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1.
Medicina (Kaunas) ; 57(9)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34577788

RESUMO

Postsurgical fat necrosis is a frequent finding in abdominal cross-sectional imaging. Epiploic appendagitis and omental infarction are a result of torsion or vascular occlusion. Surgery or pancreatitis are conditions that can have a traumatic and ischemic effect on fatty tissue. The imaging appearances may raise concerns for recurrent malignancy, but percutaneous biopsy and diagnostic follow-up assist in the accurate diagnosis of omental infarction. Herein we describe a case of encapsulated omental necrosis temporally related to gastric surgery. Preoperative CT and MRI findings showed the characteristics of encapsulated, postcontrast nonviable tumefaction in the epigastrium without clear imaging features of malignancy. Due to the size of the lesion and the patient's primary disease, tumor recurrence could not be completely ruled out, and the patient underwent surgery. Histopathological analysis confirmed the diagnosis of steatonecrosis of the omentum.


Assuntos
Necrose Gordurosa , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Recidiva Local de Neoplasia , Omento/diagnóstico por imagem , Omento/cirurgia , Tomografia Computadorizada por Raios X
2.
R I Med J (2013) ; 104(8): 11-14, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34582507

RESUMO

Coronavirus disease 2019 (COVID-19) may cause a hypercoagulability state and thrombotic complications. Multiorgan infarctions in young patients are very rare. Here we report a 35-year-old male patient with COVID-19 complicated by multiorgan infarctions. The patient had a past medical history of uncontrolled insulin-dependent diabetes mellitus and was admitted to the intensive care unit with progressive hypoxia in the setting of SARS-CoV-2 infection. The patient received prophylactic anticoagulant during the entire hospital course. During the hospitalization, the patient developed hypoxic respiratory arrest, diffuse anoxic brain injury and brain herniation. Postmortem examination demonstrated multiple infarctions and thromboses involving the heart, bilateral lungs, kidneys, and spleen. In conclusion, multiple organ infarctions may occur in young patients with COVID-19 despite prophylactic anticoagulation therapy.


Assuntos
COVID-19 , Adulto , Autopsia , Humanos , Infarto , Pulmão , Masculino , SARS-CoV-2 , Adulto Jovem
3.
BMC Pediatr ; 21(1): 372, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465285

RESUMO

BACKGROUND: Although M. pneumoniae (M. pneumoniae) infections have been associated with various extrapulmonary manifestations, there have been very few documented cases of thrombotic events in pediatrics, and none to our knowledge with such extensive involvement as the patient described here. We aim to contribute to the urgency of discovering the mechanism of the coagulopathy associated with M. pneumoniae infections. CASE PRESENTATION: This 10-year-old boy was admitted after 2 weeks of fever, sore throat, worsening cough, and progressive neck and back pain. During hospitalization, he developed clots in several different organs: bilateral pulmonary emboli, cardiac vegetations, multiple splenic infarcts, and deep venous thromboses in three of four extremities. He was treated with long-term antibiotics and anticoagulation, and fully recovered. CONCLUSIONS: This is the first case known to us of a child with an extensive number of thrombotic events in multiple anatomic sites associated with M. pneumoniae infection. The mechanism by which M. pneumoniae infection is related to thrombotic events is not fully understood, but there is evidence that the interplay between the coagulation pathways and the complement cascade may be significant. This patient underwent extensive investigation, and was found to have significant coagulopathy, but minimal complement abnormalities. By better understanding the mechanisms involved in complications of M. pneumoniae infection, the clinician can more effectively investigate the progression of this disease saving time, money, morbidity, and mortality.


Assuntos
Pediatria , Pneumonia por Mycoplasma , Antibacterianos/uso terapêutico , Criança , Humanos , Infarto/tratamento farmacológico , Masculino , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/tratamento farmacológico
4.
Neurol India ; 69(4): 1002-1004, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507429

RESUMO

Wall-eyed monocular internuclear ophthalmoplegia (WEMINO) is a rare variant of internuclear ophthalmoplegia (INO), consisting of unilateral INO and ipsilateral exotropia. This distinctive syndrome is probably associated with damage to the medial longitudinal fasciculus. However, WEMINO caused by a midbrain lesion has not been previously reported. We herein report a 50-year-old man presenting with WEMINO and vertical gaze dysfunction resulting from infarction of the midbrain tegmentum.


