scholarly journals Idiopathic spontaneous compartment syndrome of the right lower limb: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Sareesh Bandapaati ◽  
Rayno Navinan Mitrakrishnan
Keyword(s):  
Risk Factors ◽  
Compartment Syndrome ◽  
Lower Limb ◽  
Clinical Signs ◽  
Acute Compartment Syndrome ◽  
Gradual Evolution ◽  
Lower Limb Pain ◽  
History Of ◽  
Extrinsic Risk ◽  
The Right

Abstract Background Acutely painful lower limb is a common presentation to the emergency department, and acute compartment syndrome is an important differential diagnosis to consider given the correct predisposing history and clinical presentation. However, idiopathic spontaneous compartment syndrome is an uncommon occurrence. Case presentation A 54-year-old Caucasian man with no previous comorbidities presented with acute right-sided lower limb pain with classical symptoms showing gradual evolution. He had no other history of medical relevance and no preceding injury. Examination showed a marginally enlarged right lower limb with stretched skin and tenderness. Routine blood tests were normal including D-dimer levels. However, in the absence of any underlying risk factors, acute compartment syndrome was suspected on clinical merit and confirmed with magnetic resonance imaging. He underwent successful surgical intervention with fasciotomy and achieved good recovery. Discussion Acute compartment syndrome, though commonly attributed to trauma, can occur due to varied causes. Spontaneous acute compartment syndrome is attributed to diabetes mellitus. Idiopathic acute spontaneous compartment syndrome occurs in the absence of either intrinsic or extrinsic risk factors and is rarely documented in the literature. This case highlights the importance of appreciating classical clinical signs and having the clinical acumen to consider an obvious diagnosis even in its rarer form of presentation.

scholarly journals Internal Carotid Dissection as the Cause of Stroke in Childhood

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Giulia Cinelli ◽  
Vitaliana Loizzo ◽  
Lisa Montanari ◽  
Ilaria Filareto ◽  
Elisa Caramaschi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Magnetic Resonance ◽  
Internal Carotid ◽  
Clinical Signs ◽  
Cervical Pain ◽  
Resonance Imaging ◽  
Cervical Trauma ◽  
History Of ◽  
Associated Risk Factors ◽  
The Right

Internal carotid artery (ICA) dissection is a cause of stroke, but it is often underdiagnosed in children. ICAs’ risk factors and pathogenic mechanisms are poorly understood, and the treatment is still empirical. We report the case of a previously healthy 9-year-old girl who presented with involuntary hypertonic closure of the right hand associated with transient difficulty for both fine movements of the right arm and speech. She had a history of minor cervical trauma occurring 20 days prior to our observation without other associated risk factors. Magnetic resonance imaging and magnetic resonance angiography showed ischemic lesions due to the left ICA dissection. Treatment with both acetylsalicylic acid and levetiracetam allowed recanalization of the ICA associated with the resolution of clinical signs. Our clinical case suggests that the ICA dissection must be suspected early whenever a child manifests mild neurologic deficits after a cervical trauma, especially if they are associated with headache and/or cervical pain. Moreover, the management of ICA dissection must be improved.

scholarly journals Crimean-Congo haemorrhagic fever presenting with acute compartment syndrome of the extremities (think beyond normal infections)

2020 ◽  
Vol 13 (2) ◽  
pp. e232323
Author(s):  
Ishma Aijazi ◽  
Fadhil Mustafa Abdulla Al Shama ◽  
Yaseen Shandala ◽  
Rupa Murthy Varghese
Keyword(s):  
Hospital Admission ◽  
Compartment Syndrome ◽  
Disseminated Intravascular Coagulation ◽  
Direct Contact ◽  
Acute Compartment Syndrome ◽  
Haemorrhagic Fever ◽  
Cchf Virus ◽  
History Of ◽  
Crimean Congo Haemorrhagic Fever ◽  
The Right

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonosis transmitted to humans and animals (which act as a reservoir) through the bite of a ‘Hyalomma’ tick. CCHF virus belongs to the genus Nairovirus. Humans are infected when they come in direct contact with the blood or secretions of infected livestock or other infected humans. This disease initially presents with non-specific febrile symptoms common to many viral illnesses and later progresses to disseminated intravascular coagulation (DIC) with haemorrhagic manifestations.We present the case of a middle-aged man with CCHF. He presented to the hospital with DIC and acute compartment syndrome in the right forearm, requiring urgent orthopaedic intervention. The diagnosis was delayed because there was no clear history of contact. The patient was started taking ribavirin on the fifth day of hospital admission. He recovered fully.

scholarly journals Acute Common Iliac Artery Thrombosis with Concurrent Pulmonary Embolism Revealing AML M2: Role of Elevated Plasma Tissue Factor Activity

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4722-4722
Author(s):  
Hind Bennani ◽  
Raphaël Coscas ◽  
Marc Coggia ◽  
Patrick Van Dreden ◽  
Marc Vasse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Risk Factor ◽  
Ct Scan ◽  
Intermittent Claudication ◽  
Lower Limb ◽  
Elevated Plasma ◽  
History Of ◽  
The Right

