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Iwado T, Honda H, Gotoda T. A case of idiopathic gastroesophageal submucosal hematoma in a patient with no predisposition to bleeding. DEN OPEN 2024; 4:e284. [PMID: 37614750 PMCID: PMC10442609 DOI: 10.1002/deo2.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
Gastroesophageal submucosal hematoma is a disease in which blood vessels in the gastroesophageal submucosa rupture and form a hematoma. In this report, we describe a case of gastroesophageal submucosal hematoma that developed due to vomiting in a patient with no history of bleeding and resolved with conservative treatment. A 69-year-old man presented with precordial pain and hematemesis after vomiting. A diagnosis of idiopathic gastroesophageal submucosal hematoma was made by computed tomography scan, magnetic resonance imaging, and esophagogastroduodenoscopy. Healing was achieved by conservative treatment with fasting, rehydration, and acid suppression. When a patient presents with sudden chest pain, hematemesis, and dysphagia, the possibility of this disease should be considered.
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Affiliation(s)
- Takaaki Iwado
- Department of Gastroenterology and HepatologyKurashiki Central HospitalOkayamaJapan
| | - Hirokazu Honda
- Department of Gastroenterology and HepatologyKurashiki Central HospitalOkayamaJapan
| | - Tatsuhiro Gotoda
- Department of Gastroenterology and HepatologyKurashiki Central HospitalOkayamaJapan
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2
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Martínez-Checa Guiote J, Utrilla Contreras C, García Raya P, Ossaba Vélez S, Martí de Gracia M, Garzón Moll G. Checklist: Neck computed tomography in non-traumatic emergencies. RADIOLOGIA 2024; 66:155-165. [PMID: 38614531 DOI: 10.1016/j.rxeng.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/04/2023] [Indexed: 04/15/2024]
Abstract
Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.
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Affiliation(s)
| | | | - P García Raya
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - S Ossaba Vélez
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - M Martí de Gracia
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - G Garzón Moll
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
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3
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Yamamoto H, Isogai J. Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report. Heliyon 2023; 9:e19555. [PMID: 37809423 PMCID: PMC10558803 DOI: 10.1016/j.heliyon.2023.e19555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early diagnosis of TCP remains difficult. Case presentation A 51-year-old man presented with fever, chest pain, and dyspnea following preceding flu symptoms. An initial investigation suggested right-sided heart failure. Laboratory results revealed elevated inflammatory markers and hepatic enzyme levels. Echocardiography revealed pericardial effusion with a normal ejection fraction and diastolic ventricular septal bounce suggestive of pericardial constriction. Computed tomography suggested acute descending mediastinitis with pericarditis and pleuritis; however, detailed examinations ruled out this possibility. The constellation of increased serological inflammation, pericardial thickness/effusion, and constrictive physiology suggested TCP, confirmed by cardiac magnetic resonance (CMR) and hemodynamic studies. CMR also revealed coexistent myocarditis. After a thorough assessment for the cause of TCP, a viral etiology was suspected. Paired serology for virus antibody titers revealed a significant increase only in coxsackievirus A4 (CVA4) titers. With prompt anti-inflammatory treatment, the patient's pericardial structure and function and concomitant inflammation of the surrounding tissues were nearly completely recovered, leading to a final diagnosis of TCP caused by CVA4. The subsequent clinical course was uneventful without recurrence at the 1-year follow-up. Conclusions Here we described the first case of TCP caused by CVA4 concurrent with mediastinitis, myocarditis, and pleuritis, all of which were successfully resolved with anti-inflammatory treatment. Acute mediastinitis secondary to TCP is rare. This case highlights the clinical importance of assessing pericardial diseases as a source of acute mediastinitis and considering CVA4 as an etiology of TCP. An evaluation including multimodal cardiac imaging and serology for virus antibody titers may be useful for an exploratory diagnosis of TCP in right-sided heart failure patients with pericardial effusion.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Jun Isogai
- Division of Radiology, Asahi General Hospital, Asahi, Japan
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Tola GG, Tesso BA, Shale WT. A giant toxic multinodular goiter extending into the retropharyngeal space: A case report. Int J Surg Case Rep 2023; 109:108543. [PMID: 37487349 PMCID: PMC10374955 DOI: 10.1016/j.ijscr.2023.108543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION In areas with iodine deficiency, multinodular goiter is a prevalent cause of hyperthyroidism. If left untreated, it can grow until it is noticeably huge in size. Although it is a rare clinical phenomenon, thyroid swelling extending into the retro-pharyngeal space presents a substantial difficulty for the surgeon. In this article, we report a giant thyroid mass that had extended to the retro-pharyngeal space and how it posed a challenge during surgery. CASE PRESENTATION Female, 30-year-old, presented with a huge goiter of 15 years duration which extended to retro-visceral space and completely encircled them without extension to retro-sternal space. After the patient was rendered euthyroid with propylthiouracil (PTU), the thyroid mass was removed surgically. Postoperatively, the patient developed only a transient, asymptomatic hypocalcemia, as a complication. DISCUSSION If a goiter is large enough, it can grow inferiorly into the mediastinum and outside the typical boundaries of the thyroid bed. However, they rarely grow into the retro-pharyngeal space and present a management issue. The management of this patient was also more complicated as the goiter grew enormous and giant, particularly when it came to controlling the airway and surgically removing the tumor. CONCLUSION A preoperative CT scan is an important part of diagnostic studies for a giant goiter to diagnose extrathyroidal bed extension. Total or near-total thyroidectomy through a large cervical incision is the mainstay of treatment for such patients to relieve compression symptoms and treat associated hyperthyroidism.
