RESUMEN
Delayed presentation of a thoracic aortic injury is an extremely rare complication after spine surgery. We report a case of delayed presentation of a thoracic aortic injury with a vertebral pedicle screw after posterior spinal surgery without periaortic hematoma, hemorrhage or pseudoaneurysm formation and review the relevant literature.
Asunto(s)
Aorta Torácica/lesiones , Diagnóstico Tardío , Tornillos Pediculares/efectos adversos , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Femenino , Humanos , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Riesgo , Vértebras Torácicas/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Spontaneous coronary artery rupture (CAR) is an extremely rare, life-threatening entity. It is a challenge to make a diagnosis of CAR in the absence of pericardial effusion. We describe a case of a spontaneous rupture of the right coronary artery (RCA) without pericardial effusion that emphasises the benefit of high clinical suspicion and early diagnosis. A 60-year-old man was admitted to the emergency department, with inferior myocardial infarction. Echocardiogram was negative for a pericardial effusion. Coronary angiography revealed complete occlusion of the RCA with intraluminal dissection and extravasation of contrast into the epicardium at the mid-portion of the RCA, which suggested rupture of the RCA. The patient underwent uneventful emergency coronary artery bypass grafting. CAR should be considered as a differential diagnosis in patients with acute chest pain, even in the absence of pericardial effusion, particularly in case of inferior wall involvement.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Síndrome Coronario Agudo/diagnóstico , Dolor en el Pecho/etiología , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico , Rotura EspontáneaRESUMEN
A 91-year-old man was admitted to the emergency room with a 3-day history of severe pain, swelling and cyanosis in his left leg. Duplex ultrasound findings were suggestive of acute left popliteal and iliofemoral venous thrombosis. Heparin was initiated and pharmacomechanical thrombolysis (PMT) was performed with the use of a Cleaner thrombectomy device. At the completion of PMT, repeat venography revealed chronic proximal iliac vein occlusion. After the procedure, alteplase was infused via the intra-arterial catheter at a rate of 0.5 mg/h over 24 h to clear the thrombus distal to the popliteal vein and residual thrombus. The patient's signs and symptoms improved markedly after the intervention. There were no minor or systemic bleeding problems. He was discharged home 10 days after the procedure without any complications.