American Journal of Case Reports最新文献_第4页

Dynamic Ultrasound Assessment of Celiac Artery Flow Velocity in Median Arcuate Ligament Syndrome Diagnosis. 腹腔动脉血流速度的动态超声评估在中弓韧带综合征诊断中的应用

IF 1

American Journal of Case Reports Pub Date : 2024-10-09 DOI: 10.12659/AJCR.945253

Takamitsu Sakamoto, Yuutaro Nakagawa, Yoshihisa Fukuda, Teruyoshi Amagai

{"title":"Dynamic Ultrasound Assessment of Celiac Artery Flow Velocity in Median Arcuate Ligament Syndrome Diagnosis.","authors":"Takamitsu Sakamoto, Yuutaro Nakagawa, Yoshihisa Fukuda, Teruyoshi Amagai","doi":"10.12659/AJCR.945253","DOIUrl":"10.12659/AJCR.945253","url":null,"abstract":"BACKGROUND Median arcuate ligament syndrome (MALS) poses a considerable challenge in terms of diagnosis due to its manifestation of diverse symptoms linked to constriction of the median arcuate ligament surrounding the celiac artery. The present study introduces an earlier diagnostic modality using ultrasound measurements of the flow velocity of the celiac artery during the inspiratory and expiratory phases, with the latter being higher than the former, to avoid prolonged follow-up of postprandial symptomatology. CASE REPORT A 46-year-old female patient presented with acute postprandial abdominal pain, which was alleviated by analgesic medication. The findings from the physical examination and laboratory tests were within normal limits. Further investigations were conducted due to persistent symptoms, revealing an elevation in celiac artery flow velocity during expiration on ultrasound. The diagnosis of median arcuate ligament syndrome (MALS) was confirmed through contrast-enhanced CT and angiography. Subsequently, the patient underwent laparoscopic release of the median arcuate ligament, leading to alleviation of symptoms at the 1-year follow-up assessment. CONCLUSIONS Our case report highlights the importance of a dynamic imaging diagnostic strategy for MALS. When encountering challenging postprandial abdominal pain that is hard to diagnose, it could be crucial to utilize abdominal ultrasound to measure the flow velocity of the celiac artery. This approach may serve as a valuable screening method for identifying MALS and, subsequently, prompt the need for further diagnostic tests.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394110","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 Rare Complication of Cannabinoid Hyperemesis Syndrome. 一种罕见的大麻催吐综合征并发症。

IF 1

American Journal of Case Reports Pub Date : 2024-10-08 DOI: 10.12659/AJCR.945106

Hallie E Knight, Abhinav Singla, Michael Smerina, Melissa P Cortes, Tatjana Gavrancic, Deborah A Baumgarten, Adrian G Dumitrascu, Ricardo J Pagan, Aleksandra Murawska Baptista

{"title":"A Rare Complication of Cannabinoid Hyperemesis Syndrome.","authors":"Hallie E Knight, Abhinav Singla, Michael Smerina, Melissa P Cortes, Tatjana Gavrancic, Deborah A Baumgarten, Adrian G Dumitrascu, Ricardo J Pagan, Aleksandra Murawska Baptista","doi":"10.12659/AJCR.945106","DOIUrl":"10.12659/AJCR.945106","url":null,"abstract":"BACKGROUND Cognitive errors are common in medical practice and can have serious consequences for patients related to misdiagnosis and delays in diagnosis and treatment. We report a case in which cognitive error substantially influenced a patient's diagnosis and treatment. CASE REPORT This report recounts the case of an adolescent girl with symptoms similar to those of her previous episodes of tetrahydrocannabinol-induced hyperemesis, despite a 21-kg weight loss over 6 months. She sought care at multiple facilities until finally being diagnosed with superior mesenteric artery syndrome. Treatment was conservative with intravenous hydration, nasogastric feeding, and gastric decompression until duodenal compression was relieved. The patient's condition had improved at 7-month follow-up, and she declined surgical consultation. CONCLUSIONS This case report seeks to raise awareness of the effects of cognitive errors in clinical practice. This tendency to prematurely attribute symptoms to a known diagnosis and thereby overlook alternative and potentially more accurate explanations can lead to delays in diagnoses and treatments. Awareness of cognitive error is especially important in the context of the increasing prevalence of legalization of tetrahydrocannabinol/marijuana in several states. Superior mesenteric artery syndrome, although rare, is linked to high morbidity and mortality when the diagnosis is delayed; thus, it is crucial to consider it in the differential diagnosis for a patient with weight loss and abdominal pain. By sharing this case, we hope clinicians and patients can become more aware of this rare consequence of tetrahydrocannabinol use to facilitate more comprehensive patient-centered investigations.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394109","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

