Angiodysplasia simulating variceal bleeding: a challenging case report of diagnosis and intervention.

Introduction and importance: Angiodysplasia, a prevalent vascular anomaly in the gastrointestinal tract, often presents with upper gastrointestinal bleeding, sharing symptoms with gastric varices. The diagnostic challenge arises due to overlapping clinical features. This case report highlights the importance of considering angiodysplasia in the differential diagnosis, especially when variceal bleeding is less likely, and emphasizes the role of various diagnostic modalities in accurate identification. Case presentation: A 52-year-old male presented with severe hematemesis and melena, mimicking variceal bleeding. Despite initial management, bleeding persisted. Contrast-enhanced computed tomography revealed dilated vascular channels, raising suspicion for both gastric varices and angiodysplasia. Endoscopy confirmed an angiomatous lesion, inadvertently disrupted during the procedure, necessitating angiography. The angiographic findings supported the diagnosis of angiodysplasia, and successful interventions included temporary glue embolization and argon laser coagulation during endoscopy. The patient was discharged with stable hemoglobin; a 2-year follow-up showed no recurrence. Clinical discussion: The case discusses the challenges in differentiating angiodysplasia from varices, emphasizing the role of imaging and endoscopic modalities. It highlights the need for a tailored approach to treatment, including argon plasma coagulation, and underscores the significance of meticulous follow-up for recurrence. Conclusion: This case report elucidates the diagnostic and therapeutic journey in managing a patient with angiodysplasia masquerading as variceal bleeding. It emphasizes the importance of considering vascular anomalies without typical signs and the significance of individualized interventions for optimal patient outcomes. The 2-year follow-up without recurrence signifies the successful management of the case.

Post-traumatic jejunal branch of superior mesenteric artery pseudoaneurysm in paediatrics: a compelling case report highlighting early diagnosis and successful endovascular embolization.

Introduction and importance: This manuscript underscores the critical significance of prompt diagnosis and intervention in cases of post-traumatic gastroduodenal artery pseudoaneurysms. Such occurrences, particularly in the paediatric population, are rare but potentially life-threatening complications following abdominal trauma, necessitating heightened clinical awareness. Despite their rarity, the devastating consequences of delayed recognition and management emphasize the necessity for advanced imaging modalities and individualized treatment strategies. Case presentation: A 17-year-old male presented with severe epigastric pain following a football fall. Despite initial stability, persistent symptoms prompted further investigation. Conventional screening methods proved inconclusive, leading to a contrast-enhanced computed tomography (CT) scan that revealed a jejunal branch of superior mesenteric artery (SMA) pseudoaneurysm. The subsequent fluoroscopy-guided angiography and successful embolization using glue exemplify the importance of timely intervention in such cases. Conclusion: This case highlights the importance of early recognition and appropriate intervention in post-traumatic jejunal branch of SMA pseudoaneurysms. The successful outcome achieved through endovascular embolization underscores the necessity for vigilant monitoring and tailored management strategies in similar clinical scenarios.

Endovascular embolization for massive hemoptysis in intralobar pulmonary sequestration with celiac artery supply: A comprehensive case report.

Pulmonary sequestration (PS) is a rare congenital anomaly characterized by noncommunicative lung tissue supplied by an abnormal systemic vessel. We present a case of a 30-year-old male with intralobar PS, receiving arterial supply from the celiac artery, manifesting as massive hemoptysis. After urgent stabilization, endovascular embolization using polyvinyl alcohol particles was successfully employed. The patient's symptoms resolved, and follow-up confirmed satisfactory recovery. Our case underscores the diverse arterial origins of PS and the efficacy of endovascular embolization as a minimally invasive treatment. The complexity of PS, its diagnostic imaging, and alternative therapeutic options are discussed, emphasizing tailored approaches for optimal outcomes in managing this uncommon congenital anomaly.

Endovascular treatment of subdural haematoma in patient under anti-platelet therapy: a case report.

