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

A 52-Year-Old Man with Aneurysmal Subarachnoid Hemorrhage Associated with Delayed-Onset Vitreous Hemorrhage (Terson's Syndrome) Successfully Treated with Balloon-Assisted Coiling and Delayed Vitrectomy. 一名 52 岁男子动脉瘤性蛛网膜下腔出血伴迟发性玻璃体出血（特森综合征），经球囊辅助夹闭术和迟发性玻璃体切除术成功治愈。

IF 1

American Journal of Case Reports Pub Date : 2024-08-01 DOI: 10.12659/AJCR.943567

Thanos Vassilopoulos, Christos Tsitsipanis, Anastasios Stavrakakis, Konstantinos Ntotsikas, Nikolaos Moustakis, Athanasios K Theofanopoulos, Sofia Lazarioti, Christos Bartsokas, Konstantina M Raouzaiou, Andronikos Trikkos, Georgia Kritikou, Efstratios Konidis, Miltiadis K Tsilimbaris, Andreas Yannopoulos

{"title":"A 52-Year-Old Man with Aneurysmal Subarachnoid Hemorrhage Associated with Delayed-Onset Vitreous Hemorrhage (Terson's Syndrome) Successfully Treated with Balloon-Assisted Coiling and Delayed Vitrectomy.","authors":"Thanos Vassilopoulos, Christos Tsitsipanis, Anastasios Stavrakakis, Konstantinos Ntotsikas, Nikolaos Moustakis, Athanasios K Theofanopoulos, Sofia Lazarioti, Christos Bartsokas, Konstantina M Raouzaiou, Andronikos Trikkos, Georgia Kritikou, Efstratios Konidis, Miltiadis K Tsilimbaris, Andreas Yannopoulos","doi":"10.12659/AJCR.943567","DOIUrl":"10.12659/AJCR.943567","url":null,"abstract":"BACKGROUND Terson's syndrome (TS) is a medical condition characterized by intraocular bleeding that can lead to visual impairment and is associated to subarachnoid hemorrhage (SAH). The pathophysiology and natural history are not well established in the current literature. This report describes successful treatment of a 52-year-old man with aneurysmal SAH who developed late-onset TS using balloon-assisted coiling and vitrectomy to raise awareness of this important complication of aneurysmal SAH. CASE REPORT A 52-year-old smoker with no known past medical history presented to the emergency department with a sudden, severe headache that worsened with photophobia and phonophobia. The patient had a diffuse SAH and underwent an embolization procedure. After 48 hours of close Intensive Care Unit monitoring, the patient's vital signs were stable, and the GCS score was consistently 15/15. However, after 3 weeks in the hospital, the patient experienced blurred vision and a right upper quadrantanopia. Further examination revealed TS and the patient underwent a vitrectomy in 1 eye. The surgery was successful and the eye recovered to 20/20 with no complications. However, the other eye showed slow absorption of the hemorrhage, and a vitrectomy was scheduled for that eye as well. CONCLUSIONS TS is a complication of aneurysmal SAH that can lead to vision loss and increased morbidity. It often goes undiagnosed, and ophthalmologists are not regularly consulted. Late manifestation of the condition is exemplified by the present case. Early detection and intervention are crucial for better patient outcomes.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861173","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

Life-Saving Management of Traumatic Coronary Artery Dissection and Acute Myocardial Infarction in a 21-Year-Old Motorcyclist: A Case Report. 一名 21 岁摩托车手外伤性冠状动脉夹层和急性心肌梗死的抢救治疗：病例报告。

