Case Reports International最新文献

筛选

英文中文

Emergent use of a central venous catheter placed in the internal mammary vein 紧急使用置入乳内静脉的中心静脉导管

Case Reports International Pub Date : 2024-06-15 DOI: 10.5348/100127z06rj2024cr

Richard Jensen, Ashley G Henderson

{"title":"Emergent use of a central venous catheter placed in the internal mammary vein","authors":"Richard Jensen, Ashley G Henderson","doi":"10.5348/100127z06rj2024cr","DOIUrl":"https://doi.org/10.5348/100127z06rj2024cr","url":null,"abstract":"\u0000 Introduction: Central venous catheter (CVC) insertion plays an important role in critical care medicine, often utilized for vasopressor administration, volume resuscitation, reliable venous access, and central venous pressure monitoring. However, there are potential complications associated with placement, including arterial cannulation, catheter fragmentation, venous injury, pneumothorax, and malposition into a tributary vessel.\u0000\u0000 Case Report: A 35-year-old woman with a history of severe psoriasis with recurrent superinfection, and right internal jugular (RIJ) venous thrombosis was transferred to the intensive care unit with septic shock. A CVC was inserted via left internal jugular (LIJ) to facilitate antimicrobial administration and continued vasopressor support, as it was patent by bedside ultrasound. The patient was asymptomatic during and after CVC placement. However, post-procedure chest X-ray demonstrated a CVC projecting directly inferiorly, ending over the left hemidiaphragm. After review of recent cross-sectional imaging, physical examination, blood gas assessment, and ultrasound evaluation, the catheter was thought to be within the internal mammary vein (IMV). Given the patient’s instability and being asymptomatic after line placement with the CVC functioning normally, the decision was made to temporarily use the line. The next day, its placement was confirmed by using computed tomography (CT).\u0000\u0000 Conclusion: Miscannulation of a tributary vessel during CVC placement can cause significant morbidity and even mortality. However, it has been postulated that a line placed within the IMV could be used safely in the emergent setting. Our case demonstrates the safe utilization of a CVC within the IMV and provides a reasonable framework for approaching a misplaced LIJ CVC.\u0000","PeriodicalId":514212,"journal":{"name":"Case Reports International","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336689","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

Heterotopic pregnancy and the influence of letrozole 异位妊娠和来曲唑的影响

Case Reports International Pub Date : 2024-05-17 DOI: 10.5348/100126z06lo2024cr

Lovingly Ocampo, Sheeva Bahrampour, Pietra Herrero Pincinato, Adeline Bray, Adele El Kareh, Amelia Lisa Maas

{"title":"Heterotopic pregnancy and the influence of letrozole","authors":"Lovingly Ocampo, Sheeva Bahrampour, Pietra Herrero Pincinato, Adeline Bray, Adele El Kareh, Amelia Lisa Maas","doi":"10.5348/100126z06lo2024cr","DOIUrl":"https://doi.org/10.5348/100126z06lo2024cr","url":null,"abstract":"\u0000 Introduction: Heterotopic pregnancy has become increasingly common following increased use of assisted reproductive techniques. We will examine one uncommon instance of a heterotopic pregnancy occurring in the setting of a young woman undergoing letrozole therapy for primary infertility, making it an uncommonly seen case.\u0000\u0000 Case Report: We report a young otherwise healthy female G1P0 at approximately 6 weeks gestation, who was referred from her primary care office to the Emergency Department with progressive abdominal pain that started 12 hours prior and had started to exhibit signs of hemodynamic instability. History was significant for difficulty with conception requiring letrozole treatment. Emergency laparoscopy was performed and confirmed additional ectopic pregnancy in the right fallopian tube with blood originating from the fimbriated end. Evacuation of hemoperitoneum and removal of ectopic pregnancy was completed without complication. She was discharged from the hospital in stable condition.\u0000\u0000 Conclusion: In any woman of reproductive age presenting with lower abdominal pain or abnormal bleeding, there should be a strong suspicion for a pregnancy until confirmed otherwise. These patients may benefit from prompt imaging with pelvic ultrasound to assist in earlier detection of ectopic embryo implantation and, subsequently, earlier intervention. Salpingectomy, ideally via laparoscopic approach, remains the gold standard for diagnosis and treatment of patients with a ruptured ectopic pregnancy in the setting of a heterotopic pregnancy, although surgical intervention is associated with poorer outcomes for the intrauterine pregnancy.\u0000","PeriodicalId":514212,"journal":{"name":"Case Reports International","volume":"53 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965655","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