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1.
Am J Case Rep ; 22: e928889, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33863867

RESUMO

BACKGROUND We report the case of a patient undergoing a colonoscopy during which pressure applied on the abdomen by a nurse assisting in the procedure caused an extraluminal mesenteric tear. Mesenteric tears can be life-threating and need to be managed appropriately. This is the first case reported in the literature describing abdominal counter-pressure applied in the endoscopic procedure room as the cause of traumatic bowel injury. CASE REPORT A 72-year-old woman presented for a screening colonoscopy. Advancement of the colonoscope became so difficult that the procedure was temporarily aborted. To reduce looping of the colonoscope, the nurse assistant applied a forceful two-handed counter-pressure maneuver upon the abdomen to help the endoscopist advance the colonoscope to the cecum. After the procedure, the patient complained of abdominal pain and nausea. A CT scan of the abdomen showed a hematoma abutting the anterior abdominal wall. Unfortunately, laparoscopic surgery was hastily recommended over conservative medical management. Approximately 500 mL of old blood was evacuated. The patient survived postoperative complications, including pneumonia, respiratory failure, and sepsis. CONCLUSIONS Mesenteric tears are a rare but potentially life-threatening complication of colonoscopy. Post-colonoscopy patients with severe nausea, abdominal pain and/or distention, who fail to demonstrate free air in the abdomen, should have a CT scan with i.v. contrast to assess their condition. Hemodynamically stable patients should be managed with serial vitals and bedside observations, laboratory tests, imaging studies, fluid replenishment, and medication, to avoid unnecessary high-risk surgery. Abdominal counter-pressure applied safely during colonoscopy can reduce the risk of injury inherent in the procedure.


Assuntos
Abdome/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Colonoscopia/efeitos adversos , Hematoma/etiologia , Doenças Peritoneais/etiologia , Idoso , Feminino , Humanos , Tomografia Computadorizada por Raios X
2.
Pan Afr Med J ; 38: 135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912305

RESUMO

Vacuum-assisted breast biopsy (VABB) is a minimally invasive procedure and has become an important treatment method. Although VABB is a minimally invasive procedure, it might cause complications, particularly those associated with blood vessels. In this article, we aimed to describe a 35-year-old female who experienced pseudoaneurysm post-VABB and was successfully treated with embolization. She presented to the hospital with a suspected left breast tumor. The pathology report after biopsy confirmed fibroadenoma, and the patient underwent VABB to remove the tumor. One hour after VABB, the patient described pain and swelling at the location of the removed tumor. Breast ultrasound revealed a hematoma and pseudoaneurysm. The bleeding did not stop following the application of manual compression. Breast hemorrhage was controlled by endovascular embolization. Pseudoaneurysm is an uncommon complication of VABB, and embolization represents an effective method for the management of breast pseudoaneurysm.


Assuntos
Falso Aneurisma/terapia , Neoplasias da Mama/diagnóstico , Embolização Terapêutica/métodos , Hemorragia/terapia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Biópsia/efeitos adversos , Biópsia/métodos , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/etiologia , Doenças Mamárias/terapia , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia , Hemorragia/etiologia , Humanos , Ultrassonografia Mamária
3.
Am J Case Rep ; 22: e931404, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33905403

