COVID-19-Related Acalculous Groove Pancreatitis.

Introduction: Groove pancreatitis is a rare form of chronic pancreatitis. Its radiological diagnosis is challenging and it can be difficult to distinguish from pancreaticoduodenal malignancy. Case description: A 64-year-old woman was admitted to our internal medicine ward after she contracted severe COVID-19 pneumonia requiring mechanical ventilation. She presented with right upper abdominal pain, and a CT scan showed pancreaticoduodenal inflammatory tissue; malignancy was ruled out. Conclusion: Diagnosing groove pancreatitis is challenging and malignancy must be quickly excluded. No cases of COVID-19-associated groove pancreatitis have been previously described. LEARNING POINTS: Groove or paraduodenal pancreatitis is a rare form of chronic pancreatitis, and usually associated with alcohol use.The differential diagnosis includes pancreaticobiliary and duodenal malignancies.Radiological diagnosis is challenging and treatment is usually supportive.

Hepatic Coma Secondary to Fontan Conduit Thrombosis.

Introduction: The Fontan procedure is used to treat congenital heart defects and has improved long-term survival. Long-term complications include liver disease due to congestive hepatopathy. Fontan-related cirrhosis can manifest with ascites, gastrointestinal bleeding and encephalopathy. Case description: A 43-year-old man with history of Fontan surgery was admitted with COVID-19 pneumonia. There was rapid clinical and neurological deterioration, with coma and shock. CT imaging showed thrombosis of the Fontan conduit. The patient was successfully subjected to recanalization of the Fontan circulation, with progressive improvement of coma. Discussion: Fontan-associated liver disease is a major complication following the Fontan procedure. Clinicians must be aware of this pathology during patient follow-up. LEARNING POINTS: The Fontan procedure has improved the long-term survival of patients with single ventricle pathology.Fontan-associated liver disease is a result of haemodynamic changes associated with Fontan circulation; complications include hepatic encephalopathy and coma.Patients with Fontan circulation should be evaluated over time in order prevent and treat systemic complications.

SPONTANEOUS RENAL HAEMORRHAGE.

Introduction: Spontaneous renal haemorrhage is a rare condition with potentially serious complications. Case description: We describe a 76-year-old woman with a 3-day history of fever and malaise, with no associated trauma. She was admitted to our emergency room with signs of shock. A contrast-enhanced computed tomography scan revealed an extensive right kidney haematoma. Despite fast surgical management, the patient died less than 24 h after admission. Conclusion: Spontaneous renal haemorrhage should be quickly identified due to its fatal complications. Early diagnosis leads to a better prognosis. LEARNING POINTS: Spontaneous renal haemorrhage is a severe and rare condition in the absence of trauma and antithrombotic therapy.Contrast-enhanced abdominal CT scan is the gold standard for diagnosis.Surgical nephrectomy should be considered in haemodynamically unstable patients.Conservative therapy with intravenous resuscitation and blood products should be considered in stable patients.

ANTERIOR THALAMIC ISCHAEMIC STROKE SECONDARY TO CARDIOPULMONARY ARREST.

Introduction: Ischaemic anterior thalamic lesions are rare and can present with disturbances of behaviour and memory. We describe a patient with post-cardiac arrest thalamic stroke. Case description: A 63-year-old man presented with cardiac arrest, was resuscitated after receiving life support, and showed no lesions on computed tomography. Three days later, he presented with short-term memory disturbance and disorientation, with a de novo anterior thalamic lesion. Conclusion: The anterior thalamic nucleus, supplied by the posterior communicating artery, is part of the Papez circuit and has a role in modulating behaviour and memory. An anterior thalamic syndrome presents with no sensory-motor deficits. LEARNING POINTS: Anterior thalamic stroke is a rare condition and can present with disturbances of short-term memory and behaviour; it usually does not include any motor or sensory deficits.Thalamic stroke can occur due to global hypoxia, such as during cardiopulmonary arrest.