Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour.

Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient's haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.

Ruptured Ovarian Artery Aneurysm Complicating a Term Vaginal Delivery in the Early Puerperium Period: A Case Study.

Spontaneous rupture of a gonadal artery aneurysm is an extremely rare occurrence and can lead to a rapidly lifethreatening retroperitoneal hemorrhage. We report a case of a pregnancy-related spontaneous rupture of a right ovarian artery aneurysm in a multiparous woman. A 37-year-old woman, gravida 4, para 4, presented to an outside facility with right flank pain roughly six hours following spontaneous vaginal delivery of full-term baby with complication of advanced maternal age (AMA). Computerized tomography at our facility revealed contrast extravasation from a right ovarian artery aneurysm and retroperitoneal hematoma. Successful management was achieved via selective angiography and embolization using both micro-coils and gel-foam. Diagnostic angiography followed by transcatheter arterial embolization is an effective and minimally invasive technique for management of ovarian artery aneurysm.

Spontaneous globe rupture in a patient with extensive ocular surgical history.

Globe rupture is visually dramatic in appearance for emergency clinicians and is a sight-threatening injury for the patient. It requires prompt ophthalmologic surgical intervention for optimal outcomes. Cases are typically the result of ocular trauma; however, this case highlights a rare instance of spontaneous globe rupture in a patient with an extensive ocular surgical history.

The diagnostic challenge of non-traumatic bladder rupture: a pictorial essay.

Non-traumatic bladder rupture (NTBR) is relative rare pathology including spontaneous rupture and iatrogenic injury. As increasing the medical intervention for the pelvic malignancy or elderly population, NTBR will be encountered more frequently. There are few previous studies summarizing the imaging features of NTBR. We reviewed imaging characteristics of 18 previous cases of NTBR experienced. In addition, 3 presentative cases that can be a pitfall to differentiate from NTBR. The aim of this article is to clarify the key CT findings of NTBR and its pitfalls.

Spontaneous Forniceal Rupture Identified by Point-of-care Ultrasound.

Spontaneous forniceal rupture is one of the rarest diagnoses of abrupt onset abdominal pain. Moreover, urolithiasis is the most prevalent cause and coexistent condition. Delayed-phased Contrast-enhanced computed tomography scans or intravenous pyelograms are needed for an exact diagnosis in most circumstances. Herein, we report a case of a healthy middle-aged female who presented to the emergency department with flank and abdominal pain. The diagnosis of forniceal rupture was made by the emergency point of care ultrasound. To the best of our knowledge, this is one of the first cases of spontaneous forniceal rupture secondary to urolithiasis diagnosed by the physician-performed ultrasound before confirmation of the diagnosis with computed tomography. In conclusion, emergency physicians and surgeons should be aware of rare conditions like spontaneous forniceal rupture and its sonographic findings to make a rapid diagnosis of urine extravasation so that unwanted complications are avoided. Key Words: Renal stone, Ultrasound, Forniceal rupture, Renal colic, Urinoma.

Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature.

BACKGROUND: Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind. CASE PRESENTATION: A 44-year-old man with alcoholic liver cirrhosis, Child-Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum. CONCLUSION: Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum.

[Spontaneous rupture of kidney tumor. Successful surgical treatment].

A clinical case of spontaneous rupture of the kidney lesion that occurred after physical exercise is presented in the article. During the examination (ultrasound, multi-slice computed tomography of the kidneys), the diagnosis was unclear, and therefore, the patient underwent surgical treatment. Given the risks of complications and impossibility to exclude the malignancy, a decision was made to perform nephrectomy. The diagnosis was clear cell adenocarcinoma. We consider the prompt nephrectomy in this clinical situation as a success.

Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report.

BACKGROUND: Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. CASE PRESENTATION: A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. CONCLUSIONS: This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

[Hepatocellular adenoma as a cause of liver rupture and intrauterine foetal death].

During pregnancy, hepatocellular adenoma HCA may grow, which increases the risk of rupture. In this case report, a 34-year-old woman at gestational age 34+ weeks was admitted to hospital with abdominal pain, hypovolaemia and intrauterine foetal death from a ruptured hepatocellular adenoma. It was successfully managed with trans-arterial embolisation and caesarean section, followed by laparoscopic liver resection four weeks later. Spontaneous liver rupture during pregnancy is associated with an increased risk of maternal and foetal mortality, and appropriate interventional radiology and surgical measures are essential for successful treatment.

Diagnostic challenge and surgical management of Boerhaave's syndrome: a case series.

BACKGROUND: Boerhaave's syndrome is the spontaneous rupture of the esophagus, which requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging. CASE PRESENTATION: Case 1: A 54-year-old Chinese man presented to us with sudden-onset epigastric pain radiating to the back following hematemesis. Upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. Subsequent computed tomography showed frank pneumomediastinum and heterogeneous pleural effusion. Immediately, esophageal perforation repair operation and jejunostomy were performed. The postoperative period was uneventful, and he was discharged. Case 2: A 62-year-old Chinese man was admitted to the emergency department with thoracic dull pain and chest distress. Chest computed tomography scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His postoperative period was uneventful, with no leakage or stricture. Case 3: The patient was a 69-year-old Chinese male presenting with severe retrosternal and upper abdominal pain following an episode of forceful vomiting. Thoracic computed tomography scan revealed a rupture in the left distal part of the esophagus, a pneumomediastinum, and left-sided pleural effusions. Conservative treatment failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery. CONCLUSIONS: We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

Optical Coherence Tomography of Plaque Vulnerability and Rupture: JACC Focus Seminar Part 1/3.