IF 1

American Journal of Case Reports Pub Date : 2024-07-31 DOI: 10.12659/AJCR.944431

Po-Lu Li, Siou-Ting Lee, Chun-Gu Cheng, Yen-Yue Lin

{"title":"Life-Saving Management of Traumatic Coronary Artery Dissection and Acute Myocardial Infarction in a 21-Year-Old Motorcyclist: A Case Report.","authors":"Po-Lu Li, Siou-Ting Lee, Chun-Gu Cheng, Yen-Yue Lin","doi":"10.12659/AJCR.944431","DOIUrl":"10.12659/AJCR.944431","url":null,"abstract":"BACKGROUND A traumatic coronary artery dissection is a rare but severe complication of chest trauma that can result in blockage of the coronary artery. The clinical symptoms can vary considerably, from asymptomatic arrhythmia to acute myocardial infarction and sudden death. This report describes a young man with coronary artery dissection following blunt chest trauma from a motorcycle accident presenting with ventricular fibrillation due to acute myocardial infarction, which was treated with percutaneous transluminal coronary angioplasty and extracorporeal membrane oxygenation. CASE REPORT We present a 21-year-old man with chest contusion from a motorcycle accident who experienced sudden collapse due to ventricular fibrillation and acute myocardial infarction. The patient was resuscitated with extracorporeal membrane oxygenation, and 12-lead electrocardiogram showed sinus tachycardia with a hyperacute T-wave and ST elevation in leads V2-V6. Percutaneous coronary intervention revealed dissection from the ostial to proximal portion of the left anterior descending artery, and traumatic coronary artery dissection was confirmed. He was successfully treated with percutaneous transluminal coronary angioplasty, in which a drug-eluting stent was inserted to enhance blood flow in the left anterior descending artery, resulting in TIMI 2 flow restoration. After 16 days of intensive care, he was discharged and was well at a 3-month follow-up. CONCLUSIONS This report describes a case with the rare association between blunt chest trauma and coronary artery dissection and highlights that coronary artery dissection can result in ST-elevation myocardial infarction. Extracorporeal membrane oxygenation can protect the patient's circulation for coronary angioplasty. Therefore, early detection and intensive resuscitation can prevent disastrous outcomes.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861186","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

Distinct Imaging Markers of Leigh's Disease Linked to SURF1 Mutation: A Pediatric Case Study. 与 SURF1 基因突变相关的利氏病的独特影像标记：一项儿科病例研究

IF 1

American Journal of Case Reports Pub Date : 2024-07-31 DOI: 10.12659/AJCR.944514

Rama Krishna Narra, Reshma Vemuri

{"title":"Distinct Imaging Markers of Leigh's Disease Linked to SURF1 Mutation: A Pediatric Case Study.","authors":"Rama Krishna Narra, Reshma Vemuri","doi":"10.12659/AJCR.944514","DOIUrl":"10.12659/AJCR.944514","url":null,"abstract":"BACKGROUND Leigh disease (LD) is a rare progressive mitochondrial neurodegenerative disorder characterized by subacute necrotizing encephalopathy and symmetrical spongiform lesions in the brain. Cytochrome C oxidase deficiencies due to SURF1 Cytochrome C Oxidase Assembly Factor (SURF1) gene mutations are seen only in 15% of LD cases. Consideration of these genetic mutations in young patients is crucial for early diagnosis, intervention, and further genetic counseling. Although only a few cases of the SURF1 mutation have been reported, there are anecdotal case reports describing imaging features. CASE REPORT We report a case of a 2-year-old boy with developmental delay, hypotonia, involuntary movements, shortness of breath, and reduced activity since age 6 months. On blood examination there was mildly elevated lactate levels and increased lactate to pyruvate ratio and cerebrospinal fluid lactate levels. Magnetic resonance imaging findings showed symmetrical lesions in the dentate nucleus, subthalamic nucleus, midbrain (substantia nigra, periaqueductal gray matter), posterolateral pons, and olivary nucleus of the medulla extending into the cervical spinal cord, with mild elevation of the lactate peak on magnetic resonance spectroscopy. CONCLUSIONS These findings prompted further genetic analysis, which indicated a mitochondrial type IV deficiency with the SURF1 gene defect, an intranuclear type 1 mutation (MC4DN1) (OMIM 220110). Treatment is usually supportive with vitamins supplementation and physiotherapy, and genetic counseling of the parents is mandatory.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856720","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

Pelvic Necrosis with Formation of a Pelvic "Cloaca" and Necrotizing Soft Tissue Infection After Radiation for Anal Squamous Cell Carcinoma. 肛门鳞状细胞癌放疗后盆腔坏死，形成盆腔 "泄殖腔 "和坏死性软组织感染。

IF 1

American Journal of Case Reports Pub Date : 2024-07-30 DOI: 10.12659/AJCR.943599

Angeline C Rivkin, Adil H Khan, Anders F Mellgren, Alejandra M Perez-Tamayo, Vivek Chaudhry, Elisa M Bianchi, Mohamad A Abdulhai

