Unilateral Adrenal Hemorrhage and the Challenge Of Early Recognition

Adrenal hemorrhage (AH) is a rare condition with an estimated prevalence of 1% among hospital-based autopsies. It is usually discovered incidentally on computed tomography.1 Most cases are associated with the use of anticoagulation, especially in the setting of heparin-induced thrombocytopenia, anti-phospholipid antibody syndrome, trauma, metastatic disease, sepsis, and critical illness.5-7 We report a case of acute unilateral adrenal hemorrhage associated with Escherichia coli pyelonephritis in the context of recent prolonged steroid use.

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Spontaneous Intramural Esophageal Hematoma Secondary to Thrombolysis in the Setting of Pulmonary Embolism

Vascular and Endovascular Surgery ◽

10.1177/1538574421989863 ◽

2021 ◽

pp. 153857442198986

Author(s):

Nina Jalily Taghavyan ◽

Arshide Mashayekh ◽

Hamid Reza Pouraliakbar ◽

Jamal Moosavi ◽

Omid Shafe ◽

...

Keyword(s):

Myocardial Infarction ◽

Computed Tomography ◽

Pulmonary Embolism ◽

Epigastric Pain ◽

Early Recognition ◽

Intramural Hematoma ◽

Rare Condition ◽

Aortic Aneurysms ◽

Catheter Directed Thrombolysis ◽

Esophageal Hematoma

Intramural hematoma of the esophagus (IHE) represents a rare condition on the spectrum of esophageal injuries. The most common symptoms are hematemesis, epigastric pain or retrosternal chest pains, odynophagia, and dysphagia. Early recognition of IHE is important as it may mimic other diseases such as myocardial infarction, pulmonary embolism, Mallory–Weiss tears, Boerhaave’s syndrome, ruptured aortic aneurysms, and aortic dissection. Computed tomography is the preferred investigation method, and treatment is usually conservative. We herein present 2 cases of IHE associated with catheter-directed thrombolysis in the setting of pulmonary embolism.

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Usefulness of Computed Tomography and Magnetic Resonance in Fulminant Invasive Fungal Rhinosinusitis

American Journal of Rhinology ◽

10.1177/194589240101500407 ◽

2001 ◽

Vol 15 (4) ◽

pp. 255-261 ◽

Cited By ~ 41

Author(s):

R. Charles Howells ◽

Hassan H. Ramadan

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Early Recognition ◽

Bone Destruction ◽

Immunocompromised Host ◽

Intracranial Extension ◽

Tissue Ischemia ◽

Fungal Rhinosinusitis ◽

Ct Findings ◽

Invasive Fungal Rhinosinusitis

Fulminant invasive fungal rhinosinusitis is an aggressive, destructive process most commonly affecting the immunocompromised host. Although frequently fatal, prognosis is related directly to early recognition and aggressive treatment. Various reports advocate computed tomography (CT) scanning as the study of choice in evaluating suspected invasive fungal disease, reserving magnetic resonance imaging (MRI) for select cases. Others report lack of correlation between CT and surgical or pathological findings. Our aim was to investigate the usefulness of CT and MR in the diagnosis of invasive fungal rhinosinusitis. We retrospectively reviewed four cases of biopsyproven invasive disease. Correlations between radiographic, endoscopic, and surgical findings were investigated. Rhizopus species were detected in three cases and mixed Mucor and Aspergillus species in another. Superimposed bacterial sinusitis was confirmed in all cases. CT findings were nonspecific, revealing pansinusitis; no bone destruction or intracranial extension was noted. Mild orbital cellulitis was noted in one case. Anterior rhinoscopy revealed nonviable tissue in two patients. Nasal endoscopy later confirmed tissue ischemia in a third patient, whereas a final patient had normal findings on both exams. Nonspecific findings resulted in delay of diagnosis by 48–72 hours in two patients with presumed bacterial sinusitis. MR revealed intracranial extension in two patients and better represented intraoperative findings. In conclusion, CT findings in invasive fungal rhinosinusitis may be nonspecific and underestimate extent of disease. A high index of suspicion and early endoscopic examination with biopsy are mandatory for evaluation. MRI may better represent disease progression and should be considered early.

