OpenMed/multicare-articles huggingface dataset:
Shock and Awe: Successful Revascularization with Intravascular Lithotripsy in Recurrent ST-Elevation Myocardial Infarction Secondary to Stent Under-Expansion
Authors: Pramod Kumar Ponna, Akhilesh Gonuguntla, Ramya Krishna Botta, Sruthi Kotaru, Tim A Fischell, Adnan Alexander Kassier, Yashwant Agrawal
Journal: Methodist Debakey Cardiovasc J (2023)
Keywords: st-elevation myocardial infarction, calcified coronary artery, intravascular lithotripsy, under-expanded stent
MeSH terms: Lithotripsy / adverse effects, ST Elevation Myocardial Infarction / diagnostic imaging, ST Elevation Myocardial Infarction / therapy, Case Reports, Humans, Stents

We report a case of recurrent ST-segment elevation myocardial infarction (STEMI) due to a previously implanted under-expanded stent with in-stent thrombosis refractory to traditional interventional techniques. We underscore the utility of bail-out shockwave intravascular lithotripsy to tackle previously under-expanded stents in this acute setting.
Traumatic submacular hemorrhage: available treatment options and synthesis of the literature
Authors: Giamberto Casini, Pasquale Loiudice, Martina Menchini, Francesco Sartini, Stefano De Cillà, Michele Figus, Marco Nardi
Journal: Int J Retina Vitreous (2019)
Keywords: anti-vascular endothelial grow factor, blunt ocular trauma, pneumatic displacement, submacular hemorrhage, tissue plasminogen activator, vitrectomy
MeSH terms: Review

Sub-macular hemorrhage (SMH) is a hematic collection between the neurosensory retina and the retinal pigment epithelium; one of its causes is ocular blunt trauma, that usually affects young patients. Persisting SMH leads to a damage of photoreceptors mediated by three main mechanisms: iron-related toxicity, impairment of diffusion of oxygen and nutriment, mechanical damage due to clot contraction. Since early photoreceptors' damage has been reported within 24 h, it is suggested to provide an early treatment, although there are no guidelines or consensus between authors regarding treatment strategies. The aim of this review was to present and compare available treatment options, like intravitreal tissue plasminogen activator (tPA) associated with pneumatic displacement, pneumatic displacement alone, subretinal tPA injection with pneumatic displacement, and intravitreal anti-vascular endothelial growth factor (VEGF) injection. All procedures obtained consistent results, though the most effective seemed to be pars plana vitrectomy, subretinal tPA and gas tamponade, probably due to a quicker liquefaction and displacement of the clot. Limitations concern the greater invasiveness and the higher incidence of complications. Alternatively, intravitreal injection of tPA and gas may represent a less invasive option with fewer complications. Intravitreal injection of gas and prone position could be preferred in young patients without coexisting ocular pathology, being a minimally invasive treatment, with lower risk of complications and a good visual recovery. Anti-VEGF agent have found, to date, limited employment in cases of traumatic SMH even though they may be useful as alternative or adjuvant therapy. Most of the published literature consists of small studies and case reports, therefore further investigations and larger clinical trials are required to fully understand safety and efficacy of the procedures. A preoperative comprehensive evaluation may be helpful to realize a surgical plan tailored on patient.
Acute septic arthritis of the acromioclavicular joint caused by Staphylococcus aureus with marked soft tissue collection towards posterior medial aspect of the AC joint: A rare clinical presentation
Authors: Jija Thomas, Makki Daud, Simon Macmull
Journal: IDCases (2022)
Keywords: acromioclavicular joint, infection, magnetic resonance imaging, septic arthritis, staphylococcus aureus
MeSH terms: Case Reports

