Tuberculous retropharyngeal abscess presenting as severe dyspnea

Tuberculous retropharyngeal abscess is an exceptional condition, with high potential of functional morbidity and mortality if not treated appropriately. The authors report a new case of airway obstructive retropharyngeal abscess revealing cervical Pott disease. A 59 years old man presented at Ear, neck and throat (ENT) department with severe acute dyspnea. The history revealed progressive chronic dysphagia associated with asthenia and important weight loss. Physical examination found a state 3 dyspnoeic patient, presenting hyper flexed neck with limited movements. Nasofibroscopy showed a huge retropharyngeal bulge. Computed tomography (CT) scan showed a large retropharyngeal abscess located in front of vertebral spondylodiscitis with anterior dislocation of C4-C5-C6 vertebrae. Trans-oral incision with drainage of the retropharyngeal abscess was performed under general anaesthesia. Bacteriologic assessment of the pus confirmed tuberculosis infection. Anti-tuberculous medication was delivered, associated with spinal stabilization by a rigid cervical collar. Tuberculous retropharyngeal abscess is a very rare condition. Early diagnosis and treatment are necessary to prevent neurological and life-threatening complications. Collaboration between ENTs, anaesthetists, neurosurgeons and infectious disease specialists remains incontournable.

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Selected Infectious Disease Emergencies

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0013 ◽

2020 ◽

pp. 115-122

Author(s):

Scott Kobner ◽

Emily Rose

Keyword(s):

Infectious Disease ◽

Bartonella Henselae ◽

Viral Meningitis ◽

Brain Parenchyma ◽

Retropharyngeal Abscess ◽

Cat Fleas ◽

Life Threatening ◽

Tissue Space ◽

Atypical Presentations ◽

The Brain

Fever is common in children, and serious etiologies with significant sequelae must be identified and treated. This chapter discusses the classic and atypical presentations of several important pediatric infectious disease conditions, including bacterial and viral meningitis (inflammation of the meninges that typically occurs in response to an infectious process), infectious encephalitis (inflammation of the brain parenchyma that presents clinically with neurologic dysfunction), retropharyngeal abscess (a potentially life-threatening airway emergency secondary to an infection of the retropharyngeal soft tissue space), and cat scratch disease secondary to Bartonella henselae infection (an infectious lymphadenopathy after exposure to cats or cat fleas). Diagnostic confirmation and treatment of these conditions are also discussed.

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Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition

Diagnostics ◽

10.3390/diagnostics11061122 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1122

Author(s):

Jessica Graef ◽

Bernd A. Leidel ◽

Keno K. Bressem ◽

Janis L. Vahldiek ◽

Bernd Hamm ◽

...

Keyword(s):

Computed Tomography ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Image Acquisition ◽

Circulatory Arrest ◽

Motion Artifacts ◽

Current Standard ◽

Ct Protocol ◽

Life Threatening ◽

Reconstruction Time

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.

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The Global Registry for Hereditary Angioedema due to C1-Inhibitor Deficiency

Clinical Reviews in Allergy & Immunology ◽

10.1007/s12016-021-08855-4 ◽

2021 ◽

Author(s):

Andrea Zanichelli ◽

Henriette Farkas ◽

Laurance Bouillet ◽

Noemi Bara ◽

Anastasios E. Germenis ◽

...

Keyword(s):

Hereditary Angioedema ◽

Rare Condition ◽

C1 Inhibitor ◽

C1 Inhibitor Deficiency ◽

Therapeutic Decisions ◽

Life Threatening ◽

Enhance Patient Care ◽

Electronic Support ◽

The Impact ◽

Global Registry

AbstractHereditary angioedema (HAE) is a rare condition, mostly due to genetic deficiency of complement C1 inhibitor (C1-INH). The rarity of HAE impedes extensive data collection and assessment of the impact of certain factors known to affect the course of this disabling and life-threatening disease. Establishing a global registry could assist to overcome such issues and provides valuable patient data from different countries. The HAE Global Registry is a disease-specific registry, with web-based electronic support, where data are provided by physicians and patients through a dedicated application. We collected data between January 1, 2018, and August 31, 2020. Data on 1297 patients from 29 centers in 5 European countries were collected. At least one attack was recorded for 497 patients during the study period. Overall, 1182 patients were diagnosed with HAE type 1 and 115 with type 2. At the time of database lock, 389 patients were taking long-term prophylactic medication, 217 of which were on danazol. Most recorded attacks affected the abdomen, were generally moderate in severity, and occurred in patients who were not on prophylactic treatment (70.6%, 6244/8848). The median duration of attacks was 780 min (IQR 290–1740) in patients on prophylactic medication and 780 min (IQR 300–1920) in patients not on continuous prophylactic medication. In conclusion, the establishment of a registry for C1-INH-HAE allowed collection of a large amount of data that may help to better understand the clinical characteristics of this disease. This information may enhance patient care and guide future therapeutic decisions.

