Asunto(s)
Megacolon Tóxico/diagnóstico por imagen , Embolia Pulmonar/etiología , Tomografía Computarizada por Rayos X/métodos , Adulto , Colectomía/métodos , Colitis Ulcerosa/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Ileostomía/métodos , Megacolon Tóxico/complicaciones , Megacolon Tóxico/patología , Megacolon Tóxico/cirugía , Resultado del TratamientoRESUMEN
Internal jugular vein (IJV) aneurysm is a rare entity, and a thrombosed aneurysm poses diagnostic and management challenges. We came across a 53-year-old woman who presented with fever, vomiting and right neck swelling for a week. Laboratory investigations showed neutrophilic leucocytosis, raised acute phase reactant and blood culture yielded Klebsiella pneumoniae Ultrasound and contrast-enhanced CT neck revealed a large fusiform aneurysm of the right IJV with filling defect extending from the aneurysm into the right transverse sinus. There was a cavity at the right lower third molar tooth. MRI confirmed the findings with additional enhancing focus at right lower periodontal region. The swelling reduced after 2 weeks of medical therapy, and follow-up imaging 4 months later showed complete resolution of the aneurysm with residual thrombosis. After extensive workup, dental infection remains the only identifiable primary source leading to thrombophlebitis of the right IJV and subsequent sequelae.
Asunto(s)
Aneurisma/diagnóstico , Venas Yugulares/patología , Síndrome de Lemierre/diagnóstico , Aneurisma/tratamiento farmacológico , Antibacterianos , Anticoagulantes/administración & dosificación , Ceftriaxona/administración & dosificación , Enoxaparina/administración & dosificación , Femenino , Humanos , Venas Yugulares/diagnóstico por imagen , Klebsiella pneumoniae/aislamiento & purificación , Síndrome de Lemierre/tratamiento farmacológico , Síndrome de Lemierre/etiología , Metronidazol , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedades Dentales/complicaciones , Enfermedades Dentales/microbiologíaAsunto(s)
Angiografía , Dolor en el Pecho/diagnóstico por imagen , Embolia Grasa/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Accidentes de Tránsito , Dolor en el Pecho/etiología , Cuidados Críticos , Embolia Grasa/terapia , Fracturas del Fémur/diagnóstico por imagen , Humanos , Masculino , Embolia Pulmonar/terapia , Síndrome , Taquicardia , Resultado del Tratamiento , Adulto JovenAsunto(s)
Vena Ácigos/diagnóstico por imagen , Dolor en el Pecho/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitiasis/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Trombosis de la Vena/diagnóstico por imagen , Vena Ácigos/patología , Dolor en el Pecho/etiología , Coledocolitiasis/cirugía , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Trombosis de la Vena/patología , Espera VigilanteRESUMEN
Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for Burkholderia pseudomallei He was subsequently treated with ceftazidime for a month followed by oral trimethoprim-sulfamethoxazole for 3 months. Follow-up CT of abdomen a month after diagnosis and treatment showed resolving hepatic and splenic lesions.