Primary septic arthritis of the Acromioclavicular joint is an unusual disorder and is seldom seen even in an immunocompromised person. We report a case of primary septic arthritis of the acromioclavicular (A-C) joint caused by Staphylococcus aureus. The patient was admitted with pain in the left shoulder, restricted movements and fever. Laboratory parameters showed elevated C-reactive protein, raised erythrocyte sedimentation rate and leukocytosis. Ultrasound revealed a 32 mm collection at the acromioclavicular joint. Patient underwent incision and drainage of abscess. Culture and sensitivity revealed moderate growth of Staphylococcus-aureus. Patient was started on appropriate intravenous antibiotics. Magnetic resonance imaging (MRI) done after 2 weeks revealed marked erosion in the lateral end of clavicle with soft tissue collection along the posteromedial aspect A-C joint. The patient had to undergo repeat drainage of the abscess along with the decompression of lateral end of clavicle. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection.
A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions
Authors: Erol Akgul, Hasan Bilen Onan, Huseyin Tugsan Balli, Nuri Eralp Cetinalp
Journal: Case Rep Neurol Med (2016)

The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone.
Cystic Lung Disease in Down Syndrome: A Case Report and Literature Review
Authors: Mathew George, John Amodio, Haesoon Lee
Journal: Case Rep Pediatr (2016)

Subpleural lung cysts (SPC) are seen in children with Down syndrome (DS). The incidence and the long term course of these lesions are not known. It is important for pediatricians and pediatric radiologists to be aware of these lung lesions since the DS patients' longevity has increased and they have greater frequency to encounter the clinicians. Autopsy and the radiology series have shown that these lesions are often found in association with congenital heart disease, particularly the endocardial cushion defect and prematurity.
Cardiomyopathy Associated With Tertiary Adrenal Insufficiency Manifesting as Refractory Heart Failure, Shock, and Sudden Cardiac Death: A Case Report
Authors: Xuefeng Wang, Yong Luo, Jian Feng
Journal: Front Cardiovasc Med (2021)
Keywords: adrenal insufficiency, cardiomyopathy, corticosteroids, heart failure, sudden cardiac death
MeSH terms: Case Reports

Dilated cardiomyopathy is an etiologically heterogeneous disorder. Early diagnosis and prompt treatment of the underlying disease are of great significance. Primary and secondary adrenal insufficiency are considered quite rare causes of dilated cardiomyopathy. However, to the best of our knowledge, no case of cardiomyopathy associated with tertiary adrenal insufficiency has been reported. Herein, we described a 68-year-old woman with a 15-year history of seasonal dermatitis presented with frequent heart failure and shock. At first, she was diagnosed with idiopathic dilated cardiomyopathy, but standard heart failure and antishock treatment failed. Given her long-term use of dexamethasone for treating seasonal dermatitis, and clinical manifestations consistent with adrenal insufficiency, we tested her basal plasma cortisol, simultaneous corticotropin, and other pituitary hormones, confirming that she had tertiary adrenal insufficiency. Additionally, abdominal enhanced computed tomography revealed atrophic bilateral adrenal glands, indicating long-standing and severe adrenal insufficiency. Then hydrocortisone replacement therapy was initiated, and she recovered rapidly. During the next 2 years of follow-up, she never experienced any episodes of heart failure and shock. Unfortunately, she refused the implantation of defibrillator with cardiac resynchronization therapy (CRT-D) and died of sudden cardiac death 2 years later. Although we could not exclude the coincidence of idiopathic dilated cardiomyopathy with tertiary adrenal insufficiency with 100% certainty, her unique clinical course strongly indicated that her cardiomyopathy resulted from tertiary adrenal insufficiency. This case demonstrates that patients on corticosteroids are at risk for tertiary adrenal insufficiency, which may result in refractory cardiomyopathy and even sudden cardiac death.
Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function?
Authors: Eustaquio Maria Onorato, Matteo Vercellino, Annamaria Costante, Antonio L Bartorelli
Journal: Front Cardiovasc Med (2022)
Keywords: aortic valve, heart failure, hemolytic anemia, paravalvular leak, transcatheter closure
MeSH terms: Case Reports

