American Journal of Case Reports最新文献

{"title":"Aspiration Thrombectomy for High-Risk Pulmonary Embolism With Life-Threatening Anemia and Active Uterine Bleeding: A Case Report.","authors":"Okba Saoudi, Bu Wang","doi":"10.12659/AJCR.954225","DOIUrl":"https://doi.org/10.12659/AJCR.954225","url":null,"abstract":"<p><p>BACKGROUND High-risk pulmonary embolism (PE) carries significant mortality, and management becomes complex when it coexists with severe anemia and active bleeding, as thrombolysis is then contraindicated. We report the case of a patient with high-risk PE complicated by severe anemia (hemoglobin 41 g/L) and active uterine bleeding from adenomyosis. CASE REPORT A 48-year-old woman presented with haemodynamic instability (blood pressure 74/47 mm Hg), critical anemia (hemoglobin 41 g/L), and a 3-year history of irregular vaginal bleeding from adenomyosis. Computed tomography (CT) pulmonary angiography confirmed bilateral PE with right pulmonary artery main-trunk occlusion; echocardiography showed severe pulmonary hypertension, and duplex ultrasound showed extensive left lower-limb deep vein thrombosis. Thrombolysis was contraindicated. Emergency percutaneous aspiration thrombectomy was performed using large-bore catheters (22F, 20F, 16F) with concurrent inferior vena cava filter placement, reducing pulmonary artery pressure from 51/23 to 34/12 mm Hg; the estimated blood loss, quantified from filtered aspirate, was approximately 100 mL. Adjuncts included transfusion of 13 units of packed red cells, dilatation and curettage, gonadotropin-releasing hormone agonist therapy, and titrated anticoagulation. At discharge after a 24-day hospitalization she was hemodynamically stable, and free of dyspnea, with resolved edema and hemoglobin 72 g/L, on oral rivaroxaban. CONCLUSIONS In this thrombolysis-contraindicated patient, aspiration thrombectomy with inferior vena cava filter placement was a feasible rescue strategy that achieved rapid hemodynamic and angiographic improvement without thrombolysis, with palliative rather than curative intent. As a single case, it cannot establish comparative safety or efficacy, and broader conclusions regarding efficacy cannot be drawn. It illustrates a potentially useful approach in similarly complex scenarios where coordinated multidisciplinary care is essential.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954225"},"PeriodicalIF":0.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229018","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}

{"title":"Cochlear Implantation in a Child With Arnold-Chiari Syndrome, Severe Inner Ear Malformations, and Cochlear Nerve Hypoplasia: A Case Report.","authors":"Piotr Henryk Skarżyński, Aleksandra Chodkiewicz, Natalia Czajka, Henryk Skarżyński","doi":"10.12659/AJCR.954074","DOIUrl":"https://doi.org/10.12659/AJCR.954074","url":null,"abstract":"<p><p>BACKGROUND Arnold-Chiari syndrome is a congenital malformation of the posterior cranial fossa associated with neurological and otoneurological abnormalities, including hearing loss of variable severity. Cochlear implantation in patients with complex central nervous system malformations remains challenging due to uncertain auditory outcomes. This study aimed to evaluate the feasibility and early outcomes of cochlear implantation in a child with Arnold-Chiari syndrome and severe bilateral inner ear malformations. CASE REPORT A 1.5-year-old girl with Arnold-Chiari malformation, hydrocephalus, spina bifida, and profound bilateral sensorineural hearing loss was evaluated for cochlear implantation. Imaging studies revealed severe bilateral inner ear malformations, including cochlear hypoplasia, accompanied by multiple intracranial abnormalities. Despite early hearing aid use, auditory development remained limited. The patient underwent left-sided cochlear implantation with a MED-EL SYNCHRONY 2 device using a standard electrode array. Intraoperatively, significant cerebrospinal fluid leakage (\"gusher\") occurred during cochleostomy and was successfully controlled using autologous tissues and tissue adhesive. Twelve months after implantation, follow-up audiological evaluation demonstrated improved behavioral auditory responses and increased responsiveness to environmental sounds, as reported by the parents. CONCLUSIONS Cochlear implantation may provide meaningful auditory benefit in selected patients with Arnold-Chiari syndrome despite severe inner ear and central nervous system abnormalities. Comprehensive preoperative imaging and multidisciplinary assessment are essential for surgical planning and prognosis evaluation. Further studies involving larger patient cohorts are required to better define prognostic factors influencing cochlear implantation outcomes in this population.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954074"},"PeriodicalIF":0.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225174","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}

