Neurological Complications of Acute Rhinosinusitis: Meningitis

Meningitis remains a rare but potentially life-threatening intracranial complication of acute rhinosinusitis. We describe a case of a 62-year-old man with a background of chronic rhinosinusitis who presented to hospital with confusion, fever and bilateral green purulent rhinorrhoea. After immediate sepsis management, urgent contrast-enhanced computed tomography head revealed opacification of all paranasal sinuses and bony erosion of the lateral walls of both ethmoid sinuses. He was treated with intravenous antibiotics, topical nasal steroids, decongestants and irrigation. Following a turbid lumbar puncture and multidisciplinary discussion, he was admitted to the critical care unit and later intubated due to further neurological deterioration. After 13 days admission and rehabilitation in the community he made a good recovery. This case highlights the importance of timely diagnosis and appropriate management of acute rhinosinusitis and awareness of the possible complications. Joint care with physicians and intensivists is crucial in the management of these sick patients.

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Ultrasound Detection of the Aquarium Sign at the Bedside

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_002047 ◽

2020 ◽

Author(s):

Mihiro Kaga ◽

Emi Yamashita ◽

Takeshi Ueda

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Test Results ◽

Mesenteric Ischaemia ◽

Contrast Enhanced ◽

Life Threatening ◽

Hepatic Portal ◽

The Right ◽

Enhanced Computed Tomography ◽

The Relationship

Objectives: The aquarium sign is the name given to a large quantity of bubble-like echoes that suggests the presence of hepatic portal venous gas (HPVG). Few studies in the literature have addressed the relationship between the aquarium sign and HPVG. In some cases, HPVG can only be detected using ultrasonography. HPVG can be observed in a variety of conditions, including those that require emergency surgery, such as acute mesenteric ischaemia (AMI). Therefore, it is important to identify the presence of HPVG as soon as possible. Materials and methods: We report a case of the aquarium sign, where bubble-like echoes flowed from the right atrium towards the right ventricle, which was identified using bedside cardiac ultrasonography as part of a point-of-care ultrasound test. Results: This aquarium sign finding led to the diagnosis of AMI, which was confirmed using contrast-enhanced computed tomography (CT). Conclusion: The aquarium sign is a useful finding suggestive of HPVG and mesenteric ischaemia, which can be rapidly and easily observed using bedside cardiac ultrasonography. However, there are very few reports on the aquarium sign. The inability of other more cumbersome diagnostic imaging modalities, such as CT and magnetic resonance imaging, to detect HPVG emphasizes the utility and convenience of detecting the aquarium sign using bedside ultrasonography. This technique can lead to early detection of life-threatening diseases as well as improve the prognosis for patients. The diagnostic implications of the aquarium sign for HPVG are still unclear and require further research.

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Proximal Descending Thoracic Aortic Pseudoaneurysm Secondary to Pott's Spine

Aorta ◽

10.1055/s-0040-1701212 ◽

2020 ◽

Vol 08 (02) ◽

pp. 035-037 ◽

Cited By ~ 1

Author(s):

Irappa Madabhavi ◽

Malay Sarkar ◽

Chidanand Chauhan ◽

Mitul Modi

Keyword(s):

Vertebral Osteomyelitis ◽

Thoracic Vertebrae ◽

Aortic Pseudoaneurysm ◽

Contrast Enhanced ◽

Life Threatening ◽

History Of ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography ◽

Very High ◽

Antituberculous Chemotherapy

AbstractTuberculous pseudoaneurysm of the descending thoracic aorta is quite rare, life-threatening, and fatal if not diagnosed in time. This lesion exposes patients to a very high risk of unpredictable rupture. We describe a case of tuberculous pseudoaneurysm of the aorta in association with tuberculosis of the spine (Pott's spine). A 73-year-old man presented with a 2-month history of back pain. Chest roentgenography and contrast-enhanced computed tomography showed a descending thoracic aortic pseudoaneurysm with destruction of the fourth and fifth thoracic vertebrae (T4-T5). We suspected that the pseudoaneurysm was due to direct extension of tuberculous vertebral osteomyelitis. The patient was managed with antituberculous chemotherapy. The post–antitubercular therapy course was uneventful and he remained well 12 months after completion of treatment.