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Affiliation(s)
- Gutu Ganati Tola
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
| | - Birhanu Abdisa Tesso
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Wongel Tena Shale
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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5
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Khanna L, Vargas D, Menias C‘C, Katabathina V. Oncologic Emergencies in the Chest, Abdomen, and Pelvis. Radiol Clin North Am 2023; 61:91-110. [DOI: 10.1016/j.rcl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Zukowska A, Zukowski M. Surgical Site Infection in Cardiac Surgery. J Clin Med 2022; 11:jcm11236991. [PMID: 36498567 PMCID: PMC9738257 DOI: 10.3390/jcm11236991] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy.
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Affiliation(s)
- Agnieszka Zukowska
- Department of Infection Control, Regional Hospital Stargard, 73-110 Stargard, Poland
| | - Maciej Zukowski
- Department of Anesthesiology, Intensive Care and Acute Intoxication, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence: ; Tel.: +48-504-451-924
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7
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Huang D, Wilson J, Ganti L. Isolated shoulder pain secondary to pacer lead perforation. J Am Coll Emerg Physicians Open 2022; 3:e12615. [PMID: 35387322 PMCID: PMC8964928 DOI: 10.1002/emp2.12615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Derrick Huang
- Ocala Regional Medical Center Ocala Florida USA
- HCA Healthcare University of Central Florida Graduate Medical Consortium Orlando Florida USA
| | - James Wilson
- Ocala Regional Medical Center Ocala Florida USA
- HCA Healthcare University of Central Florida Graduate Medical Consortium Orlando Florida USA
- Envision Physician Services Plantation Florida USA
| | - Latha Ganti
- Ocala Regional Medical Center Ocala Florida USA
- HCA Healthcare University of Central Florida Graduate Medical Consortium Orlando Florida USA
- Envision Physician Services Plantation Florida USA
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8
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Goyal N, Keir G, Pavlica M, Little BP. Nonpulmonary Infections of the Thorax. Semin Roentgenol 2022; 57:105-118. [DOI: 10.1053/j.ro.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022]
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9
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Hu JW, Zhao Q, Hu CY, Wu J, Lv XY, Jin XH. Rare spontaneous extensive annular intramural esophageal dissection with endoscopic treatment: A case report. World J Clin Cases 2021; 9:11467-11474. [PMID: 35071579 PMCID: PMC8717524 DOI: 10.12998/wjcc.v9.i36.11467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intramural esophageal dissection (IED) is a rare disease that should be considered in patients with chest pain, dysphagia, and hematemesis. Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy, the incidence of spontaneous IED without an obvious causative agent has risen gradually.
CASE SUMMARY This report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month. Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing, prominent luminal dilation, obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity, and no obvious extravasation. Gastroscopy revealed smooth esophageal mucosa; several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor. The mucosal surface was occasionally rough and uneven, and the length of the esophageal mucosal defect exceeded 10 cm. The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes. The final diagnosis was spontaneous extensive annular IED. We treated the patient successfully using endoscopic esophagotomy, which completely relieved the symptoms without complications.
CONCLUSION Spontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.