Introduction: The incidence of chronic subdural haematoma (cSDH) is relatively high among the elderly population. Other known risk factors for cSDH include male sex, dependency on anti-platelet or anticoagulant medication, and chronic alcoholism. Although, the standard mode of treatment for cSDH is surgery, embolization of the middle meningeal artery (MMA), either upfront or as an adjunct to surgical evacuation can be used for the treatment of cSDH. Case presentation: The authors present a case of a 75-year-old female with prior history of posterior-lateral wall myocardial infarction (MI) eight years back presented to our centre with the chief complaints of a gradual onset of cough and headache for 2 months. The patient had no history of trauma, loss of consciousness, seizures, and vomiting. There was no history of diabetes, hypertension, pulmonary tuberculosis, and other chronic illness. Discussion: The concurrent use of anti- platelet drug during a surgical procedure can make the treatment challenging. Endovascular treatment can be a primary treatment modality in such situation. Conclusion: Elimination of blood supply by middle meningeal artery embolization is emerging as a safe, minimally invasive alternative to treat cSDH.

Metastatic Supraclavicular Lymph Nodes among Patients with Lung Carcinoma in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered distant metastasis for treatment purposes. Detection of supraclavicular lymph node metastasis in patients with lung cancer serves for tissue diagnosis by itself and also helps avoid more invasive biopsy from the primary lung mass itself. Ultrasonography of the lower neck can detect supraclavicular lymph nodes before they are palpable and can also be used for safe sampling of these lymph nodes. The aim of this study was to find out the prevalence of metastatic supraclavicular lymph nodes among patients with lung carcinoma in a tertiary care centre. Methods: A descriptive cross-sectional study done in a tertiary care center, carried out from 15 September 2019 to 14 September 2020. Ethical approval was obtained from the Institutional Review Committee (Reference number: 84(611)E2/076/077). The study was done among 92 patients with biopsy-proven lung cancer (lung mass or supraclavicular lymph node biopsy) who were referred for evaluation, and/or percutaneous transthoracic biopsy. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 92 patients with proven lung cancer, metastatic supraclavicular lymph nodes were seen in 13 patients (14.10%) (8.17- 19.73, 90% Confidence Interval). Among 13 patients with metastatic lymph nodes, 9 (69.23%) had palpable supraclavicular lymph nodes. The majority 11 (84.61%) had round-shaped lymph nodes. All metastatic lymph nodes showed loss of echogenic fatty hilum. A total of 12 (92.30%) metastatic lymph nodes showed a peripheral disorganized pattern of vascularity. Conclusions: The prevalence of metastatic supraclavicular lymph nodes was lower than in similar studies done in international settings. Keywords: lung cancer; malignancy; ultrasonography.

Common hepatic artery pseudoaneurysm: A rare complication following total gastrectomy: A case report.

INTRODUCTION AND IMPORTANCE: Common Hepatic Artery (CHA) Pseudoaneurysm is a rare entity, attributed to infections, trauma, and upper abdominal surgery. Most cases occur after biliary and pancreatic surgery. CHA pseudoaneurysm after total gastrectomy is uncommon and can be devastating. CASE PRESENTATION: A 58-years male who underwent D2 total gastrectomy for gastric carcinoma ten days ago, presented with hematemesis, epigastric pain, and a history of melaena. After admission, upper gastrointestinal endoscopy showed a clot at the jejunojejunostomy site. Computed tomography with angiography was diagnostic of pseudoaneurysm of CHA located inferiorly. Coil embolization of CHA was done and the patient improved. CLINICAL DISCUSSION: Pseudoaneurysm of the common hepatic artery is a serious complication after abdominal surgery. Only a few cases have been reported with similar symptoms related to gastrointestinal bleeding following various upper abdominal surgeries. Coil embolization is a gold standard technique with a high success rate. CONCLUSION: CHA pseudoaneurysm is a dreadful potential complication of abdominal surgery including gastrectomy. Early recognition and emergency management of CHA pseudoaneurysm are crucial for a favorable outcome for patients with bleeding from CHA aneurysm.

A Rare Case of Ruptured Bronchial Artery Pseudoaneurysm and Its Nonsurgical Management With Interventional Techniques.