{"title":"When Insulin Must Wait: The Role of Renal Replacement Therapy in Refractory Hypokalemia During Severe Diabetic Ketoacidosis.","authors":"Sawsan Al-Lababidi, Muhammed Umer, Maria B Herrera-Gonzalez, Rand Alkhlaifat","doi":"10.12659/AJCR.953592","DOIUrl":"https://doi.org/10.12659/AJCR.953592","url":null,"abstract":"<p><p>BACKGROUND Diabetic ketoacidosis (DKA) is a common life-threatening metabolic emergency characterized by hyperglycemia, high-anion-gap metabolic acidosis, and ketosis. Severe hypokalemia before insulin therapy is uncommon but may complicate management and delay treatment. CASE REPORT A 37-year-old man presented to the emergency department with a 2-day history of generalized abdominal pain and progressive shortness of breath. He was drowsy and tachypneic, with Kussmaul respirations. Laboratory evaluation revealed severe DKA, acute kidney injury, and severe hypokalemia. Insulin therapy was initially withheld according to the DKA protocol. Intravenous potassium supplementation failed to achieve sustained correction, resulting in repeated interruptions of insulin therapy. Due to refractory hypokalemia, an emergency 2-hour session of intermittent hemodialysis was performed, followed by continuous renal replacement therapy (CRRT). During CRRT, serum potassium increased, serum creatinine decreased, metabolic acidosis improved, and the anion gap closed. Insulin therapy was resumed without further interruption. However, the clinical course was complicated by severe septic shock, disseminated intravascular coagulation, and catastrophic intracerebral hemorrhage, ultimately resulting in death. CONCLUSIONS Severe hypokalemia at presentation in DKA poses a critical therapeutic challenge because insulin therapy must be withheld until the electrolyte abnormality is corrected. In rare cases of refractory hypokalemia, CRRT may serve as an adjunctive strategy to facilitate metabolic stabilization and safe DKA management. This case adds to the limited literature and highlights the need for further studies to clarify the role and effectiveness of this approach. Biochemical resolution of DKA may not correspond to clinical recovery, and critically ill patients warrant continuous monitoring.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953592"},"PeriodicalIF":0.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228996","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}

{"title":"Isolated Bilateral Periocular Lupus Miliaris Disseminatus Faciei: A Clinicopathological Mimicker of Granulomatosis With Polyangiitis.","authors":"Hamad Almutlaq","doi":"10.12659/AJCR.954643","DOIUrl":"https://doi.org/10.12659/AJCR.954643","url":null,"abstract":"<p><p>BACKGROUND Lupus miliaris disseminatus faciei (LMDF) is a rare idiopathic granulomatous dermatosis that presents as discrete yellow-brown, erythematous, or skin-colored papules on the central face, with a recognized preference for the eyelids and periorbital region. CASE REPORT We report a case of isolated bilateral periocular LMDF in a healthy young adult man whose initial eyelid biopsy revealed suppurative necrotizing granulomatous inflammation, raising histopathological concern for granulomatosis with polyangiitis and other systemic granulomatous diseases. Autoimmune, vasculitic, infectious, urinary, orbital, and thoracic evaluations were otherwise negative, apart from only mild inflammatory marker elevation, with an erythrocyte sedimentation rate of 21 mm/h (reference range, 0-20 mm/h) and C-reactive protein level of 0.94 mg/dL (reference range, 0.1-0.5 mg/dL). The final diagnosis was supported by the clinicopathological combination of symmetrical folliculocentric periocular papules, perifollicular necrobiotic suppurative granulomas, absence of true vasculitis, negative infectious studies, and absence of systemic disease. After 1 month of extended-release oral minocycline, the patient had marked flattening of papules and near-complete resolution of crusted inflammatory lesions. Adverse effects were monitored clinically during routine follow-up after completion of the 1-month treatment course; the patient reported no treatment-related adverse effects, and no adverse effects were observed. CONCLUSIONS Clinicopathological correlation and comprehensive systemic evaluation are necessary to differentiate this rare dermatosis from infectious or vasculitic mimics. In this patient, oral minocycline was associated with marked short-term clinical improvement after 1 month, but this single observation does not establish broader therapeutic efficacy for LMDF.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954643"},"PeriodicalIF":0.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225219","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}

