Acute Type A Aortic Dissection Diagnosed by POCUS in a 29-year-old Man
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SUBMITTER: Cardenas Lopez V
PROVIDER: S-EPMC10700150 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundGranulomatosis with polyangiitis (GPA) is characterised by the main violation of the upper and lower respiratory tract and kidney. GPA is considered a systemic vasculitis of medium-sized and small blood vessels where aortic involvement is extremely rare.Case presentationA 28-year-old male was admitted to the hospital due to 4 h of chest pain. Computed tomography scan of the aorta showed a thickened aortic wall, pulmonary lesions, bilateral pleural effusion and pericardial effusion. The aortic dissection should be considered. An emergency operation was performed on the patient. Surgical biopsies obtained from the aortic wall showed destructive changes, visible necrosis, granulation tissue hyperplasia and a large number of acute and chronic inflammatory cells. Nearly a year later, the patient was re-examined for significant pulmonary lesions. His laboratory studies were significantly positive for anti-neutrophilic antibody directed against proteinase 3. Finally, the diagnosis of GPA was obviously established.ConclusionsAlthough GPA rarely involves the aorta, we did not ignore the fact that GPA may involve large blood vessels. In addition, GPA should be included in the systemic vasculitis that can give rise to aortitis and even aortic dissection.
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Project description:ObjectiveHyperglycemia may cause acute central nervous system dysfunction manifesting as agonizing involuntary movements due to insult to the basal ganglia. We report a case of hemichorea-hemiballism (HCHB) in a patient with diabetes.MethodClinical assessment of the patient was performed, along with laboratory tests and brain imaging.ResultsThe patient was a 50-year-old man with newly detected diabetes with persistent involuntary movement of the right upper and lower limbs for few weeks. The involuntary movement was nonrhythmic, nonpatterned, purposeless, and often jerky with variable amplitude and frequency, sometimes wild and flailing in the form of hemichorea with a ballistic component (HCHB). He had a history of poor compliance to prescribed oral antidiabetic drugs. At presentation, although he was hemodynamically stable, random capillary blood glucose level was 18 mmol/L and glycated hemoglobin A1 level was 15.1% (141.5 mmol/mol). Clinical examination did not reveal any focal deficit or positive Babinski sign. There was a hyperintensity in the left basal ganglia region in T1-weighted magnetic resonance imaging (MRI) of the brain, which was iso-to-hyperintense in T2-weighted image and fluid-attenuated inversion recovery sequence. There was no restriction of diffusion on the diffusion-weighted image or blooming on gradient echo sequences, indicating absence of infarction or hemorrhage. Control of hyperglycemia resulted in disappearance of the involuntary movement within 1 month.ConclusionWhile there are many differential diagnoses for HCHB, the clinical scenario suggests hyperglycemia as the underlying cause in this patient. This case reiterates that multiple central nervous system manifestations may be attributable to diabetes.
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Project description:Introduction Sarcoma as a cause of laryngeal cancer is rare and is even rarer to have an Ewing sarcoma out of the bone presents as laryngeal cancer. In this report, we present this extremely rare case. Case presentation A 41-year-old man was seen at the ENT clinic complaining of chronic hoarseness and a lump in his neck. Flexible laryngoscopy showed a large mass occupying the left side of the larynx and then a computerized tomography scan proved it. For further evaluation, the laryngoscopy was performed and the frozen section revealed a malignancy. Consequently, the surgical decision was taken and a total Laryngectomy and thyroidectomy were carried out. A final diagnosis of Ewing sarcoma was established using histological examination and immunohistochemical staining. The patient was referred for adjuvant chemo-radiotherapy as recommended by the oncology service. Clinical discussion laryngeal cancer is rarely diagnosed as Ewing sarcoma. The defined diagnosis should be made based on histological study and immunohistochemical staining besides the clinical presentation and other examinations. Our patient was a candidate for surgical treatment and negative surgical margins were achieved. He was referred for adjuvant chemo-radiotherapy as some studies demonstrated the efficacy of multimodal therapy in treating Ewing sarcoma. Conclusion Because of the lack of similar studies and documented data in the medical literature about this rare case, Ewing sarcoma should be included in the differential diagnosis in laryngeal cancer cases. Highlights • Ewing sarcoma is a bony malignancy and rarely exists in the larynx.• Laryngeal cancer itself is rarely diagnosed as sarcoma, and rarer as Ewing sarcoma.• Ewing sarcoma should be included in the differential diagnosis of laryngeal cancer.• Ewing sarcoma should be treated with surgical removal, chemotherapy and radiotherapy as many studies showed.
| S-EPMC9577518 | biostudies-literature
Project description:ObjectiveThe goal of this study was to analyze perioperative risk factors to predict one- year mortality after operation for acute type A aortic dissection (AAD).MethodsA total of 121 consecutive patients undergoing Stanford type A AAD surgery in Beijing Anzhen Hospital were enrolled. Preoperative clinical and laboratory data from patients were collected.ResultsMultivariable Cox regression analysis showed that significant factors associated with increased one-year mortality were elder age (year) (hazard ratio (HR) 1.0985; 95% confidence interval (CI) 1.0334-1.1677), intraoperative blood transfusion ≥2000 mL (HR 8.8081; 95% CI 2.3319-33.2709), a higher level of serum creatinine (μmol/L) at postoperative one day (HR 1.0122; 95% CI 1.0035-1.0190) and oxygenation index (OI) < 200 (mmHg) at the end of surgery (HR 5.7575; 95% CI 1.1695-28.3458).ConclusionIn this study, perioperative risk factors to predict one-year prognosis are age, intraoperative blood transfusion ≥2000 mL, postoperative OI < 200 mmHg and level of postoperative serum creatinine. The results aid in the comprehension of surgical outcomes and assist in the optimization of treatment strategies for those with perioperative risk factors to decrease one-year mortality.
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