RESUMEN
Renal biopsy is usually a prerequisite in the diagnosis of adult patients with nephrotic syndrome. Acute Budd Chiari syndrome is a known complication of certain aetiologies of nephrotic syndrome like membranous glomerulopathy and minimal change disease. This complication requires emergent anticoagulation, which would preclude the performance of a renal biopsy. We report the case of a 47-year-old woman who presented with acute Budd Chiari syndrome as the initial presentation of nephrotic syndrome. The difficult situation in which we had to give anticoagulation and also perform a renal biopsy led us to devise a novel way to treat the patient, namely, the initial use of transfemoral thrombolysis and thrombosuction followed by a renal biopsy, which confirmed the diagnosis of primary membranous nephropathy. Anticoagulation was safely instituted 48 hours later with documented clinical and radiological improvement.
Asunto(s)
Síndrome de Budd-Chiari/terapia , Glomerulonefritis Membranosa/diagnóstico , Síndrome Nefrótico/diagnóstico , Terapia Trombolítica/métodos , Angiografía , Anticoagulantes/administración & dosificación , Biopsia/métodos , Síndrome de Budd-Chiari/etiología , Femenino , Fibrinólisis , Membrana Basal Glomerular/patología , Glomerulonefritis Membranosa/complicaciones , Glomerulonefritis Membranosa/patología , Humanos , Persona de Mediana Edad , Síndrome Nefrótico/etiología , Tomografía Computarizada por Rayos X , Vena Cava Inferior/diagnóstico por imagenRESUMEN
Juvenile nasopharyngeal angiofibroma (JNA) is a benign, vascular, and locally aggressive tumor that arises in the nasal cavity, extending into the nasopharynx and often in to the orbit. It may rarely present to the ophthalmologist with proptosis and optic neuropathy. Preoperative embolization of JNA is done before surgical resection. In this communication, the authors report a rare occurrence of ipsilateral central retinal artery occlusion (CRAO) following embolization with polyvinyl alcohol in a 13-year-old boy with right-sided JNA. Retrospective review of the angiograms pointed out to a suspicious communication between the external carotid artery and the ophthalmic vessels. Pre-embolization detailed study of the angiograms is necessary to avoid such devastating complications. Although rare, vision loss is a possible complication arising from embolization of nasopharyngeal and intracranial tumors, and all patients undergoing these procedures should be informed of the risk of visual loss because it has a lasting impact on the quality of life.
