scholarly journals An uncommon case of late-onset chylothorax in blunt thoracic trauma in the emergency department

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Enrico Ferri ◽  
Angelo Ianni ◽  
Laura Magrini ◽  
Chiara De Dominicis ◽  
Salvatore Di Somma
Keyword(s):  
Thoracic Duct ◽  
Late Onset ◽  
Clinical Manifestations ◽  
Clinical Problem ◽  
Emergency Setting ◽  
Radiologic Findings ◽  
Traumatic Chylothorax ◽  
Post Traumatic ◽  
Uncommon Case ◽  
The Right

Blunt chest trauma is a rare cause of chylothorax because thoracic duct is well protected by the spine posteriorly and mediastinal contents anteriorly. Ribs or vertebral fractures are often associated but isolated chylothorax has been described. Thoracic duct injury may be due to stretching over the spine, or to shearing of the duct by the right crus of the diaphragm. Chylothorax can be associated with high rates of morbidity and mortality and early diagnosis is of paramount importance in order to adequate and prompt therapy. Chilothorax is well distinguishable in CT scan but the diagnosis must be confirmed by analysis of the pleural fluid. The optimal treatment for traumatic chylothorax is unclear and a challenging clinical problem. In this article, we describe the clinical manifestations, radiologic findings, and successful medical treatment of a patient with post traumatic chylothorax diagnosed in an emergency setting.

scholarly journals An alien in the gallbladder. A rare case of biliary ascariasis in an Italian emergency department

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Enrico Ferri ◽  
Angelo Ianni ◽  
Laura Magrini ◽  
Salvatore Di Somma
Keyword(s):  
Rare Case ◽  
Clinical Manifestations ◽  
Intestinal Lumen ◽  
Emergency Setting ◽  
Abdominal Ultrasonography ◽  
Biliary Ascariasis ◽  
Radiologic Findings ◽  
Perforation Peritonitis ◽  
Sanitary Conditions ◽  
Common Infection

Ascariasis is a common infection in many developing countries. The prevalence of ascariasis is related to poverty, poor hygienic and sanitary conditions. The adult form of <em>Ascaris lumbricoides</em> usually resides in the human intestinal lumen (more frequently in the jejunum and middle ileum) and does not cause symptoms. However, it can occasionally cause severe complications such as intestinal obstruction or perforation peritonitis. Its migration into the biliary tract is not uncommon but gallbladder involvement is very rare. Abdominal ultrasonography is essential to detect the presence of this parasite. In this article, we describe the radiologic findings, clinical manifestations and successful medical treatment of a patient with gallbladder ascariasis diagnosed in an emergency setting.

scholarly journals Traumatic Thoracic Duct Transection managed with Left Thoracoscopy: A Case Report and Review of Literature

2013 ◽  
Vol 2 (2) ◽  
pp. 97-99
Author(s):  
Eduardo Smith-Singares ◽  
Abdul Saied
Keyword(s):  
Case Report ◽  
Thoracic Duct ◽  
Stab Wound ◽  
Penetrating Trauma ◽  
Tube Placement ◽  
Review Of Literature ◽  
Nonsurgical Management ◽  
Traumatic Chylothorax ◽  
Level I ◽  
The Right

ABSTRACT Context Chylothorax is an uncommon complication after penetrating trauma to the chest and the neck. Only 25% of all chylothorax cases are related to penetrating trauma. We report such a case on a transmediastinal stab wound, managed by video-assisted thoracic surgery. Case report A 48-year-old male presented to our level I trauma center after sustaining a stab wound to the right chest. Initial workup revealed a left side pneumothorax. After chest tube placement 700 ml of blood and milky fluid were recovered. The patient was managed initially with TPN, without success. On day 3, he was taken to the OR for a left VATS. The thoracic duct was dissected and the injury identified and controlled with hemoclips. The intervention was successful and the patient was discharged on POD #4. Discussion Chylothorax are classified and managed according to the daily output of the fistula. While low output chylothorax are more frequent, more likely related to malignancy of the mediastinum and lymph nodes, and more likely to close with nonsurgical management; traumatic chylothorax are generally high output and more likely to require surgical intervention. The different approaches to this difficult pathology are reviewed. How to cite this article Smith-Singares E, Saied A. Traumatic Thoracic Duct Transection managed with Left Thoracoscopy: A Case Report and Review of Literature. Panam J Trauma Critical Care Emerg Surg 2013;2(2):97-99.

scholarly journals Unilateral Palmar Post-traumatic Granuloma Annulare – Work-related?