Abstract Background: Cancer patients are exposed to an increased risk of thrombohemorrhagic events. Whereas patients with solid tumors are prone to venous thromboembolism, acute leukemia may cause coagulopathy associated with thrombocytopenia leading to life-threatening bleeding. Disordered coagulatory system is predominant in AML M3 and to a lesser extent in hyperleukocytic AML M4 and M5. Thromboembolic events are rare in the context of unrecognized AML. Risk factors for arterial thrombosis in AML are not well described. Tissue Factor (TF) is being increasingly acknowledged as an important player in cancer thrombosis. We report a case of non-hyperleukocytic AML M2 revealed by an arterial occlusion with concurrent pulmonary embolism (PE) highlighting the potential role of elevated plasma TF activity as a precipitating event and a risk factor for thrombosis. Clinical Case: A 67-year-old non-smoker patient presented to emergency department because of a 6-hour history of pain in the right lower limb with pallor and coolness. Pulses were abolished in all arteries of the right lower limb without any sensory loss or motor deficit. Contralateral pulses were normal. Clinical examination was otherwise normal. She had no history of intermittent claudication. Past medical history was remarkable for hypertension, thyroid disease and obesity treated two years ago by a gastric bypass surgery complicated by a first episode of PE treated by low molecular weight heparin (LMWH). No further testing for thrombophilia was performed at that time. A total occlusion of the right common and external iliac arteries was confirmed by a CT-scan angiography. The distal arterial tree was healthy. A chest X-ray found bilateral condensations. A helical CT-scan of the chest disclosed bilateral PE with pulmonary infarction. A lung ventilation/perfusion scan confirmed PE. A transthoracic echocardiography found no intracavitary thrombus nor patent foramen ovale. Laboratory values were hemoglobin 9.8 g/dl, WBC 13.8 × 103 µl-1, platelets 60 × 103 µl-1, 80% blasts in the peripheral blood smear. Routine coagulation tests were within usual values (UV). Bone marrow (BM) aspiration found AML M2, myeloblasts were 80% with a cup-like nuclear morphology. Immunophenotyping of BM blasts disclosed CD34 and HLA-DR negativity. The karyotype was normal. Molecular evaluation found NPM1 gene mutation and FLT3 gene internal tandem duplication (FLT3-ITD). Jak2 gene was not mutated. Treatment consisted in LMWH followed by standard induction chemotherapy. Complete remission was achieved after induction followed by 2 courses of consolidation. Of note, the patient still suffers from intermittent claudication of the right leg. Extensive testing for thrombophilia excluded antithrombin, protein C, protein S and protein Z deficiencies, factor II and factor V mutations and antiphospholipid antibody syndrome. Homocysteinemia was normal. Procoagulant activity of intact blasts evaluated by a one-step plasma recalcification time assay was normal. Plasma TF activity was quantified by a one-stage kinetic chromogenic assay. Briefly, this assay is based on the ability of plasma TF to bind to FVIIa and on the capacity of the TF-FVIIa complex to generate FXa. At diagnosis TF activity was elevated at 2.92 pmol (UV<0.45). After remission it returned to normal. Discussion: To the best of our knowledge this is the first report of concurrent arterial and venous thromboses at presentation of AML. Classical risk factors for thrombosis in AML include coagulopathy and hyperleukocytosis yet neither were present here. Laboratory work-up for thrombophilia was negative. The only abnormal finding was an elevated plasma TF activity before chemotherapy. Interestingly, procoagulant activity on circulating blasts was normal, suggesting TF might have been generated from other sources than AML cells such as activated endothelium and/or normal white blood cells (monocytes, polynuclear neutrophils). TF activity returned to baseline after remission, strongly suggesting it was AML-associated either directly or via innate immunity. Conclusion: We report a case of non-hyperleukocytic AML M2 with an unusual presentation including an occlusion of a large artery with concurrent PE. TF activity could be considered in the future as a risk factor for arterial and/or venous thrombosis in AML independently of classical conditions such as hyperleukocytosis and coagulopathy. Disclosures Van Dreden: Diagnostica Stago: Employment.

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.

Immune-Mediated Neutropenia in a Miniature Poodle

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Benjamin Brunson
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Clinical Signs ◽  
Response To Therapy ◽  
Tertiary Referral Center ◽  
Immune Mediated ◽  
Specialized Equipment ◽  
History Of ◽  
Light Sedation ◽  
The Right

ABSTRACT A 10 yr old spayed female toy poodle was presented to a tertiary referral center for a 10 day history of waxing and waning lethargy, vomiting, diarrhea, and anorexia. An immune-mediated neutropenia (IMN) was suspected to be the underlying cause of her clinical signs. A bone marrow aspirate was obtained from the chostochondral junction of the 11th and 12th ribs on the right side and provided a definitive diagnosis of IMN. A positive response to therapy and repeat blood work further confirmed the diagnosis. Obtaining bone marrow aspirates from the chostochondral junction is a safe, cheap, and reliable method of diagnosing IMN and can be performed in the private practice setting with light sedation and minimal need for specialized equipment.

