OpenMed/multicare-articles huggingface dataset:
Persistent Left Superior Vena Cava Suggested by an Unusual Central Venous Pressure Waveform
Authors: Sujana Dontukurthy, Yoshikazu Yamaguchi, Joseph D Tobias
Journal: Thorac Cardiovasc Surg Rep (2020)
Keywords: chd, anatomy, cardiovascular surgery, congenital heart disease, myocardial protection
MeSH terms: Case Reports

Background A persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the thoracic venous return. Case Description During atrial septal defect repair, a pulmonary artery (PA) catheter was placed via the left internal jugular vein. Although placement of the PA catheter in the main PA was confirmed by transesophageal echocardiography, the central venous pressure (CVP) waveform was abnormal. Intraoperatively, the PA catheter was seen exiting the coronary sinus with the CVP port within the coronary sinus. Conclusions The diagnosis of PLSVC is discussed and the differential diagnosis of the abnormal "ventricular" pattern of the CVP waveform is reviewed.
A Rare Case of Xanthogranulomatous Pyelonephritis with Spontaneous Renocolic Fistula and IVC Thrombosis
Authors: Daniele Sforza, Leandro Siragusa, Matteo Ciancio Manuelli, Linda De Luca, Bruno Sensi, Simona Grande, Renato Argirò, Marco Nezzo, Massimo Villa, Michele Grande
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Xanthogranulomatous pyelonephritis (XGPN) is a rare disorder affecting the kidney which can fistulise to the colon in exceptional cases. We herein report a case of XGPN with renocolic fistula and large vessel thrombosis presenting with sepsis and pulmonary embolism. Preoperative diagnosis and strategic planning resulted in successful management. A 64-year-old woman presented to the emergency department with abdominal pain and a septic condition, corroborated by venous thromboembolism. Workup diagnosed a left renal abscess with calicocolic fistula. Scintigraphy confirmed a nonfunctioning left kidney. The patient underwent inferior vena cava filter placement and staged surgery. The first, damage control procedure was a loop ileostomy. Ten days later, when the patient's conditions improved, she underwent left nephrectomy and left colectomy with primary anastomosis. Finally, a year later, the ileostomy was closed. At follow-up, the patient was well, with unremarkable renal function. Scrupulous diagnostics, multidisciplinary decision making, and staged intervention have been key to optimal outcome.
Orbital varix: rare cause of blepharospasm
Authors: Badii Hmida, Walid Mnari, Mezri Maatouk, Ahmed Zrig, Mondher Golli
Journal: Pan Afr Med J (2019)
Keywords: ct scan, mri, orbit, varix
MeSH terms: Blepharospasm / etiology, Orbit / blood supply, Orbital Diseases / diagnosis, Varicose Veins / diagnosis, Case Reports, Adult, Humans, Magnetic Resonance Imaging / methods, Male, Orbital Diseases / complications, Varicose Veins / complications

Orbital varix (or varicose) is an exceptional pathology with poor clinical sign. The blepharospasm can be a revealing cause. The long-term risk is optic atrophy and blindness. Magnetic resonance imaging is the best diagnostic tools. The rise of lesion dimensions by Valsalva maneuvers and prone position is characteristic. We report the observation of a 42-year-old young man, consulting for a blepharospasm of the left eye evolving for two years. Imaging investigations made the diagnosis of orbital varicose.
Successful use of next generation genomic sequencing (NGS)-directed therapy of clear cell carcinoma of the ovary (CCCO) with trametinib and metformin in a patient with chemotherapy-refractory disease
Authors: Michael P Castro, Bradford P Whitcomb, Deborah A Zajchowski, Robert L Coleman
Journal: Gynecol Oncol Res Pract (2015)
Keywords: clear cell carcinoma, genomic, kras mutation, metformin, molecular profiling, next generation sequencing, ovarian cancer, pik3ca mutation, personalized medicine, precision medicine, targeted therapy, trametinib
MeSH terms: Case Reports

