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Sprohnle-Barrera CH, Gibson JS, Price R, Graham RM, Jennison AV, Ricca MR, Allavena RE. Fatal non-traumatic gas gangrene caused by Clostridium perfringens type A in a Siberian Husky dog. J Vet Diagn Invest 2022; 34:518-522. [PMID: 35179099 PMCID: PMC9254053 DOI: 10.1177/10406387221079066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 8-y-old, castrated male Siberian Husky dog was admitted to an emergency clinic with acute collapse and severe swelling of both forelimbs, ventral thorax, and axillary region. The clinical assessment, with laboratory tests and radiologic investigation, confirmed severe subcutaneous emphysema and multi-organ failure. The animal died while receiving emergency treatment. On postmortem examination, Clostridium perfringens was isolated from the subcutaneous fluid and the effusion from the thoracic and abdominal cavities. Relevant histopathology findings included subcutaneous emphysema and multi-organ perivascular and intravascular, intralesional myriad 0.5-3-µm gram-positive rod bacteria, with no associated inflammation. Whole-genome sequencing and phylogenetic analysis identified C. perfringens type A. Virulence genes detected included cpa (alpha toxin), cadA (v-toxin), colA (collagenase A), nagH (hyaluronidase), nanH, nanI, nanJ (sialidases), and pfoa (perfringolysin). These virulence genes have previously been reported to act synergistically with alpha toxin in C. perfringens-mediated gas gangrene.
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Affiliation(s)
- Cleide H. Sprohnle-Barrera
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia (Sprohnle-Barrera, Gibson, Price, Allavena)
| | - Justine S. Gibson
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia (Sprohnle-Barrera, Gibson, Price, Allavena)
| | - Rochelle Price
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia (Sprohnle-Barrera, Gibson, Price, Allavena)
| | - Rikki M. Graham
- Public Health Microbiology, Queensland Reference Centre for Microbial and Public Health Genomics (MPHG), Forensic and Scientific Services, Health Support Queensland, Queensland Health, Brisbane, QLD, Australia (Graham, Jennison)
| | - Amy V. Jennison
- Public Health Microbiology, Queensland Reference Centre for Microbial and Public Health Genomics (MPHG), Forensic and Scientific Services, Health Support Queensland, Queensland Health, Brisbane, QLD, Australia (Graham, Jennison)
| | | | - Rachel E. Allavena
- Rachel E. Allavena, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia.
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Yang YC, Lee KH, Hsu CW, Cheng FJ, Tsai IT, Kong WM. Acute Onset of a Swollen Leg With Crepitus: A Complication With Rectal Perforation. J Acute Med 2019; 9:29-33. [PMID: 32995227 DOI: 10.6705/j.jacme.201903_9(1).0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Crepitus happened into the soft tissue is indicated subcutaneous emphysema. Subcutaneous emphysema of leg without trauma was likely to diagnose gas gangrene or gas-forming myonecrosis (GFM) at emergency department (ED). On the other hand, abdominal fatal condition with gas from the gut may spread to the leg should be considered a different diagnosis. We report a case of critically ill patient who presented to the ED with initial features suggestive of necrotizing fasciitis with gas gangrene of left leg. Assessment and further intervention revealed subcutaneous emphysema of leg secondary to a perforation of rectum associated with previous anastomosis site for rectal cancer surgery. Subcutaneous emphysema of the leg rarely happened secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems which may lead to mortality. Consequently, prompt diagnosis and aggressive treatment is imperative. Physicians and surgeons should be aware of this condition that could be fatal but curable by early intervention.
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Affiliation(s)
- Yun-Chun Yang
- E-Da Hospital, I-Shou University Department of Emergency Medicine No. 1, Yida Rd. Jiaosu Vlg., Yanchao Dist. Kaohsiung 824 Taiwan
| | - Kuo-Hsin Lee
- E-Da Hospital, I-Shou University Department of Emergency Medicine No. 1, Yida Rd. Jiaosu Vlg., Yanchao Dist. Kaohsiung 824 Taiwan .,I-Shou University School of Medicine for International Student Kaohsiung 824 Taiwan
| | - Chih-Wei Hsu
- E-Da Hospital, I-Shou University Department of Emergency Medicine No. 1, Yida Rd. Jiaosu Vlg., Yanchao Dist. Kaohsiung 824 Taiwan .,I-Shou University School of Medicine for International Student Kaohsiung 824 Taiwan
| | - Fu-Jen Cheng
- E-Da Hospital, I-Shou University Department of Emergency Medicine No. 1, Yida Rd. Jiaosu Vlg., Yanchao Dist. Kaohsiung 824 Taiwan
| | - I-Ting Tsai
- E-Da Hospital, I-Shou University Department of Emergency Medicine No. 1, Yida Rd. Jiaosu Vlg., Yanchao Dist. Kaohsiung 824 Taiwan
| | - Wai-Ming Kong
- E-Da Hospital, I-Shou University Department of Emergency Medicine No. 1, Yida Rd. Jiaosu Vlg., Yanchao Dist. Kaohsiung 824 Taiwan
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Mallia AJ, Ashwood N, Arealis G, Galanopoulos I. Retroperitoneal abscess: an extra-abdominal manifestation. BMJ Case Rep 2015; 2015:bcr-2014-207437. [PMID: 25576509 DOI: 10.1136/bcr-2014-207437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.