Unexpected Chylous Ascites During Umbilical Hernia Repair in a Patient with Necrotizing Pancreatitis: A Case Report. 一名坏死性胰腺炎患者在脐带疝修补术中意外出现乳糜腹水：病例报告。

IF 1

American Journal of Case Reports Pub Date : 2024-10-07 DOI: 10.12659/AJCR.944609

Dylan Schindele, Jacob Switzer

{"title":"Unexpected Chylous Ascites During Umbilical Hernia Repair in a Patient with Necrotizing Pancreatitis: A Case Report.","authors":"Dylan Schindele, Jacob Switzer","doi":"10.12659/AJCR.944609","DOIUrl":"10.12659/AJCR.944609","url":null,"abstract":"BACKGROUND Chylous ascites is defined as the development of lipid-rich ascitic fluid in the peritoneal cavity. The formation of chylous ascites revolves around non-portal-based and portal-based etiologies, and the diagnosis is made via paracentesis revealing an elevated triglyceride level and milky-white appearance. Chylous ascites is often reported as a postoperative complication in surgical procedures, but it has also been documented in cases of cirrhosis, malignancy, and tuberculosis. However, chylous ascites is rarely seen in chronic pancreatitis and non-cirrhotic portal hypertension. This report presents the case of a 65-year-old man with a history of necrotizing pancreatitis and portal hypertension amidst an incidental finding of chylous ascites upon elective umbilical hernia repair. CASE REPORT We present the case of a patient with chylous ascites discovered during hernia repair. A 65-year-old man with no alcohol or tobacco use and a history of recurrent episodes of acute necrotizing pancreatitis was admitted for umbilical hernia repair. However, upon entering the abdominal cavity, an enlarging mass of ascitic fluid was encountered and tracked into the hernia sac. The fluid was drained via paracentesis and cytology revealed chylous ascites. The patient was discharged in stable condition and was advised to consume a high-protein, low-fat diet. Postoperative computed topography (CT) demonstrated an unchanged necrotic mass in the head of the pancreas. CONCLUSIONS This report demonstrates that when dealing with unexpected findings, it is important to consider the existence of multiple pathologies as the driving cause. We describe a complex cause of chylous ascites, along with a review of the literature on the relationship between chylous ascites and chronic pancreatitis.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381932","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

"No-Touch" Saphenous Vein Grafting and Coronary Aneurysm Ligation in an Adult Patient with Suspected Prior Kawasaki Disease. 疑似川崎病成人患者的 "无触点 "隐静脉移植术和冠状动脉瘤结扎术

IF 1

American Journal of Case Reports Pub Date : 2024-10-06 DOI: 10.12659/AJCR.945431

Satoshi Ueno, Yuji Katayama, Takashi Kudo, Naomi Nishikawa, Yoshiro Nagao, Hideki Shimomura

{"title":"\"No-Touch\" Saphenous Vein Grafting and Coronary Aneurysm Ligation in an Adult Patient with Suspected Prior Kawasaki Disease.","authors":"Satoshi Ueno, Yuji Katayama, Takashi Kudo, Naomi Nishikawa, Yoshiro Nagao, Hideki Shimomura","doi":"10.12659/AJCR.945431","DOIUrl":"10.12659/AJCR.945431","url":null,"abstract":"BACKGROUND Coronary artery aneurysms in patients with Kawasaki disease may develop acute myocardial infarction. It is challenging to achieve complete revascularization solely through percutaneous coronary intervention in these patients. Therefore, coronary artery bypass grafting is often necessary. CASE REPORT We present a case of a 68-year-old woman who developed multiple acute myocardial infarctions due to giant aneurysms formed in the right coronary artery (RCA) and the left circumflex artery (LCx). We diagnosed the cause of the aneurysms as Kawasaki disease based on the coronary angiogram, laboratory results, and family history. After the primary balloon angioplasty, we conducted coronary artery bypass grafting, which involved grafting 2 vessels to the LCx and 1 vessel to the RCA. The internal thoracic arteries, which are the standard graft vessels, were occluded, most likely due to Kawasaki disease vasculitis. Instead, we used saphenous vein grafts harvested using the \"no-touch\" technique, which preserves the perivascular adipose tissue, to improve the long-term patency. In addition, we ligated the LCx aneurysm to prevent occlusion of the grafts and rupture of the aneurysm. Four years after the uneventful discharge, the patient is in good health and coronary computed tomography angiography revealed good patency of all grafts. CONCLUSIONS This report highlights a successful combination of \"no-touch\" saphenous vein grafting and coronary aneurysm ligation in an adult patient with Kawasaki disease. These techniques may be especially useful for this vasculitic illness which is often associated with occlusion of internal thoracic arteries.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378420","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