{"title":"Contrast-Enhanced Ultrasound Combined With Biopsy for the Preoperative Diagnosis of a Rare Pelvic Schwannoma: A Case Report.","authors":"Jinzhe Wang, Li Wei, Yufei Wang","doi":"10.12659/AJCR.953317","DOIUrl":"https://doi.org/10.12659/AJCR.953317","url":null,"abstract":"<p><p>BACKGROUND Primary pelvic schwannomas are rare and often misdiagnosed due to non-specific imaging features. Accurate preoperative evaluation remains a challenge. The clinical utility of contrast-enhanced ultrasound (CEUS) combined with time-intensity curve (TIC) analysis and targeted biopsy was evaluated for the preoperative diagnosis and management of a pelvic schwannoma. CASE REPORT A 66-year-old man presented with dysuria and lumbago. Imaging revealed a large, mixed cystic-solid pelvic mass. Conventional ultrasound demonstrated a predominantly cystic-solid lesion with limited Doppler flow, whereas CEUS showed progressive dendritic enhancement of the viable solid component from the periphery toward the center, with non-enhancement of cystic or necrotic areas. TIC analysis demonstrated a distinctive \"equal-in and slow-out\" perfusion pattern, supported by quantitative parameters (rise time, time to peak, fall time, and washout area under the curve). Based on these perfusion characteristics, ultrasound-guided biopsy was directed toward hyperenhanced viable regions while avoiding necrotic zones, thereby improving tissue sampling accuracy. Immunohistochemistry confirmed S-100 and SOX-10 positivity, establishing a definitive diagnosis. Complete surgical resection with bladder defect repair was performed. Postoperatively, urinary function recovered, and no recurrent urinary or pelvic symptoms were reported during outpatient follow-up. CONCLUSIONS Quantitative CEUS-TIC analysis combined with targeted biopsy provides an effective preoperative diagnostic strategy for pelvic schwannomas. The observed CEUS-TIC perfusion pattern may correspond to the heterogeneous microvascular distribution of Antoni A and Antoni B regions; however, this hypothesis requires validation in future imaging-pathology correlation studies.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953317"},"PeriodicalIF":0.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220794","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}

{"title":"An Integrated Approach to MSI-High Colorectal Cancer Therapy in a Young Patient: A Clinical Case.","authors":"Innara Turkpenova, Kaldygul Smagulova, Abay Jumanov, Aisha Moldasheva, Rabiga Kadyrbayeva, Azhar Imanaliyeva","doi":"10.12659/AJCR.953248","DOIUrl":"https://doi.org/10.12659/AJCR.953248","url":null,"abstract":"<p><p>BACKGROUND Colorectal cancer (CRC) is extremely rare in adolescents and often presents with advanced disease because of nonspecific symptoms. Deficient mismatch repair (dMMR) and microsatellite instability-high (MSI-H) are important biomarkers that influence prognosis, treatment selection, and the need for genetic evaluation. We report the case of an adolescent with MSI-H-associated CRC presenting with acute intestinal obstruction. CASE REPORT A 16-year-old male initially underwent appendectomy for presumed acute appendicitis. Persistent postoperative bowel obstruction prompted computed tomography (CT), revealing a descending colon tumor requiring emergency Hartmann's procedure. Histopathology demonstrated mucinous adenocarcinoma, pT4N0M0, with vascular invasion. Immunohistochemistry showed loss of MSH2/MSH6 expression with retained MLH1/PMS2, indicating dMMR and findings highly suggestive of Lynch syndrome, although germline testing was unavailable. Molecular analysis identified a KRAS mutation without NRAS alterations. Given his multiple high-risk features, including T4 disease, bowel obstruction, vascular invasion, mucinous histology, and very young age, he received 12 cycles of adjuvant FOLFOX chemotherapy. Treatment was well tolerated, and he remains disease-free more than 5 years after completion of therapy. CONCLUSIONS This case highlights the diagnostic complexity of adolescent CRC and the need to consider colorectal malignancy in young patients with persistent or atypical abdominal symptoms. Routine MMR/MSI testing and comprehensive molecular profiling are essential in young-onset CRC to identify patients who may have hereditary cancer syndromes and require genetic counseling. Although limited to a single case, this report underscores the importance of multidisciplinary decision-making and individualized treatment based on clinicopathological and molecular characteristics, which may contribute to favorable long-term outcomes.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953248"},"PeriodicalIF":0.8,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216865","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}

