Case report - Computed tomography diagnosis of an abdominal aortic aneurysm complicated with primary aortoduodenal fistula.

Abdominal aortic aneurysm has been described as a rare condition touching 1% of the population over the age of 50 years with a high percentage of mortality. Aneurysms progress in size, causing deadly complications such as ruptures and fistulas. Computed tomography angiography is considered the gold standard imaging exam for the evaluation of abdominal aortic aneurysms and their complications. We report the case of an elderly patient admitted to the emergency room due to recurrent gastrointestinal bleeding. The computed tomography imaging findings were in favor of an abdominal aortic aneurysm complicated with a primary aortoduodenal fistula.

Ortner's syndrome secondary to a thoracic thrombosed aortic aneurysm: Case report.

Ortner's syndrome refers to vocal cord paralysis resulting from compression of the left recurrent laryngeal nerve by abnormal mediastinal vascular structures. We present a case of an 89-year-old man who was an active smoker, with a clinical history of hypertension, who presented hoarseness of voice with chronic evolution. Neck and Thoracoabdominal CT angiography was performed revealing a thrombosed aneurysm of the aortic arch.

Pneumosinus dilatans with shift of midline intracranial structures: A case report.

Pneumosinus dilatans (PSD) is an abnormal dilatation and enlargement of one or more paranasal sinuses, extending beyond the anatomic bony boundaries, without defect or thinning of its bony walls. It is documented by only a few reports. Usually asymptomatic, it is in general found incidentally on imaging. It is important for radiologists to recognize the diagnosis and rule out eventual associated conditions such as meningiomas, orbital tumors, arachnoid cysts, and fibrous dysplasia. We report the case of PSD diagnosed incidentally in a 51-year-old female patient who presented to the emergency department with confusion.

Magnetic resonance imaging of non-pueperal total uterine inversion due to a leiomyoma.

We report a case of a 43-year-old woman admitted to the emergency's department for an externalized mass through the vulva. The exploration by magnetic resonance imaging shows complete uterine inversion caused by a giant leiomyoma. Non-puerperal uterine inversion is a rare condition that is usually difficult to diagnose clinically. The role of imaging, specifically magnetic resonance imaging, is essential for the diagnosis, to establish the classification and to adapt the management.

Extraskeletal Ewing sarcoma: A case report.

Extraskeletal Ewing sarcoma is a rare tumor mainly affecting young people, of poor prognosis with very high mortality rates especially in metastatic forms. It can affect different locations, without specific clinical signs, which delays the diagnosis. Imaging plays an important role for diagnosis, staging, preoperative assessment and surveillance. The diagnosis should be set early to a better management. We report a case of a 30-year-old man with a large extraskeletal Ewing sarcoma of the left thigh. The patient was initially treated with chemotherapy. Unfortunately, the tumor has increased in size making surgery impossible. The patient ultimately died of pulmonary metastases.

Giant aneurysmal bone cyst of the scapula: A case report.

Aneurysmal bone cyst (ABC) is a benign bone tumor affecting mainly children and young adults. It occurs in the metaphysis of the long bones. The scapula is a very rare location. Imaging may be highly suggestive of ABC in cases of an osteolytic, expansive, and hemorrhagic lesion with fluid-fluid levels and thin septa. The diagnosis must systematically be confirmed by performing a biopsy, in order to adopt the best therapeutic strategy. There are several therapeutic means, but wide resection remains the gold standard. The evolution is very variable and can go from spontaneous healing to recurrence with the destruction of the bone. We report a rare case of aneurysmal bone cyst of the scapula in a young patient.

Factors influencing the length of stay in the moroccan intensive care unit in patients surviving critical COVID-19 infection.

Introduction: our objective is to determine the factors that influence the length of hospitalization of patients admitted to an intensive care unit. Methods: We have conducted a mono-centric retrospective cohort of 417 patients admitted in intensive care unit for a critical infection by COVID-19, for this purpose we have realized an analytical study using the linear regression model. Results: In our study, the average length of hospitalization for a critical infection with COVID-19 is 6 days (SD = 7Days), regarding the factors that influence the length of hospitalization, the length of time between the consultation and the onset of symptoms higher thann 8 days affects the length of hospitalization (coefficient = 1.2 days; CI = 0.769; 2.102 and pValue = 0.009), the presence of obesity which also affects the length of hospitalization (Coefficient = 1.6 days CI ((0.009; 3.265), and pValue = 0.049). During hospitalization, the use of mechanical ventilation, the use of tocilizumab, having a billateral nosocomial pneumonia are all factors that impact the length of hospitalization. Conclusion: It is recommended to emphasize the importance of early consultation after the onset of respiratory symptoms in the patients who are admitted to the intensive care unit in order to improve the length of their stay.