Plaque rupture is the most common cause of acute coronary syndromes and sudden cardiac death. Characteristics and pathobiology of vulnerable plaques prone to plaque rupture have been studied extensively over 2 decades in humans using optical coherence tomography (OCT), an intravascular imaging technique with micron scale resolution. OCT studies have identified key features of plaque vulnerability and described the in vivo characteristics and spatial distribution of thin cap fibroatheromas as major precursors to plaque rupture. In addition, OCT data supports the evolving understanding of coronary heart disease as a panvascular process associated with inflammation. In the setting of high atherosclerotic burden, plaque ruptures often occur at multiple sites in the coronary arteries, and plaque progression and healing are dynamic processes modulated by systemic risk factors. This review details major investigations with intravascular OCT into the biology and clinical implications of plaque vulnerability and plaque rupture.

[Hematocele and hemoperitoneum as initial manifestation of hepatocellular carcinoma. Report of one case]. / Hematocele y hemoperitoneo como manifestación inicial de carcinoma hepatocelular: Caso clínico.

Hepatocellular carcinoma (HCC) rupture is a rare complication, with a higher prevalence in countries of Asia and Europe. Its clinical manifestations can be nonspecific, from abdominal pain and bloating to hemodynamic involvement. We report a 70-year-old male patient with a history of chronic liver disease, presenting with an enlargement and ecchymosis of the scrotum, associated with abdominal bloating. The initial abdominal ultrasound study showed increased liquid content in the scrotal sac and regional edema. A CT of the abdomen and pelvis showed a liver mass with characteristics of hepatocellular carcinoma, associated with extensive hemoperitoneum that drained into the scrotal sac. The patient was treated with embolization of the right hepatic artery and later with surgical resection of the tumor mass, with a good clinical evolution.

A case report of ruptured ectopic pregnancy plus massive hemoperitoneum on a heterotrophic pregnancy in a resource-poor setting, Mbengwi, Cameroon.

Heterotopic pregnancy is a rare obstetrics phenomenon and carries significant maternal morbidity and mortality due to the risk of rupture of the ectopic pregnancy. Physicians tend to feel comfortable and relieved when an intrauterine gestation sac is seen. This results in an inadequate inspection of the adnexae and remaining structures during emergency bedside ultrasound despite a strong initial clinical suspicion of ectopic pregnancy. We present a case report of ruptured ectopic pregnancy and massive hemoperitoneum in a patient with heterotopic pregnancy. The diagnosis was done on bedside ultrasonography in a clinically unstable 32-year-old patient with a history of infertility. She presented with acute abdominal pain, body weakness, and amenorrhea. She underwent emergency laparotomy and salpingectomy. In our context where ultrasound is not readily available, practitioners carrying out salpingectomy for ruptured ectopic pregnancies should bear in mind the plausibleness of heterotopic pregnancy to properly handle the uterus.

Laparoscopic treatment of a giant seminal vesicle cyst with hemorrhage: A case report.

RATIONALE: A seminal vesicle cyst is a benign lesion of the seminal vesicle that is usually asymptomatic. However, when a giant seminal vesicle cyst ruptures and bleeds, it can cause obvious clinical symptoms. To our knowledge, no single giant seminal vesicle cyst with hemorrhage has been reported in current studies, and surgery is the primary method to treat seminal vesicle hemorrhage with obvious symptoms. PATIENT CONCERNS: A 31-year-old man presented with urination pain but without obvious urination frequency and urgency, dysuria, and discomfort. Rectal palpation in the chest-knee position revealed a hard mass palpable in the upper right with a smooth surface and mild tenderness, and the upper edge of the mass could not be palpated. DIAGNOSIS: The results of the B-mode ultrasound indicated a mixed echogenic lump between the bladder and prostate, with a size of 81 × 76 mm. The computer tomography scan showed an "S" tubular lump in the right side of the pelvic cavity. The mass has a computer tomography value of 58 to 70 HU, and uneven reinforcement can be observed. On the basis of the results of the magnetic resonance imaging of the urinary bladder, the lump has T1 and T2 signals of equal lengths. INTERVENTIONS: The patient was diagnosed with a huge right seminal vesicle cyst with hemorrhage and was treated via laparoscopic surgery. OUTCOMES: The patient recovered quickly after the operation, and the symptoms of urination pain were significantly improved. LESSONS: Seminal vesicle hemorrhage is clinically rare, and laparoscopic treatment is an effective and safe surgical method for the treatment of seminal vesicle cysts.

Hematocele y hemoperitoneo como manifestación inicial de carcinoma hepatocelular: caso clínico / Hematocele and hemoperitoneum as initial manifestation of hepatocellular carcinoma: report of one case

Hepatocellular carcinoma (HCC) rupture is a rare complication, with a higher prevalence in countries of Asia and Europe. Its clinical manifestations can be nonspecific, from abdominal pain and bloating to hemodynamic involvement. We report a 70-year-old male patient with a history of chronic liver disease, presenting with an enlargement and ecchymosis of the scrotum, associated with abdominal bloating. The initial abdominal ultrasound study showed increased liquid content in the scrotal sac and regional edema. A CT of the abdomen and pelvis showed a liver mass with characteristics of hepatocellular carcinoma, associated with extensive hemoperitoneum that drained into the scrotal sac. The patient was treated with embolization of the right hepatic artery and later with surgical resection of the tumor mass, with a good clinical evolution.