{"title":"Large Carinal Chondrosarcoma: Resection of the Main Carina, Distal Trachea, and Orifices of the Mainstem Bronchi and Construction of a New Carina.","authors":"Dimitrios I Viskos, Ioannis P Pantazis, Fotios F Danglis, Jubrail I Dahabreh","doi":"10.12659/AJCR.953333","DOIUrl":"https://doi.org/10.12659/AJCR.953333","url":null,"abstract":"<p><p>BACKGROUND Chondrosarcoma of the trachea is an extremely rare malignancy, and tumors located at the main carina are even rarer. Carinal resection and subsequent reconstruction of a new carina constitute a demanding surgical procedure that requires extensive expertise and close collaboration between the anesthetic and surgical teams. In this case report, we aim to highlight the rarity of chondrosarcoma of the main carina and emphasize the critical role of surgical intervention despite the complexity of the procedure. Furthermore, we aim to share our clinical experience and contribute an additional case to the limited literature. CASE REPORT A 23-year-old man presented with dyspnea, fatigue, and cough. Chest computed tomography showed a lobulated soft-tissue mass anterior to the distal trachea and main carina. Fiberoptic bronchoscopy revealed widening of the main carina, clinically significant stenosis of the mainstem bronchi, and mucosal infiltration. Biopsy specimens obtained via mediastinoscopy demonstrated well-differentiated carinal chondrosarcoma. Through a right posterolateral thoracotomy, the distal trachea, main carina, and orifices of the mainstem bronchi were resected. A new carina was constructed and anastomosed to the distal trachea. Gross examination of the surgical specimen showed a well-circumscribed mass with a lobulated external surface measuring 7×6.5×5 cm. The patient remains well 17 years after tumor resection, without signs of recurrence. CONCLUSIONS Chondrosarcoma involving the distal trachea and main carina is an extremely rare tumor. Given the limited efficacy of chemotherapy and radiotherapy, surgical resection with reconstruction of a new carina is the primary treatment.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953333"},"PeriodicalIF":0.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196499","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}

{"title":"Primary Intermammary Breast Carcinoma Presenting With Direct Sternal Invasion: A Diagnostic Pitfall of Standard Screening Mammography.","authors":"Rachel Deming, Michael Fei, Harsha Choudary Pudhota, Sonal P Haerter, Moustafa Hazin","doi":"10.12659/AJCR.953831","DOIUrl":"https://doi.org/10.12659/AJCR.953831","url":null,"abstract":"<p><p>BACKGROUND Standard screening mammogram views focus on the lateral and posterior breast tissues; the view that best visualizes the intermammary area, the 90-degree lateral or cleavage view, is not typically performed. The limited field of view of mammogram increases the importance of additional imaging with CT, ultrasound, and MRI as a tool in diagnosing neoplasm in the intermammary area. To date, intermammary primary breast carcinoma has been reported only a few times in the literature, and none of these described direct sternal invasion at presentation. CASE REPORT An 85-year-old woman with a past medical history of follicular non-Hodgkin lymphoma treated with bendamustine-rituximab in 2017 (without chest radiation) and significant family history of breast cancer presented to our clinic 2 months after noticing a hard, non-tender nodule on her sternum. She had undergone a routine screening mammogram 8 months prior, which was unremarkable. Subsequent diagnostic workup including targeted ultrasound, and PET-CT identified a hypermetabolic presternal mass. Notably, diagnostic mammography 8 months after the initial screening mammogram also failed to properly visualize the lesion. Biopsy confirmed ER+/PR+, HER2- adenocarcinoma consistent with breast origin. Despite negative initial staging for distant metastasis, pathological examination after resection revealed direct invasion into the sternum, necessitating partial sternectomy. CONCLUSIONS This case highlights a rare intermammary presentation of breast carcinoma with direct sternal invasion, a feature not previously reported. It emphasizes the blind spot of standard screening mammography in the medial breast/cleavage area and the necessity of targeted imaging for palpable parasternal masses, even in the setting of recent negative screens.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953831"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184364","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}

