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

2016 ◽  
Vol 28 (4) ◽  
pp. 445-449 ◽  
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.

scholarly journals Ultrasound Detection of the Aquarium Sign at the Bedside

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.

scholarly journals A Rare Case of Pylephlebitis as a Complication of Cholecystocolonic Fistula

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Kouki Imaoka ◽  
Saburo Fukuda ◽  
Hirofumi Tazawa ◽  
Sotaro Fukuhara ◽  
Yuzo Hirata ◽  
...  
Keyword(s):  
Portal Vein ◽  
Vein Thrombosis ◽  
Anterior Branch ◽  
Life Threatening ◽  
Cholecystocolonic Fistula ◽  
Intra Abdominal Infection ◽  
Upper Abdominal ◽  
Abdominal Infections ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography

Pylephlebitis is defined as a septic thrombophlebitis of the portal vein and its tributaries that is associated with multiple suppurative abdominal infections. We report a case of pylephlebitis associated with a cholecystocolonic fistula (CCF). A 41-year-old man presented with upper abdominal pain and anorexia for 1 month. Abdominal contrast-enhanced computed tomography (CT) revealed thrombosis in the left and anterior branch of the portal vein and thickening of the walls of the portal vein and periside portals. The gallbladder was collapsed and pneumobilia was seen in the biliary tract. Blood culture was positive for Streptococcus anginosus. A diagnosis of thrombophlebitis of the portal vein associated with CCF was made, and the patient was immediately managed with an intravenous broad-spectrum antibiotic and anticoagulation. After the portal vein thrombosis (PVT) propagation and inflammation had subsided, cholecystectomy and partial resection of the transverse colon were performed. Pylephlebitis is rare but is a life-threatening complication of intra-abdominal infection. A high index of suspicion is required, and a CT scan should be performed immediately for an early diagnosis and appropriate treatment.

scholarly journals Proximal Descending Thoracic Aortic Pseudoaneurysm Secondary to Pott's Spine

Aorta ◽  
2020 ◽  
Vol 08 (02) ◽  
pp. 035-037 ◽  
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.

scholarly journals Brachiocephalic Vein Aneurysm Treated with Surgery: A Case Report

2019 ◽  
Vol 22 (5) ◽  
pp. E357-E359
Author(s):  
Jin hong Wi
Keyword(s):  
Vascular Graft ◽  
Incidental Finding ◽  
Median Sternotomy ◽  
Rare Condition ◽  
Unknown Origin ◽  
Brachiocephalic Vein ◽  
Postoperative Course ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Brachiocephalic vein aneurysm is an extremely rare condition of unknown origin. It may be asymptomatic, presenting as an incidental finding or as a result of complications it causes. We report a case of a 54-year-old man who was asymptomatic and diagnosed with an isolated saccular aneurysm of the left brachiocephalic vein using contrast-enhanced computed tomography. The patient underwent aneurysmectomy through a median sternotomy with no requirement for a vascular graft or cardiopulmonary bypass. The patient had an uneventful postoperative course and remained well two months after the surgery.

scholarly journals Pyrexia of Unknown Origin: An Atypical Presentation of Hepatic Hemangioma

2020 ◽  
Vol 06 (04) ◽  
pp. e180-e184
Author(s):  
Gunjan Desai ◽  
Dattaraj Budkule ◽  
Prasad Pande ◽  
Prasad Wagle
Keyword(s):  
Unknown Origin ◽  
Uneventful Recovery ◽  
Hepatic Hemangioma ◽  
Diagnostic Challenge ◽  
Abdominal Ultrasonography ◽  
Algorithmic Approach ◽  
Pyrexia Of Unknown Origin ◽  
Right Lobe ◽  
Sudden Decrease ◽  
Vague Abdominal Pain

AbstractPyrexia of unknown origin (PUO) has been a diagnostic challenge for decades. Hepatic hemangioma (HH) is not a common differential diagnosis of PUO. It is the most common benign hepatic tumor, commonly asymptomatic and incidentally detected, or can present with vague abdominal pain. PUO is a rare presenting feature. We describe a case of 38-year-old lady presenting with PUO. With no other identifiable source of fever despite exhaustive investigations, a giant hemangioma in right lobe of liver detected on abdominal ultrasonography was deemed to be the cause of PUO. The patient had sudden decrease in hemoglobin while undergoing workup, which on imaging showed a bleeding hemangioma and right hepatectomy was performed. Patient had an uneventful recovery and her PUO also resolved after surgery. HH should be considered a rare diagnosis of exclusion for PUO after a standard algorithmic approach does not reveal any other cause.

scholarly journals Neurological Complications of Acute Rhinosinusitis: Meningitis

2021 ◽  
Vol 12 ◽  
pp. 215265672199625
Author(s):  
Stephen Bennett ◽  
Sheneen Meghji ◽  
Farahnaz Syeda ◽  
Nazir Bhat
Keyword(s):  
Neurological Complications ◽  
Sepsis Management ◽  
Acute Rhinosinusitis ◽  
Contrast Enhanced ◽  
Intravenous Antibiotics ◽  
Nasal Steroids ◽  
Life Threatening ◽  
Enhanced Computed Tomography ◽  
Ethmoid Sinuses ◽  
Bony Erosion

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.

scholarly journals Neuroleptic Malignant Syndrome-an uncommon complication of a common drug- a case report

Biomedicine ◽  
2021 ◽  
Vol 40 (4) ◽  
pp. 554-556
Author(s):  
Vaishnavi Danasekaran ◽  
S. Lokesh ◽  
Prasanna Venkatesh ◽  
Aftab .
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Unknown Origin ◽  
Nigrostriatal Pathway ◽  
Fatal Complication ◽  
Idiosyncratic Reaction ◽  
Pyrexia Of Unknown Origin ◽  
Common Drug ◽  
Drug History ◽  
Life Threatening ◽  
History Of

Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to neuroleptics and rarely to antidopaminergics. Although the incidence in India is 0.14%, it is potentially a fatal complication. NMS occurs due to a blockade in the dopamine receptor and nigrostriatal pathway. The following report is about our patient who was diagnosed with NMS. This patient was diagnosed of NMS due to a progressive rise in CPK NAC and liver enzymes, metabolic acidosis and pyrexia of unknown origin not responding to treatment. No foci for the cause of pyrexia were ascertained. However, a positive drug history of recent administration of Inj. Metaclopramide was the present treatment in the form of supportive care, by controlling rigidity, hyperthermia and preventing complications that can occur following the affliction of this condition. NMS is a potentially reversible fatal complication with a mortality rate of 30%. Indiscriminate usage of neuroleptics and antidopaminergics can inadvertently lead to patients developing this condition. This case has been reported to create awareness amongst physicians about this complication.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
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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