and it is important to be aware of the less frequent but important pathologies that can be picked up on plain chest radiographs, which inturn should warrant further investigation. This is presented in conjunction with a review of the available literature along with a discussion regarding the differential diagnosis and management applicable to the general clinician.

EP.TU.809Challenges in management of acute diverticulitis within a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James William Butterworth ◽  
Guillaume Lafaurie ◽  
Blessing Fabowalwe-Makinde ◽  
Lois Aikins ◽  
Tayo Olatokunbo Oke
Keyword(s):  
General Hospital ◽  
Acute Diverticulitis ◽  
District General Hospital ◽  
Disease Classification ◽  
Perforated Diverticulitis ◽  
Cross Sectional ◽  
Unique Challenge ◽  
Review Management ◽  
Cross Sectional Imaging ◽  
Sigmoid Diverticular Disease

Abstract Aim Incidence of perforated sigmoid diverticular disease is estimated at 3.4 to 4.5 per 100,000. Perforation may be the first manifestation of complicated diverticulitis with a range of 50% to 70%. We aim to review management of systemically unwell patients with acute diverticulitis in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting septic with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed over a 6-month period. Results Mean time to antibiotics was 3.96 hours (range 0-23.11). Of the 7 with perforated diverticulitis severity classification included: Hinchey I – n = 1, 3.4%; Hinchey IIa – 5 (17.2%), and; Hinchey IIb – 1 (3.4%). Time to CT abdomen pelvis was 3.38 hours (range 0-16.4 hours). Two pericolic abscesses met NICE drainage criteria at 3.7 cm and 3.9 cm respectively. The 3.7 cm abscess was drained radiologically at 7 days post-admission and was re-admitted 6 days later requiring further radiological drainage. The patient with a 3.9 cm abscess received a Hartmann’s procedure and had multiple re-admissions requiring a hospital stay of 34 days. There was 0% mortality at 30 days. Conclusion Management of acute diverticulitis continues to present a unique challenge. For systemically unwell patients, timely administration of antibiotics within an hour of sepsis recognition is encouraged to optimise outcomes. Timely cross-sectional imaging is pivotal in disease classification and decision-making regarding acute management. Interventional drainage and surgical resection remain important therapeutic strategies for unwell patients with Hinchey grade II diverticulitis.

scholarly journals Hepatic Necrosis after Trans-Arterial Embolization of Metastatic Neuroendocrine Tumour

2020 ◽  
Author(s):  
Sarah Micallef ◽  
Kelvin Cortis ◽  
Claude Magri
Keyword(s):  
Portal Vein ◽  
Neuroendocrine Tumour ◽  
Arterial Embolization ◽  
Hepatic Necrosis ◽  
Selective Internal Radiotherapy ◽  
Cross Sectional ◽  
Internal Radiotherapy ◽  
Vein Thrombosis ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Liver metastases from neuroendocrine tumours (NETs) are usually seen on cross-sectional imaging at presentation. In such cases, curative surgical resection is usually not possible given that most patients have bilobar disease. Various locoregional approaches are now widely available that enable local control of disease and management of systemic symptoms. These include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), selective internal radiotherapy and thermal ablation. We describe a rare case of hepatic necrosis after TAE in a 61-year-old woman with a metastatic NET. Cross-sectional imaging showed extensive necrosis affecting segments VII and VIII of the liver. This occurred secondary to thrombosis in the portal vein branches to these segments, confirmed on a Doppler ultrasound scan. The mechanism of portal vein thrombosis after TAE could be due to the presence of occult arterioportal anastomoses. These allow transit of the embolizing agents into the portal vein branches supplying the treated segments and subsequent thrombosis.