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Heparin-Induced Thrombocytopenia After Total Knee Arthroplasty, With Subsequent Adrenal Hemorrhage

The Journal of Arthroplasty ◽

10.1016/j.arth.2012.01.012 ◽

2012 ◽

Vol 27 (7) ◽

pp. 1413.e15-1413.e18 ◽

Cited By ~ 6

Author(s):

Vinca W. Chow ◽

Freddy Abnousi ◽

James I. Huddleston ◽

Ludwig H. Lin

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Adrenal Hemorrhage ◽

Heparin Induced Thrombocytopenia ◽

Total Knee

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Normal Pressure Hydrocephalus (NPH) as a Cause of Pre-Senile and Senile Dementia: The Complementary Role of Radionuclide Cysternography (RNC) and Cranial Computed Tomography (CCT) in The Early Recognition of The Treatable Patients

Advances in Behavioral Biology - Alzheimer’s and Parkinson’s Disease ◽

10.1007/978-1-4613-2179-8_31 ◽

1986 ◽

pp. 249-255

Author(s):

I. Garty ◽

D. Steinmetz ◽

J. Braun ◽

B. Dubnov ◽

E. Flatau

Keyword(s):

Computed Tomography ◽

Normal Pressure Hydrocephalus ◽

Early Recognition ◽

Senile Dementia ◽

Normal Pressure ◽

Cranial Computed Tomography ◽

Complementary Role

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A rare case of mobile ball-like mass in right atrium associated with dilated cardiomyopathy

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1309 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Jing Dong ◽

◽

Yiqun Gao ◽

Shunji Liang ◽

Guorong Deng ◽

...

Keyword(s):

Anticoagulant Therapy ◽

Right Atrium ◽

Early Recognition ◽

Therapeutic Option ◽

Venous Pressure ◽

Rare Condition ◽

Good Clinical Condition ◽

Mobile Mass ◽

2D Echocardiogram ◽

The Right

Mobile thrombus in the Right Atrium (RA) is a rare condition. Here, we described a case of a 59-year-old male who presented in emergency room with complaints of progressively worsening dyspnea for 7 years. He was normotensive, had elevated jugular venous pressure and clear lungs. ECG revealed ventricular tachycardia. After successfully electrical defibrillation, an urgent 2D echocardiogram was obtained and revealed the enlargement of all heart chambers and a ball-like, mobile mass in the right atrium. An emergent CT scan revealed no sign of pulmonary embolism. Based on morphological features on echocardiogram, we highly suspected it as RA thrombus. The patient was treated with anticoagulant therapy comprising of low molecular heparin and warfarin since he rejected surgical treatment. Repeat echocardiogram was performed 7 days after anticoagulant therapy and showed disappearance of the RA mass. He was subsequently maintained on warfarin (INR=2.4- 3.0) and other medications for heart failure. The patient was followed up as outpatient and kept in good clinical condition. We concluded that early recognition of this rare situation and prompt management can help in preventing life-threatening complications, and anticoagulant therapy was a therapeutic option for RA thrombus.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v3 ◽

2020 ◽

Author(s):

Joseph F. Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%.Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi.Conclusions: Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v1 ◽

2020 ◽

Author(s):

Joseph Frank Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5–10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5–10%. Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi. Conclusions Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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Lobectomy for lung cancer with a displaced left B1 + 2 and an anomalous pulmonary vein: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01392-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shinichi Sakamoto ◽

Hiromitsu Takizawa ◽

Naoya Kawakita ◽

Akira Tangoku

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Pulmonary Vein ◽

Three Dimensional ◽

Lower Lobe ◽

Rare Condition ◽

3D Ct ◽

Anatomical Structures ◽

Case Presentation ◽

Anomalous Pulmonary Vein

Abstract Background A displaced left B1 + 2 accompanied by an anomalous pulmonary vein is a rare condition involving complex structures. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer. Case presentation A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B1 + 2 and hyperlobulation between S1 + 2 and S3, while the interlobar fissure between S1 + 2 and S6 was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V1 + 2 joining the left inferior pulmonary vein and a branch of the V1 + 2 running between S1 + 2 and S6. We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V1 + 2 and confirm the locations of B1 + 2 and B6 when dividing the fissure. Conclusion The aim of the surgical procedure performed in this case was to divide the fissure between S1 + 2 and the inferior lobe to reduce the risk of an unexpected bronchial injury. 3D-CT helps surgeons to understand the stereoscopic positional relationships among anatomical structures.

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