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Affiliation(s)
- Jian-Wen Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Qian Zhao
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Chi-Yv Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Jie Wu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Xiang-Yin Lv
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Xiang-Hong Jin
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
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Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, Hortal J, Lasso J, Mestres CA, Miró JM, Navas E, Nieto M, Parra A, Pérez de la Sota E, Rodríguez-Abella H, Rodríguez-Créixems M, Rodríguez-Roda J, Sánchez Espín G, Sousa D, Velasco García de Sierra C, Muñoz P, Kestler M. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections ( SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery ( SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases ( CIBERES). J Clin Med 2021; 10:5566. [PMID: 34884268 PMCID: PMC8658224 DOI: 10.3390/jcm10235566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | | | - Juan Gálvez
- Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Francisco Gutiérrez-Díez
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | - Javier Hortal
- Anesthesia and Intensive Care Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - José Lasso
- Plastic Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Carlos A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - José M. Miró
- Infectious Diseases Services, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Enrique Navas
- Infectious Diseases Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
| | - Mercedes Nieto
- Cardiovascular Unit, Intensive Care Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Antonio Parra
- Department of Radiology, Marquez de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | | | - Hugo Rodríguez-Abella
- Cardiac Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Marta Rodríguez-Créixems
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | - Gemma Sánchez Espín
- Heart Clinical Management Unit, Virgen de la Victoria University Hospital, 29006 Malaga, Spain;
| | - Dolores Sousa
- Infectious Diseases Department, A Coruña Hospital Complex, 15006 A Coruña, Spain;
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | - Martha Kestler
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
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11
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Varona Porres D, Persiva O, Sánchez AL, Cabanzo L, Pallisa E, Andreu J. Finding the bubble: atypical and unusual extrapulmonary air in the chest. RADIOLOGIA 2021; 63:358-369. [PMID: 34246426 DOI: 10.1016/j.rxeng.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. CONCLUSION In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).
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Affiliation(s)
- D Varona Porres
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain.
| | - O Persiva
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - A L Sánchez
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - L Cabanzo
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - E Pallisa
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - J Andreu
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
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Varona Porres D, Persiva O, Sánchez A, Cabanzo L, Pallisa E, Andreu J. Buscando la burbuja: aire torácico extrapulmonar atípico e inusual. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tabotta F, Ferretti GR, Prosch H, Boussouar S, Brun AL, Roos JE, Ebner L, Letovanec I, Brauner M, Beigelman-Aubry C. Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases. Insights Imaging 2020; 11:111. [PMID: 33057984 PMCID: PMC7561640 DOI: 10.1186/s13244-020-00909-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023] Open
Abstract
Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions. This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials. First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient’s history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals. Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2–3 weeks. Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum.
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Affiliation(s)
- Flavian Tabotta
- Radiodiagnostic and Interventional Radiology, CHUV-University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Gilbert R Ferretti
- Department of Diagnostic and Interventional Radiology, Grenoble Alpes University Hospital, Grenoble Alpes University, 38043, Grenoble cedex, France
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Samia Boussouar
- Radiology Department Pitié Salpetrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Anne-Laure Brun
- Department of Radiology, Cochin Hospital, Paris Descartes University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Justus E Roos
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Spitalstrasse 6000, Luzern 16, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Igor Letovanec
- Institute of Pathology, CHUV-University Hospital, Rue du Bugnon 25, CH-1011, Lausanne, Switzerland
| | - Michel Brauner
- Service de Radiologie, Hôpital Avicenne, 125 route de Stalingrad, 93000, Bobigny, France
| | - Catherine Beigelman-Aubry
- Radiodiagnostic and Interventional Radiology, CHUV-University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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Cossu A, Martin Rother MD, Kusmirek JE, Meyer CA, Kanne JP. Imaging Early Postoperative Complications of Cardiothoracic Surgery. Radiol Clin North Am 2020; 58:133-150. [DOI: 10.1016/j.rcl.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sharma B, Lowe D, Antoine M, Shah M, Szyjkowski R. Intramural Esophageal Hematoma Secondary to Food Ingestion. Cureus 2019; 11:e5623. [PMID: 31696016 PMCID: PMC6820886 DOI: 10.7759/cureus.5623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intramural esophageal hematoma (IEH) is a rare cause of submucosal esophageal bleeding and it is on the spectrum of esophageal wall injury along with mucosal tears (Mallory-Weiss syndrome) and full thickness perforation (Boerhaave's syndrome). Its risk factors include coagulopathy, trauma (foreign body ingestion or esophageal instrumentation) or it can happen spontaneously. It presents with a triad of chest pain, dysphagia, and hematemesis; however, the triad is only present in 35% of patients. We are presenting a case of IEH secondary to food ingestion that was managed successfully by conservative measures.