{"title":"Behind the Sella: A Rare Case of Pituicytoma Mimicking a Pituitary Adenoma.","authors":"Katarzyna Wołos-Kłosowicz, Nina Suligowska-Wolszczuk, Michał Szklarz, Joanna Rutkowska, Wojciech Matuszewski","doi":"10.12659/AJCR.953658","DOIUrl":"https://doi.org/10.12659/AJCR.953658","url":null,"abstract":"<p><p>BACKGROUND Pituicytoma is a rare central nervous system (CNS) World Health Organization (WHO) grade I glioma originating from pituicytes, the specialized glial cells of the neurohypophysis or infundibulum. It accounts for less than 0.1% of all sellar and suprasellar masses and often presents a diagnostic challenge because of its clinical and radiological resemblance to other pituitary lesions. CASE REPORT A 48-year-old man was admitted to the endocrinology clinic because of clinical symptoms of hypogonadism, headaches, and visual field defects. Hormonal evaluation revealed hypogonadotropic hypogonadism and hyperprolactinemia. Magnetic resonance imaging (MRI) demonstrated a sellar-suprasellar mass, initially suggestive of prolactinoma. Lack of response to initial hormone replacement therapy, progressive tumor enlargement, and worsening visual impairment, prompted surgical resection via a right-temporal craniotomy. Histopathological and immunohistochemical examination established the diagnosis of pituicytoma (CNS WHO Grade 1). The postoperative course was complicated by transient cognitive impairment and endocrine deficiencies requiring long-term hormonal replacement therapy. We also review the epidemiology, clinical presentation, and current therapeutic approaches for this uncommon tumor. CONCLUSIONS Pituicytoma is a rare benign tumor that may closely mimic pituitary adenoma, both clinically and radiologically. Clinical manifestations are non-specific and primarily reflect tumor size and local extension. MRI findings are not pathognomic, making histopathological confirmation essential. Surgical resection remains the treatment of choice, whereas radiotherapy may be considered after subtotal resection. The case underscores the importance of recognizing hyperprolactinemia secondary to pituitary stalk compression, careful endocrine interpretation, individualized surgical planning, and prolonged multidisciplinary follow-up, given the uncertain long-term prognosis and potential endocrine sequelae.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953658"},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196542","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}

{"title":"Low-Volume Superior Trunk and Superficial Cervical Plexus Block With Sedation as the Sole Regional Anesthetic for Proximal Humerus Fracture Fixation in a Patient With Alzheimer Disease.","authors":"Niruji Saengsomsuan, Lalida Sangkakit","doi":"10.12659/AJCR.954296","DOIUrl":"https://doi.org/10.12659/AJCR.954296","url":null,"abstract":"<p><p>BACKGROUND Proximal humerus open reduction and internal fixation (ORIF) is usually performed under interscalene brachial plexus block (ISB) or general anesthesia (GA). ISB causes ipsilateral phrenic nerve paresis in nearly all patients, and GA may raise the risk of postoperative neurocognitive disorders in elderly patients with cognitive impairment. We report the feasibility of a low-volume regional technique, used as the sole regional anesthetic with sedation, in a patient in whom GA avoidance was desirable. CASE REPORT A 68-year-old woman (American Society of Anesthesiologists physical status II) with Alzheimer's disease underwent ORIF of a closed right proximal humerus fracture via a deltopectoral approach under superior trunk block (STB) with 5 mL of 0.5% bupivacaine, combined with superficial cervical plexus block (SCPB) with 3 mL of 0.5% bupivacaine, totaling 8 mL, with propofol and dexmedetomidine sedation. Surgery lasted 174 minutes without intraoperative rescue analgesia. Heart rate ranged from 48 to 68 beats/min during dexmedetomidine infusion without anticholinergic treatment, and oxygen saturation remained at 100% with spontaneous ventilation preserved. The block provided analgesia for about 12 hours, with pain score 1/10 at rest at 24 hours, and satisfaction 10/10. No clinically evident respiratory compromise, Horner's syndrome, or postoperative delirium was observed, although diaphragmatic and cognitive function were not formally assessed. The patient was discharged on postoperative day 2. CONCLUSIONS In this single patient, low-volume STB combined with SCPB was a feasible sole regional anesthetic technique, supported by sedation, for proximal humerus ORIF, completed without conversion to GA or clinically evident respiratory compromise. Respiratory and cognitive outcomes were clinically uneventful but not formally measured; broader utility remains to be established.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e954296"},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184379","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}