{"title":"Pelvic Necrosis with Formation of a Pelvic \"Cloaca\" and Necrotizing Soft Tissue Infection After Radiation for Anal Squamous Cell Carcinoma.","authors":"Angeline C Rivkin, Adil H Khan, Anders F Mellgren, Alejandra M Perez-Tamayo, Vivek Chaudhry, Elisa M Bianchi, Mohamad A Abdulhai","doi":"10.12659/AJCR.943599","DOIUrl":"10.12659/AJCR.943599","url":null,"abstract":"BACKGROUND Anal squamous cell carcinoma (SCC) is a rare cancer commonly treated with the Nigro protocol, which combines chemotherapy and radiation. Patients who received radiation therapy prior to modern advances, such as computer-based tumor targeting, volumetric planning, and intensity-modulated radiation therapy, experience more acute and chronic adverse effects. Though exceedingly rare, radiation necrosis is of particular concern, as it can result in significant morbidity and mortality, including complex pelvic fistula formation and predisposition to potentially life-threatening necrotizing soft-tissue infections. CASE REPORT Here, we present a case of a 66-year-old woman with a prior history of anal SCC stage T3N×M0 who was treated with the Nigro protocol. Her treatment course was complicated by radiation proctitis, necessitating fecal diversion and ureteral strictures, requiring frequent stent exchanges. She presented 18 years after her cancer treatment, with widespread necrosis of her pelvic organs and surrounding soft tissue, resulting in formation of a large pelvic \"cloaca\", with a superimposed necrotizing soft-tissue infection. She was successfully treated by expedited resuscitation, septic source control, using multiple extensive debridements, and complete urinary diversion, utilizing a multidisciplinary team. CONCLUSIONS This case highlights the importance of monitoring patients for signs of radiation toxicity, particularly in patients who received radiation prior to the latest technological advancements, as they are at increased risk of developing severe, late adverse effects decades after treatment. When these complications are recognized, early and aggressive intervention is required to spare the patient significant morbidity and mortality.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856721","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

Retracted: Acute Eosinophilic Pneumonia Induced by Immune Checkpoint Inhibitor and Anti-TIGIT Therapy. 撤回：免疫检查点抑制剂和抗TIGIT疗法诱发的急性嗜酸性粒细胞肺炎

IF 1

American Journal of Case Reports Pub Date : 2024-07-30 DOI: 10.12659/AJCR.945973

Asna Mohammed, Bo Tang, Sean Sadikot, Guido Barmaimon

引用次数: 0

Late-Onset Mesh Infection Manifesting as Preperitoneal Abscess and Cutaneous Fistula Post-TEP Inguinal Hernia Repair: A Case Report. TEP 腹股沟疝修补术后表现为腹膜前脓肿和皮肤瘘的晚发网片感染：病例报告。

IF 1

American Journal of Case Reports Pub Date : 2024-07-30 DOI: 10.12659/AJCR.944843

Angel Chao, Hao-Chien Hung

{"title":"Late-Onset Mesh Infection Manifesting as Preperitoneal Abscess and Cutaneous Fistula Post-TEP Inguinal Hernia Repair: A Case Report.","authors":"Angel Chao, Hao-Chien Hung","doi":"10.12659/AJCR.944843","DOIUrl":"10.12659/AJCR.944843","url":null,"abstract":"BACKGROUND Endoscopic inguinal hernia repair has become the preferred technique currently. The use of mesh to facilitate a tension-free reinforcement has become the standard of care during endoscopic totally extraperitoneal (TEP), laparoscopic transabdominal pre-peritoneal, and open inguinal hernia repair. Although uncommon, late-developing mesh infections, defined as those occurring in the surgical site months or years after the procedure, can lead to severe complications. To achieve the best possible outcome for the patient, prompt imaging and a multidisciplinary approach to management, including complete surgical removal of the contaminated mesh and proper antibiotic therapy, are crucial. CASE REPORT A 39-year-old woman presented with a 1-month history of intermittent fever, progressive lower abdominal pain and fullness, and purulent discharge from the abdominal wall. Her medical history was significant for an endoscopic right TEP inguinal hernia repair performed 3 years earlier, which involved the use of an anatomic mesh and titanium screws. Physical examination and ultrasound findings revealed a large preperitoneal abscess with cutaneous fistulization, secondary to a deep-seated mesh infection. Pseudomonas aeruginosa was identified as the causative pathogen. She underwent a 2-step surgical procedure, including an initial fistulectomy followed by endoscopic abscess drainage and surgical excision of the infected mesh, combined with antimicrobial therapy, resulting in an excellent clinical response and complete resolution. This strategy also allowed for an effective assessment of the abdominal wall integrity. CONCLUSIONS This case underscores the importance of considering late-developing mesh infections in patients presenting with abdominal symptoms who have previously undergone TEP hernia repair, even years after the initial surgery.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793690","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

Porcelain Aorta and Quadruple Extracranial Vessel Occlusion: A Case of Minimal Neurological Deficits Despite Severe Vascular Blockages. 瓷主动脉和四重颅外血管闭塞：一例严重血管阻塞但神经功能缺损极小的病例。