Background:
Aortic paravalvular leak (APVL) after surgical valve replacement (AVR) is an ominous complication with a high risk of morbidity and mortality. Approximately 1-5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or hemolytic anemia.
Case summary:
A 69-year-old man with multiple comorbidities underwent surgical replacement of the aortic valve with a mechanical tilting disc prosthetic valve (Medtronic Starlight 27 mm). Several years later, recurrent episodes of congestive heart failure and hemolytic anemia developed due to a large crescent-shaped aortic PVL located at non coronary cusp (NCC) 9-12 o'clock, with moderate-to-severe regurgitation. The patient was deemed at prohibitive surgical risk due to significant multiple comorbidities and a transcatheter PVL closure (TPVLc) was planned. The huge PVL was partially closed by a first specifically designed paravalvular leak device (PLD). The procedure was complicated by transient interference of the second PLD with mechanical prosthetic valve function. This issue has however been solved with correct manipulation, orientation and downsizing of the second device implanted. At 3-month and 13-month follow-up, the patient showed a relevant clinical improvement and good quality of life. 2D TTE color Doppler confirmed the stable position of the two PLDs with trace residual leak.
Discussion:
Surgical redo has been considered the treatment of choice for symptomatic patients with PVLs. Notwithstanding, TPVLc is a less invasive alternative, particularly in patients at high surgical risk in whom early diagnosis and prompt interventional treatment are crucial for improving expectancy and quality of life. Dedicated devices, appropriate procedural techniques, and the close interaction between imaging modalities, allowed to deal successfully with a challenging case of severe symptomatic aortic PVL.
The debate is still open; benign or malignant: a case report of a multifocal epithelioid haemangioma of fibula
Authors: Hamid Rajebi, Shahzad Madanipour, Sahar Shiraj, Arthur Yegorov
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

In this case, we report an epithelioid haemangioma (EH) of the fibula with ill-defined multifocal lesions and a resultant pathologic fracture. Based on radiographic appearance, these lesions were initially thought to represent a malignant process, such as primary malignant bone tumour, metastases or multiple myeloma. Osseous EHs are rare. Although they can present as multifocal lesions, the majority of bony EHs are solitary and arise in the diaphysis or metaphysis of long tubular bones, with a predilection for the lower extremity. Non-specific radiological findings, debatable cytological appearance and unpredictable clinical growth patterns commonly cause misdiagnosis of malignancy. To the best of our knowledge, a case of EH with multiple growing lesions of the fibula has not yet been reported in the literature.
Tumour-induced osteomalacia: a literature review and a case report
Authors: Jolanta Dadoniene, Marius Miglinas, Dalia Miltiniene, Donatas Vajauskas, Dmitrij Seinin, Petras Butenas, Tomas Kacergius
Journal: World J Surg Oncol (2016)
MeSH terms: Femoral Neoplasms / diagnosis, Hemangiopericytoma / diagnosis, Hypophosphatemia / etiology, Osteomalacia / etiology, Paraneoplastic Syndromes / etiology, Case Reports, Review, Femoral Neoplasms / complications, Fibroblast Growth Factor-23, Hemangiopericytoma / complications, Humans, Hypophosphatemia / diagnosis, Male, Middle Aged, Osteomalacia / diagnosis, Paraneoplastic Syndromes / diagnosis

Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterised by severe hypophosphataemia and osteomalacia, with renal phosphate wasting that occurs in association with tumour. The epidemiology likewise aetiology is not known. The clinical presentation of TIO includes bone fractures, bone and muscular pains, and sometimes height and weight loss. TIO may be associated with mesenchymal tumours which may be benign or malignant in rare cases. Mesenchymal tumour itself may be related to fibroblast growth factor 23 (FGF23), which is responsible for hypophosphataemia and phosphaturia occurring in this paraneoplastic syndrome. Hypophosphataemia, phosphaturia and elevated alkaline phosphatase are the main laboratory readings that may lead to more precise investigations and better diagnosis. Finding the tumour can be a major diagnostic challenge and may involve total body magnetic resonance imaging, computed tomography and scintigraphy using radiolabelled somatostatin analogue. The treatment of choice for TIO is resection of a tumour with a wide margin to insure complete tumour removal, as recurrences of these tumours have been reported. We provide here an overview on the current available TIO case reports and review the best practices that may lead to earlier recognition of TIO and the subsequent treatment thereof, even though biochemical background and the long-term prognosis of the disease are not well understood. This review also includes a 4-year-long history of a patient that featured muscular pains, weakness and multiple stress fractures localised in the hips and vertebra with subsequent recovery after tumour resection. Because the occurrence of such a condition is rare, it may take years to correctly diagnose the disease, as is reported in this case report.
Fever-related ataxia: a case report of CAPOS syndrome
Authors: Ida Stenshorne, Magnhild Rasmussen, Panagiotis Salvanos, Chantal M E Tallaksen, Laurence A Bindoff, Jeanette Koht
Journal: Cerebellum Ataxias (2019)
Keywords: atp1a3 gene, ataxia, capos syndrome, cerebellum
MeSH terms: Case Reports