scholarly journals Otitis with Aspergillus niger in a patient with SARS-CoV-2 and multiple comorbidities

2021 ◽  
Vol 24 (3) ◽  
pp. 137-140
Author(s):  
Andreea Florentina Stoenescu ◽  
◽  
Geta Vancea ◽  
Dana Ispas ◽  
Nicoleta Voicu-Pârvu ◽  
...  
Keyword(s):  
Aspergillus Niger ◽  
Antiviral Treatment ◽  
Clinical Signs ◽  
Acute Onset ◽  
Suppurative Otitis Media ◽  
Vein Thrombosis ◽  
Significant Incidence ◽  
Lower Lung ◽  
History Of ◽  
The Right

Introduction. COVID-19 is associated with a significant incidence of bacterial and fungal superinfections and with the exacerbation of pre-existing infections, representing a diagnostic and therapeutic challenge. Case presentation. A 64-year-old woman, confirmed with COVID-19 by the SARS-CoV-2 antigen test, is hospitalized accusing fatigue, nausea, watery stools, cough and vertigo started 10 days ago, aggravated 4 days before the presentation. It also reports recurrent episodes of otalgia and otorrheic pluriantibiotic treatment in the last 2 months. From the personal pathological antecedents we remember: hypothyroidism, dyslipidemia, hypertension, ischemic heart disease, history of deep vein thrombosis (DVT) and secondary pulmonary thromboembolism, in chronic anticoagulant treatment. Pathological clinical signs at admission: bilateral basal crackling rales. Biologically, inflammatory syndrome is detected, and radiologically, interstitial-alveolar infiltrates in the lower lung fields. On day 3 of hospitalization, the patient shows purulent secretion in the right external auditory canal and the ENT consultation confirms chronic suppurative otitis media in acute onset. Bacteriological examination of otic secretion reveals Aspergillus niger. Antiviral treatment with Remdesivir is initiated, antibiotic therapy initiated at home with Azithromycin is continued for one day, then escalated to Ceftriaxone i.v. (in the context of clinical-paraclinical aggravation), systemic corticotherapy, anticoagulation with Dalteparin in the prophylactic regime of DVT, systemic treatment with Voriconazole p.o. (according to the antifungal program) and topical (local) with a slow favorable evolution. Conclusions. The association of COVID-19 with otitis with Aspergillus is a rare and particular clinical picture.

scholarly journals Recurrent Self-Induced Nontraumatic Orbital Emphysema Causing Orbital Compartment Syndrome with Optic Nerve Dysfunction

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
S. Cutting ◽  
C. Davies-Husband ◽  
C. Poitelea
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Compartment Syndrome ◽  
Valsalva Manoeuvre ◽  
First Case ◽  
Orbital Emphysema ◽  
History Of ◽  
Nerve Dysfunction ◽  
The Right ◽  
Needle Decompression

The majority of cases of orbital emphysema are due to trauma. Complications are rare, and therefore, the need for surgical intervention is uncommon. We present the first case of which we are aware in which nontraumatic orbital emphysema led to orbital compartment syndrome and subsequent optic nerve dysfunction. The patient underwent emergency needle decompression. A 51-year-old man presented to the Emergency Department with right-sided unilateral proptosis, reduced visual acuity, and binocular diplopia. This occurred after performing a Valsalva manoeuvre with no history of head trauma. He also mentioned that over the past year he had experienced multiple episodes of transient proptosis occurring after Valsalva manoeuvres. Visual acuity in the right eye was reduced to 6/21. A relative afferent pupillary defect was present and intraocular pressure (IOP) was 12 mmHg. The CT scan showed significant orbital emphysema in the medial aspect of the right orbit. Needle decompression was performed resulting in immediate resolution of his symptoms. This case demonstrates that, in cases of orbital emphysema, a lack of a history of trauma and a normal IOP cannot always be used to rule out serious pathology.

scholarly journals An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nada A. Alyousefi
Keyword(s):  
Emergency Room ◽  
Lower Limb ◽  
Varicose Veins ◽  
Hormonal Contraception ◽  
Oral Contraception ◽  
Contraceptive User ◽  
Lower Limb Pain ◽  
The Right ◽  
D Dimer ◽  
Ethinyl Oestradiol

Abstract Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

scholarly journals Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India

2020 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Clinical Signs ◽  
Increased Risk ◽  
History Of

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results A total of 302 children were included in the study, out of which 47% (95% CI 41.4%-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous one week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

scholarly journals Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Deng ◽  
Hai Nan Hong ◽  
Xin Bing Feng ◽  
Zheng Hua Hong ◽  
Guo Ping Cai ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lower Limb ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Psoas Muscle ◽  
Lumbar Interbody Fusion ◽  
Segmental Artery ◽  
Post Surgery ◽  
Lower Limb Pain ◽  
The Right

Abstract Background Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery. Case presentation Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared. Conclusion Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication.

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