Assuntos
Exotropia , Transtornos da Motilidade Ocular , Oftalmoplegia , Humanos , Infarto , Masculino , Mesencéfalo/diagnóstico por imagem , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia
5.
BMJ Case Rep ; 14(9)2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34580135

RESUMO

Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.


Assuntos
Aneurisma Dissecante , Nefropatias , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Dissecação , Humanos , Infarto/diagnóstico por imagem , Masculino , Artéria Renal/diagnóstico por imagem
7.
J Card Surg ; 36(11): 4416-4418, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34448511

RESUMO

A 75 years old man with previous aortic abdominal aneurysm surgery through a transverse laparotomy underwent bilateral internal thoracic artery to coronary artery bypass grafting. He immediately thereafter developed a severe chest and upper abdominal walls ischemia with metabolic acidosis, and finally deep sternum wound infection and upper abdominal wall necrosis. He benefitted from sternal reconstruction and vaccum assisted treatment, with delayed pectus major flap reconstruction. Chest and abdominal wall infarction following bilateral internal thoracic artery (BITA) harvesting is a very rare but life-threatening complication. Caution use of BIMA should be in order in patients with inferior epigastric artery flow impairment.


Assuntos
Aneurisma da Aorta Abdominal , Doença da Artéria Coronariana , Artéria Torácica Interna , Parede Torácica , Idoso , Humanos , Infarto , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-34360347

RESUMO

Omental infarction (OI) is a rare disease occurring in children. Important risk factors include overweight and obesity. The clinical presentation is often non-specific, and the main symptom is acute abdominal pain. In addition, infarcted omentum may present with fever, anorexia, nausea, vomiting, diarrhea and dysuria. Due to the localisation of the pain, OI should be differentiated from acute appendicitis. The diagnosis of OI is sometimes made intraoperatively, during appendectomy for suspected acute appendicitis. Hence, it is important to state a correct preoperative diagnosis, which is commonly based on abdominal ultrasound and computed tomography. The treatment of OI is still inconclusive. Both conservative and surgical treatments are used. Both methods have their advantages and disadvantages. The decision of which treatment to follow should be multifactorial and include the patient's clinical condition at the time of admission, the progression or regression of symptoms during hospitalization and laboratory and imaging findings. We present a clinical case of a 9-year-old overweight girl with OI, whose diagnosis was based on imaging diagnostics and enabled conservative treatment with no complications. The case we have described confirms that the conservative treatment is an effective and safe therapy.


Assuntos
Apendicite , Tratamento Conservador , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/terapia , Omento/cirurgia
9.
Eur J Radiol ; 143: 109899, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34392005

RESUMO

PURPOSE: This study aimed to use the automated Alberta Stroke Program Early CT Score (ASPECTS) software to assess the value of different CT modalities (non-contrast CT, CT angiography [CTA]-arterial, CTA-venous, and arterial- and venous-phase mismatch-ASPECTS) in predicting the final infarct extent and clinical outcome in large-vessel occlusion stroke. METHODS: This retrospective study included patients with large-vessel occlusion stroke who underwent reperfusion therapy during 2015 to 2019. Correlations between different CT-ASPECTS modalities and follow-up CT-ASPECTS and outcome were determined using Spearman rank correlation coefficient. Receiver operating characteristic curve analysis was used to assess the ability of different CT-ASPECTS modalities to identify patients with good outcomes. RESULTS: One hundred and thirty-five patients were included. We found almost-perfect correlation between CTA-venous-ASPECTS and follow-up CT-ASPECTS (r = 0.92; 95% CI: 0.89-0.95), better than that in other CT modalities. The 90-day modified Rankin scale (mRS) score substantially correlated with CTA-venous-ASPECTS (r = -0.64; 95% CI: -0.73 to -0.52). The ROC curve analysis showed CTA-venous-ASPECTS had the highest area under the curve (AUC: 0.82; 95% CI: 0.75-0.89; P < 0.001), followed by mismatch-ASPECTS (AUC: 0.75; 95% CI: 0.65-0.85; P < 0.001). When emphasizing the sensitivity for identifying patients with good outcomes, the best cut-off point of mismatch-ASPECTS was -3 with the highest sensitivity (91.30%). CONCLUSIONS: CTA-venous-ASPECTS is a reliable tool to predict the infarct extent and outcome. Furthermore, mismatch-ASPECTS may represent images in different angiographic phases and was sensitive for prognosis prediction.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Alberta , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Humanos , Infarto , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
BMJ Case Rep ; 14(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380679