P-BN30 Retroperitoneal biloma: a case report of spontaneous retroperitoneal bike leak and collection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Robert Bickerton ◽  
Amy Godden ◽  
Georgios Bointas ◽  
Marize Bakhet ◽  
George Bingham ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Rare Complication ◽  
Gallstone Disease ◽  
Bile Leak ◽  
Liver Function Tests ◽  
Interesting Case ◽  
Gallbladder Perforation ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Cbd Stone

Abstract Background Retroperitoneal biloma is a rare complication of gallstone disease. Only a handful of cases have been reported in the literature with various mechanisms postulated.  Here, we report a case of spontaneous retroperitoneal biloma arising from gallbladder perforation. Methods An 87-year-old female patient presented with right upper quadrant pain in the context of known gallstone disease. Inflammatory markers and liver function tests were deranged. Cross sectional imaging found acute cholecystitis and a gallbadder neck perforation with an impacted 2cm proximal common bile duct (CBD) stone.   A cholecystostomy was placed and she improved clinically. However, inflammatory markers remained high, and a subsequent computed tomography (CT) found a large collection in the retroperitoneum.   Results The retroperitoneal collection measured 14cm x 7cm, and there had been evidence on prior CT scans of retroperitoneal inflammation. It was urgently drained under ultrasound guidance and found to contain bilious content.  Subsequent endoscopic retrograde cholangiopancreatography (ERCP) was unable to retrieve the CBD stone, but left stents either side of the stone. The patient clinically and biochemically improved. She was discharged and had an elective ERCP, which successfully retrieved the stone, with a plan for urgent elective laparoscopic cholecystectomy.  Conclusions Here, we report an interesting case of retroperitoneal biloma successfully managed with ultrasound-guided drainage. Perforation of the distal CBD can result in retroperitoneal bile leak, but the proximal CBD stone in this case would have likely prevented passage of bile. A more likely cause is adhesion of the gallbladder neck to the posterior parietal peritoneum due to chronic inflammation, with subsequent perforation and release of bile into the retroperitoneum. This has previously been described in the literature. Regardless of mechanism, knowledge of the potential for this rare complication is important for anticipating and appropriately managing complications of gallbladder perforation. 

State-of-the-art pulmonary arterial imaging – Part 2

VASA ◽  
2018 ◽  
Vol 47 (5) ◽  
pp. 361-375 ◽  
Author(s):  
Harold Goerne ◽  
Abhishek Chaturvedi ◽  
Sasan Partovi ◽  
Prabhakar Rajiah
Keyword(s):  
Pulmonary Artery ◽  
State Of The Art ◽  
Therapy Monitoring ◽  
Pulmonary Arteries ◽  
Imaging Modalities ◽  
Cross Sectional ◽  
Multiple Imaging ◽  
Cross Sectional Imaging ◽  
Pulmonary Arterial ◽  
Arterial Imaging

Abstract. Although pulmonary embolism is the most common abnormality of the pulmonary artery, there is a broad spectrum of other congenital and acquired pulmonary arterial abnormalities. Multiple imaging modalities are now available to evaluate these abnormalities of the pulmonary arteries. CT and MRI are the most commonly used cross-sectional imaging modalities that provide comprehensive information on several aspects of these abnormalities, including morphology, function, risk-stratification and therapy-monitoring. In this article, we review the role of state-of-the-art pulmonary arterial imaging in the evaluation of non-thromboembolic disorders of pulmonary artery.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

Identification of Root Cause Failure in Silicon on Insulator Body Contacted nFETs Using Scanning Capacitance Microscopy and Scanning Spreading Resistance Microscopy

2006 ◽  
Author(s):  
J.S. McMurray ◽  
C.M. Molella
Keyword(s):  
The Body ◽  
Silicon On Insulator ◽  
Back Side ◽  
Cross Sectional ◽  
Plan View ◽  
Spreading Resistance ◽  
Scanning Capacitance Microscopy ◽  
Root Cause ◽  
Cross Sectional Imaging ◽  
Active Channel

Abstract Root cause for failure of 90 nm body contacted nFETs was identified using scanning capacitance microscopy (SCM) and scanning spreading resistance microscopy (SSRM). The failure mechanism was identified using both cross sectional imaging and imaging of the active silicon - buried oxide (BOX) interface in plan view. This is the first report of back-side plan view SCM and SSRM data for SOI devices. This unique plan view shows the root cause for the failure is an under doped link up region between the body contacts and the active channel of the device.

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