Renal Infarction and Pulmonary Embolism in Patient with Myelodysplastic

The myelodysplastic syndrome-myeloproliferative neoplasms (MDS/MPNs) are defined by a group of heterogeneous hematological malignancies resulting from stem cell−driven clonal growth of pathological hematopoietic progenitors and ineffective hematopoiesis, they are characterized concomitant myelodysplastic and myeloproliferative signs. Myelodysplastic/myeloproliferative disorders have been considered to have a higher risk of thrombus formation.We report a rare case about a 64 years old Moroccan woman, experienced renal infarction (RI) associated with pulmonary embolism as a complication of a myelodysplastic/myeloproliferative disorder.The patient complained of acute-onset severe left flank pain, a contrast-enhanced computed tomography (CT) of the chest and abdomen revealed RI by a large wedge-shaped defect in the right kidney with pulmonary embolism.Biological exam showed deep anemia, the bone marrow aspiration found myelodysplasia.the bone biopsy showed signs of myeloproliferatif disease. The karyotype was normal, BCR-ABL, JAK2, CALR mutations were absents, and MPL mutation was positive. The International Prognostic Scoring System (IPSS-R) was 0, and the patient was included to the low risk group.Anticoagulation therapy was initiated with heparin to treat RI and pulmonary embolism. Three months later, pulmonary embolism had resolved without the appearance of additional peripheral infarction.This case emphasizes the need to consider myelodysplastic/myeloproliferative disorders as a cause of infraction renal and pulmonary embolism.

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Spontaneous renal artery dissection: an elusive diagnosis

BMJ Case Reports ◽

10.1136/bcr-2021-245949 ◽

2021 ◽

Vol 14 (9) ◽

pp. e245949

Author(s):

Catherine Mary Henry ◽

Peter MacEneaney ◽

Gemma Browne

Keyword(s):

Renal Artery ◽

Antihypertensive Treatment ◽

Rare Condition ◽

Acute Onset ◽

Flank Pain ◽

Artery Dissection ◽

Renal Infarction ◽

Ct Angiogram ◽

Systemic Anticoagulation ◽

The Right

Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.

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Dermatomyositis with renal infarction: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060517709673 ◽

2017 ◽

Vol 45 (6) ◽

pp. 2153-2157 ◽

Cited By ~ 1

Author(s):

Ti Zhang ◽

Xin Liu ◽

Huji Xu

Keyword(s):

Corticosteroid Therapy ◽

Abdominal Ultrasound ◽

Renal Infarction ◽

Low Back ◽

X Ray ◽

Contrast Enhanced ◽

Low Sensitivity ◽

The Right ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Renal infarction is a rare clinical entity that is not easily detected by low-sensitivity ultrasound. We herein report a case of dermatomyositis with renal infarction detected during corticosteroid therapy. The patient was followed up for 18 months. A woman who was clinically diagnosed with dermatomyositis complained of severe pain in the right flank of the low back and abdomen, accompanied by nausea and vomiting during corticosteroid therapy. Based on the findings of routine blood tests, abdominal X-ray radiography, and abdominal ultrasound, the patient was diagnosed with acute gastroenteritis and treated with levofloxacin. However, her symptoms were not relieved. Abdominal contrast-enhanced computed tomography revealed renal infarction. Clinicians should be alert to the occurrence of thrombosis, especially when it manifests as vasculitis in patients with rheumatic disease who complain of severe abdominal pain, because it may suggest the presence of renal infarction.