2019 ◽  
Vol 4 (2) ◽  
pp. 98-100
Author(s):  
Anca Chiriac ◽  
Piotr Brzezinski ◽  
Liliana Foia ◽  
Horațiu Moldovan ◽  
Cristian Podoleanu ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Skin Condition ◽  
Granuloma Annulare ◽  
Unknown Etiology ◽  
Trigger Factors ◽  
Pathogenic Mechanisms ◽  
Work Related ◽  
Direct Trauma ◽  
Post Traumatic ◽  
The Right

Abstract Granuloma annulare (GA) is a granulomatous skin condition that can present with a diversity of clinical manifestations and locations, with an unknown etiology and diagnosed on clinical-pathological grounds/correlations. Although many trigger factors have been described and several pathogenic mechanisms proposed, the etiology of GA remains unknown. We report a case of work-related, isolated, unilateral GA localized on the right palmar area of a young worker, possibly induced by work-related direct trauma.

scholarly journals Radiographic Thrombus within the External Jugular Vein: Report of a Rare Case and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Sayyad Yaseen Zia ◽  
Richard L. Bakst ◽  
Qiusheng Si ◽  
Mike Yao ◽  
Peter M. Som
Keyword(s):  
Jugular Vein ◽  
Clinical Manifestations ◽  
External Jugular Vein ◽  
Review Of The Literature ◽  
Primary Malignancy ◽  
Target Delineation ◽  
Radiologic Findings ◽  
Palliative Radiation Therapy ◽  
The Right

We are reporting a case of a 91-year-old male with a primary malignancy of the right parotid gland with radiographic thrombus extension within the right external jugular vein. He was treated with palliative radiation therapy to the right parotid mass with a marked clinical response. The rarity of this occurrence as documented in the review of the literature provides for uncertainty with regard to proper management. Radiographic evidence of thrombus in the absence of clinical manifestations, the role of anticoagulation, and the proper radiation target delineation were all challenges encountered in the care of this patient. Our case represents a rare occurrence with unique radiologic findings that has implications for management.

Late-onset malignant glaucoma

2020 ◽  
Vol 3 ◽  
pp. 1
Author(s):  
Ramiro José Daud ◽  
Horacio Freile ◽  
Mauricio Freile ◽  
Soledad Mariano
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Acute Pain ◽  
Late Onset ◽  
Slit Lamp ◽  
Normal Range ◽  
Slit Lamp Examination ◽  
Complete Occlusion ◽  
Malignant Glaucoma ◽  
The Right

A case report on a 49-year-old female with diagnoses of ocular hypertension in her left eye (LE) treated with 250 mg/day acetazolamide for 2 years. During the slit-lamp examination, complete occlusion of both iridocorneal angles was detected. Intraocular pressure (IOP) was 10 and 35 mmHg in the right eye and LE, respectively. Phacotrabeculectomy was performed in the LE. After 1 month of the procedure, the patient developed a slowly progressive miopization from −1 to −3 diopters (D) the following months. Approximately 3 months after surgery, the patient developed an episode of acute pain, athalamia, and IOP 45 mmHg in her LE. Late-onset malignant glaucoma was suspected and the patient was treated with topical hypotensive and cycloplegic agent until a prompt vitrectomy was performed. Deepening of the anterior chamber and restoration of IOP to normal range was obtained after surgery.

scholarly journals An autopsy-proven case of Corticobasal degeneration heralded by Pontine infarction

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dallah Yoo ◽  
Sung-Hye Park ◽  
Sungwook Yu ◽  
Tae-Beom Ahn
Keyword(s):  
Neurodegenerative Disorders ◽  
Clinical Manifestations ◽  
Neuronal Loss ◽  
Corticobasal Degeneration ◽  
Executive Dysfunction ◽  
Lacunar Infarction ◽  
Cortical Atrophy ◽  
Dystonic Posturing ◽  
Proven Case ◽  
The Right