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Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽

10.1177/27325016211005062 ◽

2021 ◽

pp. 273250162110050

Author(s):

Samuel Ruiz ◽

Rizal Lim

Keyword(s):

Pediatric Population ◽

Rare Complication ◽

Disease Process ◽

Rare Condition ◽

External Drainage ◽

Direct Extension ◽

Life Threatening ◽

History Of ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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Visceral Mycotic Aneurysm: Superior Mesenteric Artery Aneurysm Caused by K. pneumoniae

Dubai Medical Journal ◽

10.1159/000517222 ◽

2021 ◽

pp. 1-4

Author(s):

Reham Almasoud ◽

Alaaeddin Nwilati ◽

Saeb Bayazid ◽

Mamoun Shafaamri

Keyword(s):

Infectious Disease ◽

Antibiotic Therapy ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mycotic Aneurysm ◽

Artery Aneurysm ◽

Management Plan ◽

Resected Tissue ◽

Infectious Disease Specialists

We herein report a rare case of mycotic aneurysm of the superior mesenteric artery caused by Klebsiella pneumoniae. A 66-year-old man, a known case of hypertension and aorto-oesophageal fistula with stented aorta in 2010 and 2018, presented to the emergency department multiple times over 2 months with severe postprandial abdominal pain associated with vomiting and fever. On his last presentation, the obtained blood cultures grew ESBL positive K. pneumoniae and a repeated computed tomography (CT) showed a growing aneurysm at the origin of the ileocecal branch of the superior mesenteric artery measuring 17 × 10 mm (the aneurysm was 8 × 7.5 mm in the CT angiography on the previous admission). Extensive workup did not reveal the underlying cause of the mycotic aneurysm, thus we believe the cause to be the infected aortic stent, leading to bacteraemia and vegetations to the mesenteric artery causing the aneurysm. The management plan was placed by a multidisciplinary team consisting of vascular surgeons and infectious disease specialists along with review from a dietician to evaluate the patient’s nutritional status. The patient was started on total parenteral nutrition due to his postprandial pain and on antibiotic therapy according to the infectious disease team’s recommendation. He underwent surgical resection of the mycotic aneurysm, which showed a thrombosed aneurysm in the jejunoileal mesenteric area. The histopathology of the resected tissue demonstrated inflammatory aneurysm of the mesenteric artery. Following the surgery, the patient continued his antibiotic therapy and was discharged on the 13th post-operative day with follow-up appointments in the vascular surgery and infectious disease clinic.

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415 Improving Preoperative Computed Tomography Staging for Men with Suspected Testicular Cancer

British Journal of Surgery ◽

10.1093/bjs/znab134.421 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S A Stanley ◽

C T Berridge ◽

T R L Griffiths

Keyword(s):

Computed Tomography ◽

Testicular Cancer ◽

Median Time ◽

University Hospitals ◽

Treatment Pathway ◽

Pathway Data ◽

Life Threatening ◽

Neo Adjuvant Chemotherapy ◽

The University ◽

Urology Clinic

Abstract Introduction Neo-adjuvant chemotherapy may be considered for suspected testicular malignancy if widespread life-threatening metastases are identified on computed tomography (CT) imaging. Staging preoperatively enables this and may prevent delays in ongoing oncological care. This project aimed to increase the proportion of staging scans performed preoperatively in the University Hospitals of Leicester NHS trust. Method All referrals between 01/01/2016 and 31/12/2018 to the urology multidisciplinary team for suspected testicular cancer were reviewed. Exclusion criteria were applied prior to collecting treatment pathway data for each patient. Based on initial audit findings, clinicians were advised to request staging CT scans at the first urology clinic appointment. Re-audit was between 01/01/2019 and 31/12/2019. Results Initial audit included 95 patients and re-audit included 23 patients. The proportion of preoperative scans increased from 28.4% to 82.6% following intervention. Median time from first ultrasound to CT was reduced from 44 days to 17 days without affecting median time to orchidectomy (27 to 23 days) or oncology appointment (61 days). Conclusions Requesting a staging CT scan as part of the first clinic assessment improved the proportion of preoperative scans without affecting time to surgery or oncology appointment.

