The American Journal of Case Reports最新文献

Intrapulmonary Shunting and Paradoxical Air Embolism in Liver Transplantation: A Case Report 肝移植手术中的肺内分流和矛盾性空气栓塞：病例报告

The American Journal of Case Reports Pub Date : 2024-04-17 DOI: 10.12659/AJCR.943042

Bradly Brown, Peter E Frasco, Alexander D. Stoker

{"title":"Intrapulmonary Shunting and Paradoxical Air Embolism in Liver Transplantation: A Case Report","authors":"Bradly Brown, Peter E Frasco, Alexander D. Stoker","doi":"10.12659/AJCR.943042","DOIUrl":"https://doi.org/10.12659/AJCR.943042","url":null,"abstract":"Patient: Male, 60-year-old Final Diagnosis: Paradoxical pulmonary thromboembolism Symptoms: Hypotension Clinical Procedure: — Specialty: Anesthesiology Objective: Unusual clinical course Background: A paradoxical air embolism (PAE) occurs when air entering the central venous circulation reaches the systemic circulation, occurring through an intracardiac shunt or intrapulmonary shunting. Patients presenting for liver transplantation often have intrapulmonary shunting due to pulmonary arterial vasodilation, even in the absence of hepatopulmonary syndrome. Here, we present a case of hemodynamic collapse believed to be caused by a PAE, which was diagnosed intraoperatively with transesophageal echocardiography (TEE). Case Report: A 60-year-old man who was diagnosed with non-alcoholic steatohepatitis cirrhosis presented for deceased donor orthotopic liver transplantation with utilization of normothermic machine perfusion. Following reperfusion of the liver allograft, TEE detected intrapulmonary shunting resulting in air within the left atrium, left ventricle, and ascending aorta. The patient developed severe biventricular dysfunction with ST-segment changes on electrocardiography monitoring and became acutely hypotensive with significant hepatic congestion 5 min after liver reperfusion. High doses of inotropic and vasopressor support were used as well as inhaled nitric oxide. The patient recovered after 30 min of medical management. The liver transplantation operation was successfully completed and the patient was discharged home on postoperative day 7. Conclusions: Intracardiac air at the time of reperfusion during liver transplantation can originate from the donor allograft and result in PAE in the setting of intrapulmonary shunting. PAE can result in intracoronary air and should be considered in cases of hemodynamic instability in liver transplantation, especially if air is seen within the left atrium, left ventricle, and ascending aorta.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":"132 3","pages":"e943042-1 - e943042-4"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Rare Case of Small Bowel Obstruction in a 15-Year-Old Girl: Internal Hernia Associated with Meckel's Diverticulum. 15 岁女孩小肠梗阻的罕见病例：内疝伴梅克尔憩室

The American Journal of Case Reports Pub Date : 2024-02-19 DOI: 10.12659/ajcr.943071

