Rapidly Spreading Deep Dissecting Hematoma Occurring One Month After A Minor Trauma: A Case Report.

Abstract Background: Deep dissecting hematoma (DDH) is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. A delay of several weeks between the appearance of a superficial haematoma following a minor trauma and its sudden decompensation into a rapidly spreading DDH has been scarcely mentioned in the medical literature. Case presentation: We report the admission of a 70-year-old woman under anticoagulation to the emergency department of our hospital for the sudden appearance of a rapidly evolving hematoma one month after a negligible trauma to the right leg. A complete skin examination revealed clinical signs (spontaneous superficial skin haematomas, lacerations, wrinkles, stellate pseudo-scars) of advanced dermatoporosis, especially on the forearms. The initial biological testing disclosed an International Normalized Ratio of 3.15. The clinical aspect of the haematoma, its rapid extension and the cutaneous signs of dermatoporosis on the forearms allowed the diagnosis of DDH. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Due the extent of the lesion and the risk of extended skin necrosis, surgical debridement and hematoma drainage were performed. The operative report confirmed the diagnosis of DDH. Wound healing was obtained spontaneously after three months. Conclusion: DDH is the most serious complication of dermatoporosis. Given its rapid horizontal extension and the risk of skin necrosis it induces, DDH is a medical-surgical emergency and must be diagnosed early. This observation emphasises that in patients with severe dermatoporosis, on the occasion of a Vitamin K Antagonist overdose, a limb-threatening DDH can develop suddenly, even several weeks after a minor impact.

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Rapidly Evolving Deep Dissecting Hematoma With Sudden Onset, Developed One Month After A Minimal Trauma.

10.21203/rs.3.rs-889457/v1 ◽

2021 ◽

Author(s):

Rémy Hamdan ◽

Narcisse Zwetyenga ◽

Yvan Macheboeuf ◽

Patrick Ray

Keyword(s):

Ultrasound Examination ◽

Sudden Onset ◽

Blood Collection ◽

Case Presentation ◽

Minimal Trauma ◽

Muscle Fascia ◽

History Of ◽

Operative Report ◽

The Right ◽

A Minor

Abstract Background: Deep dissecting hematoma is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. Case presentation: We report the admission of a 70-year-old woman to the emergency department of our hospital for the onset of a deep dissecting hematoma one month after a negligible trauma in the right leg, complicating secondary iatrogenic dermatoporosis. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Surgical debridement and hematoma drainage were performed due to rapid horizontal extension of the hematoma and unresolved pain, with the operative report confirming the diagnosis. Conclusion: This observation emphasises that in patients with severe dermatoporosis, several weeks can elapse between a minor impact and the sudden development of a limb-threatening deep dissecting hematoma.

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Management of giant osteoma in the mandible associated with minor trauma: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03217-2 ◽

2022 ◽

Vol 16 (1) ◽

Author(s):

Isabela Wolf-Grotto ◽

Lucas M. Nogueira ◽

Basilio Milani ◽

Erica C. Marchiori

Keyword(s):

Tooth Extraction ◽

Present Report ◽

Tumor Development ◽

Minor Trauma ◽

Case Presentation ◽

Tumor Lesion ◽

The Right ◽

A Minor ◽

Possible Cause

Abstract Background Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. Case presentation A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. Conclusion Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.

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Subarachnoid Hemorrhage following Posterior Spinal Artery Aneurysm

Interventional Neuroradiology ◽

10.1177/159101991001600211 ◽

2010 ◽

Vol 16 (2) ◽

pp. 183-190 ◽

Cited By ~ 23

Author(s):

S. Geibprasert ◽

T. Krings ◽

J. Apitzsch ◽

M.H.T. Reinges ◽

K.W. Nolte ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Resection ◽

Artery Aneurysm ◽

Treatment Method ◽

Dissecting Aneurysm ◽

Vascular Lesions ◽

Minor Trauma ◽

Posterior Spinal Artery ◽

The Right ◽

A Minor

Isolated posterior spinal artery aneurysms are rare vascular lesions. We describe the case of a 43-year-old man presenting with spinal subarachnoid hemorrhage after a minor trauma who was found to have a dissecting aneurysm of a posterior spinal artery originating from the right T4 level. Endovascular treatment was not contemplated because of the small size of the feeding artery, whereas surgical resection was deemed more appropriate because of the posterolateral perimedullary location that was well appreciated on CT angiography. After surgical resection of the aneurysm the patient had a complete neurological recovery. In comparison to anterior spinal artery aneurysms whose pathogenesis is diverse, posterior spinal aneurysms are most often secondary to a dissection and represent false or spurious aneurysms. Although the definite diagnosis still requires spinal angiography, MRI and CT may better delineate the relationship of the aneurysm to the spinal cord in order to determine the best treatment method. Prompt treatment is recommended as they have high rebleeding and mortality rates.