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Diagnosing gastric volvulus in chest X-ray: report of three cases

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa229 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Narendra Pandit ◽

Abhijeet Kumar ◽

Tek Narayan Yadav ◽

Qamar Alam Irfan ◽

Sujan Gautam ◽

...

Keyword(s):

Computed Tomography ◽

Acute Abdomen ◽

Gastric Volvulus ◽

X Ray ◽

Pain Abdomen ◽

Life Threatening ◽

Chest X Ray ◽

High Index Of Suspicion ◽

Specific Symptoms ◽

Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

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Successful Management of Acquired Hemophilia A Associated with Bullous Pemphigoid: A Case Report and Review of the Literature

Case Reports in Hematology ◽

10.1155/2017/2057019 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Quentin Binet ◽

Catherine Lambert ◽

Laurine Sacré ◽

Stéphane Eeckhoudt ◽

Cedric Hermans

Keyword(s):

Bullous Pemphigoid ◽

Neutralizing Antibodies ◽

Hemophilia A ◽

Rare Condition ◽

Term Treatment ◽

Acquired Hemophilia A ◽

Acquired Hemophilia ◽

Short Term Treatment ◽

Life Threatening ◽

Dose Levels

Background. Acquired hemophilia A (AHA) is a rare condition, due to the spontaneous formation of neutralizing antibodies against endogenous factor VIII. About half the cases are associated with pregnancy, postpartum, autoimmune diseases, malignancies, or adverse drug reactions. Symptoms include severe and unexpected bleeding that may prove life-threatening.Case Study. We report a case of AHA associated with bullous pemphigoid (BP), a chronic, autoimmune, subepidermal, blistering skin disease. To our knowledge, this is the 25th documented case of such an association. Following treatment for less than 3 months consisting of methylprednisolone at decreasing dose levels along with four courses of rituximab (monoclonal antibody directed against the CD20 protein), AHA was completely cured and BP well-controlled.Conclusions. This report illustrates a rare association of AHA and BP, supporting the possibility of eradicating the inhibitor with a well-conducted short-term treatment.

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Executive Summary: 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adultsa

Clinical Infectious Diseases ◽

10.1093/cid/civ633 ◽

2015 ◽

Vol 61 (6) ◽

pp. 859-863 ◽

Cited By ~ 56

Author(s):

Elie F. Berbari ◽

Souha S. Kanj ◽

Todd J. Kowalski ◽

Rabih O. Darouiche ◽

Andreas F. Widmer ◽

...

Keyword(s):

Infectious Disease ◽

Clinical Practice ◽

Practice Guidelines ◽

Antimicrobial Therapy ◽

Healthcare Professionals ◽

Surgical Intervention ◽

Vertebral Osteomyelitis ◽

Executive Summary ◽

Orthopedic Surgeons ◽

Infectious Disease Specialists

Abstract These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

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INFECTIOUS AND INFLAMMATORY COMPLICATIONSIN OPHTHALMOLOGYAMID COVID-19

UZBEK MEDICAL JOURNAL ◽

10.26739/2181-0664-2021-5-8 ◽

2021 ◽

Vol 2 (5) ◽

pp. 40-44

Author(s):

Khalidjan Kamilov ◽

◽

Munirakhon Kasimova ◽

Gavkhar Khamraeva ◽

Manzurakhon Rizaeva

Keyword(s):

Infectious Disease ◽

Sinus Thrombosis ◽

Correct Diagnosis ◽

Secondary Glaucoma ◽

Cavernous Sinus Thrombosis ◽

Optic Nerve Atrophy ◽

Ocular Complications ◽

Adequate Treatment ◽

Infectious Disease Specialists ◽

Corneal Penetration

Inflammatory complications of the organ of vision in the time of COVID-19 can be manifested as conjunctivitis, scleritis, episcleritis, keratitis, uveitis and optic neuritis. It is essential to collect anamnesis, examine the blood for the presence of COVID 19 and treat these patients with the help of infectious disease specialists. Correct diagnosis of inflammatory ocular complications in the presence of COVID 19 makes it possible to prevent ocular complications, such as: ulcers and corneal penetration; fusion and overgrowth of the pupil,which leadto secondary glaucoma; endoophthalmitis, panophthalmitis and optic nerve atrophy. Timely intensive medical care and adequate treatment of these complications lead to a decrease in disability in this category of patients.Keywords:Ophthalmology, COVID-19,complications, ulcers, endoophthalmitis, panophthalmitis, gastrointestinal tract, cavernous sinus thrombosis

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