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Sclerosing Extramedullary Hematopoietic Tumor: A Case Report

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620956463 ◽

2020 ◽

Vol 8 ◽

pp. 232470962095646

Author(s):

Dapeng Wang ◽

Eduardo Castro ◽

Arundhati Rao ◽

Christopher Michael McPhaul

Keyword(s):

Computed Tomography ◽

Lymphoblastic Leukemia ◽

Bone Marrow Aspiration ◽

Jak2 V617f ◽

Myeloproliferative Disorders ◽

Extramedullary Hematopoiesis ◽

Hematological Disorders ◽

History Of ◽

Exon 9 ◽

The Right

Sclerosing extramedullary hematopoietic tumor (SEMHT) is a rare disease that was originally named fibrous hematopoietic tumor or myelosclerosis. The process typically occurs in patients with a history of chronic myeloproliferative disorders and may afflict the skin, lung, breast, gastrointestinal tract, breast, kidney, lymph node, and thyroid gland. In this article, we report the case of a 37-year-old female with more than 5 years history of acute B-cell lymphoblastic leukemia who presented with right upper quadrant pain and tenderness. Computed tomography scan showed multiple new ring-enhancing low-density lesions within the right and left hepatic lobes. A computed tomography–guided liver core biopsy was performed on one of the new liver lesions and showed extramedullary hematopoiesis with atypical megakaryocytes and sinusoidal capillarization with associated fibroblastic proliferation. Numerous atypical megakaryocytes were scattered in the background of haphazard collagen deposition. No significant blasts or a leukemic process were identified. Bone marrow aspiration and biopsy showed extensive reticulin fibrosis (MF-3), trilineage dysplasia, increased blasts (10% to 19%), and hypercellularity (close to 100%), which was consistent with MDS-EB-2. Cytogenetics was reported as follows: 44~46,XX,-3,add(3)(p13),-5,-6,-7,17,del(17)(p12),+1~5mar[cp9]/46,XX. Molecular analysis was negative for both JAK2 V617F and CALR exon 9 activating mutations. In summary, we contributed a new case of SEMHT diagnosis in a synchronous presentation with poor clinical evolution associated chromosome 7 deletion and intact JAK2 and CALR exon 9. Care should be taken when diagnosing intraabdominal and retroperitoneal soft tissue masses with the history of hematological disorders.

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Rare pulmonary embolism caused by the combination of bilateral popliteal venous aneurysms and antiphospholipid syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-236341 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236341

Author(s):

Tomoki Fukui ◽

Nobuyuki Ogasawara ◽

Shinji Hasegawa

Keyword(s):

Pulmonary Embolism ◽

Antiphospholipid Syndrome ◽

Venous Aneurysm ◽

Renal Infarction ◽

Antiphospholipid Antibody ◽

First Case ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right

Popliteal venous aneurysm (PVA) and antiphospholipid syndrome (APS) are under-recognised as potential causes of pulmonary embolism (PE). A 66-year-old woman presented with progressive shortness of breath. A contrast-enhanced CT revealed bilateral PE, a small renal infarction and bilateral PVAs. Direct oral anticoagulant (DOAC) therapy was initiated immediately for venous thrombosis. Given the positivity for serum antiphospholipid antibody (aPL) in an initial blood test, low-dose aspirin was included to prevent further arterial thrombosis. Her symptoms resolved and she was discharged 1 week later. Twelve weeks later, she was diagnosed with APS because of persistent aPL. Surgical resection of the right PVA was performed 1 year later from her hospitalisation. To the best of our knowledge, this is the first case of PE caused by the combination of bilateral PVAs and APS. This report emphasises the importance of careful screening to identify PE causes, and its optimal management.

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Omental Infarction: A Case Treated with Laparoscopic Surgery

10.31487/j.ijscr.2019.02.03 ◽

2019 ◽

pp. 1-3

Author(s):

Bertrand Ng ◽

Arafat Yasser

Keyword(s):

Diabetes Mellitus ◽

Laparoscopic Surgery ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Inflammatory Markers ◽

Acute Onset ◽

Laparoscopy Surgery ◽

History Of ◽

Background History ◽

The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

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A review of current knowledge of myeloproliferative disorders in the horse

Acta Veterinaria Scandinavica ◽

10.1186/s13028-021-00573-3 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Katy Satué ◽

Juan Carlos Gardon ◽

Ana Muñoz

Keyword(s):