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Complicated periorbital cellulitis: case report and literature review

The Journal of Laryngology & Otology ◽

10.1017/s0022215111002350 ◽

2011 ◽

Vol 126 (1) ◽

pp. 94-96 ◽

Cited By ~ 6

Author(s):

N Parvizi ◽

N Choudhury ◽

A Singh

Keyword(s):

Case Report ◽

Literature Review ◽

Lacrimal Gland ◽

Clinical Course ◽

Neurological Complications ◽

Team Approach ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

AbstractObjective:Periorbital cellulitis secondary to rhinosinusitis is common. However, very rarely this can be complicated by a lacrimal gland abscess. We report such a case.Method:We present a case report and literature review concerning lacrimal gland abscess secondary to periorbital cellulitis.Results:Due to the location of this condition, prompt assessment and management is vital to avoid potential ophthalmological and neurological complications. Our patient failed to respond to initial conservative medical treatment, and was subsequently identified as having a lacrimal gland abscess, confirmed on contrast-enhanced computed tomography. Following definitive surgical treatment, the patient's clinical course improved. This case furthers our knowledge of this condition, and adds to the two previously reported paediatric cases.Conclusion:This case emphasises the importance of prompt management, and the fact that failure of clinical improvement following orbital decompression should alert the clinician to the rare possibility of an associated lacrimal gland abscess. The case also emphasises the key role of imaging and a multidisciplinary team approach when managing this condition.

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Diagnosis and Treatment of Atraumatic Splenic Rupture: Experience of 8 Cases

Gastroenterology Research and Practice ◽

10.1155/2019/5827694 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Jian Liu ◽

Yanyu Feng ◽

Ang Li ◽

Chunqing Liu ◽

Fei Li

Keyword(s):

Splenic Rupture ◽

Diagnosis And Treatment ◽

Etiological Factors ◽

Contrast Enhanced ◽

Life Threatening ◽

Grade Ii ◽

Atraumatic Splenic Rupture ◽

Total Splenectomy ◽

Traumatic Splenic Rupture ◽

Enhanced Computed Tomography

Atraumatic splenic rupture (ASR) is rare but life threatening. In this study, we retrospectively described our experience on the diagnosis and treatment of 8 patients (male: 6; female: 2; mean age: 49.6) with ASR. ASR accounted for 3.2% (8/251) of the splenic ruptures. The clinical presentation of ASR was similar to traumatic splenic rupture (TSR). The sensitivity of ultrasound and contrast-enhanced computed tomography (CECT) in ASR diagnosis was 57.1% and 85.7%, respectively. According to the classification of the American Association for the Surgery of Trauma (AAST), 2 cases were classified as grade II splenic ruptures, 4 cases were classified as grade III ruptures, 1 case was classified as grade IV rupture, and 1 case was not classified. All the spleens became swollen, and hematomas were observed in 6 patients. Total splenectomy was recommended in most cases. At least 62.5% (5/8) of the patients with 7 etiological factors belonged to “atraumatic-pathological splenic rupture.” Local inflammation and cancer were the most common etiological factors.

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Super-mesenteric-vein-expia-thrombosis, the clinical sequelae can be quite atrocious

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2015-0040 ◽

2016 ◽

Vol 28 (4) ◽

pp. 445-449 ◽

Cited By ~ 1

Author(s):

Benjamin Howell Lole Harris ◽

Jason Leo Walsh ◽

Sarfraz A. Nazir

Keyword(s):

Elevated Serum ◽

Unknown Origin ◽

Mesenteric Vein ◽

Pyrexia Of Unknown Origin ◽

Presenting Symptoms ◽

Contrast Enhanced ◽

Life Threatening ◽

Intra Abdominal Infection ◽

Enhanced Computed Tomography ◽

Vague Abdominal Pain

Abstract Superior mesenteric vein (SMV) thrombosis is a rare, potentially life-threatening complication of intra-abdominal infection. Here we present a case of massive SMV thrombosis secondary to appendicitis in a 13-year-old boy. He presented with vague abdominal pain and associated symptoms, persistently elevated serum inflammatory markers and a pyrexia of unknown origin. Sonography proved inconclusive, and a definitive diagnosis was made by abdominal contrast-enhanced computed tomography. He was treated with antibiotics and anticoagulation before interval elective laparoscopic appendectomy. The non-specific nature of the presenting symptoms makes SMV thrombosis an important differential to consider when dealing with such patients.

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