RESUMO

BACKGROUND Perinephric hematomas are rare, especially following ureteral stent placement. Etiologies of perinephric hematomas include post-extracorporeal shockwave lithotripsy, Wunderlich syndrome, and renal cell carcinoma, none of which occurred in our patient, who underwent stent replacement. Subcapsular renal hematoma, rather than a perinephric hematoma, can occur following double-J ureteral stent placement. Also, renal parenchymal perforation leading to perinephric hematoma development are complications of double-J ureteral stent placement. Herein, we present a case of a perinephric hematoma following a double-J ureteral stent placement for a ureteral obstruction causing hydronephrosis. CASE REPORT A 43-year-old woman with type 2 diabetes mellitus, hypertension, systemic lupus erythematosus, and recurrent nephrolithiasis presented to our hospital with left flank pain of a 1-day duration. The patient was found to have an obstructive kidney stone causing hydronephrosis. She underwent stent placement and then developed a perinephric hematoma days later. Typically, hematomas are treated conservatively and have spontaneous resolution. The patient received 2 weeks of intravenous antibiotics and 2 more weeks of oral antibiotics, and failed conservative treatment. She re-presented to our hospital 3 days after discharge. Upon the second admission, a perinephric drain was placed. The patient was given another course of antibiotics and was discharged 18 days later. CONCLUSIONS A perinephric hematoma is a rare complication after ureteral stent placement. Perinephric hematoma development can be decreased by controlling blood pressure, treating preoperative urinary tract infections, and shortening operating time during ureteroscopy. It is important to reevaluate potential causes of continued abdominal pain with laboratory testing and repeat imaging.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hematoma/etiologia , Hidronefrose/etiologia , Pielonefrite/complicações , Stents/efeitos adversos , Obstrução Ureteral/complicações , Adulto , Feminino , Hematoma/diagnóstico por imagem , Humanos , Cálculos Renais , Complicações Pós-Operatórias , Resultado do Tratamento , Cálculos Ureterais/terapia , Obstrução Ureteral/diagnóstico por imagem , Ureteroscopia
4.
Ugeskr Laeger ; 183(12)2021 03 22.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33829999

RESUMO

The Covid-19 pandemic has led to extensive testing by oropharyngeal swab. Although it is a relatively uncomplicated procedure, complications may occur. This is a case report of an 81-year-old male with a history of atrial flutter receiving anticoagulant therapy, who developed an oropharyngeal haematoma and subsequent infection following a test for SARS-CoV-2 by oropharyngeal swab. Anticoagulant therapy is widely used and should lead to caution when performing oropharyngeal swabs.


Assuntos
Hematoma , Orofaringe , Idoso de 80 Anos ou mais , Hematoma/etiologia , Humanos , Masculino
5.
J Am Vet Med Assoc ; 258(6): 654-660, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33683965

RESUMO

OBJECTIVE: To characterize the clinical features, treatment, and outcome of aural hematomas in horses. ANIMALS: 7 horses with 1 or 2 aural hematomas (8 ears in total) treated at a veterinary teaching hospital in 2008 through 2019. PROCEDURES: Data retrieved from medical records included signalment, pertinent historical information, clinical signs, diagnostic procedures (including dermatologic assessment), and treatments. Case outcome was determined from documentation in the medical record or via telephone communication with owners or referring veterinarians. RESULTS: 3 horses were presented after recurrence of aural hematoma following treatment by the referring veterinarian. Four horses had a history of allergic skin disease prior to aural hematoma development. Most (6/7) horses were unilaterally affected. Diagnostic assessments included otoscopic evaluation (3 horses), ultrasonography (3 horses), cytologic examination of ear canal swab samples (3 horses), and histologic examination of a pinnal biopsy specimen (1 horse). Of the 8 pinnae, 2 were treated by nonsurgical needle drainage (1 with concurrent corticosteroid injection) and the remaining 6 underwent surgical incision and placement of compressive sutures. Follow-up information was available for 6 horses, and all affected pinnae were fibrotic with 4 horses having permanent drooping of the pinna. One horse developed a hematoma in the contralateral pinna 1 year after hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Equine aural hematoma is a rare condition. The main principle of treatment is drainage, and treatment options commonly used in small animal practice can be successfully applied in horses. Permanent changes in the cosmetic appearance of the pinna are likely to develop owing to secondary fibrosis.


Assuntos
Otopatias , Doenças dos Cavalos , Animais , Otopatias/diagnóstico , Otopatias/terapia , Otopatias/veterinária , Hematoma/etiologia , Hematoma/terapia , Hematoma/veterinária , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/terapia , Cavalos , Hospitais Veterinários , Hospitais de Ensino , Recidiva Local de Neoplasia/veterinária , Estudos Retrospectivos , Resultado do Tratamento
9.
Artigo em Chinês | MEDLINE | ID: mdl-33540980

RESUMO

The clinical manifestations were hoarseness, and no sore throat, fever, dyspnea and dysphagia were found. The patient was in good health and had no history of cardiovascular disease, throat disease, diabetes, asthma, tumor, etc. The left vocal cord paralysis was seen by electronic laryngoscope, and aortic intramural hematoma was found by chest CT examination. In addition, we combined MIMICS digital 3D reconstruction technology to further clarify the lesion. After a series of physical examinations and related examinations, the patient was finally diagnosed as Ortner's syndrome caused by a rare cause of aortic intramural hematoma.


