scholarly journals Malignant cerebellar edema in three-year-old girl following accidental opioid ingestion and fentanyl administration

2019 ◽  
Vol 32 (5) ◽  
pp. 386-391 ◽  
Author(s):  
Cathy H Chen ◽  
Alexander J Mullen ◽  
Dustin Hofstede ◽  
Tanvir Rizvi
Keyword(s):  
Computed Tomography ◽  
Case Reports ◽  
External Ventricular Drain ◽  
Opioid Analgesics ◽  
Gas Chromatography Mass Spectrometry ◽  
Motor Deficits ◽  
Acute Hypertension ◽  
Toxic Leukoencephalopathy ◽  
Hospital Days ◽  
Fentanyl Administration

A three-year-old girl was found altered with an unknown timeline. Gas chromatography mass spectrometry was positive for hydromorphone, dihydrocodeine, and hydrocodone. Initial computed tomography and magnetic resonance imaging suggested a malignant cerebellar edema not confined to a vascular distribution. She received fentanyl boluses on hospital days 0 and 1 before receiving a continuous infusion on day 1. On day 3, she had an episode of acute hypertension and bradycardia. Emergent computed tomography showed an evolving hydrocephalus and similar diffuse edema throughout both cerebellar hemispheres. External ventricular drain was placed to relieve the increased intracranial pressure. Following drain placement and fentanyl discontinuation, the patient recovered, though not without fine- and gross-motor deficits at the four-month follow-up. Our case adds to a handful of case reports of opioid toxicity in pediatric patients that present as toxic leukoencephalopathy. Though the mechanism is poorly understood, it has been suggested to be a consequence of the neurotoxic effects of the drug, which has particular affinity for µ opioid receptors—the primary opioid receptor found in the cerebellum. Clinicians would do well to recognize that this syndrome is primarily caused by direct toxicity rather than ischemia. This case adds insight by suggesting that lipophilic opioid analgesics may worsen this neurotoxicity. When intervening with mechanical ventilation, clinicians should consider avoiding lipophilic opioid drugs for analgesia until the pathogenesis of cerebellar edema is better understood.

scholarly journals Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

2020 ◽  
Author(s):  
Majid Anwer ◽  
Atique Ur Rehman ◽  
Farheen Ahmed ◽  
Satyendra Kumar ◽  
Md Masleh Uddin
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Postoperative Period ◽  
Road Traffic ◽  
Case Reports ◽  
Mass Effect ◽  
Extradural Hematoma ◽  
Traumatic Head Injury ◽  
Neurologic Deterioration ◽  
The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

scholarly journals Granuloma Caused by Carbon Deposition in the Dermis

2014 ◽  
Vol 2014 ◽  
pp. 1-2
Author(s):  
Rintaro Shibuya ◽  
Yuichiro Endo ◽  
Akihiro Fujisawa ◽  
Miki Tanioka ◽  
Yoshiki Miyachi
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Malignant Melanoma ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Foreign Body Reaction ◽  
Carbon Deposition ◽  
Case Reports ◽  
Initial Injury ◽  
Pencil Lead

Pencil core granuloma is characterized by a delayed foreign-body reaction against retained fragments of pencil lead. Previous case reports presented pencil core granuloma resembling malignant melanoma, haemangioma, or soft tissue sarcoma. We present a case of pencil core granuloma arising from the palm 25 years after the initial injury. The patient presented a bluish nodule that had been present over 25 years before. The nodule initially measured 5 mm in diameter. However, five years before presentation, it suddenly enlarged to the size of 30 mm during six months. Computed tomography (CT) of the lesion revealed a linear radiopaque structure of 8 mm long with a mass on its distal end. Surgical resection revealed a bluish muddy mass and pencil lead. Histological examination revealed degenerative tissue with calcification surrounded by massive amounts of black granular material in the middle and lower dermis.