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Affiliation(s)
- Alvin James Mallia
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Neil Ashwood
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - George Arealis
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
| | - Ilias Galanopoulos
- Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton on Trent, UK
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Monneuse O, Gruner L, Barth X, Malick P, Timsit M, Gignoux B, Tissot E. [Gas gangrene of the abdominal wall due to underlying GI pathology: seven cases]. ACTA ACUST UNITED AC 2008; 144:307-12. [PMID: 17925736 DOI: 10.1016/s0021-7697(07)91959-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Gas gangrene of the abdominal wall is a rare clinical occurrence with high rates of morbidity and mortality. The primary source of the infection is often unknown. To analyze the primary underlying intestinal etiologies and diagnostic approaches of gas gangrene of the abdominal wall, and to highlight specific treatment problems, particularly that of constructing a colostomy exteriorized through a massively infected abdominal wall. PATIENTS AND METHODS Seven cases of abdominal wall gas gangrene due to a gastrointestinal etiology were identified. (Cases arising from proctologic sources or related to recent abdominal surgery were excluded.) During the same period, 39 other patients presenting with abdominal wall gangrene from non-intestinal sources were treated. RESULTS The etiologies were: perforated sigmoid diverticulitis (n=2), perforated appendicitis (n=1), acute pancreatitis with associated cecal perforation (n=1), and perforated colorectal cancer (n=3). Four of the seven patients died despite treatment (mortality of 57%). CONCLUSION The clinical presentations of these seven cases demonstrate that a GI source must be suspected whenever a patient presents with abdominal wall gas gangrene, even when there are no specific GI symptoms. Imaging, particularly with CT scan, is essential both to visualize the extent of tissue necrosis and to reveal underlying primary GI pathology. This optimizes the surgical approach both by allowing for complete debridement and drainage of infected tissue, and by focussing the intervention on correction of the underlying primary GI source of infection.
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Affiliation(s)
- O Monneuse
- Service d'Urgences Chirurgicales Viscérales, Hôpital Edouard Herriot - Lyon
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Kobayashi S, Negoro K, Uchida K, Kokubo Y, Takeno K, Yayama T, Katayama K, Yamaguchi A, Baba H. Successful treatment of nonclostridial gas gangrene extending from retroperitoneum to thigh associated with occult cecal cancer. J Orthop Sci 2007; 12:585-91. [PMID: 18040642 DOI: 10.1007/s00776-007-1172-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 06/20/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Shigeru Kobayashi
- Department of Orthopaedics, Fukui University School of Medicine, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Fukui, 910-1193, Japan
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Yildiz M, Karakayali AS, Ozer S, Ozer H, Demir A, Kaptanoglu B. Acute appendicitis presenting with abdominal wall and right groin abscess: A case report. World J Gastroenterol 2007; 13:3631-3. [PMID: 17659716 PMCID: PMC4146805 DOI: 10.3748/wjg.v13.i26.3631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.
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Affiliation(s)
- Mustafa Yildiz
- Department of General Surgery, Ministry of Health Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey.
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Hsieh CH, Wang YC, Yang HR, Chung PK, Jeng LB, Chen RJ. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: An extremely fulminant form of a common disease. World J Gastroenterol 2006; 12:496-9. [PMID: 16489659 PMCID: PMC4066078 DOI: 10.3748/wjg.v12.i3.496] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.
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Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, China
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8
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Postma VA, Engelbrecht MR, de Rooy JW, Nagtegaal ID, Wobbes T. Sister Joseph's Nodule and pneumatosis: A rare presentation of ovarian cancer. Gynecol Oncol 2005; 99:517-8. [PMID: 16126265 DOI: 10.1016/j.ygyno.2005.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 06/27/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The condition of pneumatosis intestinalis is characterized by gas in the intestinal wall, with a variety of causes. CASE A septic patient with intestinal pneumatosis, locally advanced ovarian cancer, and Sister Joseph's Nodule. CONCLUSION The clinical significance of this rare combination of symptoms and signs is discussed.
