RESUMO
A 46-year-old man presented with a painless mass on his dorsal right foot one week after striking it on a door. A traumatic hematoma was suspected, and needle aspiration of the mass is considered. However, point-of-care ultrasound performed by the emergency physician identified a pseudoaneurysm of the dorsalis pedis artery, a rare condition that can occur after minor trauma or iatrogenic intervention. This report demonstrates how point-of-care ultrasound can be used to identify a pseudoaneurysm of the lower extremity, thereby expediting emergency department workup and preventing potentially dangerous diagnostic procedures.
RESUMO
Abdominal pseudocysts are rare complications of ventriculoperitoneal (VP) shunts characterized by accumulations of cerebrospinal fluid surrounded by fibrous layers in the intra-abdominal cavity or abdominal wall. We present a woman with bilateral VP shunts who presented with right-sided abdominal distension, pain, and tenderness and who was found to have an abdominal pseudocyst on point-of-care ultrasound and computed tomography. Given the potential to develop a secondary infection or VP shunt malfunction, it is important for emergency providers to consider intra-abdominal complications of VP shunts, including rare ones such as abdominal pseudocysts, in these patients who present with vague abdominal complaints.
RESUMO
BACKGROUND: Acute on chronic neuropathic pain is often refractory to analgesics and can be challenging to treat in the emergency department (ED). In addition, systemic medications such as opiates and nonsteroidal inflammatory drugs have risks, including hypotension and kidney injury, respectively. Difficulties in managing pain in patients with neuropathy can lead to prolonged ED stays, undesired admissions, and subsequent increased health care costs. CASE REPORT: We describe the case of a 51-year-old woman who presented to the ED on two separate occasions for left forearm pain secondary to chronic ulnar neuropathy. During her first ED visit, the patient received multiple rounds of intravenous opiates and required hospital admission, which was complicated by opiate-induced hypotension. During her second visit, she underwent an ultrasound-guided ulnar nerve block performed by the emergency physician; her pain resolved and she was discharged home. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: Ultrasound-guided nerve blocks are an effective, safe, and relatively inexpensive alternative to opioids. Our case demonstrates that emergency providers may be able to perform ultrasound-guided regional anesthesia to treat an acute exacerbation of chronic neuropathic pain.
Assuntos
Braço/inervação , Bloqueio Nervoso/métodos , Neuralgia/prevenção & controle , Ultrassonografia de Intervenção , Serviço Hospitalar de Emergência , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Spilled gallstones are common during laparoscopic cholecystectomy; however, they rarely lead to postoperative complications. Perihepatic abscesses develop in < 0.1% of patients with spilled gallstones and are typically contained within the peritoneal cavity. CASE REPORT: We present a 57-year-old man with history of cholecystectomy 2 years prior who presented with cough and flank pain and was discovered to have a perihepatic abscess invading his lung and kidney secondary to a spilled gallstone. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: Although most perihepatic abscesses can be treated with percutaneous drainage and antibiotics, abscesses secondary to spilled gallstones usually require open or laparoscopic surgery to drain the abscess and retrieve the gallstone. Prompt identification of spilled gallstones in patients with intra-abdominal and intrathoracic abscesses can thereby guide disposition and decrease morbidity and mortality.
Assuntos
Abscesso Abdominal/etiologia , Cálculos Biliares/complicações , Complicações Pós-Operatórias/diagnóstico , Abscesso Abdominal/fisiopatologia , Colecistectomia/efeitos adversos , Tosse/etiologia , Dor no Flanco/etiologia , Cálculos Biliares/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgiaRESUMO
Hematometrocolpos is a rare congenital abnormality of the female urogenital system that leads to an imperforate hymen and subsequent retrograde menstruation. We present the case of a 14-year-old female patient who presented to the emergency department with amenorrhea and abdominal pain, and was found to have an imperforate hymen and hematometrocolpos on trans-abdominal point-of-care ultrasound. It is important for emergency physicians to consider this diagnosis in pubescent female patients presenting with abdominal pain, as missed diagnosis can lead to infertility and other complications.