Cardiac metastasis of osteosarcoma

Open Medicine ◽  
2010 ◽  
Vol 5 (5) ◽  
pp. 551-555
Author(s):  
Hilal Sahin ◽  
Naim Ceylan ◽  
Selen Bayraktaroglu ◽  
Recep Savas
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Case Reports ◽  
Primary Tumour ◽  
Cardiac Metastasis ◽  
Imaging Findings ◽  
Cardiac Metastases ◽  
Enhanced Computed Tomography ◽  
Demographic Features

AbstractCardiac osteosarcoma metastasis is extremely rare and is documented in several case reports in the literature. The behaviour of osteosarcoma metastases is similar to the primary tumour. Thoracic non-enhanced computed tomography (CT) examination is beneficial in the detection of calcific cardiac metastases. In this case report, we describe a 29-year-old woman with cardiac osteosarcoma metastasis after 7 years of follow-up, compare the demographic features with previous cases and discuss the imaging findings.

scholarly journals The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

2020 ◽  
Author(s):  
Nadeem Jimidar ◽  
Patrick Lauwers ◽  
Emmanuela Govaerts ◽  
Marc Claeys
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Case Reports ◽  
Gunshot Wounds ◽  
Computed Tomography Scan ◽  
Imaging Studies ◽  
Left Chest ◽  
Case Summary ◽  
Tomography Scan

Abstract Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.

Computed tomography (CT) features of pelvic rhabdomyosarcoma (RMS) in children

2021 ◽  
Vol 17 ◽  
Author(s):  
Lu Tian ◽  
Yue Cai ◽  
Xiaomeng Li ◽  
Jinhua Cai
Keyword(s):  
Computed Tomography ◽  
Blood Vessels ◽  
Lymphatic Metastasis ◽  
Case Reports ◽  
High Specificity ◽  
Muscle Density ◽  
Paediatric Patients ◽  
Sensitivity Range ◽  
Neoplastic Lesions ◽  
Ct Features

Background: Currently, there are few literature reports on the CT features of pelvic rhabdomyosarcoma, most of which exist in the form of case reports, and some literature reports have suggested that CT features of pelvic rhabdomyosarcoma lack specificity. This study was designed to investigate the CT features of pelvic RMS in children to provide imaging evidence for clinical diagnosis. Methods: We retrospectively reviewed radiographic and clinical data of all paediatric patients with pelvic neoplastic lesions pathologically proven to be malignant in our hospitals from January 2012 through March 2021. The data of the included paediatric patients were divided into two groups according to whether the pathology results indicated RMS. CT features of RMS (n= 37) and non-RMS (n= 91) were compared by two abdominal radiologists. Results: A total of 9 CT features were statistically significant for the diagnosis of pelvic RMS in children (p＜0.05). The sensitivity (range, 0.64–0.74) and specificity (range, 0.86–0.93) of the CT features showing multinodular fusion, surrounding blood vessels, and heterogeneous progressive centripetal enhancement were both relatively high. The CT features indicating lower than muscle density, necrosis, non-calcification and non-haemorrhage exhibited high specificity (range, 0.86–0.97), but the sensitivity (range, 0.32–0.40) was relatively low, while the sensitivity (range, 0.37–0.46) and specificity (range, 0.75–0.83) of other CT features used for diagnosing pelvic RMS, namely, lobulated and lymphatic metastasis, were both relatively low. Conclusion: Pelvic rhabdomyosarcoma in children has its own specific CT features.

Eight Case Reports of Acute Hypertension Following Myometrial Injection of Prostaglandin F2 alpha

1987 ◽  
Vol 20 (3) ◽  
pp. 425
Author(s):  
Young Joo Lee ◽  
Young Joo Kim ◽  
Young Suck Lee ◽  
Chung Hyung Cho
Keyword(s):  
Case Reports ◽  
Acute Hypertension ◽  
Prostaglandin F2 Alpha

scholarly journals Acute Liver Failure with Diffuse Liver Metastasis from Breast Cancer, Not Detected by Computed Tomography: 2 Case Reports

2018 ◽  
Vol 11 (3) ◽  
pp. 699-704 ◽  
Author(s):  
Takatsugu Ogata ◽  
Yuichiro Kikawa ◽  
Misato Ogata ◽  
Hironaga Satake ◽  
Yukimasa Hatachi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Liver Metastasis ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Hepatic Failure ◽  
Poor Prognosis ◽  
Alcoholic Hepatitis ◽  
Case Reports ◽  
History Of

