scholarly journals Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jiayue Wang ◽  
Degang Wang ◽  
Jianjiao Chen
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Early Diagnosis ◽  
Postoperative Period ◽  
Esophageal Wall ◽  
Boerhaave’S Syndrome ◽  
Computed Tomography Scan ◽  
Old Chinese ◽  
Boerhaave's Syndrome ◽  
Tomography Scan

Abstract Background Boerhaave’s syndrome is the spontaneous rupture of the esophagus, which requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging. Case presentation Case 1: A 54-year-old Chinese man presented to us with sudden-onset epigastric pain radiating to the back following hematemesis. Upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. Subsequent computed tomography showed frank pneumomediastinum and heterogeneous pleural effusion. Immediately, esophageal perforation repair operation and jejunostomy were performed. The postoperative period was uneventful, and he was discharged. Case 2: A 62-year-old Chinese man was admitted to the emergency department with thoracic dull pain and chest distress. Chest computed tomography scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His postoperative period was uneventful, with no leakage or stricture. Case 3: The patient was a 69-year-old Chinese male presenting with severe retrosternal and upper abdominal pain following an episode of forceful vomiting. Thoracic computed tomography scan revealed a rupture in the left distal part of the esophagus, a pneumomediastinum, and left-sided pleural effusions. Conservative treatment failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery. Conclusions We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

scholarly journals Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

2020 ◽  
Author(s):  
Jiayue Wang ◽  
Degang Wang ◽  
Jianjiao Chen
Keyword(s):  
Pleural Effusion ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Ct Scan ◽  
Medical History ◽  
Subcutaneous Emphysema ◽  
Esophageal Perforation ◽  
Esophageal Rupture ◽  
Boerhaave’S Syndrome ◽  
Boerhaave's Syndrome

Abstract BACKGROUND: Boerhaave’s syndrome is the spontaneous rupture of the esophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality, which is why it requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging.CASE PRESENTATION: Case one: A 54-year-old man presented to us with sudden-onset epigastric pain radiating to the back following hematemes. His previous medical history included gastric ulcer. His physical signs suggested early shock. Combined with his medical history and physical signs, emergency doctor suspected a diagnosis of peptic ulcer with hematemesis, and esophagegastroscopy was performed. However, upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. The subsequent computed tomography (CT) showed frank pneumomediastinum and heterogeneous pleural effusion. He was subsequently referred to us in view of suspected Boerhaave’s syndrome and clinical worsening. In view of hemodynamic instability with uncontrolled sepsis, he was planned for surgery. Esophageal perforation repair operation and jejunostomy was performed for him. The postoperative period was uneventful, and he was discharged.Case two: A 62-year-old man was admitted to the emergency department with thoracic dull pain and chest distress that started after he had been vomiting several hours before presentation. On physical examination, he presented rough bronchovesicular breathing sound, and crepitant rales in lungs prompting subcutaneous emphysema. Chest CT scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Therefore, spontaneous esophageal perforation was suspected. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His vital signs remained stable intraoperatively, and his postoperative periods were uneventful with no leakage or stricture. Case three: The patient was a 69-year old male presenting with a severe retrosternal and upper abdominal pain followed an episode of forceful vomiting. At admission, he was diaphoretic and in respiratory distress. Physical examination revealed extensive cervical and thoracic subcutaneous emphysema but was otherwise unremarkable. A thoracic CT scan revealed a rupture in the left distal part of the oesophagus, a pneumomediastinum and left-sided pleural effusions. Conservative treatment, with cessation of oral intake, nasogastric suction, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum anti-biotics, proton pump inhibitors and drainage of the pleural effusion by left-sided thoracostomy, failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery.CONCLUSIONS: We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

scholarly journals The first experience of partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis

2021 ◽  
Vol 26 (3) ◽  
pp. 97-103
Author(s):  
A. V. Shabunin ◽  
V. V. Bedin ◽  
P. A. Drozdov ◽  
O. N. Levina ◽  
V. A. Tsurkan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Liver Cirrhosis ◽  
Postoperative Period ◽  
Primary Liver Cancer ◽  
Abdominal Cavity ◽  
Early Postoperative Period ◽  
Computed Tomography Scan ◽  
Intravenous Contrast ◽  
Viral Hepatitis C ◽  
Tomography Scan

Aim. To assess the efficacy and safety of interventional endovascular partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis.Material and methods. From September 2019 to March 2020, 5 partial spleen embolizations were performed at the surgical clinic of the Botkin Hospital. The indication was the impossibility of conducting courses of regional chemotherapy for primary liver cancer in 2 patients with cirrhosis, portal hypertension, hypersplenism, thrombocytopenia, in 3 patients – the impossibility of conducting adequate antiviral therapy with cirrhosis as a result of chronic viral hepatitis C. The platelet count was < 25 thousand/μl (19.34 ± 1.34 thousand/μl) in all patients at the time of the procedure. The median spleen volume was 1967.54 ± 476.13 (1324.34–2163.54) cm3 . We used Progreat® Terumo 2.8 Fr microcatheter 130 cm for catheterization branches of the splenic artery. Endovascular embolization was performed with microspheres 600 ± 75 nm – 2 ml before occlusion. Computed tomography scan of abdominal cavity with intravenous contrast enhancement and laboratory test of platelet levels were performed. Follow up of patients was carried out at 1, 3 and 6 months after this intervention.Results. The postoperative period in all patients was uncomplicated. Postembolization syndrome (pain, hyperthermia) developed in the early postoperative period in all patients on the next day after the procedure. Computed tomography scan of the abdominal cavity revealed areas of an irregular shape of low density that did not accumulate a contrast agent. The duration of hospitalization was 7.63 ± 3.32 (5–11) days. There were not in-hospital and 30-day mortality in our study.Conclusion. The first experience of endovascular partial spleen embolization showed its safety and efficacy in the correction of thrombocytopenia in patients with liver cirrhosis.