Assuntos
Traumatismos Craniocerebrais/complicações , Diplopia/diagnóstico , Idoso , Angiografia por Tomografia Computadorizada , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Diferencial , Diplopia/etiologia , Diplopia/fisiopatologia , Feminino , Seguimentos , Humanos , Fatores de Tempo , Acuidade VisualRESUMO
BACKGROUND: Fewer than 150 cases of stercoral colitis have been reported in the literature. Stercoral colitis develops when feces impacts in the colon, resulting in increased luminal pressure, colon wall ulceration, and an inflammatory colitis. Patients are typically over the age of 60 years and have history of constipation. Mortality from colon perforation secondary to stercoral colitis is as high as 60%. CASE REPORT: We present two male patients, ages 26 and 35 years old, with history of psychiatric illness who presented with constipation and abdominal pain, who were found to have stercoral colitis on computed tomography. One patient developed stercoral perforation of the colon requiring emergent laparotomy. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: Stercoral colitis is a rare but potentially fatal etiology of abdominal pain that should be considered in young patients with history of constipation.
Assuntos
Dor Abdominal/diagnóstico , Colite/diagnóstico , Doenças Raras/diagnóstico , Dor Abdominal/etiologia , Adulto , Transtornos de Ansiedade/complicações , Colite/etiologia , Constipação Intestinal/diagnóstico , Humanos , Masculino , Doenças Raras/etiologia , Esquizofrenia/complicações , Úlcera/diagnósticoAssuntos
Malformações Arteriovenosas/diagnóstico , Artéria Hepática/anormalidades , Veias Hepáticas/anormalidades , Telangiectasia Hemorrágica Hereditária/diagnóstico , Idoso , Malformações Arteriovenosas/complicações , Dispneia/etiologia , Epistaxe/etiologia , Feminino , Artéria Hepática/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Telangiectasia Hemorrágica Hereditária/complicações , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Arnica , Bebidas/toxicidade , California , Feminino , Flores , Humanos , Taquicardia/induzido quimicamente , Adulto JovemRESUMO
Adenoid cystic carcinomas, the most common malignancies of the lacrimal gland, are rare overall. We describe a patient who presented with right periorbital swelling developing over 5 months and magnetic resonance imaging findings of a soft tissue mass in the lacrimal fossa with invasion of the adjacent bone. The patient underwent right lateral orbitotomy with tumor debulking. Pathologic analysis showed neoplastic cells in a predominantly cribriform pattern, and the patient was diagnosed with an adenoid cystic carcinoma of the lacrimal gland. We review the clinical, radiographic, and histopathologic features of these rare, aggressive malignancies as well as treatment options with reference to the current literature.
RESUMO
This article provides an assessment over time of the incidence of newspaper-reported Internet-initiated sexual assaults among U.S. adolescents undergoing adjudication from 1996 to 2007. Of 812 newspaper reports of adjudicated Internet-initiated sexual assault, most (79.2%) victims were female, and the median age was 14 years. The incidence rate of these reports increased over the 12-year period for females but remained steady for males. The frequency of these assaults was much less than reported for other types of sexual assaults in this age group. These estimates hopefully will assist in a greater understanding of these assaults, aid in interventions to decrease their occurrence, and guide effective policymaking that will reduce all types of sexual assault among adolescents.
Assuntos
Abuso Sexual na Infância/estatística & dados numéricos , Internet , Jornais como Assunto , Estupro/estatística & dados numéricos , Adolescente , Feminino , Humanos , Incidência , MasculinoRESUMO
OBJECTIVE: Lower extremity lymphoceles secondary to saphenous vein grafting are exceptionally rare and there is only 1 previously reported case in the English literature. Data on treatment of lower extremity lymphoceles are limited and based on studies of groin lymphoceles. We discuss operative resection with selective ligation of feeding lymphatic vessels as a treatment option of lower extremity lymphoceles. METHODS: A 64-year-old man who had undergone coronary artery bypass grafting 6 years prior presented with a left lower extremity mass at the site where his saphenous vein had been harvested. Examination demonstrated a 12-cm, mobile, nonpulsatile mass at his medial left calf. The findings of magnetic resonance imaging were consistent with a lymphocele. RESULTS: Intraoperative injection of isosulfan blue dye was used to identify feeding lymphatic vessels and the lymphocele cavity was excised. Leg drains were discontinued after 3 days, and the patient was discharged home after 6 days. CONCLUSION: Operative resection with isosulfan blue dye lymphatic mapping and selective ligation of lymphatic vessels is a viable treatment of lower extremity lymphoceles.