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Affiliation(s)
- Victor A Postma
- Department of Surgical Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, The Netherlands.
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9
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Lee KB, Moon ES, Jung ST, Seo HY. Subcutaneous emphysema mimicking gas gangrene following perforation of the rectum: a case report. J Korean Med Sci 2004; 19:756-8. [PMID: 15483358 PMCID: PMC2816345 DOI: 10.3346/jkms.2004.19.5.756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of extensive subcutaneous emphysema of the lower extremity mimicking gas gangrene following perforation of the rectum in a 38-yr-old man. Subcutaneous emphysema of the leg may rarely occur secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems and high mortality rates. Therefore, prompt diagnosis and aggressive treatment is imperative.
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Affiliation(s)
- Keun-Bae Lee
- Department of Orthopaedic Surgery, Chonnam National University School of Medicine, Gwangju, Korea.
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10
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Abstract
The risk of bacteremia in patients with cirrhosis increases with more advanced Child classification. Escherichia coli is the most frequently implicated organism in these bacteremic episodes. Unusually, E. coli can produce a bullous cellulitis or myonecrosis. Two previous cases of E. coli-associated myonecrosis in patients with cirrhosis have been reported. We describe a third case in a cirrhotic patient with E. coli-associated bilateral lower extremity gas gangrene and review the existing literature. In the three patients with cirrhosis and E. coli myonecrosis, no obvious gastrointestinal perforation was found as the source of bacteremia. Intestinal edema due to portal hypertension is thought to have facilitated mucosal microperforations and bacteremia. Awareness of this unusual presentation may facilitate earlier diagnosis.
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Affiliation(s)
- Vivian Levy
- Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, California 94305, USA.
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11
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Case Report: A Giant Leg Abscess in a Patient With Dementia. J Am Med Dir Assoc 2002. [DOI: 10.1016/s1525-8610(04)70531-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Ríos Zambudio A, Piñero Madrona A, González Sánchez F, Parrilla Paricio P. [Subcutaneous emphysema of the lower limb as presenting manifestation of colon dehiscence]. Rev Clin Esp 2002; 202:571-2. [PMID: 12361563 DOI: 10.1016/s0014-2565(02)71149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Ito T, Shiraki K, Sekoguchi K, Hamada M, Yamanaka T, Takase K, Nakano T. Metastatic gas gangrene of the leg due to acute emphysematous cholecystitis. Dig Dis Sci 2001; 46:2480-3. [PMID: 11713957 DOI: 10.1023/a:1012336222483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- T Ito
- First Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan
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Affiliation(s)
- S D Pande
- Purley Hospital, Purley, CR8 2YL, Surrey, UK
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15
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Abstract
Leg pain may be a presenting symptom of intra-abdominal disease. I report a case of subcutaneous emphysema of the thigh that was a complication of diverticular perforation and abscess formation. Healthy leg muscle was found at operation, showing that myonecrosis need not necessarily be present even with finding of extensive gas accumulation.
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822, USA
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Murata K, Shimizu A, Takase K, Nakano T, Tameda Y. Liver cirrhosis with synchronous gas gangrene and spontaneous bacterial peritonitis due to E. coli. J Gastroenterol 1997; 32:264-7. [PMID: 9085180 DOI: 10.1007/bf02936380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of synchronous gas gangrene and spontaneous bacterial peritonitis associated with liver cirrhosis. The patient was a 52-year-old man who was being followed for decompensated liver cirrhosis. He experienced sudden onset lower abdominal pain with distension and pain in the left leg. A bullous lesion, with crepitation, later appeared in the thigh and showed air-bubbles on X-ray. Eschericia coli was cultured from ascites and the bullous lesions; there was associated gas gangrene. The patient died of bacteremia with disseminated intravascular coagulopathy 26 h after admission, despite receiving intensive care. We discuss the route of bacteria causing the spontaneous bacterial peritonitis and simultaneous gas gangrene.
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Affiliation(s)
- K Murata
- First Department of Internal Medicine, Mie University School of Medicine, Japan
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Jager GJ, Joosten F, vd Berkmortel FW, Salemans JM. Subcutaneous emphysema of the lower extremity secondary to a perforated esophageal carcinoma. ABDOMINAL IMAGING 1995; 20:23-5. [PMID: 7894292 DOI: 10.1007/bf00199637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The psoas muscle is a potential pathway of disease from the mediastinum to the leg. We describe a case of subcutaneous emphysema of the lower extremity due to a perforated esophageal carcinoma in a 58-year-old man.
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Affiliation(s)
- G J Jager
- Department of Diagnostic Radiology, University Hospital St Radboud, Nijmegen, The Netherlands
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