RESUMO

A middle-aged man had been diagnosed as retinitis and treated with steroids previously. The patient had developed macular infarction in the course of illness. We diagnosed him to have rickettsial retinitis on the basis of clinical features and positive Weil-Felix test. The patient's condition improved after treatment with oral antibiotics. The vasculature of the infarcted macula showed partial reperfusion late in the course of follow-up.


Assuntos
Doenças Retinianas , Retinite , Rickettsia , Humanos , Infarto/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Retinite/diagnóstico , Retinite/tratamento farmacológico , Remodelação Vascular
11.
Hinyokika Kiyo ; 67(7): 343-347, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34353018

RESUMO

We report a case of global testicular infarction associated with epididymitis. A 26-year-old man with a history of clean intermittent self-catheterization since he was 1 year old presented to our hospital with left scrotal pain and swelling. He was diagnosed with epididymitis and was prescribed levofloxacin. On the next day, he returned with worsened symptoms of left scrotal pain, swelling, and fever. He was admitted because of his severe symptoms and high C-reactive protein level in the blood test. Antimicrobial therapy with intravenous flomoxef and analgesic treatment with pentazocine and loxoprofen were started but the symptoms did not improve. The color-Doppler ultrasound repeated on the 1st, 4th, and 5th day of admission showed left epididymal hypervascularity but it did not indicate testicular hypovascularity in any examinations. On the 6th day of admission, a contrast-magnetic resonance imaging (MRI) scan revealed no contrast enhancement in the left testis and high orchiectomy was performed. On pathological examination, abscess of the entire epididymis and generalized necrosis of the testes were observed. Inflammatory cell infiltration and thrombus formation were observed in almost all veins of the testis and spermatic cord, and the diagnosis of global testicular infarction associated with epididymitis was made. Global testicular infarction has been reported as a rare complication of epididymitis and should be considered in the case of atypical course of epididymitis.


Assuntos
Epididimite , Adulto , Epididimo , Epididimite/tratamento farmacológico , Humanos , Lactente , Infarto/diagnóstico por imagem , Infarto/etiologia , Masculino , Orquiectomia , Testículo/diagnóstico por imagem
12.
Kyobu Geka ; 74(9): 664-667, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446618

RESUMO

A 42-year-old man presented with a one-month history of back pain. Chest computed tomography revealed a mass (7.6×5.7 cm) in the right upper lobe, suspicious of chest wall invasion. We performed right upper lobectomy combined with chest wall resection. Partial dissections of the second to sixth ribs and the third and fourth vertebral bodies were conducted. Postoperatively, motor paralysis of the right lower extremity was observed and a diagnosis of spinal infarction was made. After cerebrospinal fluid drainage and administration of edaravone with early rehabilitation, he was able to walk with a brace and was discharged from the hospital.


Assuntos
Isquemia do Cordão Espinal , Parede Torácica , Adulto , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Masculino , Coluna Vertebral , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia
13.
Neurosurg Focus ; 51(1): E13, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34198252