Bone Marrow ◽

Myeloid Leukemia ◽

Current Knowledge ◽

Myeloproliferative Neoplasms ◽

Myeloproliferative Disorders ◽

World Health ◽

Chronic Granulocytic Leukemia ◽

Current State ◽

Multiple Cell ◽

Health Organization

AbstractMyeloid disorders are conditions being characterized by abnormal proliferation and development of myeloid lineage including granulocytes (neutrophils, eosinophils and basophils), monocytes, erythroids, and megakaryocytes precursor cells. Myeloid leukemia, based on clinical presentation and proliferative rate of neoplastic cells, is divided into acute (AML) and myeloproliferative neoplasms (MPN). The most commonly myeloid leukemia reported in horses are AML-M4 (myelomonocytic) and AML-M5 (monocytic). Isolated cases of AML-M6B (acute erythroid leukemia), and chronic granulocytic leukemia have also been reported. Additionally, bone marrow disorders with dysplastic alterations and ineffective hematopoiesis affecting single or multiple cell lineages or myelodysplastic diseases (MDS), have also been reported in horses. MDSs have increased myeloblasts numbers in blood or bone marrow, although less than 20%, which is the minimum level required for diagnosis of AML. This review performed a detailed description of the current state of knowlegde of the myeloproliferative disorders in horses following the criteria established by the World Health Organization.

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An incidental finding of testicular seminoma in the context of acute pulmonary embolism: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02925-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Kaitlin J. Mayne ◽

Emma Lewis ◽

Lewis Vickers

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Guidelines ◽

Acute Pulmonary Embolism ◽

Incidental Finding ◽

White Male ◽

Vena Cava ◽

Testicular Seminoma ◽

Computed Tomography Scanning ◽

The Right

Abstract Background Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient. Case presentation A 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy. Conclusions This case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”

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Recurrence hernia in the broad ligament of the uterus: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01030-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Yoshifumi Hashimoto ◽

Tatsuo Kanda ◽

Tadasu Chida ◽

Kazuyoshi Suda

Keyword(s):

Small Bowel ◽

Rare Disease ◽

Broad Ligament ◽

Significant Risk ◽

Disease Recurrence ◽

The Right ◽

Enhanced Computed Tomography ◽

Bowel Segments ◽

Hernia Orifice ◽

Bowel Herniation

Abstract Background Bowel herniation through a defect in the broad ligament of the uterus is a rare disease and few cases of recurrence have been reported. We report herein a recurrence case of a patient with broad ligament hernia (BLH), along with a review of the literature. Case presentation A 53-year-old woman complaining of abdominal pain was transported to our hospital. She had a history of laparotomy for small-bowel obstruction associated with hernia in the broad ligament of the uterus 10 years ago at a local hospital. Abdominal pelvic contrast-enhanced computed tomography revealed that the mesentery of the dilated bowels converged at a thick band in the pelvis, suggesting closed loop obstruction of the small bowel. The patient underwent urgent laparotomy and was diagnosed with bowel herniation through an opening in the broad ligament of the uterus on the right side, which was ipsilateral with the previous surgery. The hernia orifice was widened by incision and incarcerated bowel segments were released and preserved because ischemia was reversible. The membranous defect of BLH was closed by suture with braded silk strings. Conclusions Although BLH is a rare disease, patients face a significant risk of disease recurrence. Nonabsorbable suture may be advisable for closure of the hernia orifice in BLH.

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Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1718399 ◽

2020 ◽

Vol 46 (08) ◽

pp. 895-907

Author(s):

Nina D. Anfinogenova ◽

Oksana Y. Vasiltseva ◽

Alexander V. Vrublevsky ◽

Irina N. Vorozhtsova ◽

Sergey V. Popov ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

High Risk ◽

Transesophageal Echocardiography ◽

Three Dimensional ◽

Right Atrial ◽

Treatment Protocols ◽

High Risk Patients ◽

Risk Patients ◽

The Right

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

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