Concurrent Diagnosis of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma: Report of 2 Cases and Differential Diagnostic Considerations. 慢性淋巴细胞白血病和浆细胞骨髓瘤的并发诊断：两例病例报告与鉴别诊断考虑。

IF 1

American Journal of Case Reports Pub Date : 2024-10-05 DOI: 10.12659/AJCR.944707

Oluwole Odujoko, Shubhneet Bal, Neil Kansal, Nusrat F Pathan, Gunjan Gupta

{"title":"Concurrent Diagnosis of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma: Report of 2 Cases and Differential Diagnostic Considerations.","authors":"Oluwole Odujoko, Shubhneet Bal, Neil Kansal, Nusrat F Pathan, Gunjan Gupta","doi":"10.12659/AJCR.944707","DOIUrl":"10.12659/AJCR.944707","url":null,"abstract":"BACKGROUND Simultaneous occurrence of chronic lymphocytic leukemia (CLL) and plasma cell myeloma (PCM) is an uncommon hematological condition, with most patients presenting in late adult life. When these diagnoses occur concurrently, it often poses diagnostic challenges to the pathologist, with other important differential diagnoses including lymphoplasmacytic lymphoma, marginal-zone lymphoma, and chronic lymphocytic leukemia with plasmacytoid differentiation. Ancillary studies are indispensable in arriving at a reliable diagnosis in this clinical scenario. CASE REPORT We present 2 cases of simultaneous CLL and PCM that were diagnosed in our facility. The bone marrow in these patients showed increased plasma cells with a separate population of neoplastic lymphoid cells. Bone marrow examination and ancillary studies (immunohistochemistry, fluorescence in situ hybridization, and molecular studies) were performed in both cases to arrive at the diagnosis and rule out other important differential diagnoses. While the first patient was still being observed at the time of writing this report, and found to be clinically stable during his last clinic visit, the second patient succumbed to the disease as a result of gram-negative sepsis. CONCLUSIONS CLL and PCM can occasionally co-exist, posing diagnostic challenges to the pathologist. Ancillary diagnostic techniques are important in making a correct diagnosis. Making an accurate diagnosis is vital as this will guide appropriate treatment strategies. Whenever these 2 conditions occur simultaneously, patients often succumb as a result of progression of PCM.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376143","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

Acute Cholecystitis Due to Taeniasis: A Case Report of an Unusual Site of Taenia saginata or Taenia asiatica Infection. Taeniasis 引起的急性胆囊炎：矢状洮疟或亚洲洮疟感染部位罕见的病例报告。

IF 1

American Journal of Case Reports Pub Date : 2024-10-04 DOI: 10.12659/AJCR.944894

Kornnatthanai Namsathimaphorn, Teerada Daroontum, Sangob Sanit, Worawit Aimim-Arnant, Komson Wannasai

{"title":"Acute Cholecystitis Due to Taeniasis: A Case Report of an Unusual Site of Taenia saginata or Taenia asiatica Infection.","authors":"Kornnatthanai Namsathimaphorn, Teerada Daroontum, Sangob Sanit, Worawit Aimim-Arnant, Komson Wannasai","doi":"10.12659/AJCR.944894","DOIUrl":"10.12659/AJCR.944894","url":null,"abstract":"BACKGROUND Taeniasis is a helminthic infection caused by the Taenia species, specifically T. solium, T. saginata, and T. asiatica. Generally, the parasites infect the small intestine; however, instances of atypical migration have also been reported. CASE REPORT A 47-year-old Thai woman presented to Nan Hospital with epigastric pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and laboratory analysis revealed mild direct hyperbilirubinemia. Abdominal ultrasonography revealed multiple gallstones and acute cholecystitis. During an elective cholecystectomy, a 70-cm-long tapeworm was found in the gallbladder. Histological examination confirmed the presence of parasitic infection suggestive of Taenia spp., with acute inflammation and focal mucosal necrosis of the gallbladder. Microscopic examination revealed 20 to 22 uterine branches in each of the 5 gravid proglottids, with 42 to 55 uterine twigs and an average ratio of uterine twigs to branches of 2.41, confirming that the parasite in question was possible for T. saginata or T. asiatica. The patient's symptoms resolved after surgery. She was prescribed an oral antibiotic and antiparasitic drug after the operation and experienced no post-surgical complications. CONCLUSIONS Certain parasitic worms can migrate from the intestine to the biliary system. Although less common, T. solium, T. saginata, and T. asiatica can also be detected in the gallbladder and cause acute cholecystitis. This case stresses the potential for misdiagnosis in imaging studies and advises clinicians in endemic areas to consider Taenia spp. infections in the biliary system.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373059","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