Assuntos
Rouquidão , Paralisia das Pregas Vocais , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Síndrome , Prega Vocal
10.
Medicine (Baltimore) ; 100(7): e24737, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607818

RESUMO

ABSTRACT: Early hematoma expansion of hypertensive cerebral hemorrhage is affected by various factors. This study aimed to clarify the risk factors and develop a nomogram to predict early hematoma expansion.A retrospective analysis was carried out in patients with hypertensive cerebral hemorrhage admitted to our institution between January 1, 2012 and December 31, 2018; the patients were divided into 2 groups according to the presence of early hematoma expansion. Univariate and multivariate analyses were performed to analyze the risk factors of hematoma expansion. The nomogram was developed based on a multivariate logistic regression model, and the discriminative ability of the model was analyzed.A total of 477 patients with hypertensive cerebral hemorrhage and with a baseline hematoma volume <30 ml were included in our retrospective analysis. The hematoma expansion rate was 34.2% (163/477). After multivariate logistic regression, 9 variables (alcohol history, Glasgow coma scale score, total serum calcium, blood glucose, international normalized ratio, hematoma shape, hematoma density, volume of hematoma on initial computed tomography scan, and presence of intraventricular hemorrhage) identified as independent predictors of hematoma expansion were used to generate the nomogram. The area under the receiver operating characteristic curve of the nomogram was 0.883 (95% confidence interval 0.851-0.914), and the cutoff score was -0.19 with sensitivity of 75.5% and specificity of 87.3%.The nomogram can accurately predict the risk of early hematoma expansion.


Assuntos
Hematoma/etiologia , Hemorragia Intracraniana Hipertensiva/complicações , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Casos e Controles , Hemorragia Cerebral/complicações , Progressão da Doença , Feminino , Escala de Coma de Glasgow , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
11.
Dermatol Surg ; 47(2): 245-249, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565777

RESUMO

BACKGROUND: Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage. PATIENTS AND METHODS: We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019. RESULTS: Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001). CONCLUSION: The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control. LEVELS OF EVIDENCE: II.


Assuntos
Anestesia Local , Curetagem/instrumentação , Epinefrina , Hiperidrose/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Vasoconstritores , Anestésicos Locais , Axila/cirurgia , Curetagem/efeitos adversos , Desbridamento , Feminino , Hematoma/etiologia , Humanos , Lidocaína , Masculino , Necrose/etiologia , Necrose/cirurgia , Odorantes , Dor Pós-Operatória/etiologia , Reoperação , Estudos Retrospectivos , Seroma/etiologia , Pele/patologia , Sucção/instrumentação , Infecção da Ferida Cirúrgica/cirurgia
12.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468637

RESUMO

A 26-year-old man presented with a 4-week history of right lower quadrant abdominal pain which was managed conservatively at home with ibuprofen. Three days later, he presented to the emergency department with worsening pain and swelling following an episode of coughing and slipping in the bathroom. Following his admission, CT angiography showed an active bleed into a 4.6×6.7×11 cm right rectus sheath haematoma, just inferior to the umbilicus. The patient was then referred to interventional radiology for an angiogram and coil embolisation. A superselective branch angiogram showed contrast extravasation from a medial branch of the right inferior epigastric artery, successfully embolised without incident.


Assuntos
Transtornos Traumáticos Cumulativos/complicações , Hemorragia Gastrointestinal/etiologia , Hematoma/diagnóstico , Hematoma/etiologia , Reto do Abdome/lesões , Adulto , Embolização Terapêutica , Hematoma/terapia , Humanos , Masculino
14.
Plast Reconstr Surg ; 147(1): 82e-93e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370060