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Negative Pressure Wound Therapy for Necrotizing Fasciitis and Compartment Syndrome of the Upper Extremity — a case report

Negative Pressure Wound Therapy Journal ◽

10.18487/npwtj.v6i1.47 ◽

2019 ◽

Vol 6 (1) ◽

pp. 5-8

Author(s):

Attila Enyedi ◽

Gábor Mudriczki ◽

Tamás Bazsó ◽

Ferenc Győry ◽

Zsolt Susán ◽

...

Keyword(s):

Case Report ◽

Necrotizing Fasciitis ◽

Upper Extremity ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Clinical Signs ◽

Wound Therapy ◽

Superficial Skin ◽

Pectoral Region ◽

The Right

Aims: Necrotizing fasciitis (NF) is a life threatening infection of the subcutaneous tissues that spreads along the underlying fascia. Despite the early and aggressive surgical fasciotomy and necrosectomy its mortality rate is still high. In NF the negative pressure wound therapy (NPWT) has good effects on wound healing and on the primary closure of the concomitant extended tissue defects. Case report: A 32 year-old male patient was admitted with four-day history of fever (39.1 C⸰), pain, swelling, erythema of the right elbow and upper arm. On admission extensive erythema and swelling were seen on the right forearm, arm and the pectoral region with superficial skin bullas on it. On the basis of the clinical signs, laboratory tests, immediate surgery was indicated. Extended fasciotomy and necrosectomy were performed on the full extremity and pectoral region. Negative pressure wound therapy was started immediately with -120 mmHg of pressure. Antibiotic therapy was also administered. Results: After five cycles of NPWT the patient recovered without the need of any plastic surgical intervention. The functional and aesthetic results were excellent. Conclusion: In case of extended NF of the upper extremity the aggressive surgery and NPWT are safe and effective.

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Aneurysmal subarachnoid hemorrhage accompanied by changes in the patterns of chronic migraine: a case report

10.31083/jomh.2021.054 ◽

2021 ◽

Keyword(s):

Subarachnoid Hemorrhage ◽

Chronic Migraine ◽

Cerebral Aneurysm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neurological Diseases ◽

Clinical Signs ◽

Good Prognosis ◽

Specific Medication ◽

The Right ◽

A Minor

Subarachnoid hemorrhage (SAH) has a high mortality rate, and cerebral aneurysm ruptures account for 80% of all cases. Although several previous case studies have reported a headache before aneurysmal SAH, no previous study has reported a case of SAH after a change in the existing migraine pattern without any other clinical signs. A 43-year-old male patient who had suffered chronic migraines for 10 years visited the emergency department due to migraine symptoms, which exacerbated 3 days before the visit. He was admitted for symptom management, and his condition improved after taking migraine-speciﬁc medication. However, his consciousness deteriorated, and he became drowsy 8 days from the onset of headache aggravation. Brain computed tomography angiography revealed SAH. A small ruptured aneurysm, which was not detected by brain magnetic resonance angiography performed a few days earlier, was found in the A1 segment of the right anterior cerebral artery. We performed emergency endovascular coil embolization in the right A1 without any other complications. After the procedure, his neurological symptoms no longer exacerbated during hospitalization. He showed only a mild headache after 2 weeks and was discharged. Aneurysmal SAH is one of the most devastating neurological diseases, but early detection and treatment of aneurysms before major rupture may facilitate a good prognosis. If the pattern of previously diagnosed chronic migraine changes suddenly, a minor leak before the major rupture of a cerebral aneurysm should be considered, even if a sentinel headache has not been suggested.

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Acute abdomen in pregnancy: a retrospective study of pregnant patients hospitalised for abdominal pain

Perspectives in Surgery ◽

10.33699/pis.2020.99.3.131-135 ◽

2020 ◽

Vol 99 (3) ◽

pp. 131-135

Keyword(s):