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Affiliation(s)
- Bashar Sharma
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Dhruv Lowe
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
| | - Marsha Antoine
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Mili Shah
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Ronald Szyjkowski
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
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López-Frías López-Jurado A, Pecharromán de Las Heras I, Pérez Templado Ladrón de Guevara J. An Unusual Case of Descending Necrotizing Mediastinitis. Arch Bronconeumol 2019; 55:435. [PMID: 30651175 DOI: 10.1016/j.arbres.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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17
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Imaging findings of complications after thoracic surgery. Jpn J Radiol 2019; 37:209-219. [PMID: 30637569 DOI: 10.1007/s11604-018-00806-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Many surgical procedures are used for the treatment of lung, heart, and mediastinal diseases. The techniques can result in postoperative complications. The nature of these complications differs according to the duration of thoracic surgery and the onset of the complication. The complications occurring within 1 month and more than 1 month generally considered as early and late complications, respectively. Chest radiographs and CT scans obtained in patients who have undergone thoracic surgery show normal changes during the surgical procedure and diverse postsurgical complications. Familiarity with the clinical and radiologic findings of the normal alterations and possible complications after thoracic surgery is crucial in minimizing the increased morbidity and mortality.
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18
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Mandavdhare HS, Gupta P, Maity P, Sharma V. Image Diagnosis: Esophageal Intramural Hematoma in Sudden-Onset Chest Pain and Dysphagia. Perm J 2018; 23:18-141. [PMID: 30589409 DOI: 10.7812/tpp/18-141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pankaj Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Maity
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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19
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Mark R, Song S, Mark P. Taking heed of the 'danger space': acute descending necrotising mediastinitis secondary to primary odontogenic infection. BMJ Case Rep 2018; 2018:bcr-2018-225019. [PMID: 29848536 DOI: 10.1136/bcr-2018-225019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or 'danger' space, a potential anatomical space posterior to the true retropharyngeal space.1 Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention.2-4 This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.
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Affiliation(s)
- Rose Mark
- Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Swithin Song
- Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Peter Mark
- Radiology, Fiona Stanley Hospital, Murdoch, Australia
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20
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Intramural Hematoma of the Esophagus Complicating Severe Preeclampsia. Case Rep Obstet Gynecol 2017; 2017:6304194. [PMID: 28607783 PMCID: PMC5451774 DOI: 10.1155/2017/6304194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/22/2017] [Accepted: 04/27/2017] [Indexed: 12/29/2022] Open
Abstract
Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forceful vomiting and coagulopathy are common underlying causes in the elderly population taking antiplatelets or anticoagulation agents. Acute retrosternal pain followed by hematemesis and dysphagia differentiates the hematoma from other cardiac or thoracic emergencies, including acute myocardial infarction or aortic dissection. Direct inspection by endoscopy is useful, but chest computed tomography best assesses the degree of obliteration of the lumen and excludes other differential diagnoses. Intramural hematoma of the esophagus is generally benign and most patients recover fully with conservative treatment. Bleeding can be managed medically unless in hemodynamically unstable patients, for whom surgical or angiographic treatment may be attempted; only rarely esophageal obstruction requires endoscopic decompression. We report an unusual case of esophageal hematoma, presenting in a young preeclamptic woman after surgical delivery of a preterm twin pregnancy, with a favorable outcome following medical management.
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21
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Chida Y, Inokuchi R, Ishida T, Shinohara K. Spontaneous mediastinal haematoma. BMJ Case Rep 2016; 2016:bcr-2016-217799. [PMID: 27793874 DOI: 10.1136/bcr-2016-217799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yasuyuki Chida
- Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Ryota Inokuchi
- Emergency and Critical Care Medicine, The University of Tokyo Hospital, BunkyoKu, Japan
| | - Tokiya Ishida
- Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Kazuaki Shinohara
- Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Japan
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22
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Sipe A, McWilliams SR, Saling L, Raptis C, Mellnick V, Bhalla S. The red connection: a review of aortic and arterial fistulae with an emphasis on CT findings. Emerg Radiol 2016; 24:73-80. [DOI: 10.1007/s10140-016-1433-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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23
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Chronic Esophageal Perforation With Periesophageal Abscess Mimicking Malignancy on FDG PET/CT. Clin Nucl Med 2016; 41:494-6. [DOI: 10.1097/rlu.0000000000001180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR. From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography. ACTA ACUST UNITED AC 2016; 39:802-23. [PMID: 24584681 DOI: 10.1007/s00261-014-0110-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While confirming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specific findings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.