RESUMO

OBJECTIVE: In patients with large-vessel occlusion (LVO) acute ischemic stroke (AIS), determinations of infarct size play a key role in the identification of candidates for endovascular stroke therapy (EVT). An accurate, automated method to quantify infarct at the time of presentation using widely available imaging modalities would improve screening for EVT. Here, the authors aimed to compare the performance of three measures of infarct core at presentation, including an automated method using machine learning. METHODS: Patients with LVO AIS who underwent successful EVT at four comprehensive stroke centers were identified. Patients were included if they underwent concurrent noncontrast head CT (NCHCT), CT angiography (CTA), and CT perfusion (CTP) with Rapid imaging at the time of presentation, and MRI 24 to 48 hours after reperfusion. NCHCT scans were analyzed using the Alberta Stroke Program Early CT Score (ASPECTS) graded by neuroradiology or neurology expert readers. CTA source images were analyzed using a previously described machine learning model named DeepSymNet (DSN). Final infarct volume (FIV) was determined from diffusion-weighted MRI sequences using manual segmentation. The primary outcome was the performance of the three infarct core measurements (NCHCT-ASPECTS, CTA with DSN, and CTP-Rapid) to predict FIV, which was measured using area under the receiver operating characteristic (ROC) curve (AUC) analysis. RESULTS: Among 76 patients with LVO AIS who underwent EVT and met inclusion criteria, the median age was 67 years (IQR 54-76 years), 45% were female, and 37% were White. The median National Institutes of Health Stroke Scale score was 16 (IQR 12-22), and the median NCHCT-ASPECTS on presentation was 8 (IQR 7-8). The median time between when the patient was last known to be well and arrival was 156 minutes (IQR 73-303 minutes), and between NCHCT/CTA/CTP to groin puncture was 73 minutes (IQR 54-81 minutes). The AUC was obtained at three different cutoff points: 10 ml, 30 ml, and 50 ml FIV. At the 50-ml FIV cutoff, the AUC of ASPECTS was 0.74; of CTP core volume, 0.72; and of DSN, 0.82. Differences in AUCs for the three predictors were not significant for the three FIV cutoffs. CONCLUSIONS: In a cohort of patients with LVO AIS in whom reperfusion was achieved, determinations of infarct core at presentation by NCHCT-ASPECTS and a machine learning model analyzing CTA source images were equivalent to CTP in predicting FIV. These findings have suggested that the information to accurately predict infarct core in patients with LVO AIS was present in conventional imaging modalities (NCHCT and CTA) and accessible by machine learning methods.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Infarto , Acidente Vascular Cerebral/diagnóstico por imagem
15.
BMC Neurol ; 21(1): 299, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330224

RESUMO

BACKGROUND: The precise etiology of anterior inferior cerebellar artery (AICA) infarction is difficult to identify because of the high anatomic variability of vertebrobasilar arteries and the limitations of conventional vascular examinations. Basi-parallel anatomic scanning magnetic resonance imaging (BPAS-MRI) can reveal the outer contour of the intracranial vertebrobasilar arteries, which may be helpful to distinguish the arteriosclerosis from congenital dysplasia and dissection. CASE PRESENTATION: In this study, we reported 3 cases of AICA infarction and discussed the diagnostic value of BPAS-MRI in the evaluation of vascular etiology. CONCLUSIONS: The BPAS-MRI could be considered as an important supplementary in the diagnosis of vascular etiology of infarction in AICA territory.


Assuntos
Artéria Basilar , Imageamento por Ressonância Magnética , Idoso , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Infarto , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
20.
Am J Case Rep ; 22: e931098, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34314403

RESUMO

BACKGROUND Omental infarction (OI) is an infrequent cause of acute abdominal pain, and there is no consensus on whether conservative or surgical treatment should be performed. The clinical manifestations are nonspecific, so many patients are referred for surgery because of acute abdominal signs that may indicate other diseases such as cholecystitis, appendicitis, or peptic ulcer perforation. In most cases, infarction of the greater omentum is diagnosed only during emergency surgery for other diseases of the abdomen. Currently, multisequence computed tomography is performed for acute abdomen, and this disease is increasingly diagnosed preoperatively. CASE REPORT We report on 2 patients who were referred to our Emergency Department for acute abdominal pain. Both were female and middle-aged. The first patient presented with vomiting and right upper-quadrant pain with thickened and right subcostal omental infiltration on computed tomography (CT). The second patient presented with right subcostal pain and fever. CT showed signs of infiltration, thickening of the omentum, and a right upper subcostal mass measuring 22×60 mm. We performed emergency laparoscopic surgery to explore the abdominal cavity. Both patients were discharged after 3 days. CONCLUSIONS Omentum infarction is a rare disease that causes a diagnostic dilemma, as there is a wide spectrum of causes of acute abdomen. Many patients are diagnosed only during surgery. Laparoscopic surgery should be performed as soon as possible.


Assuntos
Abdome Agudo , Laparoscopia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Dor Abdominal/etiologia , Grupo com Ancestrais do Continente Asiático , Feminino , Hospitais , Humanos , Infarto/diagnóstico por imagem , Infarto/cirurgia , Pessoa de Meia-Idade , Omento/cirurgia
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