RESUMO
Pulmonary artery dissection is a rare and fatal disease. Diagnosis is mainly made during autopsy because most patients die suddenly due to pulmonary artery dissection in the pericardium resulting in pericardial tamponade. The optimum management is not clearly defined because of the paucity of cases in the literature. We describe the case of an 81-year-old man, affected by rheumatoid arthritis and with history of aortic valve replacement surgery, who attended an emergency department for non-specific symptoms, started complaining of chest pain rapidly deteriorated into cardiac shock. Computed tomography scan, performed on suspicion of an acute aortic pathology and/or a pulmonary embolism, allowed the identification of pulmonary artery dissection associated with aorto-pulmonary fistula. Despite early diagnosis in the emergency department, the outcome was unfortunately fatal.
Assuntos
Dissecção Aórtica , Artéria Pulmonar , Humanos , Idoso de 80 Anos ou mais , Masculino , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Evolução Fatal , Tomografia Computadorizada por Raios X , Fístula Vascular/cirurgia , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagemRESUMO
Carbon Monoxide (CO) intoxication is still a leading cause of mortality and morbidity in many countries. Due to the problematic detection in the environment and subtle symptoms, CO intoxication usually goes unrecognized, and both normobaric and hyperbaric oxygen (HBO) treatments are frequently administered with delay. Current knowledge is mainly focused on acute intoxication, while Delayed Neurological Sequelae (DNS) are neglected, especially their treatment. This work details the cases of two patients presenting a few weeks after CO intoxication with severe neurological impairment and a characteristic diffused demyelination at the brain magnetic resonance imaging, posing the diagnosis of DNS. After prolonged treatment with hyperbaric oxygen, combined with intravenous corticosteroids and rehabilitation, the clinical and radiological features of DNS disappeared, and the patients' neurological status returned to normal. Such rare cases should reinforce a thorough clinical follow-up for CO intoxication victims and promote high-quality studies.
Assuntos
Intoxicação por Monóxido de Carbono , Oxigenoterapia Hiperbárica , Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/terapia , Progressão da Doença , Humanos , Oxigênio , Oxigenoterapia/métodosRESUMO
BACKGROUND AND AIM: In middle-aged men, omental torsion (OT) can be a cause of acute abdomen.The right side of the omentum is longer, heavier and more mobile than the left one and, as a consequence, it can twist more easily on its vascular axis. Consequently, OT localization in the lower right quadrant is more frequent, and therefore it can mimic acute appendicitis clinical onset.In most cases, OT is defined as "primary" in the absence of any other underlying pathologies, or, rarely, "secondary", when caused by other intra-abdominal diseases such as inguinal hernia, tumors, cysts or post-surgical scarring. To date, clinical diagnosis of OT still remains a challenging one in a preoperative setting and most cases are diagnosed intraoperatively. If diagnosis is correctly achieved preoperatively by adequate imaging examinations, most patients presenting with OT do not undergo surgery anymore. Such considerations gain importance at the time of COVID 19 pandemic, where a conservative management and an early discharge may be preferred owing to in-hospital morbidity after abdominal surgery whenever surgery may be avoided. METHODS AND RESULTS: We present a case of an OT successfully treated in a non-operative manner during COVID-19 outbreak in Norhern Italy and offer a review of the literature that supports such a clinical attitude. Conclusions: OT preoperative diagnosis is challenging and is usually achieved by abdominal CT-scan. The suggested OT initial management is conservative, leaving a surgical approach, preferably by laparoscopy, for the 15% of cases not improving with a non-surgical approach.
Assuntos
Apendicite , COVID-19 , Doenças Peritoneais , Tratamento Conservador , Humanos , Masculino , Pessoa de Meia-Idade , Omento/irrigação sanguínea , Omento/patologia , Omento/cirurgia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/cirurgia , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/patologia , Anormalidade Torcional/cirurgiaRESUMO
Most patients with traumatic aortic lesions of the thoracic aorta die at the accident site but 15% arrive at the hospital with vital signs. Digital subtraction angiography is considered the gold standard for the diagnosis of traumatic lesions of the thoracic aorta. Other non-invasive diagnostic techniques, such magnetic resonance and spiral computed tomography, proved to be reliable alternatives. Sometimes the diagnosis can be delayed by the relative lack of significant symptoms as well as the presence of unusual clinical findings. A case of post-traumatic intramural haematoma of the descending aorta revealed during a magnetic resonance of the spine is described. The final diagnosis was obtained with spiral computed tomography.
Assuntos
Aorta Torácica/lesões , Desaceleração/efeitos adversos , Hematoma/diagnóstico , Imageamento por Ressonância Magnética , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos Torácicos/diagnóstico , Acidentes de Trânsito , Idoso , Aorta Torácica/patologia , Aortografia , Dor nas Costas/etiologia , Progressão da Doença , Diagnóstico Precoce , Evolução Fatal , Hematoma/diagnóstico por imagem , Hematoma/patologia , Humanos , Achados Incidentais , Masculino , Traumatismos da Coluna Vertebral/patologia , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/patologia , Tomografia Computadorizada Espiral , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/patologiaRESUMO
Ganglion cysts of the common peroneal nerve are rarely described in the literature and a bilateral lesion has not been previously reported. We present a case of a 41-year-old man with a bilateral cyst of the common peroneal nerve diagnosed with ultrasound and magnetic resonance imaging.