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Affiliation(s)
- Andrew J Del Gaizo
- Department of Radiology, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC, 27157, USA,
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25
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Jennings S, Peeceeyen S, Horton M. Tension pneumomediastinum after blunt chest trauma. ANZ J Surg 2013; 85:90-1. [PMID: 24172602 DOI: 10.1111/ans.12378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Scott Jennings
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, New South Wales, Australia
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26
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Katabathina VS, Restrepo CS, Betancourt Cuellar SL, Riascos RF, Menias CO. Imaging of Oncologic Emergencies: What Every Radiologist Should Know. Radiographics 2013; 33:1533-53. [DOI: 10.1148/rg.336135508] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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27
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Spontaneous esophageal hematoma in a patient with atrial fibrillation. Ann Thorac Surg 2013; 95:1089-91. [PMID: 23438542 DOI: 10.1016/j.athoracsur.2012.07.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 06/27/2012] [Accepted: 07/16/2012] [Indexed: 11/21/2022]
Abstract
We report a case of a spontaneous esophageal hematoma in an anticoagulated patient with atrial fibrillation previously complicated by a cerebrovascular accident. A multidisciplinary discussion resulted in holding of anticoagulation until the esophageal hematoma resolved. The patient was managed nonoperatively and discharged, but returned with a new neurologic deficit 3 weeks later. Aspirin treatment was resumed. After complete resolution of hematoma on outpatient scans, warfarin treatment was restarted. The challenges of managing an esophageal hematoma in a patient requiring anticoagulation are discussed.
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28
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Krishnan S, Papworth DP, Farivar RS, Ueda K. Identification of coronary sinus injury by transesophageal echocardiography during placement of a retrograde cardioplegia catheter for minimally invasive cardiac surgery. Anesth Analg 2013; 116:560-2. [PMID: 23400977 DOI: 10.1213/ane.0b013e31827bc352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sundar Krishnan
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52246, USA.
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29
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Hong M, Warum D, Karamanian A. Spontaneous intramural esophageal hematoma (IEH) secondary to anticoagulation and/or thrombolysis therapy in the setting of a pulmonary embolism: a case report. J Radiol Case Rep 2013; 7:1-10. [PMID: 23705034 DOI: 10.3941/jrcr.v7i2.1210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Intramural esophageal hematoma is part of a spectrum of esophageal injuries. Vomiting and straining, endoscopic procedures and bleeding disorders are the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia and hematemesis. Computed tomography is the modality of choice and treatment is medically conservative with the cessation of Warfarin and thrombolysis use. When anticoagulation and/or thrombolysis therapy is necessary, periodic reassessment for symptoms of intramural esophageal hematoma may be helpful for early identification and management. We described one case of intramural esophageal hematoma possibly resulting from anticoagulation and/or thrombolysis therapy in the setting of pulmonary embolism.
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Affiliation(s)
- Melina Hong
- Saba University School of Medicine, Saba, Netherland-Antilles.
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30
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Sliker CW, Steenburg SD, Archer-Arroyo K. Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene. Emerg Radiol 2012; 20:185-95. [PMID: 23065070 DOI: 10.1007/s10140-012-1082-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Abstract
An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.
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Affiliation(s)
- Clint W Sliker
- Diagnostic Imaging Department, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
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31
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Abstract
We report the case of a patient with an intramural hematoma of the esophagus. This rare condition is more common in elderly women and can be misdiagnosed as cardiovascular or other digestive emergent disease. The classical clinical triad includes chest pain, sudden dysphagia or odynophagia and minor hematemesis. Known precipitating factors are Valsalva maneuver, blunt, direct or iatrogenic injuries, but spontaneous cases have also been described. Chest imaging including computed tomography or magnetic resonance imaging as well as upper gastrointestinal endoscopy are useful tools for diagnosis. The treatment is conservative and the prognosis usually excellent with complete resolution within a few weeks.
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Affiliation(s)
- Dahlia Thao Cao
- Department of Medical Specialties, Gastroenterology and Hepatology Division, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
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