Abstract Background Neurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction. Case presentation A 58-year-old man presented with acute ataxia associated with a lacunar infarction in the right paramedian pons. His ataxia persisted with additional progressive gait difficulty and left arm clumsiness. Six months later, a follow-up neurological examination showed asymmetrical bradykinesia, apraxia, dystonic posturing, postural instability, and mild ataxia of the left limbs. Cognitive examination revealed frontal executive dysfunction and visuospatial difficulties. Dopamine transporter imaging scan demonstrated bilateral reduced uptakes in mid-to-posterior putamen, more prominent on the right side. Levodopa-unresponsive parkinsonism, asymmetric limb dystonia, and ideomotor apraxia became more conspicuous, while limb ataxia gradually vanished. The patient became unable to walk without assistance after 1 year, and died 4 years after the symptom onset. Autopsy findings showed frontoparietal cortical atrophy, ballooned neurons, and phosphorylated tau-positive astrocytic plaques and neuropil threads with gliosis and neuronal loss, confirming the corticobasal degeneration. Conclusions The case illustrates that precedent clinical events such as stroke might tip a patient with subclinical CBS into overt clinical manifestations.

scholarly journals Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

2020 ◽  
Vol 12 (3) ◽  
pp. 433-439
Author(s):  
Riwaj Bhagat ◽  
Siddharth Narayanan ◽  
Marwa Elnazeir ◽  
Thong Diep Pham ◽  
Robert Paul Friedland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
The Other ◽  
Neurological Deficits ◽  
Brainstem Stroke ◽  
Neurological Features ◽  
The Right ◽  
Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

scholarly journals Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yan Le Ho ◽  
Pui Fong Ng ◽  
Sotheenathan Krishinan ◽  
Basheer Ahamed Abdul Kareem
Keyword(s):  
Right Atrium ◽  
Clinical Manifestations ◽  
Clinical Information ◽  
Interatrial Septum ◽  
Papillary Fibroelastoma ◽  
Case Presentation ◽  
Intracardiac Masses ◽  
The Right ◽  
Embolic Risk

Abstract Background Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. Case presentation We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. Conclusion Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

scholarly journals Spontaneous Resolution of Late-Onset, Symptomatic Fluid Collection Localized in the Meningioma Resection Cavity: A Case Report and Suggestion of Possible Pathogenesis

2021 ◽  
Vol 11 (3) ◽  
pp. 299
Author(s):  
Yeong Jin Kim ◽  
Tae-Young Jung ◽  
In-Young Kim ◽  
Shin Jung ◽  
Kyung-Sub Moon
Keyword(s):  
Brain Imaging ◽  
Late Onset ◽  
Fluid Collection ◽  
Good Condition ◽  
Treatment Strategies ◽  
Imaging Studies ◽  
Resection Cavity ◽  
Perilesional Edema ◽  
Posterior Neck ◽  
The Right

Postoperative complications after brain tumor surgery occur occasionally and it is important for clinicians to know how to properly manage each complication. Here, we described a rare case of late-onset, subdural fluid collection localized at the resection cavity that caused motor weakness after convexity meningioma resection, requiring differentiation from an abscess, to help clinicians determine treatment strategies. A 58-year-old right-handed female was admitted to the hospital with a headache and posterior neck pain. Brain computed tomography (CT) scans and magnetic resonance (MR) images showed a homogeneously enhanced, calcified, and multi-lobulated mass adjacent to the right motor strip without perilesional edema. The patient underwent surgery without incident or residual deficit and was discharged from the hospital in good condition. Six weeks after surgery, the patient complained of left arm monoparesis without infection-related symptoms. Brain imaging studies showed a localized fluid collection in the resection cavity with an enhanced margin and perilesional edema. Diffusion restriction was not detected. After three months of conservative treatment without surgery or antibiotics, she recovered from the neurologic deficits, and brain imaging studies showed the spontaneous regression of the fluid collection and perilesional edema. Late-onset, localized fluid collection at the resection cavity, which is similar to an abscess, could occur three to eight weeks after meningioma resection. When there are predisposing factors, including blood components and hemostatic materials in the surgical cavity, it is important for clinicians to understand this type of complication and choose conservative management as a feasible strategy.

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