RESUMO

BACKGROUND: Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. METHODS: The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. RESULTS: In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. CONCLUSIONS: Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Redução Aberta/estatística & dados numéricos , Fraturas Orbitárias/terapia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Hematoma/diagnóstico , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos , Traumatismos do Nervo Óptico/diagnóstico , Traumatismos do Nervo Óptico/epidemiologia , Traumatismos do Nervo Óptico/etiologia , Traumatismos do Nervo Óptico/prevenção & controle , Órbita/irrigação sanguínea , Órbita/diagnóstico por imagem , Órbita/lesões , Órbita/cirurgia , Fraturas Orbitárias/complicações , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
15.
J Clin Neurosci ; 82(Pt A): 99-104, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317748

RESUMO

BACKGROUND AND OBJECTIVE: To develop and validate a clinical nomogram for individualized predicting hematoma expansion (HE) in patients with Intracerebral Hemorrhage (ICH). METHODS: A total of 1025 patients with ICH were retrospectively enrolled in the development cohort between 2010 and 2016. We identified and integrated significant factors for HE to build a nomogram. The model was subjected to validation with a separate cohort of 397 patients from the 2017-2019. The predictive accuracy and discriminative ability were measured by concordance index (C-index). The primary outcome was HE, defined as hematoma growth more than 6 mL or 33% increase in the volume. RESULTS: A total of 1025 patients were included for univariable analysis. HE occurred in 180 patients (17.6%). The time to initial CT (≤6h vs. >6 h; p = 0.001), NIHSS score (0-4 vs. 5-14 vs. ≥15; p = 0.031), CTA spot sign (yes vs. no vs. absent; p = 0.018), hypodensities (p = 0.000), blend sign (p = 0.005), and INR (<1.2 vs. ≥1.2; p = 0.009) were identified and entered into the nomogram. The calibration curves for probability of HE showed optimal agreement between nomogram prediction and actual observation. The C-index was 0.751. The validation cohort consisted of 397 patients and HE occurred in 78 patients (19.6%). The C-index was 0.743. CONCLUSIONS: We developed and validated a nomogram that can individually predict HE for ICH in Chinese populations. This practical prognostic nomogram may help clinicians make decision of clinical practice and design of clinical studies.


Assuntos
Hemorragia Cerebral/complicações , Hematoma/diagnóstico , Hematoma/etiologia , Nomogramas , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
16.
BMJ Case Rep ; 13(12)2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310827

RESUMO

A 14-year-old boy was injured from playing football, and subsequently developed worsening abdominal pain. CT of the abdomen and pelvis was concerning for a mass of ascending colon, with free fluid in the pelvis. The patient was emergently taken to the operating room where he was found to have a cecal haematoma. The patient underwent a right hemicolectomy and ileocolostomy and was discharged home just days later without any acute complications. As cecal haematomas are a rare entity, the best approach to management is not well defined. When the diagnosis is uncertain, or if the possibility of full-thickness injury exists, exploratory laparoscopy or laparotomy is the safest approach.


Assuntos
Doenças do Ceco/cirurgia , Futebol Americano/lesões , Hematoma/cirurgia , Dor Abdominal/cirurgia , Adolescente , Doenças do Ceco/diagnóstico por imagem , Doenças do Ceco/etiologia , Colectomia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Ileostomia , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370948

RESUMO

Visceral artery aneurysms (VAAs) are uncommon with an approximate incidence of 0.01%-0.2%. Gastroduodenal artery (GDA) aneurysm is a rare subtype of these uncommon visceral aneurysms that can be fatal if ruptured. We present a case of a 58-year-old Caucasian woman with a VAA and a large haematoma arising from an actively bleeding GDA. While patients with VAA may remain asymptomatic, with some of the aneurysms found incidentally during imaging, they may also present with abdominal pain, anaemia and possible multiorgan failure which may be fatal.


