Cases reported "Hematoma"

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1/65. The sternomastoid "tumor" of infancy.

    The sternomastoid "tumor" of infancy is a firm, fibrous mass, appearing at two to three weeks of age. It may or may not be associated with torticollis. Generally, the "tumor" initially grows, then stabilizes, and in about half the cases recedes spontaneously after a few months. It may leave a residual torticollis or may be associated with a facial or cranial asymmetry of a delayed torticollis. The etiology is unknown, a direct cause and effect relationship to birth trauma has been largely disproved although approximately half these children are products of breech deliveries. The treatment is controversial. Approximately half of these "tumors" will resolve spontaneously without sequelae. Progressive torticollis or development of facial asymmetry are considered indications for surgery. The purpose of this report is to acquaint the head and neck surgeon with this entity which may confront him for diagnosis and treatment.
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keywords = neck
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2/65. Spontaneous cervical hematoma: a report of two cases.

    Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma--one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours' duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.
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keywords = neck
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3/65. life-threatening airway obstruction caused by a retropharyngeal haematoma.

    We present the case of a 68-year-old woman who had a large cervicomediastinal haematoma that caused life-threatening airway obstruction. Retropharyngeal haematoma may occur in any age group and following a variety of causes. Retropharyngeal haematomas must be considered as a cause of airway obstruction following common injuries such as blunt cervical trauma or internal jugular vein cannulation. A high index of suspicion and early lateral neck X-ray is essential for safe management of this rare but potentially life-threatening injury.
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keywords = neck
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4/65. Cervical subarachnoid hematoma of unknown origin: case report.

    OBJECTIVE AND IMPORTANCE: Spontaneous spinal subarachnoid hematoma is rare, having been reported in the English literature in only seven other cases. We describe the first case of spontaneous subarachnoid hematoma located in the cervical spinal cord of a 43-year-old man. The pathologic examination showed no apparent source of bleeding, but there was evidence of cervical spondylotic myelopathy. CLINICAL PRESENTATION: The patient presented with a 10-day history of severe neck pain, followed by the onset of quadriparesis that was more evident on the left side, urinary retention, and sensory loss below C5. His medical history included hypertension. magnetic resonance imaging showed a massive hemorrhage in the cervical spinal canal. INTERVENTION: A C4-C5 subarachnoid hematoma was removed. The patient died due to respiratory distress and uncontrollable hypotension on day 6 after surgery. Surgical exploration, neuroradiologic examinations, and autopsy showed no evidence of vascular malformations, tumors, or other possible sources of bleeding. CONCLUSION: After excluding more common causes of spontaneous subarachnoid hematoma in this patient, we suggest that chronic spinal cord compression (spondylotic myelopathy) and arterial hypertension in this patient may have caused the pathogenesis of this rare clinical entity. Experimental data supporting this hypothesis are discussed.
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keywords = neck
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5/65. Penetrating neck injury: case report and evaluation of management.

    Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention. We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.
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ranking = 8
keywords = neck
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6/65. A method for providing a unilateral pressure dressing in the neck.

    The application of a reliable adequate pressure dressing to one side of the neck has always proved difficult, because of the risk of occluding the airway and the vasculature. We describe a method of maintaining well-localized pressure to one side of the neck without undue pressure on the vasculature and the airway by using a stiff cervical collar. This method was used successfully in the conservative management of neck haematoma in two patients.
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ranking = 7
keywords = neck
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7/65. color Doppler ultrasound for monitoring free flaps in the head and neck region.

    The use of microvascular free flaps has become established as a very reliable reconstructive technique following tumor surgery or trauma in the head and neck region. Occasionally, flap compromise may occur which will require immediate re-exploration. early diagnosis of vascular insufficiency is essential. Clinical signs are not always reliable. Numerous systems have been described for monitoring the viability of microsurgical free flaps. The authors consider that color Doppler ultrasound is one of the most useful diagnostic tools. Three cases are reviewed in which this technique aided the decision whether re-exploration was necessary.
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ranking = 5
keywords = neck
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8/65. Open reduction of subcondylar fractures via an anterior parotid approach.

    Visualization of subcondylar fractures is limited, and rigid fixation technically difficult, employing standard open surgical techniques--especially when the condyle is displaced out of the glenoid fossa. The majority of condylar neck fractures are treated by closed reduction with maxillomandibular fixation, to obviate the potential for permanent injury to the facial nerve. The technique described employs an anterior parotid, two-layer, sub-SMAS (superficial musculo-aponeurotic system) approach via a rhytidectomy incision that reliably identifies and preserves the neural elements and provides direct access to the pericondylar region. The thirteen patients presented here exhibited satisfactory functional and aesthetic results. Complications included temporary nerve palsies, plate fractures, and a hematoma.
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ranking = 1
keywords = neck
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9/65. Use of cerebral oximetry to detect and manage cerebral desaturation with a rapidly expanding neck hematoma.

    BACKGROUND: We report a case in which cerebral oximetry was used to successfully demonstrate when cerebral oxygen saturation is dangerously low. methods: In a 60-year-old-man with end-stage multiple myeloma and hyperviscosity syndrome, a rapidly expanding hematoma developed after insertion of an internal jugular central venous catheter. As the hematoma expanded, the patient became lethargic and disoriented (Glasgow coma Score of E2/M4-5/V2-ETT). His platelet count was 17,000.mm(-3), hemoglobin was 4.5 g/dl, partial thromboplastin time was 51 s, and his international ratio was 1.7. Although carotid pulses became unpalpable, blood pressure and heart rate remained stable. Cerebral oximeter probes positioned on the patient's forehead showed that cerebral oxygen saturation was 22-26% bilaterally. The surgery team was advised to surgically evacuate the hematoma. RESULTS: The hematoma was evacuated and a small needle hole in the right internal jugular vein adjacent to the central-venous catheter was found and repaired. Cerebral oxygen saturation increased to 56-58% within 1 h and stabilized near 60%. The patient awoke with normal cognitive function. CONCLUSION: This case demonstrates how cerebral oximetry can be used to give quantitative evidence of cerebral hypoxia, thus showing that immediate surgical intervention is necessary.
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ranking = 4
keywords = neck
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10/65. Aortic dissection and rupture presenting as suprasternal bruising and neck swelling.

    BACKGROUND: a 76-year-old man presented with transient loss of consciousness associated with swelling of the neck, bruising in the suprasternal notch and an absent left carotid pulse. blood pressure was equal in both arms and chest x-ray was normal, but computed tomography of the neck and thorax showed dissection and rupture of the thoracic aorta with extensive intra-mediastinal bleeding. OUTCOME: surgical intervention was inappropriate in this situation and the patient died within 4 hours of presentation. CONCLUSION: syncope is a common presentation to hospital in older people and its cause may be difficult to elucidate, particularly if the patient is unable to provide a reliable history. syncope without pain is a rare presentation of aortic dissection and the occurrence of anterior chest wall bruising has not been described previously. pulse deficits and abnormal chest x-ray findings are often cited as indicative of aortic dissection but are rare manifestations and their absence should not be used to exclude this diagnosis.
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ranking = 6
keywords = neck
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