Spontaneous rupture of the inferior vena cava (IVC) in the setting of IVC filter thrombosis: case report.

Spontaneous rupture of the inferior vena cava (IVC) is a rare entity. We report a case of a spontaneous IVC rupture associated with IVC filter thrombosis in a patient presenting with severe atraumatic back pain. Computed tomography (CT) identified a retroperitoneal hematoma and suggested IVC thrombosis. Magnetic resonance (MR) imaging confirmed the presence of IVC filter thrombosis and demonstrated a large defect in the infrarenal IVC, with the vessel lumen in free communication with the adjacent hematoma. The patient was managed conservatively and discharged in stable condition. MR imaging played an important role in characterizing the CT findings, which were unclear.

Intraluminal pressure in a uterine tamponade balloon is curvilinearly related to the volume of fluid infused.

We studied the effect of incremental infusion of fluid volume in a tamponade balloon on intraluminal pressure and uterine blood flow. Following placental delivery, a tamponade balloon was inserted into the uterus and incrementally inflated. Intraluminal pressure was measured at incremental volumes. Ultrasound was used to determine positioning of the catheter, uterine wall thickness, and uterine artery velocity waveforms in eight patients. Pressure-volume relationship was estimated by regression analysis. Significance was p < 0.05. There was a significant exponential curvilinear relationship between balloon pressure and infused volume at the maximum volume for each subject ( R = 0.64, p = 0.01). Doppler ultrasound showed that at or above 1000 mL inflation volume, 5/6 patients (83%) showed reversal of uterine artery diastolic flow. At maximal inflation volume, all of the patients with reversed diastolic flow had intraluminal pressure less than systolic blood pressure. Intraluminal pressure increases curvilinearly as volume of an intrauterine tamponade balloon is increased. The mechanism of action of tamponade balloons is likely related to a reduction in uterine artery perfusion pressure. Whether this is the result of direct compression of the artery in the lower segment or due to wall conformational changes is not clear.

A Case of Hyperemesis Gravidarum due to Gastric Cancer Masquerading as Preeclampsia.

Nausea and vomiting are symptoms frequently seen in normal pregnancy. We report a patient with gastric carcinoma who presented with severe hyperemesis gravidarum that led to extreme volume depletion, hypertension, proteinuria, and acute renal failure. A 35-year-old woman (para 2-1-0-1) with a prenatal course significant for persistent nausea, vomiting, and poor weight gain presented at 36 weeks' gestation with elevated blood pressure (157/114 mm Hg), proteinuria (4+), hypochloremic metabolic alkalosis, and severe intravascular volume contraction. A presumptive diagnosis of severe preeclampsia was made, the patient was given intravenous MgSO4, and cesarean delivery was accomplished uneventfully. When significant emesis persisted in the postoperative period, esophagogastroduodenoscopy revealed an antral/prepyloric mass with a biopsy-proven poorly differentiated adenocarcinoma. To our knowledge, this is the first report of a case of hyperemesis gravidarum with gastric cancer masquerading as preeclampsia.