David Daoyong Lai, Xi Zhen Low, Yang Yang Lee, Weizhong Jonathan Sng

{"title":"A Rare Case of Small Bowel Obstruction in a 15-Year-Old Girl: Internal Hernia Associated with Meckel's Diverticulum.","authors":"David Daoyong Lai, Xi Zhen Low, Yang Yang Lee, Weizhong Jonathan Sng","doi":"10.12659/ajcr.943071","DOIUrl":"https://doi.org/10.12659/ajcr.943071","url":null,"abstract":"BACKGROUND Meckel's diverticulum is a congenital remnant of the omphalomesenteric duct and is the most common congenital gastrointestinal malformation. Most patients are asymptomatic, but a rare presentation is with subacute small bowel obstruction (SBO) due to herniation of bowel loops through an internal hernia formed by the Meckel's diverticulum and adjacent mesentery that forms an internal hernia. This report is of a 15-year-old girl presenting as an emergency with vomiting and small bowel obstruction due to an internal hernia associated with Meckel's diverticulum. CASE REPORT We present a case of a 15-year-old girl who presented to the Children's Emergency (CE) department with persistent vomiting and abdominal distension and tenderness. X-rays demonstrated dilated small bowel loops, prompting admission under Pediatric Surgery (PAS). A subsequent computed tomography (CT) scan was performed, which demonstrated multiple dilated small bowel loops, confirming SBO, and a blind-ending \"C-shaped\" bowel loop at the region of the terminal ileum. A diagnostic laparotomy was performed, which confirmed the presence of a Meckel's diverticulum. The tip of the Meckel's diverticulum was adherent to part of the small bowel mesentery, forming an internal hernia defect through which a loop of proximal ileum had herniated, resulting in SBO. She then underwent a laparoscopy-assisted transumbilical Meckel's diverticulectomy (LATUM). The patient recovered uneventfully and was discharged on the 4th postoperative day. CONCLUSIONS In children presenting with SBO, the possibility of Meckel's diverticulum as an etiology should be considered as a differential diagnosis. Early diagnosis and prompt intervention will improve clinical outcomes and avoid complications.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":"55 1","pages":"e943071"},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140449365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prostatic Fossa Pseudoaneurysm After Robot-Assisted Radical Prostatectomy (RARP): A Case Report. 机器人辅助根治性前列腺切除术 (RARP) 后的前列腺窝假动脉瘤：病例报告。

The American Journal of Case Reports Pub Date : 2024-02-16 DOI: 10.12659/ajcr.942746

Vasco Manuel Almeida Rodrigues, Carlos Silva, N. Dias, José Teixeira de Sousa, Luís Afonso Morgado

{"title":"Prostatic Fossa Pseudoaneurysm After Robot-Assisted Radical Prostatectomy (RARP): A Case Report.","authors":"Vasco Manuel Almeida Rodrigues, Carlos Silva, N. Dias, José Teixeira de Sousa, Luís Afonso Morgado","doi":"10.12659/ajcr.942746","DOIUrl":"https://doi.org/10.12659/ajcr.942746","url":null,"abstract":"BACKGROUND RARP is an established procedure in treatment of localized prostate cancer. Hemorrhagic complications in the postoperative period are rare, but sometimes life-threatening. Adequate monitoring and prompt intervention in these unusual scenarios rely on clinical judgement and blood and imaging studies. Prostatic fossa pseudoaneurysm formation after RARP is very rare and its etiology is not well known; it may be related to small vessel trauma. It becomes apparent with the development of hematuria 1-6 weeks after surgery. CASE REPORT A 58-year-old man underwent RARP with extended lymph node dissection for intermediate-risk prostate cancer, with bilateral preservation of neurovascular bundles and puboprostatic ligaments. He was discharged on day 2 without complications. In the following 4 weeks he came to the Emergency Department 3 times with hematuria and acute urinary retention. Four weeks after surgery, a pelvic CT angiogram showed a 20-mm pseudoaneurysm in the prostatic fossa, which was embolized by percutaneous angiography, with resolution of symptoms. He was discharged soon thereafter. CONCLUSIONS This case study describes a patient with prostatic fossa pseudoaneurysm after RARP. It was diagnosed 1 month after surgery and effectively managed by percutaneous embolization. Despite being a very rare condition, it must be kept in mind, especially when postoperative hematuria develops 1-6 weeks after surgery. Use of a management algorithm including serial blood tests, CT angiogram, and percutaneous angiography can lead to early detection and avoid life-threatening hemorrhage and overall postoperative morbidity.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":"55 10","pages":"e942746"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140455119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report. 胸椎神经鞘瘤是脊骨神经痛的一种罕见病因:一例报告。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-16 DOI: 10.12659/AJCR.938448