Purpose:
Compared to other subtypes of epithelial ovarian cancer, clear cell carcinoma of the ovary bears an ominous reputation for chemotherapy resistance, increased relapse rate, and diminished survival. Among patients with distinct histopathologic subtypes, molecular analyses have identified a variety of known drivers of the malignant behavior, and depict a striking heterogeneity.
Methods:
A patient with rapidly metastatic CCCO that was refractory to taxane, platinum, pemetrexed, and bevacizumab-based strategies underwent molecular profiling which disclosed dual MAPK and PI3K/AKT/mTOR pathway mutations.
Results:
Combined targeted therapy with trametinib and metformin resulted in a dramatic disease regression without toxicity.
Conclusion:
The case highlights the utility of precision medicine combining individual molecular diagnosis with rational therapeutic intervention with targeted agents.
Complications during pharmacological stress echocardiography: a video-case series
Authors: Albert Varga, Giuliano Kraft, Ferenc Lakatos, Riccardo Bigi, Rafael Paya, Eugenio Picano
Journal: Cardiovasc Ultrasound (2005)
MeSH terms: Arrhythmias, Cardiac / chemically induced, Cardiotonic Agents / adverse effects, Echocardiography / adverse effects, Exercise Test / adverse effects, Heart Rupture / chemically induced, Myocardial Ischemia / chemically induced, Case Reports, Aged, Female, Humans, Male, Middle Aged, Video Recording, Cardiotonic Agents

Background:
Stress echocardiography is a cost-effective tool for the modern noninvasive diagnosis of coronary artery disease. Several physical and pharmacological stresses are used in combination with echocardiographic imaging, usually exercise, dobutamine and dipyridamole. The safety of a stress is (or should be) a major determinant in the choice of testing. Although large scale single center experiences and multicenter trial information are available for both dobutamine and dipyridamole stress echo testing, complications or side effects still can occur even in the most experienced laboratories with the most skilled operators.
Case presentation:
We decided to present a case collection of severe complications during pharmacological stress echo testing, including a ventricular tachycardia, cardiogenic shock, transient ischemic attack, torsade de pointe, fatal ventricular fibrillation, and free wall rupture.
Conclusion:
We believe that, in this field, every past complication described is a future complication avoided; what happens in your lab is more true of what you read in journals; and Good Clinical Practice is not "not having complications", but to describe the complications you had.
A Multimodal Imaging Study in a Case of Bilateral Thalamic Damage With Multidomain Cognitive Impairment
Authors: Mariachiara Longarzo, Carlo Cavaliere, Mario Orsini, Liberatore Tramontano, Marco Aiello, Marco Salvatore, Dario Grossi
Journal: Front Neurol (2019)
Keywords: mri, pet, connectivity, dementia, stroke, thalamus
MeSH terms: Case Reports

Severe thalamic injury can determine a particular type of vascular dementia affecting multiple network dysfunctions, considered the central role of thalamus as a hub for afferent and efferent stimuli. A 67-year-old male patient with bilateral thalamic stroke was studied with positron emission tomography, magnetic resonance imaging, and cognitive assessment, performed at baseline and at two follow-up evaluations. A pattern primarily involving thalamo-frontal connections was observed by both PET and tractography analyses. All significant differences between the patient and controls involved the anterior thalamic radiation, one of the major fiber tracts in the fronto-thalamic circuitry. In particular, altered tractography indices of higher radial diffusivity and apparent diffusion coefficient and reduced fractional anisotropy values for the anterior thalamic radiation were reported. In accordance with imaging findings, neuropsychological evaluation demonstrated a multidomain impairment including memory, executive functions, and attention. Additionally, the patients displayed behavioral symptoms, in absence of mood alterations. Multimodal imaging assessment, revealing the metabolic and microstructural alterations that attend to multidomain neuropsychological impairment, demonstrated multiple levels of adaptations to bilateral vascular thalamic injury.
Intracardiac Teratoma in an Infant: Report of a New Case and Literature Review
Authors: Mustapha Azzakhmam, Amine Kessab, Abderrahmane Malihy, Lamiae Rouas, Najat Lamalmi
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

Primitive intracardiac tumours are rare, especially in childhood, and are often discovered on autopsy. The intracardiac teratoma is the rarest intracardiac tumours of childhood. Herein, we report the case of an 11-month-old infant, which featured recurrent bronchoalveolitis since the age of 3 months, with a thoracic deformation. Physical examination did found discrete respiratory distress signs. Chest radiography showed large mediastinal enlargement. The computed tomography showed a solid cystic-cloisonned mass with fat and central calcification highly suggestive of an intracardiac teratoma. A radical surgical excision was made and the histological examination found a well circumscribed tumour containing elements of the three germ layers confirming the diagnosis of mature well-differentiated teratoma, with no need of immunohistochemical support.
Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series
Authors: Weijun Wang
Journal: Biomed Res Int (2016)
MeSH terms: Head / diagnostic imaging, Hematoma, Epidural, Cranial / surgery, Minimally Invasive Surgical Procedures / methods, Activities of Daily Living, Adolescent, Adult, Aged, Child, Child, Preschool, Drainage, Female, Follow-Up Studies, Hematoma, Epidural, Cranial / diagnostic imaging, Humans, Male, Middle Aged, Tomography, X-Ray Computed, Treatment Outcome, Young Adult

Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13-145 mL); postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10-20 minutes); no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n = 1), 41-60 (n = 1), and >60 (n = 55); scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.
Case Report: Immune reconstitution inflammatory syndrome after hematopoietic stem cell transplantation for severe combined immunodeficiency
Authors: Shuangjun Liu, Feng Huo, Guorui Dai, Jie Wu, Maoquan Qin, Huawei Mao, Quan Wang
Journal: Front Immunol (2022)
Keywords: bcg disseminated tuberculosis, hsct = hematopoietic stem cell transplant, il2rg, iris - immune reconstitution inflammatory syndrome, severe combined immunodeficiency
MeSH terms: Hematopoietic Stem Cell Transplantation / adverse effects, Immune Reconstitution Inflammatory Syndrome / diagnosis, Immune Reconstitution Inflammatory Syndrome / etiology, Severe Combined Immunodeficiency, Case Reports, BCG Vaccine / adverse effects, Humans, Ibuprofen, Immunosuppressive Agents, BCG Vaccine, Immunosuppressive Agents, Ibuprofen

We report a case of immune reconstitution inflammatory syndrome (IRIS) after hematopoietic stem cell transplantation (HSCT). The patient had sever bacillus Calmette-Guerin (BCG) vaccine-caused disseminated infection and had received allogeneic HSCT for X-linked severe combined immunodeficiency disease. After HSCT, complicated by treatment-responding veno-occlusive disease and acute graft-versus-host disease, at the time when immunosuppressants were withdrawn, the patient experienced recurrent fever accompanied by elevated inflammatory indicators. After receiving glucocorticoids and ibuprofen, the patient's condition improved, and a diagnosis with BCG-related IRIS was made.
Case report: Severe pneumonia and pneumomediastinum in a previously robust adolescent caused by Omicron BA.5.2
Authors: Tianxin Xiang, Jianhua Fang, Tao Cheng, Zhongmin Li, Daxian Wu, Shouhua Zhang, Shanfei Ge, Wei Zhang
Journal: Front Med (Lausanne) (2023)
Keywords: covid-19, omicron, adolescent, mediastinal emphysema, severe pneumonia
MeSH terms: Case Reports

The manifestation of severe pneumonia is only occasional, and pneumomediastinum is a condition that occurs rarely in Coronavirus disease 2019 (COVID-19) patients, especially in those patients who are infected with the Omicron variant. In addition, whether severe pneumonia or pneumomediastinum often occurs in patients in older age, in poor physical condition, or with underlying diseases remains to be ascertained. To date, severe pneumonia and pneumomediastinum due to Omicron infection had not been reported in a young patient with an excellent physical condition. In this study, we report such a case with the aforementioned manifestations in a robust adolescent infected with Omicron BA.5.2.
Malignant pediatric gliosarcoma defies general survival data
Authors: Jovita Martin, Premkumar Devadoss, Kalaichelvi Kannan, Suresh Kumar Sundarraj
Journal: Case Rep Med (2014)

Gliosarcoma, a variant of glioblastoma multiforme, is a dimorphic tumor known for its intra-axial occurrence and poor survival of less than a year. Here is an 11-year-old boy with gliosarcoma. He had a near total excision and postoperative chemoradiotherapy. He has lived through the disease for over 34 months with a residual disease.This case report is to report an unusual long survival of gliosarcoma in a teenager (Ravisankar et al., 2012).
A rare case of volvulus after off-pump coronary artery bypass graft surgery in an opium addict patient revised
Authors: Feridon Sabzi, Mohammad Rozbahani, Aghighe Heidar, Reza Faraji
Journal: Caspian J Intern Med (2021)
Keywords: colonoscopy, laparatomy=, volvulus
MeSH terms: Case Reports