A very rare case of chylomicronemia revealed by cerebral thrombophlebitis in a 4-month-old infant.

INTRODUCTION: Hyperchylomicronemia is a disorder of lipid's metabolism that can present fatal complications such us such venous or arterial thrombosis, pancreatitis, and cardiovascular incidents. CASE PRESENTATION: In this report case we report a 4months old patient who was admitted in the emergency room for hypotonia and during the blood sampling we were surprised by the macroscopic latescent aspect of the blood. During the investigations we found that the patient had a fatty cerebral venous thrombosis that revealed hyperchylomicronemia. Furthermore, the patient presented tuberculosis cerebral abscess and stage A pancreatitis and was successfully treated. DISCUSSION: Primary hypertriglyceridemia results from the accumulation of genes polymorphisms encoding for proteins involved in the triglycerides metabolism but before thinking about primary origin a secondary one should be pushed aside. Biological investigations should test lipoprotein lipase activity that can be absent or reduced to confirm a lipid disorder, then lipoprotein electrophoresis and genetic study can deliver the diagnosis. The management of this disease is based on low fat diet that should not be over than 25-30g per day, also statin, fibrate, omega 3 acid, heparin and insulin can be used. CONCLSUION: Adequate treatment and exploration permits to obtain the optimum care to avoid any complications.

Special case of a patient in the blast phase of chronic myeloid leukemia successfully treated with tocilizumab during critical SARS-CoV-2 infection.

The medical care of patients with hematological malignancies who develop coronavirus disease 2019 (COVID-19) has been a major challenge during the current pandemic. We herein describe a patient in the blast phase of chronic myeloid leukemia who was hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was successfully treated with tocilizumab, and intubation was avoided. The severity of SARS-CoV-2 infection is mostly related to a severe acute respiratory distress syndrome that develops secondary to cytokine release syndrome, and interleukin 6 is the main cytokine involved in cytokine release syndrome. Very few reports have described the use of tocilizumab in patients with hematologic malignancies who develop SARS-CoV-2 infection, although a few cases of patients with multiple myeloma have been reported. To our knowledge, however, this is the first report of a SARS-CoV-2-infected patient in the blast phase of chronic myeloid leukemia who had a favorable response to treatment with tocilizumab. The management of patients with hematological malignancies who become infected with SARS-CoV-2 is a major challenge for practitioners, necessitating more specific research in this direction.

Post Myocardial Infarction Ventricular Septal Rupture Revealed By Acute Liver Failure Symptoms: A Case Report.

INTRODUCTION: The mechanical complications of acute myocardial infarction (AMI) still kill despite the evolution of medicine. Early diagnosis and adequate management are necessary to improve the prognosis, and this requires first, a good clinical examination that should raise the suspicion of a mechanical complication, then the echocardiography is performed to confirm the diagnosis. CASE PRESENTATION: We present a case of a 64-year-old patient admitted to the emergency room for jaundice with delayed ST-segment elevation myocardial infarction (STEMI). Physical examination revealed signs of right heart failure, which led us to associate jaundice with signs of acute liver failure secondary to right heart failure. Echocardiography confirmed the diagnosis of a ventricular septal rupture (VSR) with left-right shunt, and a significant dilation of the right ventricle. The patient underwent surgical closure of the VSR with fatal evolution. DISCUSSION: VSR is a rare life-threatening mechanical complication of AMI. The clinical signs depend on the left-right shunt and the onset of heart failure, which are 2 major determinants of the therapeutic strategy and the timing of the surgery. Despite surgical closure of the VSR, the mortality remains high, but the prognosis is better in patients treated with surgery than in patients who are treated medically only. CONCLUSION: The clinical presentation of VSR may differ from a patient to another. Good clinical sense and echocardiography are essential to set early diagnosis, and thus decide on the adequate management at the right time.

Cerebral Salt Wasting Syndrome (CSW): An unusual cause of hypovolemia after spontaneous cerebral hemorrhage successfully treated with fludrocortisone.