Eric Chun-Pu Chu, Robert J Trager

{"title":"Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report.","authors":"Eric Chun-Pu Chu, Robert J Trager","doi":"10.12659/AJCR.938448","DOIUrl":"https://doi.org/10.12659/AJCR.938448","url":null,"abstract":"BACKGROUND Sciatica, which is pain radiating along the sciatic nerve distribution, is most often caused by degenerative conditions of the lower back and rarely results from lesions of the spinal cord. This case report illustrates a patient with suspected lumbar radiculopathy, ultimately diagnosed with a thoracic schwannoma after visiting a chiropractor. CASE REPORT A 61-year-old woman presented to a chiropractor with progressively worsening lower back pain radiating to the right lower extremity and unsteady gait. Her symptoms began 10 years previously and she had been diagnosed by an orthopedist with lumbar disc herniation causing radiculopathy via magnetic resonance imaging (MRI) and was treated with physical therapy and diclofenac. Upon examination by the chiropractor, the patient had bilateral lower-extremity neurologic deficits, hyperreflexia, and upgoing Babinski responses. The chiropractor ordered thoracic MRI, but the patient preferred to initiate a trial of care, which was unsuccessful. After a delay imposed by cardiac bypass surgery, the patient returned to the chiropractor with worsened symptoms and underwent thoracic MRI, revealing an intraspinal mass at T9. The patient underwent laminectomy and tumor removal, with histopathology confirming a diagnosis of schwannoma. The patient gradually improved after surgery with the help of rehabilitative exercises. CONCLUSIONS Clinicians should suspect a spinal cord lesion as a cause of sciatic pain when patients fail to improve with treatment, have a broad sensorimotor distribution unexplained by lumbar imaging findings, hyperreflexia/pathological reflexes, or other atypical findings (eg, negative neural tension tests). In such cases, MRI of the cervical and thoracic spine may be indicated.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e938448"},"PeriodicalIF":1.2,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/eb/amjcaserep-23-e938448.PMC9677567.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40687808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Large Desmoid Tumor of the Pancreas: A Report of a Rare Case and Review of the Literature. 胰腺大硬纤维瘤1例报告及文献复习。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-15 DOI: 10.12659/AJCR.937324

Alexis Litchinko, Camille Brasset, Matthieu Tihy, Marie-Laure Amram, Frederic Ris

{"title":"Large Desmoid Tumor of the Pancreas: A Report of a Rare Case and Review of the Literature.","authors":"Alexis Litchinko, Camille Brasset, Matthieu Tihy, Marie-Laure Amram, Frederic Ris","doi":"10.12659/AJCR.937324","DOIUrl":"https://doi.org/10.12659/AJCR.937324","url":null,"abstract":"BACKGROUND Desmoid tumor (DT), also known as aggressive fibromatosis or desmoid-type fibromatosis, is a rare disease. It can occur in anyone at any age, and is more likely to appear in female patients. DTs are sometimes associated with familial adenomatous polyposis and rare syndromes such as Gardner syndrome. Arising from specific cells, fibroblasts, they tend to develop in patients with a history of abdominal surgery and rarely produce metastases. CASE REPORT We present a case of a 41-year-old man who was referred for abdominal discomfort with no digestive or general symptoms. An abdominal CT scan revealed a mass in the left hypochondrium, corresponding to an intraperitoneal tumor extending to left colon. Based on MRI, we suspected a gastrointestinal stromal tumor. Colonoscopy showed no intraluminal tumor in the colon. A PET-CT scan revealed tumor hypermetabolism and no metastases. The mass was diagnosed as a DT after percutaneous biopsy. Six weeks after diagnosis and as the tumor continued increasing despite pharmacological treatment, the patient underwent surgical pancreatic tail resection with splenectomy and left colonic segmentectomy. Histological examination revealed a 7.047-g DT with severe infiltration of pancreatic parenchyma and transmural colic barrier, with no high-grade differentiation and negative resection margins. The postoperative recovery was uneventful, and we proposed surveillance with MRI. CONCLUSIONS The DT was surgically removed and patient remains under MRI surveillance. Other reported management approaches consist of radiotherapy, tyrosine kinase inhibitors, anti-hormonal therapies/non-steroidal anti-inflammatory drugs, chemotherapy, or close surveillance only. This is, to our knowledge, the largest and heaviest DT reported in the modern literature.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937324"},"PeriodicalIF":1.2,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/c8/amjcaserep-23-e937324.PMC9676065.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40464674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Late-Onset Ornithine Transcarbamylase Deficiency Complicated with Extremely High Serum Ammonia Level: Prompt Induction of Hemodialysis as the Key to Successful Treatment. 迟发性鸟氨酸转氨基甲酰基酶缺乏合并血清氨水平极高:及时诱导血液透析是成功治疗的关键。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-15 DOI: 10.12659/AJCR.937658

