Cases reported "Wounds, Penetrating"

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1/9. Penetrating injury of the chest and coronary arteriovenous fistula.

    An unusual case of coronary artery fistula, due to a stab wound in the chest in a 17-year-old male patient, with a resultant acute inferior myocardial infarction is presented. At surgery, complete transection of the right coronary artery was found, which formed a fistulous communication with both the right atrium and the right ventricle. The development of a continuous murmur in the period immediately after the injury, the absence of hemopericardium, and multiple cardiac-chamber involvements were unique features of the case. The inferior myocardial wall was akinetic due to infarction and did not improve following revascularization surgery. A brief review of the literature is also presented.
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2/9. Caval perforation with bronchial communication: a rare complication of long-term venous access.

    Superior vena cava (SVC) perforation with bronchial communication is a very rare complication of long-term venous access. A patient recently presented with erosion of a venous port catheter into a bronchus, with infusion of medications into the bronchus and associated SVC syndrome. A high position of the catheter tip against the wall of the SVC and the beveled style of cut on the catheter tip contributed to this complication. A unique combination of percutaneous techniques was helpful in managing this complication, and surgery was avoided.
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3/9. Late-onset congestive heart failure with multiple carotid-jugular fistulae and pseudoaneurysm after penetration injury.

    Trauma-acquired multiple arteriovenous fistulae with late-onset congestive heart failure has not been documented. We describe a 29-year-old man who presented with progressive congestive heart failure 25 years after a penetrating trauma to the left side of the neck. The neck duplex showed a large shunt between the carotid artery and internal jugular vein. Arteriography showed three high-flow arteriovenous fistulae between these two vessels. magnetic resonance angiography (MRA) showed a carotid pseudoaneurysm originating from three different loci of the carotid artery with a large aneurysm-venous communication between the pseudoaneurysm and the internal jugular vein. Reconstruction of contrast MRA showed three different arteriovenous fistulae, leading to the decision to perform aneurysmectomy, carotid artery repair and jugular vein patch angioplasty. The favorable outcome of this case illustrates that surgery is a reasonable alternative when an endovascular approach is not feasible in patients with trauma-acquired arteriovenous fistulae.
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4/9. A bizarre penetrating head wound with intraoral communication. Report of a case.

    A case of a transcervical-intraoral penetrating foreign body in a 49-year-old man is presented. This is of interest because of the unusual mechanism of this potentially fatal injury, including the oral cavity, and because of the absence of serious neurologic sequelae.
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5/9. Pseudomonas labyrinthitis.

    pseudomonas aeruginosa is the gram-negative bacterial rod which is often isolated from chronic aural discharge. This microorganism may also cause necrotizing infection of the external auditory canal in certain patients with impaired host-defense mechanisms. Involvement of the inner ear by this microbe is extremely rare. In this communication, we report a case of pseudomonas labyrinthitis which resulted from traumatic middle ear injury. infection produced massive granulations and extensive bone destruction of the otic capsule. This case shows that while P.aeruginosa is usually an avirulent opportunistic pathogen, it may also cause a highly destructive labyrinthitis if the inner ear is entered.
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6/9. Traumatic right coronary artery--right atrial fistula.

    Traumatic coronary artery fistulae and intracardiac shunts due to penetrating wounds of the heart are rare, with only 19 reported cases in the literature. The communication, which may involve one or both coronary arteries, is classified into two major types depending on whether the drainage is into the left or right heart. We report a right coronary artery (RCA) right atrial fistula (RA) secondary to shrapnel injury in 1944.
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7/9. Intraperitoneal and extraperitoneal bladder rupture secondary to rectal impalement.

    A 9-year-old boy presented with rectal impalement injury associated with through-and-through bladder rupture and intraperitoneal communication. We believe this to be the first reported case of rectal impalement causing an intraperitoneal bladder rupture.
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8/9. A wooden foreign body in the neck.

    foreign bodies in the throat and/or neck are uncommon and transpharyngeal impaction of a wooden foreign body in the neck without vascular injury is very rare. The patient presented in this communication, reported to our center five days after severe physical assault with a pharyngocutaneous fistula in the left side of the neck. Clinical examination and x-rays were unremarkable. Conservative treatment led to healing of the fistula and he was discharged. Two weeks later he was readmitted with an abscess in the right supraclavicular region. Exploration under general anaesthesia revealed a 7 cm long wooden fragment of a spear in the abscess cavity. The fragment was removed. After several days' antibiotic treatment, he recovered fully and was discharged.
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9/9. Traumatic arteriovenous fistula of the leg. An easily missed diagnosis.

    An arteriovenous fistula is an abnormal communication between the arterial and venous systems. It may be an incidental finding in an asymptomatic patient or it may manifest clinically with pain, edema, varicosities, and even heart failure. It is important for clinicians to be aware of this disorder because early diagnosis and treatment can prevent its long-term sequelae. This report presents a patient with a posttraumatic arteriovenous fistula.
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