scholarly journals Pleural effusion in hematological pathology

CytoJournal ◽  
2021 ◽  
Vol 18 ◽  
pp. 3
Author(s):  
Neeraja Yerrapotu ◽  
Abid Rahman ◽  
Ali Gabali ◽  
Vinod B Shidham
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Chronic Myelomonocytic Leukemia ◽  
Computed Tomography Scan ◽  
Atypical Cells ◽  
Night Sweats ◽  
History Of ◽  
Myelomonocytic Leukemia ◽  
Tomography Scan ◽  
Fluid Cytology

A 51-year-old male with a history of chronic myelomonocytic leukemia-2 (CMML-2) presented with fatigue, night sweats, dyspnea, and right-sided chest pain exacerbated by deep breath. Computed tomography scan demonstrated right-sided pleural effusion with atelectasis. Pleural fluid cytology showed reactive mesothelial cells mixed with atypical cells [Figure 1]. The immunostains are performed using the SCIP approach.[1] The atypical cells were immunoreactive for vimentin, CD68, and CD163, while non-immunoreactive for cytokeratin, calretinin, BerEP4, and MOC31.

Early Diagnosis of Acute Myeloid Leukemia by Computed Tomography Scan

2012 ◽  
Vol 30 (23) ◽  
pp. e207-e208 ◽  
Author(s):  
Fuad El Rassi ◽  
Brent P. Little ◽  
Stacie Holloway ◽  
David Roberts ◽  
Hanna Jean Khoury
Keyword(s):  
Computed Tomography ◽  
Acute Myeloid Leukemia ◽  
Early Diagnosis ◽  
Myeloid Leukemia ◽  
Computed Tomography Scan ◽  
Tomography Scan ◽  
Acute Myeloid

Bronchoalveolar Carcinoma Presenting as Malignant Pericardial Effusion

1997 ◽  
Vol 5 (4) ◽  
pp. 244-246
Author(s):  
Raju S Iyer ◽  
Sanjeev Agarwal ◽  
Bharadwaja Vamaraju ◽  
Srinivasu Kola ◽  
Srinivas Bhavanarushi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Lung Lesion ◽  
Pericardial Fluid ◽  
Malignant Cells ◽  
Computed Tomography Scan ◽  
Rare Presentation ◽  
Malignant Pericardial Effusion ◽  
Tomography Scan

A 35-year-old male underwent emergency pericardiectomy for repeated tamponade. A computed tomography scan of the thorax showed a consolidated lung lesion with pleural effusion. Emergency aspiration removed hemorrhagic pericardial fluid and straw colored pleural effusion. Both fluids tested negative for malignant cells. He later underwent a pneumonectomy after a biopsy revealed carcinoma of the lung. The case is reported to illustrate this rare presentation of bronchoalveolar carcinoma.

scholarly journals Managing the penetrated traumatic spinal injury by an airgun shot: A case report from Dr. Soetomo Hospital, Surabaya, Indonesia

2021 ◽  
Vol 5 (1) ◽  
pp. 46-52
Author(s):  
Januardi Rifian Jani ◽  
Eko Agus Subagio
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Vertebral Body ◽  
Spinal Injury ◽  
Esophageal Wall ◽  
Computed Tomography Scan ◽  
The Right ◽  
Air Rifle ◽  
Tomography Scan ◽  
Breathing Problem

Penetrated Traumatic Spinal Injury by Airgun Shot are rare events. As a result, handling this case is both, thrilling and challenging. We present a case of a penetrated traumatic spinal injury from an airgun, as well as a summary of the literature on how to treat them. A 9-year-old boy was taken to hospital after being shot in the right side of his front neck with an air rifle. The patient had been shot from a distance with an upfront direction. The patient had no breathing problem but complained of pain during swallowing. The patient was conscious, alert, and oriented. There was no breathing distress. The head and neck Computed Tomography Scan displayed a foreign body with metal-density at the vertebral body of the first thoracal and discontinuity of the esophageal wall. Debridement and exploration surgery have successfully released the bullet. Repair trachea had been performed. Postoperatively, the patient had no complications. We can conclude that a foreign body at the spine, especially in the vertebral body of the cervical, can be effectively and safely released by exploration surgery.

scholarly journals Pneumomediastinum Complicating Diabetic Ketoacidosis and Boerhaave’s Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Samer Alkhuja ◽  
Natalya Gazizov ◽  
Gervais Charles
Keyword(s):  
Diabetic Ketoacidosis ◽  
Gastric Tube ◽  
Altered Mental Status ◽  
Boerhaave’S Syndrome ◽  
Computed Tomography Scan ◽  
X Ray ◽  
Boerhaave's Syndrome ◽  
Chest X Ray ◽  
The Right ◽  
Tomography Scan

An 18-year-old man presented with altered mental status. He was found to have diabetic ketoacidosis. Chest X-ray showed pneumomediastinum. After intubation for air-way protection, an oral-gastric tube was placed. A chest computed tomography scan showed the tip of the oral-gastric tube to be in the right hemithorax. The patient underwent a thoracotomy and was managed in the intensive care unit. Both diabetic ketoacidosis and Boerhaave's syndrome should be considered as possible causes of pneumomediastinum in a patient with similar presentation. Boerhaave's syndrome should be ruled out prior to the insertion of an oral-gastric tube to avoid further morbidities.

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