Bilateral adrenal haemorrhage with renal infarction after ChAdOx1 nCoV-19 AstraZeneca vaccination.

Vaccine-induced thrombotic thrombocytopaenia (VITT) is a rare syndrome associated with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine. We detail a case of vaccine-induced thrombotic thrombocytopaenia in a 47-year-old female who was found to have bilateral adrenal haemorrhage, renal vein thrombosis, renal infarction and pulmonary embolism 13 days post-vaccination with ChAdOx1 nCoV-19.

Incidental pulmonary embolism in oncology patients with current macroscopic malignancy: incidence in different tumour type and impact of delayed treatment on survival outcome.

OBJECTIVES: To evaluate the incidence and outcome of incidental pulmonary embolism (iPE) in patients with current macroscopic malignancy and delayed anticoagulation due to late reporting of CT scan. METHODS: Reports of CT thorax with i.v. contrast done on oncology patients between 1 January 2015 and 31 December 2015 in two district general hospitals in UK were reviewed. Electronic patient records of iPE patients were reviewed for demographic and treatment information. RESULTS: 26 iPEs were reported in 1,604 scans (731 patients), incidence 1.6%; female = 15; median age = 66 (range 32-90); main artery = 10; lobar artery = 8; segmental = 7; subsegmental = 1; median time (range) from scan to reporting = 1 day (0-60); scan to anticoagulation = 5 days (0-61) (three had no treatment); scan to death = 7 months (1-22+) with nine still alive and two lost to follow up. All had metastatic disease. There was no sudden death. None of the patients whose anticoagulation started more than 5 days after the iPE CT scan died within 3 months. iPE was absent in all repeat staging CT scans (done average 3.4 months after the anticoagulation) in 16 patients, without any anticoagulation in one patient with segmental iPE. CONCLUSION: Incidence of iPE in patients with current macroscopic malignancy is low-1.6%-mostly seen in lung, breast and colorectal cancer probably due to frequency of imaging. A few days' delay in anticoagulation does not appear to have an impact on the risk of sudden cardiac death. Advances in knowledge: This study tells us that iPE is infrequent, that it can be treated appropriately with anticoagulation, but this does not necessarily need to begin on the same day of diagnosis.

Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication.

STUDY DESIGN: An unusual complication resulting from an artificial disc replacement for lumbar degenerative disc disease and its treatment are reported OBJECTIVE: To describe the clinical circumstance, radiologic findings, treatment, and outcome of bilateral pedicle fractures associated with dislocation of the polyethylene inlay of a ProDisc replacement at L5/S1 level. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no published reports in the English literature have described bilateral pedicle fractures following a single level artificial lumbar total disc replacement. METHODS: A 30-year-old male underwent a ProDisc total disc replacement at L5/S1 level for discogenic pain. Six-week postoperative assessment showed improvement in the visual analog and Oswestry scores. Assessment at 18 weeks postoperatively for acute pain revealed an anterior slip of the superior plate component, and computerized tomography showed bilateral pedicle fractures of the fifth lumbar vertebra. At surgery, the poly insert was found to have dislocated anteriorly. A salvage interbody fusion was then performed using the stand-alone anterior lumbar interbody fusion cage. RESULTS: The most recent review confirmed radiologic evidence of fusion with improvement in the subjective evaluation scores CONCLUSIONS: We hypothesize that the current implant design in which the contribution to lordosis angle is purely from the superior component may be responsible for the reported complication. We suggest that dividing the contribution equally between both endplates might increase the stability, and this has been discussed with the manufacturers.