Our objective is to demonstrate the interest of thinking about Cerebral salt wasting syndrome (CSW) in front of hyponatremia with severe hypovolemia after a brain injury, and at the same time the interest to differentiate between Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Cerebral salt wasting syndrome (CSW) as two etiologies to be evoked in front of a hyponatremia with brain injury. Case report: We report the case of a 63-year-old patient with a recent history of hemorrhagic stroke admitted for severe hypovolemic shock in whom the investigations find a very deep hypotonic hyponatremia secondary to a cerebral salt wasting syndrome successfully treated with fludrocortisone. Discussion: CWS is characterized by hypotonic hyponatremia associated with cerebral associated with hypovolemia, the difficulty of the diagnosis is explained by the points of convergences with SIADH which is also presented with hyponatremia. The treatment is based on filling with saline, if the symptoms are severe, hypertonic saline has its place. Fludrocortisone has proven its effectiveness in the correction of refractory hyponatremia in CWS. Conclusion: It is essential to differentiate between hyponatremia in CWS and hyponatremia in SIADH because the medical care is categorically different.

SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review.

Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.

Consider systemic capillary leak syndrome in monoclonal gammopathy with shock.

INTRODUCTION AND IMPORTANCE: The cappilary leacking syndrome is a very rare disease that can be idiopathic (clarkson syndrome) or secondary to other pathologys. CASE PRESENTATION: We report a case of 37-year-old women who was admitted in the emergency room for a hemodynamic shock of neither cardiac nor septic cause, and the patient wasn't presenting any bleeding. The investigations showed that the diagnosis was a Clarkson syndrome crisis and the patient was having supportive treatment containing fluid therapy, vasoactive drugs, and ECMO. And died after 48h of hospitalization. CLINICAL DISCUSSION: the cappilary leacking syndrome is a very fatal affection, its physiopathologis remains unknown. It evoluate by crisis made by hypotension and anasarca, in severe cases it is presented as fatal hypovolemic schock. Biological investigations show hemoconcentration associated with hypoalbunemia which is pathognomonic of the disease. The treatment is essentially based on crisis treatment support by fluid therapy, vasoactives drugs, some practicien report the use of theophilyn for prevention but without any proven efficiency. CONCLUSION: For all this reasons we are in the obligation of investing in fundamental studies to better understand this fatal disease.

Brainstem stroke: A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection: A case report and literature review.

Coronavirus disease (COVID-19) disease is a serious pandemic that put the world on an exceptional sanitary alert. It is a multifaceted disease, since it can affect the lung, the cardiovascular system and the central nervous system at the same time. A 66-year-old man, diabetic, hypertensive, admitted to the emergency room for medical management of acute dyspnea, diagnosed with COVID-19 infection. The evolution is marked by respiratory distress as well as new onset atrial fibrillation and a severe ischemic stroke of the brainstem. COVID-19 disease is associated with very serious thromboembolic complications of high incidence, and this is explained by the coagulopathy secondary to the alteration of the microcirculation after the hyper-inflammatory state. Ischemic stroke is one of these complications. The occurrence of new onset atrial fibrillation during COVID-19 infection makes the incidence of ischemic stroke very high and the prognosis more severe. The treatment is mainly based on antithrombotic therapy. Thromboembolic complications remain a real problem to manage in COVID-19 patients given the several mechanisms that promote this situation.

Multiple cranial nerve palsies revealing blast crisis in patient with chronic myeloid leukemia in the accelerated phase under nilotinib during severe infection with SARS-COV-19 virus: Case report and review of literature.

Since the introduction of tyrosine kinase inhibitors as primary therapy for patients with chronic myeloid leukemia (CML), the prognosis of these patients has improved significantly, and the number of patients who progress to the blast phase has decreased considerably. We report the case of a 35 year-old CML patient in accelerated phase treated with nilotinib, who presents a severe COVID-19 infection requiring non-invasive ventilation, and who subsequently presents a multiple cranial nerve palsy revealing a blast crisis of his CML. Multiple cranial nerve palsy is a sign of neurological involvement of CML in its blast phase. The blast crisis represents a real challenge for the clinician, especially during COVID-19 infection. The treatment remains the association of a tyrosine kinase inhibitors with a chemotherapy protocol, as well as the administration of methotrexate and cytarabine by intrathecal and intravenous infusion in high doses. Despite the importance of the association of CML with COVID-19 infection, there is not yet enough data to know the true impact of this infection on the evolution of this hemopathy.