Satsuki Yamamoto, Shun Yamashita, Toshihiko Kakiuchi, Kazuya Kurogi, Tomoyo M Nishi, Masaki Tago, Shu-Ichi Yamashita

{"title":"Late-Onset Ornithine Transcarbamylase Deficiency Complicated with Extremely High Serum Ammonia Level: Prompt Induction of Hemodialysis as the Key to Successful Treatment.","authors":"Satsuki Yamamoto, Shun Yamashita, Toshihiko Kakiuchi, Kazuya Kurogi, Tomoyo M Nishi, Masaki Tago, Shu-Ichi Yamashita","doi":"10.12659/AJCR.937658","DOIUrl":"https://doi.org/10.12659/AJCR.937658","url":null,"abstract":"BACKGROUND Ornithine transcarbamylase deficiency (OTCD) is an X-linked semi-dominant disorder, causing possible fatal hyperammonemia. Late-onset OTCD can develop at any time from 2 months after birth to adulthood, accounting for 70% of all OTCDs. CASE REPORT A 35-year-old man with chronic headaches stated that since childhood he felt sick after eating meat. Fourteen days before hospital admission, he began receiving 60 mg/day of intravenous prednisolone for sudden deafness. The prednisolone was stopped 5 days before hospital admission. Four days later, he was transferred to our hospital because of confusion. On admission, he had hyperammonemia of 393 µmol/L. Because he became comatose 7 hours after admission, and his serum ammonia increased to 1071 µmol/L, we promptly started hemodialysis. Because his family history included 2 deceased infant boys, we suspected late-onset OTCD. On day 2 of hospitalization, we began administering ammonia-scavenging medications. Because he gradually regained consciousness, we stopped his hemodialysis on day 6. After his general condition improved, he was transferred to the previous hospital for rehabilitation on day 32. We definitively diagnosed him with late-onset OTCD due to the low plasma citrulline and high urinary orotic acid levels found during his hospitalization. CONCLUSIONS Clinicians should suspect urea cycle disorders, such as OTCD, when adult patients present with marked hyperammonemia without liver cirrhosis. Adult patients with marked hyperammonemia should immediately undergo hemodialysis to remove ammonia, regardless of causative diseases.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937658"},"PeriodicalIF":1.2,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/0e/amjcaserep-23-e937658.PMC9676062.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40685797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Should a Living Donor Renal Graft be Removed Due To Prolonged Delayed Function? A Case Report. 活体肾移植是否应因功能延迟而切除?一个病例报告。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-14 DOI: 10.12659/AJCR.936921

Ahmed Salem Al-Thahir, Ali Abdullah Al-Yami, Emadeldeen Saeed, Rafat Zahid, Hamad Mohd Al-Bahili, Ioannis Theodoropoulos