IF 1

American Journal of Case Reports Pub Date : 2024-07-29 DOI: 10.12659/AJCR.944099

Reza Golchin Vafa, Nazanin Hosseini, Mohammad Montaseri, Javad Kojuri

{"title":"Porcelain Aorta and Quadruple Extracranial Vessel Occlusion: A Case of Minimal Neurological Deficits Despite Severe Vascular Blockages.","authors":"Reza Golchin Vafa, Nazanin Hosseini, Mohammad Montaseri, Javad Kojuri","doi":"10.12659/AJCR.944099","DOIUrl":"10.12659/AJCR.944099","url":null,"abstract":"BACKGROUND Cerebrovascular occlusion is a critical health concern associated with strokes, a leading cause of mortality worldwide. Large vessel occlusion, constituting a significant portion of acute ischemic strokes, presents serious patient outcomes. Occlusions involving multiple extracranial vessels are rare but pose challenges in early detection due to potential absence of overt symptoms. CASE REPORT A 65-year-old man with a significant smoking history and no prior history of hypertension or cardiovascular disease presented with recurrent generalized tonic seizures occurring 4 to 5 times daily. Despite normal neurological examinations, neck sonography indicated potential obstruction in the carotid and vertebral arteries. Conventional angiography revealed mild coronary artery plaques but complete occlusion of all cranial branches originating from the aorta, alongside porcelain aorta. Neck CT angiography confirmed complete occlusion of the supra-aortic branches of the aorta and absence of the right internal carotid artery, with evidence of proximal occlusion of the left internal carotid artery. Medical management without surgical intervention was pursued due to the patient's stable condition. He was discharged with a medication regimen including antiplatelet therapy and statins. Four-month follow-up showed significant symptom improvement, with minimal changes in brain blood flow circulation noted on CT. CONCLUSIONS This case underscores the brain's remarkable adaptive capacity in withstanding severe vascular challenges. The rarity of multiple extracranial vessel occlusions and presence of porcelain aorta further complicated the case. Utilizing advanced imaging techniques and personalized treatment approaches are crucial in managing complex vascular conditions. Ongoing research and careful monitoring are essential to advance understanding and management in such cases.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789354","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

Bilateral Facet Joint Septic Arthritis Induced by Acupuncture: A Case Report Highlighting Diagnostic Challenges and the Importance of Early Intervention. 针灸诱发双侧面关节化脓性关节炎：病例报告突显诊断难题和早期干预的重要性。

IF 1

American Journal of Case Reports Pub Date : 2024-07-29 DOI: 10.12659/AJCR.944596

Jing Yuan, Adriel Guang Wei Goh, Mohammad Taufik Bin Mohamed Shah

{"title":"Bilateral Facet Joint Septic Arthritis Induced by Acupuncture: A Case Report Highlighting Diagnostic Challenges and the Importance of Early Intervention.","authors":"Jing Yuan, Adriel Guang Wei Goh, Mohammad Taufik Bin Mohamed Shah","doi":"10.12659/AJCR.944596","DOIUrl":"10.12659/AJCR.944596","url":null,"abstract":"BACKGROUND Facet joint septic arthritis (SAFJ) is a rare clinical entity that is extremely challenging to diagnose, often presenting unilaterally and with nonspecific clinical symptoms. However, SAFJ has significant morbidity and mortality, especially with delayed diagnosis. It becomes all the more important for the clinician to recognize that SAFJ can present bilaterally and be associated with direct inoculation, such as in acupuncture. CASE REPORT A 53-year-old woman with chronic alcoholism and well-controlled type 2 diabetes mellitus was initially admitted for progressively worsening atraumatic lower back pain. Initial non-contrast magnetic resonance imaging (MRI) of the lumbar spine revealed bilateral L4-L5 and L5-S1 nonspecific facet joint effusions. Clinical examination was unremarkable. Biochemically, the patient had mildly elevated inflammatory markers. She was treated conservatively with close outpatient follow-up. However, her back pain progressively worsened, with new-onset lower limb weakness and numbness. Repeat MRI showed L4-L5 bilateral facet joint fluid collection with adjacent bony destruction, as well as posterior paraspinal and epidural fluid collections compatible with L4-L5 bilateral SAFJ with paraspinal and epidural abscesses. Urgent surgical drainage and bilateral lateral facet decompression was performed. Intraoperative cultures revealed methicillin-sensitive Staphylococcus aureus as the causative organism. Postoperatively, 6 weeks of intravenous and oral antibiotics were given with good recovery. CONCLUSIONS We describe a case of bilateral SAFJ following acupuncture that was initially missed. With the increasing prevalence of acupuncture treatment for lower back pain, bilateral SAFJ should be a diagnostic consideration. Detailed clinical history is key; this, as well as a high index of suspicion, early evaluation and treatment, are essential to obtain a favorable outcome.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793689","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 Aortic Dissection Presenting as Rectal Tenesmus. 急性主动脉夹层表现为直肠痛经

