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Introduction: Veillonella parvula is a bacteria that can be found in normal oral and gastrointestinal flora. Veillonella infection is rare in immunocompetent patients but is known to cause periorbital cellulitis, endocarditis, osteomyelitis and bacteremia; however, its association with acute respiratory distress syndrome (ARDS) has not been previously documented. Case presentation: A 36-year-old female with no known history who presented with right-sided chest, flank and upper abdominal pain after a motor vehicle accident. Computed tomography showed multiple right rib fractures, small right pneumothorax, and a grade 4 liver laceration with active extravasation of the posterior aspect of the right liver lobe. Over the hospital course, the patient developed ARDS and was intubated for hypoxemia. A right posterior liver abscess was percutaneously drained, with a copious amount of air and ~30 ml turbid fluid aspirated. Cultures from the liver abscess grew Veillonella parvula. She was treated with Micafungin, Levofloxacin, and Metronidazole for the hepatic abscess, and was discharged home with outpatient follow-up. Discussion: The authors present one of the first reported cases of a V. parvula infected liver abscess associated with ARDS in an immunocompetent patient. Conclusion: These clinical findings are unique due to the nature of our patient's ARDS onset and the dearth of similar cases in the literature. The favorable outcome of our patient was due to a multidisciplinary and early identification of a V. parvula hepatic abscess. The authors' findings contribute to the future management of V. parvula and a greater understanding of its disseminating effects and presentation in immunocompetent patients.
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Type A aortic dissection is a life-threatening emergency requiring prompt surgical treatment. The dissection itself and use of cardiopulmonary bypass can lead to further postoperative complications, including aortic branch occlusion, thrombosis, ischemia, and fatal end-organ damage. Celiac artery occlusion with consequent hepatic malperfusion is one feared complication of aortic dissection, which requires urgent surgical intervention. Optimal management of celiac artery dissection in the setting of type A aortic dissection has not yet been described in the literature. In this report, we describe a 39-year-old female patient with hypertension who was found to have celiac artery dissection and impending hepatic failure less than 48 hours after emergent ascending aortic replacement for type A aortic dissection. Placement of an ultrasound-guided endovascular celiac artery stent enabled reperfusion of the liver, ultimately saving the patient's life.
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Rib plating is a recommended intervention for patients with multiple rib fractures or flail chest to improve shortness of breath, significantly reduce pain, and shorten the length of hospital stay. Here, we report a unique and extremely rare finding in a patient with empyema following intrathoracic rib fixation. A 32-year-old male with a history of alcohol use disorder presented to the emergency department trauma bay after a motor vehicle accident. Computed tomography (CT) showed right hemopneumothorax and fourth to ninth rib fractures with displacement. The right fifth and sixth ribs were then plated using a titanium RibFix bridge, implanted intrathoracically along the posterior surface of the ribs. On postoperative day 11, the patient developed an empyema and a CT-guided drainage catheter was placed into the collection. The patient was given a 3-day course of tissue plasminogen activator (tPA) and DNase for the treatment of his empyema. On postoperative day 15, a repeat CT scan demonstrated significant improvement in the empyema with evidence of abscess resolution. Antibiotics were discontinued after a total of 7 days and the patient was discharged on postoperative day 20. This case report contributes information to the management of complications in intrathoracic rib fixation.