Abdominal Pain ◽

Clinical Signs ◽

University Hospital ◽

Diagnostic Process ◽

Abdominal Emergency ◽

Lower Abdominal Quadrant ◽

Abdominal Emergencies ◽

The Right ◽

Abdominal Quadrant ◽

In Pregnancy

Introduction: Abdominal emergencies occur in pregnant women with the rate of 1:500−635 pregnancies. Such conditions usually develop from full health and worsen rapidly. Symptoms are often similar to those in physiological pregnancy (abdominal pain, vomiting, constipation). The diagnostic process is thus difficult and both the mother and her child are at risk. Our aim was to evaluate the frequency of abdominal emergencies in the Department of Surgery, University Hospital in Pilsen and to consider their impact on pregnancy and on the newborn. Methods: We acquired a set of patients by retrograde collection of data. We searched for pregnant patients suspected of developing an abdominal emergency admitted to the Department of Surgery, Faculty of Medicine, Pilsen between 2004 and 2015. We evaluated a number of clinical signs to statistically describe the set. Results: The set included 121 patients; 42 of the patients underwent a surgical procedure and 79 received conservative treatment. 38 patients underwent appendectomy; 6 appendixes were with no pathologies. McBurney’s incision was an approach of choice in most cases. The most frequent symptom was pain in the right lower abdominal quadrant. The foetus has been lost in none of the cases. Conclusion: Acute appendicitis was the most frequent abdominal emergency in our set and also the most frequent reason for surgical intervention. The most specific sign was pain in the right lower abdominal quadrant. No impact of appendicitis or appendectomy on the health of the newborn has been observed. Even though abdominal emergencies in pregnancy are relatively rare, the results of the department are very good.

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Right to Parental Care

10.1093/oso/9780199470716.003.0003 ◽

2017 ◽

Author(s):

Asha Bajpai

Keyword(s):

Law Reform ◽

Best Interest ◽

Family Courts ◽

Custody Of Children ◽

The Family ◽

Shared Parenting ◽

The Right ◽

A Minor ◽

And Control ◽

Physical Care

Custody refers to the physical care and control of a minor whereas guardianship is a wider term and includes rights and duties with respect to the care and control of minor’s person and property, and includes the right to make decisions relating to the minor. The present legal regime relating to guardianship and custody of children is discussed, including the Guardians and Wards Act, 1890, the Hindu Minority and Guardianship Act, 1956, the personal and matrimonial laws, and relevant provisions in the Family Courts Act and Protection of Women against Domestic Violence Act, 2005. The emerging concepts of shared parenting, joint custody, and the interparental child removal or abduction of child is included. There is review and analysis of some major reported judicial decisions. A comparative survey of international laws and trends has been done. Suggestions for law reform in the best interest of the child have been given.

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Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00123-8 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Kaoutar Cherrabi ◽

Hind Cherrabi

Keyword(s):

Septic Arthritis ◽

Temporomandibular Joint ◽

Nutritional Assessment ◽

Acute Otitis Media ◽

Clinical Signs ◽

Rare Condition ◽

Pediatric Emergency ◽

Ear Infections ◽

The Right

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

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Chalastospora gossypii in a Maine Coon cat: case report and literature review

Journal of Veterinary Diagnostic Investigation ◽

10.1177/10406387211022298 ◽

2021 ◽

pp. 104063872110222

Author(s):

Samantha M. Norris ◽

Paula A. Schaffer ◽

Noah B. Bander

Keyword(s):

Soft Tissue ◽

Needle Aspiration ◽

Tissue Mass ◽

Large Numbers ◽

Formalin Fixed Paraffin ◽

Formalin Fixed Paraffin Embedded ◽

Soft Tissue Masses ◽

Subcutaneous Mass ◽

The Right ◽

A Minor

A 15-y-old castrated male Maine Coon cat was evaluated for an ulcerated soft tissue mass on the right hindlimb that had been observed for 4 mo and had grown rapidly. A 3 × 3 cm soft, raised, amorphous, and ulcerated subcutaneous mass was observed on the lateral right metatarsus. In-house cytology via fine-needle aspiration was nondiagnostic. Incisional biopsy of the mass and further staging was declined, and amputation was elected. The amputated limb was submitted for histopathology, which revealed severe chronic nodular granulomatous dermatitis and multifocal granulomatous popliteal lymphadenitis with large numbers of intralesional fungal hyphae. Fungal PCR and sequencing on formalin-fixed, paraffin-embedded tissue identified Chalastospora gossypii. No adjunctive therapy was elected at the time. The patient has done well clinically 1 y post-operatively. C. gossypii is a rare microfungus found worldwide and is considered a minor pathogen of several plants. To our knowledge, infection by this fungus has not been reported previously in veterinary species. Features in our case are comparable to other mycotic infections. Nodular granulomatous mycotic dermatitis and cellulitis, although uncommon, should be a differential for soft tissue masses in veterinary species; C. gossypii is a novel isolate.

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