Rare Case of Post-Traumatic Abducens-Oculomotor Nerve Synkinesis Exhibiting Unusual Ocular Motility. 罕见的外伤后视神经-眼球运动神经综合症病例，表现出异常的眼球运动能力。

IF 1

American Journal of Case Reports Pub Date : 2024-10-03 DOI: 10.12659/AJCR.944565

Ahmad M Alaraj

{"title":"Rare Case of Post-Traumatic Abducens-Oculomotor Nerve Synkinesis Exhibiting Unusual Ocular Motility.","authors":"Ahmad M Alaraj","doi":"10.12659/AJCR.944565","DOIUrl":"10.12659/AJCR.944565","url":null,"abstract":"BACKGROUND Acquired synkinesis is a well-known phenomenon following oculomotor nerve injury. The abnormal movement appears within the distribution of 1 nerve, or other cranial nerves may be involved. The common misdirection of aberrant regeneration of oculomotor nerve involves the lid, extraocular muscles, or pupil. This report presents a case of aberrant connection between abducens and oculomotor nerve, which is quite rare. CASE REPORT A 21-year-old man with history of left-sided frontal, lateral orbital wall, and zygomatic fracture from head trauma in a motor vehicle accident presented for evaluation. He was comatose for 6 weeks in the intensive care unit. Six months later, he presented to the ophthalmology clinic for an eye examination. He had no history of eye problems prior to this accident. His best corrected visual acuity in the right eye was 20/20 and the left eye had no light perception. The right eye exam was normal, with normal ocular motility. The left eye exam showed small esotropia in primary position with markedly decreased adduction, elevation, and minimal depression, but on attempted abduction, the left eye would adduct instead. There was no globe retraction when left eye abduction was attempted. The abnormal movement seen resulted from third nerve function during sixth nerve stimulation, due to unusual ocular motility with abnormal connection between the sixth and third cranial nerves. CONCLUSIONS The most likely pathophysiologic mechanism here is peripheral neuronal misdirection hypothesis after trauma. Careful and detailed examination of a patient presenting with unusual ocular motility after trauma is very important. The abnormal connection between the sixth and third cranial nerves is quite rare but can occur.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366842","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

Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study. 极度肥胖低通气综合征的管理：病例研究。

IF 1

American Journal of Case Reports Pub Date : 2024-10-02 DOI: 10.12659/AJCR.945112

Yuya Miyoshi, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Hongo, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

{"title":"Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study.","authors":"Yuya Miyoshi, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Hongo, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito","doi":"10.12659/AJCR.945112","DOIUrl":"10.12659/AJCR.945112","url":null,"abstract":"BACKGROUND Obesity hypoventilation syndrome (OHS) is characterized by hypercapnia in obese patients, with acute hypercapnic respiratory failure often worsened by various conditions. Managing super-super obese patients presents complex challenges in critical care. Our case report details the successful treatment of acute respiratory failure in a patient with a body mass index (BMI) over 80 kg/m², highlighting the importance of comprehensive, multidisciplinary care in the Intensive Care Init (ICU). CASE REPORT A 39-year-old man with a BMI of 81.1 kg/m² presented to our emergency department with respiratory distress, altered consciousness, and an inability to move independently. Arterial blood gas analysis revealed severe hypercapnia and hypoxemia, indicating decompensated OHS. Laboratory tests and computed tomography scans suggested his condition was exacerbated by pneumonia and congestive heart failure. The patient was managed in the ICU with endotracheal intubation, mechanical ventilation, and esophageal pressure monitoring. In addition to antibiotics, diuretics were used to manage fluid balance. His care included multidisciplinary support with nutritional management and active physiotherapy. After 15 days, he was weaned from the ventilator and discharged from the ICU on day 20, continuing rehabilitation until he was discharged home on day 60. CONCLUSIONS This case report describes the successful treatment of acute hypercapnic respiratory failure from decompensated OHS in a super-super obese patient. Addressing the underlying conditions and tailoring clinical practices to the patient's specific needs, especially regarding ventilatory support, fluid balance, and nutrition, were crucial. A collaborative multidisciplinary approach was essential for improving outcomes.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362183","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

Pulmonary Arterial Hypertension in Adult-Onset Still's Disease: A Rare but Severe Complication. 成人型斯蒂尔病的肺动脉高压：罕见但严重的并发症。

