Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization.

PURPOSE: To assess the safety and efficacy of embolization for spontaneous bleeding in anticoagulated patients with COVID-19. MATERIAL AND METHODS: Single center retrospective study in 9 patients with COVID-19 who experienced bleeding complications following anticoagulation. The study included 8 men and 1 woman aged from 48 to 80 years (mean 69.7 years), who had a total of 10 soft tissue haematomas: 1 in the thigh, 1 in the anterior abdominal wall, 6 retroperitoneal and 2 thoracic haematomas. All patients were referenced for vascular embolization, mostly with Onyx-18. RESULTS: A total of 10 haematomas were embolized in 9 patients. Technical success was achieved in all patients. No complications or adverse events were noted. One patient required percutaneous drainage of an infected haematoma 88 days after embolization. The mean hemoglobin level before embolization was 8,64 mg/dL and increased to 9,08 mg/dL after embolization (p = 0,3). After embolization all patients recovered haemodynamic stability and blood pressure levels improved. Seven patients resumed anticoagulation therapy after embolization. There were no recurrences or new bleedings in all treated patients. No patients required any additional invasive therapies or surgery. Mean intensive unit care and hospital stay was 6.7 and 35.2 days, respectively. All patients were discharged and were well at follow-up clinic visits 2-7 months after embolization. Seven patients performed a control CT scan 1-6 months after embolization, showing complete resolution of the haematoma. CONCLUSION: Embolization is safe and effective to treat spontaneous haematomas in anticoagulated patients with COVID-19, allowing to resume anticoagulation therapy. Level of evidence IV Level 4, case-series.

Ictus recidivante, acrocianosis y livedo racemosa: ¿siempre síndrome de Sneddon? / No disponible

No disponible

Embolismo arterial gaseoso paradójico tras una herida incisa craneal directa / Paradoxical arterial gas embolism following a direct incisive injury to the skull

Introducción. El embolismo arterial gaseoso se define como la presencia de aire en la circulación arterial. Se trata de una causa extremadamente rara de ictus que se ha descrito en multitud de escenarios clínicos, generalmente relacionados con procesos yatrógenos. Se aporta un caso clínico en el que el embolismo arterial gaseoso sucedió tras un traumatismo craneoencefálico, y se revisan los aspectos más relevantes del diagnóstico y la etiopatogenia. Caso clínico. Mujer de 52 años que presentaba herida incisa craneofacial tras una agresión con un hacha. La tomografía computarizada inicial objetivó fractura en los arcos cigomático, esfenoidal y maxilar izquierdos, así como neumoencéfalo en los senos cavernosos y el canal carotídeo derecho. Una hora más tarde, la paciente mostró un déficit neurológico hemisférico derecho, por lo que se solicitó de forma urgente una nueva tomografía computarizada craneal con estudio vascular multimodal, que objetivó la movilización del neumoencéfalo y descartó una oclusión arterial de gran vaso. Un estudio de shunt mediante Doppler transcraneal y ecocardiografía comprobó la presencia de un foramen oval permeable como causa de comunicación arteriovenosa que justificaba un embolismo arterial gaseoso. La tomografía computarizada de control a las 48 horas confirmó la aparición de una lesión isquémica parietal derecha. Conclusión. En este caso queda reflejada la presencia simultánea de aire en la circulación cerebral arterial y venosa y la comunicación periférica a través de un foramen oval permeable. Este mecanismo de producción está escasamente documentado en la bibliografía

Introduction. An arterial gas embolism is defined as the presence of air in the arterial circulation. This is an extremely rare cause of stroke that has been described in a multitude of clinical scenarios, generally related to iatrogenic processes. A clinical case is reported in which the arterial gas embolism occurred after a traumatic brain injury, and the most relevant aspects of diagnosis and aetiopathogenesis are reviewed. Case report. We report the case of a 52-year-old woman with an open craniofacial wound resulting from an attack with an axe. The initial CT scan found fractures in the left zygomatic, sphenoidal and maxillary arches, as well as pneumocephalus in the cavernous sinuses and the right carotid canal. One hour later, the patient showed a neurological deficit in the right hemisphere, and so a new cranial computed tomography scan with multimodal vascular study was urgently requested, which revealed the mobilisation of the pneumocephalus and ruled out a large vessel arterial occlusion. A shunt study using transcranial Doppler and echocardiography showed the presence of a patent foramen ovale to be the cause ofarteriovenous communication that justified an arterial gas embolism. The follow-up CT scan at 48 hours confirmed the appearance of a right parietal ischaemic lesion. Conclusion. This case reflects the simultaneous presence of air in the arterial and venous circulation of the brain, as well as the peripheral communication through a patent foramen ovale. This production mechanism is poorly documented in the literature