Assuntos
Dor Abdominal/etiologia , Falso Aneurisma/diagnóstico , Embolização Terapêutica/instrumentação , Hematoma/etiologia , Artéria Hepática/diagnóstico por imagem , Dor Abdominal/terapia , Falso Aneurisma/complicações , Falso Aneurisma/terapia , Angiografia Digital , Feminino , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
18.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370969

RESUMO

A 91-year-old Caucasian man on warfarin for atrial fibrillation presented in view of sudden-onset haemoptysis with fresh bleeding with clots immediately after having eaten a piping-hot traditional cheesecake (pastizz) and burning the soft-palate of his mouth. The haemoptysis had resolved by the time that the patient had arrived to hospital. On examination, a 2 cm by 2 cm dark red, solitary mass could be seen just anterior to the uvula. This was not causing any pain or discomfort to the patient. Blood results were mostly unremarkable except for a raised international normalised ratio (INR) of 3.53. The patient was administered 5 mg vitamin K orally in attempt to lower the INR level and warfarin was subsequently omitted for 7 days. He was also prescribed oral steroids on discharge. The lesion resolved in 7 days and warfarin was restarted then with no further consequences.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Queimaduras/diagnóstico , Hematoma/diagnóstico , Hemoptise/etiologia , Varfarina/efeitos adversos , Idoso de 80 Anos ou mais , Coagulação Sanguínea/efeitos dos fármacos , Queimaduras/etiologia , Alimentos/efeitos adversos , Hematoma/tratamento farmacológico , Hematoma/etiologia , Hemoptise/tratamento farmacológico , Temperatura Alta/efeitos adversos , Humanos , Coeficiente Internacional Normatizado , Masculino , Palato Mole/irrigação sanguínea , Palato Mole/lesões , Úvula/irrigação sanguínea , Úvula/lesões , Vitamina K/administração & dosagem
19.
BMC Geriatr ; 20(1): 539, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33353545

RESUMO

BACKGROUND: In late December 2019, a cluster of pneumonia cases due to a novel betacoronavirus, SARS-CoV-2 was reported in China. The so-called COVID 19 is responsible not only for respiratory symptoms, from mild up to pneumonia and even acute respiratory distress syndrome, but also for extrapulmonary involvement. CASES PRESENTATION: Here we present two cases of spontaneous muscle hematoma in patients with SARS-CoV-2 infection, both on therapeutic LMWH for atrial fibrillation: the first one was an 86-year-old Caucasian female with a history of hypertensive cardiomyopathy and the second one was an 81-year-old Caucasian male with a history of hypertension, diabetes and ischemic heart disease. Blood tests revealed a considerable drop of hemoglobin and alterations of coagulation system. In both cases, embolization of femoral artery was performed. A few other cases of bleeding manifestations are reported in literature, while a lot has been published about the hypercoagulability related to COVID-19. CONCLUSIONS: Our reports and literature review highlight the need of active surveillance for possible hemorrhagic complications in patients with SARS-CoV-2 infection.


Assuntos
Hematoma , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Heparina de Baixo Peso Molecular , Humanos , Masculino , Músculos
20.
No Shinkei Geka ; 48(11): 1035-1042, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199661

RESUMO

A 69-year-old woman presented on an emergency basis, with headache and left hemiparesis. Initial head CT at the time of admission revealed a large subcortical hematoma with perihematomal edema extending from the right parietal to the occipital lobe. A small part of the hematoma extended toward the trigone of the right lateral ventricle. CT angiography revealed no vascular abnormalities. Emergency craniotomy was erformed, and the patient's initial postoperative course was unremarkable. However, the patient's neurological symptoms worsened 10 days postoperatively, and CT revealed a new low-density cystic lesion with perifocal edema at the site of hematoma removal, in addition to severe cerebral compression. We performed a reoperation, and intraoperatively we observed hematoma fluid mixed with cerebrospinal fluid without any abnormal blood vessels or neoplastic lesions in the hematoma cavity. We identified the choroid plexus deep within the surgical field, and slight leakage of cerebrospinal fluid was detected from the ventricular aspect, indicating the formation of a small passage between the hematoma cavity and the ventricle. After the second operation, her postoperative course was uneventful without recurrent cyst formation. An early symptomatic expanding porencephalic cyst in the hematoma cavity after removal of an intracerebral hematoma is rare, and only a few cases have been reported in the literature. Based on literature review and considering the likely mechanism of cyst development, we speculated that progressive cyst expansion could be attributed to a check valve mechanism between the ventricle and the cavity from which the hematoma was removed, as observed in the present case.


Assuntos
Cistos , Hematoma , Adulto , Idoso , Hemorragia Cerebral , Plexo Corióideo , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Tomografia Computadorizada por Raios X
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