IF 1

American Journal of Case Reports Pub Date : 2024-07-28 DOI: 10.12659/AJCR.943991

Adam D Fratczak, Jeffrey A Nielson, Roy L Johnson

{"title":"Acute Aortic Dissection Presenting as Rectal Tenesmus.","authors":"Adam D Fratczak, Jeffrey A Nielson, Roy L Johnson","doi":"10.12659/AJCR.943991","DOIUrl":"10.12659/AJCR.943991","url":null,"abstract":"BACKGROUND Acute aortic dissection (AAD) is a life-threatening medical emergency that requires a high index of clinical suspicion to be diagnosed promptly. The variability in the clinical presentation of AAD has historically made it difficult to identify in the acute setting. There remains significant inter-physician variability in the use of imaging. The median time to diagnosis in the Emergency Department is over 4 h and AAD has a mortality rate of 68% when diagnosis is delayed by over 48 h after onset of symptoms. CASE REPORT We discuss a case of a 69-year-old woman presenting with gastrointestinal symptoms in the Emergency Department who ultimately was found to have AAD. The patient had delayed presentation by 12 h due to misattribution of her rectal tenesmus to irritable bowel syndrome. However, after a thorough history and physical exam, the Emergency Medicine physician appropriately risk-stratified the patient and correctly diagnosed her with a Stanford Type A aortic dissection using a computed tomography study of the chest, abdomen, and pelvis with intravenous contrast. CONCLUSIONS AAD is an uncommon disease often requiring emergency intervention. We summarize the research and scoring systems and discuss the physical exam findings, comorbidities, imaging modalities, and risk stratification tools. Although imperfect, the Aortic Dissection Detection Risk Score with the addition of a D-dimer test is currently the best-validated tool and should be an important part of clinical decision making prior to performing computed tomography imaging.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789353","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

Conservative Management of a Monochorionic Twin Pregnancy with an Intrauterine Fetal Death at 20-21 Weeks and Successful Term Delivery of the Second Twin. 保守治疗单绒毛膜双胎妊娠，20-21 周胎儿宫内死亡，第二胎成功足月分娩。

IF 1

American Journal of Case Reports Pub Date : 2024-07-27 DOI: 10.12659/AJCR.942321

Fadhilah Zulfa, Dian Tjahyadi, Raden Mas Sonny Sasotya, Adhi Pribadi, Dani Setiawan, Arnova Reswari, Luthfi Rahman

{"title":"Conservative Management of a Monochorionic Twin Pregnancy with an Intrauterine Fetal Death at 20-21 Weeks and Successful Term Delivery of the Second Twin.","authors":"Fadhilah Zulfa, Dian Tjahyadi, Raden Mas Sonny Sasotya, Adhi Pribadi, Dani Setiawan, Arnova Reswari, Luthfi Rahman","doi":"10.12659/AJCR.942321","DOIUrl":"10.12659/AJCR.942321","url":null,"abstract":"BACKGROUND One of the obstetric complications of twin pregnancy was the intrauterine death of one fetus. The death that occurs in the first trimester usually leads to fewer complications than the death in the second and third trimester. In the second and third trimesters, single fetal death of twin pregnancy was reported to increase the death, preterm birth, and neurological injury of the surviving co-twin. Although rare, it might trigger a coagulation defect in the mother as well. Neurological morbidities were also more common in monochorionic twins than in dichorionic gestation. Thus, a consideration of pregnancy termination might persist. CASE REPORT We present a case of a primigravida with a monochorionic twin pregnancy whose intrauterine death of one fetus at 20-21 weeks of gestation. We managed this patient with pregnancy continuation under close monitoring more than 12 weeks until she delivered the surviving one at term. The outcome of the surviving baby was normal condition and appropriate weight, no fetal morbidity, and no maternal morbidity related to coagulation disorder in the mother. CONCLUSIONS Conservative management under close monitoring until term in monochorionic twin pregnancy with single fetal death could be the best option to obtain a favorable outcome. We recommend conservative management with close surveillance monitoring using non-stress tests after 32 weeks, biweekly ultrasound, and at least of one maternal coagulation profile test.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767614","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