Background:
CAPOS (Cerebellar ataxia, Areflexia, Pes cavus, Optic atrophy and Sensorineural hearing loss) syndrome is caused by the heterozygous mutation, c.2452G > A, in the ATP1A3 gene. Other mutations in this gene can cause a spectrum of overlapping phenotypes including alternating hemiplegia of childhood, rapid onset dystonia parkinsonism, early infantile epileptic encephalopathy and fever induced paroxysmal weakness and encephalopathy. The phenotype is still mistaken for mitochondrial/metabolic disorders and follow up studies are scare.
Case presentation:
We report a 20 year old Norwegian male with ataxia, sensorineural deafness and visual loss. Before the age of five he experienced three fever related episodes of acute neurological deterioration when he temporarily lost his acquired motor skills and developed persistent gait and limb ataxia. In childhood, he developed bilateral optic atrophy and bilateral sensorineural hearing loss. Motor skills improved and at age 20 the patient showed a mild ataxia, hearing loss and reduced vision. A c.2452G > A mutation in the ATP1A3 gene was identified and CAPOS syndrome was confirmed.
Conclusions:
This is the first Norwegian patient reported with CAPOS syndrome. Our patient had a de novo, previously identified ATP1A3 mutation. The combination of recurrent episodes of fever related ataxia, loss of motor skills in early childhood, and early onset hearing and vision loss is typical of CAPOS syndrome. Previous reports suggest a gradual progression of the disease after the initial episodes, while this patient showed a good outcome with improvement of motor skills from adolescence long after the last deterioration episode.
Identification of resting-state networks using dynamic brain perfusion SPECT imaging: A fSPECT case report
Authors: Matthieu Doyen, Gabriela Hossu, Sébastien Heyer, Timothée Zaragori, Laetitia Imbert, Antoine Verger
Journal: Front Hum Neurosci (2023)
Keywords: brain perfusion spect, case report, connectivity, fpet, resting-state networks
MeSH terms: Case Reports

Connectivity studies with nuclear medicine systems are scarce in literature. They mainly employ PET imaging and group level analyses due to the low temporal resolution of PET and especially SPECT imaging. Our current study analyses connectivity at an individual level using dynamic SPECT imaging, which has been enabled by the improved temporal resolution performances provided by the 360°CZT cameras. We present the case of an 80-year-old man referred for brain perfusion SPECT imaging for cognitive disorders for whom a dynamic SPECT acquisition was performed utilizing a 360°CZT camera (temporal sampling of 15 frames × 3 s, 10 frames × 15 s, 14 frames × 30 s), followed by a conventional static acquisition of 15 m. Functional SPECT connectivity (fSPECT) was assessed through a seed correlation analysis and 5 well-known resting-state networks were identified: the executive, the default mode, the sensory motor, the salience, and the visual networks. This case report supports the feasibility of fSPECT imaging to identify well known resting-state networks, thanks to the novel properties of a 360°CZT camera, and opens the way to the development of more dedicated functional connectivity studies using brain perfusion SPECT imaging.
Individualized ventilatory management in patients with COVID-19-associated acute respiratory distress syndrome
Authors: Hiroki Taenaka, Takeshi Yoshida, Haruka Hashimoto, Hirofumi Iwata, Yukiko Koyama, Akinori Uchiyama, Yuji Fujino
Journal: Respir Med Case Rep (2021)
Keywords: ards, covid-19, eit, mechanical ventilation, peep
MeSH terms: Case Reports

