1/884. Pellet embolization to the right atrium following double shotgun injury. A 28-year-old man sustained two shotgun injuries of the left inguinal region from a distance of about 1.5 m by simultaneous discharge of both shells from a sawn-off double-barrelled 16-bore shotgun (diameter of the lead pellets, 4 mm). The first X-ray examination carried out soon after hospital admission showed a single embolized pellet near the right margin of the cardiac silhouette. Eight months later, the man committed suicide by drug intoxication. At autopsy, the embolized pellet was found embedded between the pectinate muscles of the right atrium. On the basis of the reported case and with reference to the pertinent literature, the paper points out the medico-legal aspects of venous bullet/pellet embolism and the risk of lead poisoning after shotgun injury. ( info) |
2/884. Embolic bacterial aneurysm of the basilar artery: case report. A patient with basilar artery rupture caused by a septic embolus originating from a mitral valve vegetation is reported. The pathogenesis, investigation and management of infected cerebral aneurysms are reviewed. ( info) |
3/884. Embolism in a single functioning kidney: report of two cases. 2 cases of embolism in single functioning kidneys are reported. In the first case there was an occlusion of the main trunk of the renal artery; the patient was treated by embolectomy. In the second case the occlusion of a major arterial branch was demonstrated; because of the bad general conditions the patient was treated with medical therapy. The authors review the literature and the indications for embolectomy in embolism in a solitary kidney. ( info) |
4/884. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report. BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations. ( info) |
5/884. Cerebral and renal embolization after lymphography in a patient with non-Hodgkin lymphoma: case report. An unusual case of lipid embolization to brain and kidney after lymphography in a patient with non-Hodgkin lymphoma of the upper anterior mediastinum is reported. Contrast material-enhanced echocardiography demonstrated a right-to-left shunt to the left atrium without evidence of a patent foramen ovale. Echo contrast particles were transiently present within the tumor surrounding the great vessels. ( info) |
6/884. Acute neoplastic arterial embolism after pneumonectomy. Intra-arterial tumour embolism after pneumonectomy is a known but rare complication. It arises because of tumour involvement of pulmonary veins. Usual outcome of this complication is grave when embolism is to a major vessel. If embolism occurs in a peripheral circulation, timely intervention can avoid significant morbidity. We report a case where embolisation occurred in both the femoral arteries. Emergency embolectomy was done successfully avoiding major complication. ( info) |
7/884. Disseminated intravascular meconium in a newborn with meconium peritonitis. A 3-day-old premature infant with meconium peritonitis, periventricular leukomalacia, and pulmonary hypertension died with respiratory insufficiency. An autopsy disclosed intravascular squamous cells in the lungs, brain, liver, pancreas, and kidneys. Numerous pulmonary capillaries and arterioles were occluded by squamous cells, accounting for pulmonary hypertension. brain parenchyma surrounding occluded cerebral vessels showed infarct and gliosis. A mediastinal lymph node filled with squamous cells alluded to the mechanism by which these cells from the peritoneal cavity likely entered the bloodstream--namely, via diaphragmatic pores connecting with lymphatics. Thus, disseminated intravascular meconium rarely may complicate meconium peritonitis and have devastating consequences. ( info) |
8/884. Witnessed embolization of a right atrial mass during transesophageal echocardiography: implications regarding the safety of esophageal intubation. A patient with chronic lung disease and a right atrial density that was difficult to distinguish on a transthoracic echocardiogram underwent transesophageal echocardiography (TEE) that demonstrated two mobile masses attached to the anterior right atrial wall. During the TEE procedure, the patient experienced coughing and retching due to the esophageal intubation, and the embolization of one of the right atrial masses was observed. This case is the first to document this mechanism of pulmonary embolism (a mechanism that was suspected in two prior reports), and it questions the safety of procedures that induce retching and coughing in patients with mobile right atrial masses. ( info) |
| PURPOSE: disseminated intravascular coagulation (DIC) is a well-known complication of an amniotic fluid embolus. However, clinical experience has shown that, in some patients, clinical hemorrhage may be the initial presentation. Mortality in this subset of patients is high. This report describes a patient with a suspected amniotic fluid embolus who survived and in whom the initial presentation was post partum hemorrhage. CLINICAL FEATURES: During the post delivery repair of a fourth degree perineal tear a 29 yr old prima gravida was noted to have excessive vaginal bleeding despite a well contracted uterus. Laboratory investigations revealed a decrease in hemoglobin from 126 g x l(-1) to 86 g x l(-1) and a severe disseminated intravascular coagulopathy (PT 27.5 sec, APPT 149 sec, direct fibrinogen < 0.6 g x l(-1), FDP > 640 g x l(-1)). Treatment included massive blood component therapy and, eventually, total abdominal hysterectomy. The patient subsequently recovered without sequelae. In the absence of any other explanation, the coagulopathy was considered to be secondary to amniotic fluid embolus. CONCLUSION: amniotic fluid embolus remains an important cause of maternal mortality. Clinical reports, reviews of the literature, and the development of the national registry have all contributed to our understanding of this syndrome. Contrary to earlier beliefs, not all patients present with sudden cardiorespiratory collapse. As the present case illustrates, a less common presentation is the development of an isolated DIC in the peripartum period without antecedent hemodynamic or respiratory instability. Therefore, anesthesiologists must maintain a high index of suspicion for the disorder in order to facilitate early recognition and treatment. ( info) |
10/884. Diagnostic and surgical approach of innominate artery saddle embolus. patients with an acute arterial occlusion of the right upper extremity and absent axillary pulse should have a Doppler scan examination before a balloon catheter embolectomy is performed. If there is no arterial pulse detectable, an angiography should be performed afterwards to localize the embolus. In the case of a proximal arterial occlusion of the right arm, the authors recommend this procedure to prevent an embolus dislocation by catheter embolectomy and subsequent cerebral embolization. For direct surgical embolectomy the authors recommend a supraclavicular incision. ( info) |