Extensive retroperitoneal hematoma after laparoscopic appendectomy

The retroperitoneum is the abdominal portion located behind the sac of the peritoneal cavity and extending from the diaphragm to the pelvic inlet. A Retroperitoneal hematoma is a rare but a fearsome complication after appendectomy. The management of retroperitoneal hematomas can be difficult as the decision between a surgical intervention, angiographic embolization, and conservative management with fluids can be difficult to make. This case report would be outlining the clinical presentation, radiological findings, and outcome of a 60-year-old male who has been diagnosed with an intra-abdominal, retroperitoneal hematoma and flank ecchymosis with no signs of active bleeding after laparoscopic appendectomy. Retroperitoneal hematomas can be extensive post-laparoscopic abdominal surgeries. A comprehensive physical examination, radiological imaging, and laboratory investigations should be considered to rule out the possibilities of bleeding disorders and/or active bleeding contributing to the development of retroperitoneal hematomas.

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Axial osseous sarcoidosis: rare clinical presentation and radiological findings

Clinical Radiology ◽

10.1016/j.crad.2009.11.002 ◽

2010 ◽

Vol 65 (2) ◽

pp. 167-171 ◽

Cited By ~ 3

Author(s):

S. Yanny ◽

A.P. Toms ◽

D. MacIver ◽

T. Barker ◽

A. Wilson

Keyword(s):

Clinical Presentation ◽

Radiological Findings ◽

Osseous Sarcoidosis

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Splenic Infarction and Infectious Diseases in Korea

10.21203/rs.3.rs-44746/v4 ◽

2020 ◽

Author(s):

Jae Hyoung Im ◽

Moon-Hyun Chung ◽

Hye-Jin Lee ◽

Hea Yoon Kwon ◽

JiHyeon Baek ◽

...

Keyword(s):

Risk Factors ◽

Immune Cells ◽

Clinical Presentation ◽

Scrub Typhus ◽

Systemic Infection ◽

Splenic Infarction ◽

University Hospital ◽

Radiological Findings ◽

Epstein Barr ◽

The Relationship

Abstract Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed.Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n =12], babesiosis [n =1]); bacteria (scrub typhus [n =5]); viruses (Epstein–Barr [n =1], cytomegalovirus [n =1]); and unidentified pathogen[s] (n =7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.

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An Autochthonous Outbreak of the SARS-CoV-2 P.1 Variant of Concern in Southern Italy, April 2021

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6030151 ◽

2021 ◽

Vol 6 (3) ◽

pp. 151

Author(s):

Daniela Loconsole ◽

Anna Sallustio ◽

Francesca Centrone ◽

Daniele Casulli ◽

Maurizio Mario Ferrara ◽

...

Keyword(s):

Neutralizing Antibodies ◽

Clinical Presentation ◽

Southern Italy ◽

Receptor Binding Domain ◽

Gene Target ◽

Health Measures ◽

Molecular Tests ◽

Laboratory Investigations ◽

The Impact ◽

Mild Clinical Presentation

The SARS-CoV-2 P.1 variant of concern (VOC) was first identified in Brazil and is now spreading in European countries. It is characterized by the E484K mutation in the receptor-binding domain, which could contribute to the evasion from neutralizing antibodies. In Italy, this variant was first identified in January 2021. Here, we report an autochthonous outbreak of SARS-CoV-2 P.1 variant infections in southern Italy in subjects who had not travelled to endemic areas or outside the Apulia region. The outbreak involved seven subjects, three of whom had received a COVID-19 vaccine (one had received two doses and two had received one dose). Four patients had a mild clinical presentation. Laboratory investigations of nasopharyngeal swabs revealed that all strains were S-gene target failure-negative and molecular tests revealed they were the P.1 variant. Whole-genome sequencing confirmed that five subjects were infected with closely related strains classified as the P.1 lineage. The circulation of VOCs highlights the importance of strictly monitoring the spread of SARS-CoV-2 variants through genomic surveillance and of investigating local outbreaks. Furthermore, public health measures including social distancing, screening, and quarantine for travelers are key tools to slow down the viral transmission and to contain and mitigate the impact of VOC diffusion, and rapid scaling-up of vaccination is crucial to avoid a possible new epidemic wave.

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Hyperkinetic Movement Disorders

10.2310/im.6271 ◽

2015 ◽

Author(s):

Devin Mackay ◽

Edison Miyawaki

Keyword(s):

Computed Tomography ◽

Clinical Features ◽

Movement Disorders ◽

Clinical Presentation ◽

Genetic Correlations ◽

Practical Approach ◽

Involuntary Movements ◽

Computed Tomography Scans ◽

Paroxysmal Disorders ◽

Laboratory Investigations

The hyperkinetic movement disorders include heterogeneous diseases and syndromes, all characterized by one or a variety of excessive, involuntary movements. The hyperkinetic movement disorders are heterogeneous in clinical presentation, but a rational and practical approach to diagnosis exists based on new genetic correlations and targeted laboratory investigations. Treatments informed by a still-developing picture of motor pathophysiology offer significant benefit for these disorders. This chapter discusses choreiform disorders, including patterns in choreiform diagnosis; tremor disorders; paroxysmal disorders, including tics and myoclonus; dystonias, including monogenic primary dystonias; and pathophysiology and treatment in the hyperkinetic movement disorders. Figures include clinical photos, computed tomography scans, and an algorithm representing cortical-subcortical circuitry. Tables delineate definitions, distinguishing clinical features, medications, genetics, protein products, and treatments associated with various disorders. This review contains 6 figures, 12 tables, and 145 references.