Due to the coronavirus disease 2019 pandemic, the number of coronavirus disease 2019-associated acute respiratory distress syndrome is rapidly increasing. The heterogeneity of coronavirus disease 2019-associated acute respiratory distress syndrome contributes to the complexity of managing patients. Here we described two patients with coronavirus disease 2019-associated acute respiratory distress syndrome showing that the bedside physiological approach including careful evaluation of respiratory system mechanics and visualization of ventilation with electrical impedance tomography was useful to individualize ventilatory management.
Subcapsular Kidney Urinoma After Percutaneous Nephrolithotomy
Authors: Eugenio Di Grazia, Letterio D'Arrigo, Alberto Saita, Giuseppe Giordano, Giuseppe Russo, Giuseppe Morgia, Pasquale La Rosa
Journal: J Endourol Case Rep (2017)
Keywords: pcnl complication, kidney trauma, percutaneous nephrolitothomy, urinoma
MeSH terms: Case Reports

Background: A rare percutaneous nephrolithotomy (PCNL) complication and its management is reported. Case Presentation: A male patient, 43 years of age, underwent PCNL for a large left pyelocaliceal stone. Surgery was performed in the Valdivia-Galdakao supine position. The percutaneous tract was established by combined radiologic and sonographic guidance. The tract was dilated by balloon and a 24F Amplatz sheath was located. As complete clearance was not achieved because of a residual lower pole caliceal stone, a ureteral Double-J and a 20F nephrostomy were located for a second-look PCNL through the same tract after 7 days. After second-look PCNL residual stone was still not cleared because it was unreachable through the tract established and the patient was discharged without nephrostomy and with the ureteral stent, retrograde intrarenal surgery (RIRS) was planned in 3 to 4 weeks. Hemoglobin, hematocrit, and the renal function were normal. On the seventh day after PCNL, no leakage was detected from the percutaneous tract, but the patient started to complain about flank discomfort and fever. Imaging showed a 6 cm lower pole subcapsular collection. After 3 days of conservative management with antibiotics, the subcapsular collection did not resolve and a percutaneous 6F mono-J drainage in the collection was placed. Drain output was at first purulent and evolved into urine throughout the following days. Drain urine culture was positive for Escherichia coli infection and carbapenemic-targeted antibiotic was offered to the patient. Collection drained about 400 cc in 7 days and the drain was removed when the output was less than 10 cc per day. No late complications were reported and RIRS was scheduled in 1 month to clear the residual stone. Conclusion: Subcapsular urinoma post-PCNL is an uncommon but severe complication. Prompt and correct drainage may solve it.
Case Report: A Child with Gross Hematuria and the Importance of Travel History
Authors: Ibrahim F Shatat
Journal: Front Pediatr (2018)
Keywords: schistosoma haematobium, gross hematuria, pediatrics, schistosomiasis, travel health
MeSH terms: Case Reports

We report a case of a 5-year-old girl who presented with a 3-month-long history of gross hematuria. She underwent an extensive laboratory workup (including an automated urine microscopy) and a kidney biopsy, all of which were within normal limits. While being prepared for a cystoscopy and more advanced imaging of the urinary tract, the family mentioned history of travel to a schistosomiasis endemic area prompting a more thorough ova and parasite examination of the urine. Urine microscopy confirmed the diagnosis of Schistosoma hematobium.
Association of trichilemmal and basal cell carcinomas: a case report
Authors: Moad El Mekkaoui, Bouchra Dani, Oussama Amraoui, Razika Bencheikh, Anas Benbouzid, Abdelilah Oujilal, Leila Essakalli, Hafsa Elouazzani, Ismail Boujida, Nadia Cherradi
Journal: Pan Afr Med J (2022)
Keywords: trichilemmal carcinoma, actinic keratosis, basal cell carcinoma, case report
MeSH terms: Carcinoma, Basal Cell / diagnosis, Carcinoma, Basal Cell / pathology, Carcinoma, Basal Cell / surgery, Hair Diseases / pathology, Skin Diseases / pathology, Skin Neoplasms / diagnosis, Skin Neoplasms / pathology, Case Reports, Aged, Hair Follicle / pathology, Humans

Proliferating trichilemmal tumor (PTT) is a benign tumor arising from the isthmic portion of the hair follicle. Malignant transformation in PPT is very rare and unusual. Indeed, only about sixty well-documented cases have been found in the English literature. We present here the case of a 72-year-old patient with an exceptional combination of malignant trichilemmal carcinoma and basal cell carcinoma, occurring on actinic keratosis lesions. The aim of this work is to describe the diagnostic and therapeutic modalities of this association which is exceptional.