Ruptured bronchial artery pseudoaneurysms with mediastinal hematoma are rare entities with a very limited number of published cases to date. The diagnosis of such cases can be difficult as the patient may present with symptoms mimicking other diseases, mainly mediastinal malignancy. A high degree of clinical suspicion and imaging techniques like contrast-enhanced computed tomography (CECT) chest and computed tomography angiography (CTA) aids in the diagnosis. Under the lights of an interventional radiologist, an urgent endovascular approach is most commonly preferred for its nonsurgical management. We present a rare case of a 47-year-old male with no previous lung disease or trauma with dyspnea and sudden onset chest pain. A massive effusion was suspected on the right side. CECT chest and digital subtraction angiography (DSA) revealed a pseudoaneurysm of a bronchial vessel with associated mediastinal hematoma, collapse of basal right lower lobe, and collection in right pleural space. This patient was later successfully treated by endovascular embolization techniques. Bronchial artery pseudoaneurysm may be considered a remote possibility in the absence of trauma or other lung diseases that may present with a massive hemothorax or mediastinal hematoma. Although CECT can be useful, digital angiography is considered the gold standard. Early intervention with the endovascular approach is a commonly recommended technique.

Flexible Bronchoscopic Removal of a Forgotten Intrabronchial Foreign Body.

Foreign body aspiration is uncommon in adults and the diagnosis may be delayed in the elderly, as many fail to provide a history of choking during initial evaluation. Flexible bronchoscopy is a useful tool for foreign body extraction from the tracheobronchial tree in selected cases. A Sixty-two year old male presented with history of cough, purulent sputum and intermittent hemoptysis. CT scan of the thorax demonstrated a radio-dense foreign body in the bronchus intermedius causing focal narrowing. Flexible fiberoptic bronchoscopy revealed a glistening white bone in the distal bronchus intermedius which was successfully grasped with the flexible forceps and extracted via the oral route with the bronchoscope. Keywords: Elderly; flexible bronchoscopy; foreign body aspiration.

Microbiological burden in air culture at various units of a tertiary care government hospital in Nepal.

BACKGROUND: The environmental matrices (water, air, and surfaces) play a vital role as reservoirs of Legionella spp. and Pseudomonas aeruginosa (Pseudomonas spp.). Hence, hospital environment control procedures are effective measures for reducing nosocomial infections. AIMS: This study was carried out to explore the profiles of microorganisms in air culture at various wards/units of a tertiary care hospital in Nepal. METHODS: A descriptive cross-sectional study was carried out at various wards/units of a tertiary care hospital in Nepal between January and September 2015 to explore the microbiological burden in inanimate objects. Each week one ward or unit was selected for the study. Bed, tap, the entire room, trolley, computer, phone, rack handles, table, chair, door, stethoscope, oxygen mask, gown, cupboard handles, and wash basins were selected for air culture testing. Ten different wards/units and 77 locations/pieces of equipment were selected for air culture by employing a simple random sampling technique. Information about the organisms was entered into the Statistical Package for the Social Sciences (SPSS) Version 22 (IBM: Armonk, NY) and descriptive analyses were carried out. RESULTS: Staphylococcus aureus (S. aureus), Micrococcus, coagulase negative staphylococcus (CONS), Bacillus, Pseudomonas aeruginosa, yeast, and Acinetobacter were the most commonly detected organisms. In the postoperative ward, S. aureus was the most frequently detected microorganism. Micrococcus was detected in four out of 10 locations. In the x-ray unit, S. aureus was detected in three out of four locations. CONCLUSION: S. aureus, Micrococcus, CONS, Bacillus, Pseudomonas, yeast, and Acinetobacter were the most common organisms detected.

Lupus mastitis of the male breast.

A 39-year-old male with no known co-morbid conditions presented with gradually increasing bilateral breast lumps for 1.5 years. Clinically, tender subcutaneous masses were detected. Mammograms revealed masses on both sides that on ultrasound were hyperechoic and showed internal vascularity. An MRI was suggested to assess the extent of the disease that confirmed bilateral masses but was otherwise inconclusive. Core biopsy revealed evidence of panniculitis with likely autoimmune aetiology. Evaluation of autoimmune markers was carried out that was positive and multidisciplinary team discussion concluded the diagnosis as lupus mastitis. Male breast pathology and lupus mastitis are both uncommon conditions, making lupus mastitis of male breast an extremely unusual presentation. However, its close clinical and radiological similarity with malignancy makes it important in spite of its rarity. Here we report a case of bilateral lupus mastitis in male breast with its radiological features.