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Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201234 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1622

Author(s):

Jigyasa Singh ◽

Kalpana Kumari ◽

Vandana Verma

Keyword(s):

Platelet Count ◽

Prospective Observational Study ◽

Clinical Presentation ◽

Tertiary Care ◽

Late Pregnancy ◽

Normal Platelet ◽

Gestational Thrombocytopenia ◽

Underlying Causes ◽

In Pregnancy ◽

Rule Out

Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes.

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Isolated leptomeningeal angiomatosis in the sixth decade of life, an adulthood variant of Sturge Weber Syndrome (Type III): role of advanced Magnetic Resonance Imaging and Digital Subtraction Angiography in diagnosis

BMC Neurology ◽

10.1186/s12883-020-01944-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Vetrivel Muralidharan ◽

Gaetano Failla ◽

Mario Travali ◽

Tiziana Liliana Cavallaro ◽

Marco Angelo Politi

Keyword(s):

Clinical Presentation ◽

Subcortical White Matter ◽

Digital Subtraction ◽

Resonance Imaging ◽

Radiological Findings ◽

Hyperintense Signal ◽

Right Cerebral Hemisphere ◽

Weber Syndrome ◽

Sturge Weber Syndrome ◽

The Right

Abstract Background Sturge-Weber syndrome (SWS) is primarily diagnosed in pediatric population, but clinical presentation in late adulthood is rarely reported. Evolution of radiological findings in the adulthood variant of SWS with isolated leptomeningeal angiomatosis has never been reported to our knowledge. Case presentation We report here a case of an isolated temporo-parieto-occipital leptomeningeal angiomatosis on the right cerebral hemisphere in a sixty-two-year-old male who presented with generalized seizure, GCS score 14/15 (E4 V4 M6) with equal and reacting pupils, psychomotor slowing, left hemineglect and grade 4 power in the left upper and lower limbs. Over a period of 48 h his neurological status deteriorated, but recovered spontaneously over a week on titration with anticonvulsants. He had a prior history of treatment for focal leptomeningitis, three years ago. Cerebrospinal fluid (CSF) analysis showed glucose of 75 mg/dL, proteins of 65 mg/dL and culture grew no organisms. On follow-up, he had intermittent episodes of focal seizure for two years. Initial, computed tomography of brain showed hyperdense lesion in the parieto-occipital convexity subarachnoid space on the right cerebral hemisphere mimicking subarachnoid hemorrhage and computed tomography angiography showed no significant abnormality. Magnetic resonance imaging (MRI) of brain showed intense pial enhancement in the right temporo-parieto-occipital region with a subtle T2W hyperintense signal in the underlying subcortical white matter without edema or infarct or mass effect. Digital subtraction cerebral angiography (DSA) showed hypertrophy of the cerebral arteries, arteriolo-capillary bed and venules in the right temporo-parieto-occipital territory associated with early arterio-capillary and venous opacification. Serial MRI done after six months, one and two years showed increase in the T2W hyperintense signal in the subcortical white matter and cortical atrophy with no changes in the pial enhancement. MR perfusion imaging showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the right parieto-temporo-occipital cortical and subcortical regions and increased perfusion in the leptomeninges with reduction of the NAA / Cr ratios in spectroscopy. Conclusion Conglomeration of various radiological findings in MRI, Perfusion, MRS and DSA with the clinical presentation can aid in establishing the diagnosis of this rare presentation of SWS-type 3 variant in late adulthood.

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Lymphocytic colitis: clinical presentation and long term course

Gut ◽

10.1136/gut.43.5.629 ◽

1998 ◽

Vol 43 (5) ◽

pp. 629-633 ◽

Cited By ~ 90

Author(s):

B Mullhaupt ◽

U Güller ◽

M Anabitarte ◽

R Güller ◽

M Fried

Keyword(s):

Colonic Mucosa ◽

Clinical Presentation ◽

Collagenous Colitis ◽

Endoscopic Examination ◽

Watery Diarrhoea ◽

Lymphocytic Colitis ◽

Radiological Findings ◽

Benign Course

Background—Lymphocytic colitis is characterised by chronic watery diarrhoea with normal endoscopic or radiological findings and microscopic evidence of pronounced infiltration of the colonic mucosa with lymphocytes.Aim—To investigate the long term clinical and histological evolution of the disease in a large group of patients with well characterised lymphocytic colitis.Methods—Between 1986 and 1995 the histological diagnosis of lymphocytic colitis was obtained in 35 patients; 27 of these agreed to a follow up examination. All clinical, endoscopic, and histopathological records were reviewed at that time and the patients had a second endoscopic examination with follow up biopsies.Results—The patients initially presented with the typical findings of lymphocytic colitis. After a mean (SD) follow up of 37.8 (27.5) months, diarrhoea subsided in 25 (93%) and histological normalisation was observed in 22 (82%) of the 27 patients. Progression from lymphocytic colitis to collagenous colitis was not observed.Conclusions—Lymphocytic colitis is characterised by a benign course with resolution of diarrhoea and normalisation of histology in over 80% of patients within 38 months. Considering the benign course of the disease, the potential benefit of any drug treatment should be carefully weighed against its potential side effects.

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