{"title":"Should a Living Donor Renal Graft be Removed Due To Prolonged Delayed Function? A Case Report.","authors":"Ahmed Salem Al-Thahir, Ali Abdullah Al-Yami, Emadeldeen Saeed, Rafat Zahid, Hamad Mohd Al-Bahili, Ioannis Theodoropoulos","doi":"10.12659/AJCR.936921","DOIUrl":"https://doi.org/10.12659/AJCR.936921","url":null,"abstract":"BACKGROUND Delayed graft function (DGF) is defined as failure of the transplanted kidney to function in the early -post-transplant period. DGF is a rare complication after living donor kidney transplant and is most common after deceased donor kidney transplant, probably due to prolonged warm and cold ischemia times during retrieval. Most cases of DGF resolve spontaneously within days to weeks. There are very few reported cases in the literature of DGF lasting over 4 weeks. We present a case that resolved after 55 days. The recipient subsequently achieved normal renal function. CASE REPORT Our patient was a 52-year-old man with end-stage renal disease who underwent a second living donor renal transplant. The donor was his son, with whom he had 1 antigen mismatch. Postoperative day 1, the patient developed anuria and failed to improve with fluids and diuretics. Investigations ruled out common causes of renal dysfunction (rejection, ischemia), but failed to disclose the cause of this condition. After an extended period of watchful waiting, the graft function returned, reaching normal creatinine and urine output levels. CONCLUSIONS DGF after living donor kidney transplantation is rare, and few cases lasting more than a month have been reported. Before diagnosing DGF, other causes of renal dysfunction (rejection, ischemia, medication adverse effects) must be ruled out. In the absence of these, expectant management is appropriate and full graft recovery can be expected, even with anuria and hemodialysis.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e936921"},"PeriodicalIF":1.2,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/a9/amjcaserep-23-e936921.PMC9676063.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40685282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Case of Mitral Valve Prolapse - Associated Sudden Cardiac Death in Pregnancy. 妊娠期二尖瓣脱垂致心源性猝死1例。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-13 DOI: 10.12659/AJCR.938000

Nguyen Ngoc Khoi Truong, Vu Hoang Vu, Binh Quang Truong

{"title":"Case of Mitral Valve Prolapse - Associated Sudden Cardiac Death in Pregnancy.","authors":"Nguyen Ngoc Khoi Truong, Vu Hoang Vu, Binh Quang Truong","doi":"10.12659/AJCR.938000","DOIUrl":"https://doi.org/10.12659/AJCR.938000","url":null,"abstract":"BACKGROUND Mitral valve prolapse (MVP) is a frequent echocardiographic finding that can be accompanied by symptoms ranging from a benign course to occasionally catastrophic complications, such as heart failure, and rarely, sudden cardiac death. Female sex, younger age, physiological or psychological stress, electrical instability, and changes in the structure of the mitral apparatus all seem to be risk factors for fatal ventricular arrhythmias in patients with MVP. We report a case of MVP-related cardiac arrest in a pregnant woman, which is rarely reported. CASE REPORT A 34-year-old woman who had collapsed at home from cardiac arrest was transported to the hospital. She had no history of cardiac diseases and was 8 weeks pregnant. Premature ventricular complexes and sinus tachycardia were observed on the 12-lead electrocardiogram as she arrived at the Emergency Department. The second cardiac arrest she experienced while in the hospital was observed to be from torsades de pointes. Further investigations revealed severe mitral valve regurgitation due to posterior leaflet prolapse and regional hypokinesis of the inferior wall and interventricular septum. CONCLUSIONS Ventricular arrhythmia is a frequent finding of mitral valve regurgitation. However, it rarely results in serious consequences. Malignant arrhythmic mitral valve regurgitation can result in sudden cardiac death; therefore, physicians need to be aware of patients with MVP who exhibit characteristics of a potential high-risk profile in order to avoid tragic outcomes.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e938000"},"PeriodicalIF":1.2,"publicationDate":"2022-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/fc/amjcaserep-23-e938000.PMC9670019.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inflammation of Pericardial Transverse Sinus Leading to Suspicion of Takayasu Syndrome. 心包横窦炎症疑为高须综合征。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-11 DOI: 10.12659/AJCR.937196

