A 48-Year-Old Man Presenting as an Emergency with Severe Back Pain, a Large Anterior Paravertebral Hematoma, and Spontaneous Rupture of the Right 9th Intercostal Artery Successfully Managed by Transcatheter Arterial Embolization: A Case Report.

BACKGROUND The rupture of an intercostal artery is rare and is usually associated with trauma, neurofibromatosis type 1, or coarctation of the aorta. Transcatheter arterial embolization is a minimally invasive vascular surgical procedure used to control hemorrhage of an intercostal artery. This report describes a case of a 48-year-old man who presented with severe back pain. This was due to a large anterior paravertebral hematoma following the spontaneous rupture of the right 9th intercostal artery. The rupture was successfully managed by transcatheter arterial embolization. CASE REPORT A 48-year-old man suddenly felt severe back pain while walking. He had no previous medical history and he had not experienced any external injury. On arrival, he was tachycardic and hypertensive. He did not have abnormal physical findings. His chest radiograph, 12-lead electrocardiogram, ultrasonography, and blood test findings were unremarkable. A chest computed tomography scan with contrast media was performed, which revealed a 4.3×2.7×7.0 cm mass, enhanced with contrast media, anterior to the 9th vertebral body. The patient was diagnosed with spontaneous rupture of the right ninth intercostal artery. The lesion was embolized with 8 microcoils. The patient was discharged on the 8th hospital day without complications. CONCLUSIONS This report presents a rare case of the rupture of an intercostal artery in which no cause was identified. It highlights the role of imaging as an important diagnostic tool. Furthermore, this report shows the benefits of the timely use of emergency transcatheter arterial embolization, which in this instance resulted in a successful outcome.

Cardiac Strangulation Due to Partial Pericardial Defect Presenting as Acute Myocardial Infarction.

A 79-year-old man with chest pain and dyspnea underwent emergency percutaneous coronary intervention for acute myocardial infarction. However, he died 17 days later due to refractory heart failure. An autopsy revealed cardiac strangulation caused by herniation of the apical heart through a pericardial defect due to partial absence of the pericardium. (Level of Difficulty: Advanced.).

Complement Activation in Human Sepsis is Related to Sepsis-Induced Disseminated Intravascular Coagulation.

INTRODUCTION: In human sepsis, little is known about the relationships between complement activation and the clinical characteristics of sepsis, including disseminated intravascular coagulation (DIC), interventions, and prognosis. PATIENTS AND METHODS: Adult patients with sepsis admitted from November 2016 to December 2018 were included. We used the plasma levels of soluble C5b-9 (SC5b-9) as a marker of complement activation. We compared the clinical characteristics and complement components between patients with and without DIC. We also compared the clinical characteristics and each DIC parameter across quartile groups for the SC5b-9 value. RESULTS: Forty-nine sepsis patients were eligible. Thirty-four patients developed DIC, and eight patients died. The median (interquartile range) SC5b-9 value was 342 (261-501) ng/mL. Compared with patients without DIC, patients with DIC showed lower C3 levels (mean, 95.7 vs. 70.4 mg/dL, P < 0.01) and higher SC5b-9 levels (median, 287 vs. 400 ng/mL, P = 0.01). Patients were stratified by SC5b-9 quartile (ng/mL: low: < 260, moderate: 260-342, high: 343-501, highest: > 501). The mean Sequential Organ Failure Assessment score varied across these groups (P = 0.02). In the high and highest groups, many more patients received vasopressors and developed DIC. In the highest group, the coagulation parameters were severe, and thrombocytopenia was prolonged. In-hospital mortality tended to be high (33%) in the highest group. CONCLUSIONS: The degree of complement activation is related to DIC, severity, intensive interventions, and mortality. Further studies are needed to confirm the usefulness of SC5b-9 for stratifying sepsis patients.

Sensory axonal polyneuropathy due to 2,4-dinitrophenol.

A 24-year-old man developed subacute onset of numbness and pain in the upper and lower limbs. Physical examination demonstrated decreased pinprick sensation, but was otherwise normal. Blood and cerebrospinal fluid parameters were normal except for mild hepatic dysfunction. No data were suggestive of connective tissue disease. Nerve conduction studies demonstrated sensory neuropathy. A detailed medical interview revealed that the patient had been taking self-imported 2,4-dinitrophenol (DNP) for 2 months to decrease body weight. Six months after discontinuing DNP, subjective symptoms and liver dysfunction resolved completely, and the patient was diagnosed with drug-induced peripheral neuropathy and hepatopathy. There are no case reports of health risks posed by DNP in Japan, and even worldwide, cases of peripheral neuropathy due to DNP are rare. Obtaining a detailed drug history is important, as is providing information on the dangers of self-imported medicines.