scholarly journals VITT following Ad26.COV2.S vaccination presenting without radiographically demonstrable thrombosis

2021 ◽  
Author(s):  
Vanessa E Kennedy ◽  
Chelsea C Wong ◽  
Jessica M Hong ◽  
Theodore An Peng ◽  
Sam Brondfield ◽  
...  
Keyword(s):  
Immune Globulin ◽  
Clinical Setting ◽  
Clinical Picture ◽  
Antibody Test ◽  
Leg Pain ◽  
Radiographic Evidence ◽  
Platelet Factor ◽  
Thrombotic Complications ◽  
The Right ◽  
Negative Imaging

We report a case of vaccine-induced immune thrombotic thrombocytopenia (VITT) in a young man diagnosed 13 days after Ad26.COV2.S COVID-19 (Johnson & Johnson/Janssen) vaccination. He presented to us with five days of progressive left leg pain, thrombocytopenia, hypofibrinogenemia, and markedly elevated D-dimers, but without radiographically-demonstrable thrombosis. Despite negative imaging, we initiated treatment for presumptive VITT given the striking clinical picture that included the timing of his recent adenovirus-based COVID-19 vaccine, leg symptoms, marked thrombocytopenia, and consumptive coagulopathy. He received intravenous immune globulin (IVIG), prednisone, and argatroban and was discharged seven days later much improved. His positive Platelet Factor 4 (PF4) ELISA antibody test returned after treatment was initiated. To our knowledge, this is the first reported case of VITT following Ad26.COV2.S vaccination presenting without radiographically-demonstrable thrombosis. Our patient highlights the importance of knowing vaccine status and initiating treatment as soon as possible in the right clinical setting, even in the absence of radiographic evidence of thrombus. Early VITT recognition and treatment provides an opportunity to prevent serious thrombotic complications.

Sacral plexus disorder caused by a wooden toothpick in the rectum

2021 ◽  
Vol 14 (1) ◽  
pp. e238690
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Lower Limb ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Sacral Plexus ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Preoperative Ct ◽  
History Of ◽  
History Of Pain ◽  
The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

scholarly journals Successful removal of a central venous catheter misplaced in the right subclavian artery using an intravascular stent: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Haruka Yoshida ◽  
Shinichiro Ikemoto ◽  
Yasuyuki Tokinaga ◽  
Kanako Ejiri ◽  
Tomoyuki Kawamata
Keyword(s):  
Central Venous Catheter ◽  
Subclavian Artery ◽  
Axillary Artery ◽  
Insertion Site ◽  
Venous Catheter ◽  
Central Venous ◽  
Thrombotic Complications ◽  
Successful Removal ◽  
Intravascular Stent ◽  
The Right

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

scholarly journals A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Marco Angelillis ◽  
Marco De Carlo ◽  
Andrea Christou ◽  
Michele Marconi ◽  
Davide M Mocellin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Arterial Thrombosis ◽  
Leg Pain ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Total Occlusion ◽  
Left Common Iliac Artery ◽  
Acute Limb Ischaemia ◽  
The Right

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

scholarly journals Paratesticular Liposarcoma: A Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Haider Alyousef ◽  
Elsawi M. Osman ◽  
Mohamed A. Gomha
Keyword(s):  
Case Report ◽  
Local Excision ◽  
Wide Local Excision ◽  
Histopathological Examination ◽  
Well Differentiated ◽  
The Right ◽  
Paratesticular Liposarcoma ◽  
Paratesticular Mass ◽  
Negative Imaging

Introduction. Liposarcoma is a rare pathological entity. By far it is the most common histological subtype of genitourinary sarcomas in adults. Approximately two hundred cases were reported in the literature. We are hereby presenting a case with a typical clinical scenario of paratesticular liposarcoma.Case report. A 75-year-old gentleman presented with a painless right hemiscrotal swelling that was progressively increasing in size over the last 6 years. Testicular tumour markers were negative. Imaging showed a heterogenous mass with fat component. Subsequently he underwent wide local excision that included the paratesticular mass along with the right testicle and all right inguinal canal contents up to the deep inguinal ring with the sparing of right illioinguinal nerve. Histopathological examination showed a well differentiated liposarcoma of the spermatic cord. He remained recurrence-free so far after 18 months of followup.Conclusion. Radical orchidectomy with wide local excision comprises the cornerstone of treatment of paratesticular liposarcoma. Due to the rarity of the disease there is no definite universal consensus of opinion as regards the role of radiotherapy and chemotherapy.

THE HAMMAN-RICH SYNDROME IN CHILDHOOD

PEDIATRICS ◽  
1958 ◽  
Vol 22 (2) ◽  
pp. 279-288
Author(s):  
Israel Diamond
Keyword(s):  
Pulmonary Artery ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Clinical Picture ◽  
Lung Biopsy ◽  
Progressive Dyspnea ◽  
Fibrotic Process ◽  
Persistent Cough ◽  
Right Pulmonary Artery ◽  
The Right

The Hamman-Rich syndrome is described in a 4-year-old Negro male. The clinical picture was that of persistent cough and progressive dyspnea beginning at 4 months of age. Diagnosis was made ante mortem by lung biopsy. The fibrotic process and arteriolosclerosis were more marked in the right lung. The disease may have been initiated by a bout of aspiration. There was accompanying stenosis of the right pulmonary artery and vein and occlusion of the lumen of the right pulmonary vein at its entrance to the left atrium. The hilar vascular findings are believed to be secondary to hilar areolar inflammation.