Diffuse liver metastasis is a rare pattern of liver metastasis that is associated with hepatic failure and poor prognosis. We experienced 2 cases of acute liver failure due to diffuse metastasis that could not be detected using computed tomography. In case 1, it was difficult to differentiate diffuse metastasis from alcoholic hepatitis. In case 2, it was difficult to diagnose diffuse liver metastasis because the patient had no history of malignancy. When liver enzyme levels are elevated, it is necessary to consider liver metastasis as a potential cause, regardless of computed tomography findings.

scholarly journals Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anna Rieth ◽  
Tamás Kovács ◽  
Zoltán Novák ◽  
Katalin Kapus ◽  
Aurél Ottlakán ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Conservative Treatment ◽  
Inflammatory Markers ◽  
Late Onset ◽  
Case Reports ◽  
Bronchopleural Fistula ◽  
Tension Pneumothorax ◽  
Safe Alternative ◽  
Chest Computed Tomography ◽  
Initial Symptoms

Abstract Background Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The diagnosis has some difficulties for the reason that soon after the aspiration initial symptoms, such as coughing, wheezing or vomiting disappear and bronchoscopy is mostly negative. At least serious complications such as tension pneumothorax, bronchopleurocutaneous fistula or even spontaneous percutan elimination may develope. Case presentation We present two cases of pleuropneumonia resulting from aspiration of the head of barley grass. Soon after the accidents initial symptoms diminished, inflammatory markers improved and bronchoscopy was unable to confirm the presence of awn. Despite of conservative treatment (antibiotics, physiotherapy, bronchodilators, expectorants, and inhalation) localized pulmonary inflammation developed after 1 and 9 months showed up on chest computed tomography. After ineffective conservative treatment, surgical resections became inevitable in order to remove chronically inflamed parts (lobectomy, segmentectomy) and foreign bodies. Both patients recovered and were discharged home after successful interventions. Conclusions Due to its peculiar shape and behaviour, awn inhalation is a special and atypical form of aspiration, thus great care and awareness is needed in its treatment. Negative bronchoscopic result does not exclude the presence of bronchial grass head. Symptomless child with negative bronchoscopy and improved inflammatory markers should be followed up thoroughly to recognize late complications in time. Regular diagnostic steps (chest ultrasound/X-ray) should be performed to localize potential chronic lung inflammation. Chest computed tomography is a valuable diagnostic tool for identifying and localising the foreign body. In cases with localized inflammation and peripheric localisation, segmentectomy can be a successful and safe alternative of lobectomy.

Presence of retained calcified fibrin sheath after central venous catheter removal: A systematic literature review

2020 ◽  
pp. 112972982096932
Author(s):  
Patrycja S Matusik ◽  
Piotr Łoboda ◽  
Katarzyna Krzanowska ◽  
Tadeusz J Popiela ◽  
Grzegorz Heba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Dwell Time ◽  
Case Reports ◽  
Central Venous ◽  
Factors Associated ◽  
Fibrin Sheath ◽  
Common Risk Factors

Central venous catheters (CVC) are used in many clinical settings for a variety of indications. We performed a systematic literature review concerning case reports of retained calcified fibrin sheaths after dialysis CVC removal. The aim of our study was to systematize the knowledge regarding clinical management of this phenomenon, placing special emphasis on diagnostic radiological features in different imaging modalities, including chest radiography, echocardiography, computed tomography, and magnetic resonance imaging. We discuss the most common risk factors associated with this CVC complication. In our review, we found eight cases of hemodialysis patients. The most common risk factors associated with calcified fibrin sheath formation in the analyzed cases were pro-thrombotic and pro-calcification factors related to patient comorbidities, and prolonged catheter dwell time. Differentiating between a calcified fibrin sheath (present in about 6% of patients with long-term indwelling CVC as diagnosed by computed tomography) and a retained catheter tip can be challenging. The initial diagnosis based on imaging methods was incorrect in most of the analyzed cases. This suggests that some cases of retained fibrin sheaths may remain undetected or misinterpreted. This is important in patients with known pro-thrombotic and pro-calcification risk factors and prolonged catheter dwell time. Therefore, implementation of preventive strategies, familiarity with radiological findings of this phenomenon, comparison with previous imaging studies, and an overall comprehensive assessment with clinical data is imperative.

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