IF 1

American Journal of Case Reports Pub Date : 2024-10-01 DOI: 10.12659/AJCR.943591

Gerson Quintero, Sophia Mourad, Timea Kovacs, Murali K Iyyani, Mohammed Omar Al Salihi, Omar Qazi, Stephen J Carlan

{"title":"Pulmonary Arterial Hypertension in Adult-Onset Still's Disease: A Rare but Severe Complication.","authors":"Gerson Quintero, Sophia Mourad, Timea Kovacs, Murali K Iyyani, Mohammed Omar Al Salihi, Omar Qazi, Stephen J Carlan","doi":"10.12659/AJCR.943591","DOIUrl":"10.12659/AJCR.943591","url":null,"abstract":"BACKGROUND Adult-onset Still's disease (AOSD) is a rare multisystem inflammatory disorder with a highly variable clinical presentation. Pulmonary complications of AOSD most commonly include pleural effusion and transient pulmonary infiltrates. In extremely rare cases, pulmonary arterial hypertension (PAH) develops as a complication. We present the case of a 49-year-old woman with adult-onset Still's disease presenting with fever, dyspnea, and pleuritic chest pain who was diagnosed with PAH. CASE REPORT A 49-year-old woman with a history of adult-onset Still's disease presented to the Emergency Department due to 1 week of fever, dyspnea, and pleuritic chest pain. Imaging, cardiac, immunologic, and infectious workups were performed and detected elevated inflammatory markers. She then underwent right-heart catheterization, which revealed high pulmonary artery pressure (PAP) and mean PAP at 43/18 mmHg and 27 mmHg, respectively. The patient was stabilized and discharged for further management of heart failure with preserved ejection fraction, and group 1 pulmonary arterial hypertension secondary to Still's disease. CONCLUSIONS Pulmonary complications of adult-onset Still's disease, such as PAH, are rare but potentially life-threatening. The treatment of PAH in adult-onset Still's disease involves the use of pulmonary vasodilators, immunosuppressive therapy, and regular monitoring to assess the prognosis of PAH. Our case report highlights the importance of considering PAH in patients with adult-onset Still's disease who present with dyspnea, fatigue, and chest pain. Increased clinician awareness of this extremely rare complication of AOSD can assist with rapid identification and improved patient outcomes.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355925","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

Exceptional Tumor Regression in Diffuse Intrinsic Pontine Glioma Post-Radiotherapy: A Case Study. 弥漫性桥脑胶质瘤放疗后肿瘤异常消退：病例研究。

IF 1

American Journal of Case Reports Pub Date : 2024-09-30 DOI: 10.12659/AJCR.944869

Ashish Dilip Uke, Anurag Luharia, Shweta Dahake, Gaurav V Mishra, Chandrashekhar Mahakalkar

{"title":"Exceptional Tumor Regression in Diffuse Intrinsic Pontine Glioma Post-Radiotherapy: A Case Study.","authors":"Ashish Dilip Uke, Anurag Luharia, Shweta Dahake, Gaurav V Mishra, Chandrashekhar Mahakalkar","doi":"10.12659/AJCR.944869","DOIUrl":"10.12659/AJCR.944869","url":null,"abstract":"BACKGROUND Diffuse intrinsic pontine glioma represent approximately 10% to 20% of all pediatric central nervous system tumors. Classic brain stem symptoms are cranial nerve deficits, long tract signs, ataxia, alone or in combination. Focal radiotherapy has been the standard of care in patients with diffuse intrinsic pontine gliomas with minimum response. Here, we present an unusual case with excellent tumor regression with radiotherapy and good clinical outcome. CASE REPORT A 13-year-old girl presented with headache and imbalance during walking for the past 2-3 months, along with a deviation of the right eye in the last month. Brain magnetic resonance imaging (MRI) suggested a well-defined solid cystic altered-signal-intensity lesion involving the pons and medulla, causing its expansion up to the midbrain on the left side. The lesion was 4.6×3.7×3.6 cm. We applied the intensity-modulated radiotherapy technique (IMRT) using a 6-MV photon beam with the conventional dose fractionation of 54 Gy in 30 fractions (1.8 Gy/fraction). Three months later, MRI brain with spectroscopy and perfusion showed evidence of non-enhancing, altered-signal-intensity lesion in the pons and medulla, measuring 1.9×2.2×2.4 cm. CONCLUSIONS Early detection of symptoms of DIPG in a young patient along with effective radiological investigation with valid tumor board decision as definitive radiotherapy as a sole therapeutic treatment option and with robust radiotherapy planning resulted in an excellent response, with 80% reduction in gross tumor volume (GTV) as seen in pre-radiotherapy (RT) and post-RT MRI images.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355920","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