Optic nerve perineuritis and retroperitoneal panniculitis: rare first presentations of Behçet’s disease

2021 ◽  
Vol 14 (7) ◽  
pp. e243997
Author(s):  
Katsunobu Yoshioka ◽  
Eiko Morita
Keyword(s):  
Optic Nerve ◽  
Eye Movement ◽  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Leg Pain ◽  
Warning Sign ◽  
Behcet's Disease ◽  
Eye Pain ◽  
The Right

A 46-year-old woman was admitted to our hospital because of high fever and lumbago. CT revealed increase in density of fat tissue around the aorta, suggesting retroperitoneal panniculitis. The following day, she reported of leg pain, pain in the mouth, painful urination and right eye pain that was exacerbated by eye movement. We observed erythema nodosum, aphthous stomatitis and genital ulceration. Ophthalmologic examination revealed mild right optic disc oedema. Visual acuity was normal in both eyes. MRI with gadolinium infusion revealed enhancement around the right optic nerve, suggesting optic nerve perineuritis (ONP). A diagnosis of Behçet’s disease was made. She was treated with prednisolone and colchicine with a favourable response. A warning sign of ONP is eye pain that is exacerbated by eye movement. MRI with gadolinium infusion should be performed immediately in such cases to prevent vision-threatening sequelae.

scholarly journals A Case of Mycoplasma Pneumoniae-Associated Encephalomyelitis in a 16-Year-Old Female Presenting to an Adult Teaching Hospital

2013 ◽  
Vol 6 ◽  
pp. CCRep.S13309
Author(s):  
Hieu Tran ◽  
Anthony Allworth ◽  
Cameron Bennett
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Mycoplasma Pneumoniae ◽  
Clinical Setting ◽  
Clinical Picture ◽  
Viral Encephalitis ◽  
Age Group ◽  
Resonance Imaging ◽  
Left Frontal Lobe

We report a rare cause of encephalitis that is not often described in the adult clinical setting. Our case was a 16-year-old female who presented with a clinical picture of viral encephalitis; however, magnetic resonance imaging showed a demyelinating lesion of the left frontal lobe. In this age group, differential diagnoses of acute demyelination encephalomyelitis and multiple sclerosis were entertained. Further investigations demonstrated positive Mycoplasma pneumoniae serology. As a result, a diagnosis of Mycoplasma pneumoniae-associated encephalitis was made based on a process of exclusion.

scholarly journals Prediction of Heparin Induced Thrombocytopenia (HIT) Using a Combination of 4Ts Score and Screening Immune Assays

2020 ◽  
Vol 26 ◽  
pp. 107602962096285
Author(s):  
Rajat Thawani ◽  
Srikant Nannapaneni ◽  
Vivek Kumar ◽  
Phone Oo ◽  
Michael Simon ◽  
...  
Keyword(s):  
High Risk ◽  
Community Hospital ◽  
Antibody Test ◽  
Elisa Test ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
T Score ◽  
Risk Patients ◽  
Immune Assays ◽  
Antibody Tests

Clinical assessment (4Ts) followed by testing for Heparin/platelet factor 4 (HPF4) antibody in intermediate and high risk patients is the standard algorithm of pretest for Heparin induced thrombocytopenia (HIT), and the diagnosis is confirmed by serotonin releasing assay (SRA) in those who have positive antibodies. We conducted a retrospective analysis in a cohort of patients treated in a community hospital who had HIT antibody test by either ELISA or a rapid Particle Immunofiltration Assay (PIFA), regardless of their 4Ts scores. Among 224 patients, 17 had HIT. The PPV for those with a 4 T score ≥4 was 10.4%, which misdianosed 3 patients with HIT who tested positive for antibodies. Combining 4 T score ≥4 AND positive HIT antibody showed a PPV of 20.3% and a sensitivity of 70.6%, misdiagnosing 5 HIT patients. Using 4Ts ≥4 OR positive HIT antibody showed 100% sensitivity and 100% negative predictive value (NPV). The ELISA test had 100% sensitivity and 100% NPV, while the PIFA test missed 2 HIT patients, with sensitivity of 60% and NPV of 96.7%. Our results suggest that SRA testing should be conducted if a patient presents with a 4 T score ≥4 OR a positive HIT antibody, and antibody tests should be conducted for every patient suspected of HIT.

scholarly journals An unusual case of unilateral limb hypertrophy: Lipoma of sacral roots

2012 ◽  
Vol 03 (01) ◽  
pp. 89-92 ◽  
Author(s):  
Archana B Netto ◽  
Sanjib Sinha ◽  
Arun B Taly ◽  
Chandrajit Prasad ◽  
A Mahadevan ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Unusual Case ◽  
Tethered Cord ◽  
Leg Pain ◽  
Lumbosacral Spine ◽  
Resonance Imaging ◽  
Chronic Denervation ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Progressive Enlargement

ABSTRACTWe report an unusual case of unilateral limb pseudo hypertrophy in a 21-year-old lady who developed progressive enlargement of the right calf followed by thigh in association with chronic leg pain. Magnetic resonance imaging (MRI) of the affected limb confirmed enlargement of various muscles. Electromyography revealed neurogenic features consistent with S1 radiculopathy. MRI of the lumbosacral spine showed tethered cord with a lipoma infiltrating multiple sacral roots. Our case illustrates that muscular pseudo hypertrophy may follow chronic denervation as a consequence of spinal neural compressive disease. The various mechanisms postulated for this distinct condition are outlined.

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