Dominika Stępniak, Maciej Żechowicz, Beata Moczulska, Leszek Gromadziński

{"title":"Inflammation of Pericardial Transverse Sinus Leading to Suspicion of Takayasu Syndrome.","authors":"Dominika Stępniak, Maciej Żechowicz, Beata Moczulska, Leszek Gromadziński","doi":"10.12659/AJCR.937196","DOIUrl":"https://doi.org/10.12659/AJCR.937196","url":null,"abstract":"BACKGROUND The purpose of this case report was to present a rare course of pericarditis starting with transverse sinus inflammation in a patient with recurrent chest pain. Typically, the effusion accumulates along the diaphragmatic surface of the back heart, and other localizations, such as the transverse sinus, are uncommon. The main risk factor for pericarditis in Europe is viral infection. In this uncommon case, we strongly suspected underlying Takayasu syndrome. The positive response to treatment with steroids in pericarditis and Takayasu arteritis may be misleading. CASE REPORT A 61-year-old woman was admitted to the Cardiology Clinic because of recurrent chest pain in the form of a retrosternal burning pain with radiation to both arms. With the results of laboratory tests, electrocardiogram, and computer tomography (CT), we excluded acute coronary syndrome, pulmonary embolism, and aortic dissection. In chest CT and transthoracic echocardiography (TTE), we found an effusion around the ascending aorta with uncertain inflammation and in the transverse sinus of the pericardium. After typical pericarditis treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and afterward with steroids, which is similar to Takayasu syndrome treatment, we observed a significant improvement of the patient's clinical condition and no recurrence of chest pain. CONCLUSIONS Despite clinical symptoms, laboratory results, and aorta thickening with surrounding inflammation, Takayasu syndrome was excluded by rheumatologists because of the patient's age. Transverse sinus inflammation is a very rare presentation of pericarditis, but should be considered, especially based on TTE and CT imaging, when other possible causes of retrosternal pain are excluded.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e937196"},"PeriodicalIF":1.2,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/00/amjcaserep-23-e937196.PMC9664416.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 70-Year-Old Woman Presenting with Confusion and Muscle Spasms Due to Serotonin Syndrome Associated with Paroxetine and Quetiapine Treatment. 一位70岁的妇女，在帕罗西汀和喹硫平治疗后出现血清素综合征引起的精神错乱和肌肉痉挛。

IF 1.2

The American Journal of Case Reports Pub Date : 2022-11-11 DOI: 10.12659/AJCR.938268

Elizabeth Mostel, Savan Patel, Brian G Wiener

{"title":"A 70-Year-Old Woman Presenting with Confusion and Muscle Spasms Due to Serotonin Syndrome Associated with Paroxetine and Quetiapine Treatment.","authors":"Elizabeth Mostel, Savan Patel, Brian G Wiener","doi":"10.12659/AJCR.938268","DOIUrl":"https://doi.org/10.12659/AJCR.938268","url":null,"abstract":"BACKGROUND Serotonin toxicity, often referred to as 'serotonin syndrome,' is a drug-induced condition due to excess serotonin released from brain synapses, resulting in symptoms that may be autonomic, neuromuscular, and/or cognitive in nature. Most cases involve more than 1 of the following drug regimens: monoamine oxidase inhibitors (MAOIs), serotonin releasers, selective serotonin reuptake inhibitors (SSRIs), or serotonin-norepinephrine reuptake inhibitors (SNRIs). This report is of a 70-year-old woman who presented with confusion and muscle spasms due to serotonin toxicity associated with paroxetine and quetiapine treatment. CASE REPORT An elderly woman with dementia presented to the Emergency Department with fever, altered mental status, labile blood pressures, and inducible clonus. No known medication dosage increases had been made, nor had any new serotonergic agents been added to the patient's drug regimen. She underwent a thorough workup in the Emergency Department and later during her hospitalization. A presumptive diagnosis of serotonin toxicity was made early on during her stay, with the etiology attributed to use of paroxetine and quetiapine. Clinical improvement was observed after benzodiazepine administration, discontinuation of offending agents, and a brief cyproheptadine course. The patient survived her hospital stay and was ultimately discharged to hospice care with a return to her baseline level of functioning. CONCLUSIONS Diagnosing serotonin toxicity requires a high degree of clinical suspicion and can occur in the absence of increased dosage of existing, or initiation of new, serotonergic agents.","PeriodicalId":205256,"journal":{"name":"The American Journal of Case Reports","volume":" ","pages":"e938268"},"PeriodicalIF":1.2,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/64/amjcaserep-23-e938268.PMC9664415.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0