Background:
Volvulus of colon is a very rare phenomenon in post cardiac surgery course, and their predicting factor in most patients is unknown. Between colonic volvulus, splenic flexure is the rarest site for torsion in general population. The main symptoms are vague abdominal pain, vomiting and distension. The primary diagnostic images include plain chest x-ray, CT scan and colonoscopy.
Case presentation:
We report the case of a 57-year -old opium male addict, who was. Admitted for abdominal pain, nausea, and vomiting five days after off-pump coronary artery bypass surgery (OPCAB). An abdominal x-ray reported a colonic volvulus. Exploratory laparotomy showed acute abdomen resulting from a gangrene of long segment of splenic flexure caused by volvulus.
Conclusion:
Gastrointestinal complication such as volvulus is an exceedingly rare complication of OPCAB, despite the absence of anatomic abnormalities only complete colonic malrotation as the result of mega colon and constipation, the main pathogenetic causes. This patient was unique because of careful literature search revealed that this case was the first reported volvulus that has been described so far.
Case report of squamous cell cancer arising in perineal epidermal inclusion cyst, presenting as rapidly enlarging and cavitating lesion
Authors: Jose Vale, Yijun Pang, Arthur Kumpf, David Fitkin, Scott Drew
Journal: Int J Surg Case Rep (2018)
Keywords: case report, cavitating lesion, epidermal inclusion cyst, perineal, squamous cell cancer

Introduction:
Cutaneous squamous cell cancer (cSCC) is a common condition, with straight forward and well-known heuristics regarding diagnosis, treatment, and surveillance. cSCC arising in an epidermal inclusion cyst is rare, but not unheard of. In contrast, the authors' are unaware of any prior reports of cSCC arising in an epidermal inclusion cyst within an atypical cavernous and cavitating lesion in the perineum.
Presentation of case:
A 48-year-old male presented with a cavitating and rapidly growing cutaneous perineal lesion. Preliminary diagnostic procedures (biopsy) showed benign pathology and imaging showed no involvement of perineal organs such as prostate or rectum. Discordance between initial diagnostics and clinical features prompted multi-specialty consultation, including dermatological pathology. Repeat biopsy yielded in situ, possibly invasive squamous cell cancer, arising in the background of an epidermal inclusion cyst. Wide excision with advancement flap reconstruction was employed, with temporary diverting colostomy to avoid perineal sepsis.
Discussion:
Location and appearance of this lesion provided a diagnostic and treatment challenge requiring multi-specialty involvement for diagnosis and successful treatment. Specialists from urology, general surgery, dermatology, general and dermatological pathology, plastic and reconstructive surgery, colorectal surgery and medical and radiation oncology were involved in diagnosis, treatment plan and execution. None of the specialists involved had seen this singular presentation before, and this created an ownership and management challenge.
Conclusion:
The cavitating, atypical appearance of lesion complicated diagnosis. Location required pre-treatment coordination and deliberation between dermatology, urology, general surgery, and plastic surgery. Malignant degeneration of inclusion cysts, although rare, has to be kept in mind, especially when presenting with rapid growth, and persistence in ruling out malignant diagnosis is fundamental.
Toxoplasmosis chorioretinitis mimicking acute retinal necrosis associated with local corticosteroid
Authors: Jason N Crosson, Sanjana Kuthyar, Jessica G Shantha, Matthew R Debiec, Philip W Laird, Cindy S Hwang, Hans E Grossniklaus, Steven Yeh
Journal: Int J Retina Vitreous (2020)
Keywords: acute retinal necrosis, corticosteroids, toxoplasmosis
MeSH terms: Case Reports

Background:
The cases discussed highlight the atypical presentation and diagnostic dilemmas of toxoplasmosis with fulminant retinal necrosis and the potentially devastating visual outcomes of toxoplasma chorioretinitis following local corticosteroid exposure.
Case presentation:
We report a series of three patients who presented with toxoplasmosis mimicking severe acute retinal necrosis. Patients were between 59 and 77 years old and had been exposed to local corticosteroids preceding our evaluation. All patients demonstrated diffuse retinal whitening with severe vision loss on presentation. Polymerase chain reaction testing (PCR) was diagnostic in two patients, and histopathologic examination of a vitrectomy specimen was diagnostic in one patient. All cases of retinitis resolved with anti-parasitic medication; however, visual acuity failed to improve in all patients due to disease severity and presentation.
Conclusions:
Local corticosteroid injection may trigger or exacerbate toxoplasmosis chorioretinitis, leading to fulminant retinal necrosis and severe vision loss. Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, particularly following local corticosteroid injection regardless of their baseline systemic immune status. Diagnostic vitrectomy may be helpful in patients in whom PCR testing is negative and ocular toxoplasmosis is suspected.
Case report: Sudden cardiorespiratory collapse in a healthy male after coronavirus disease 2019 vaccination at a vaccination center
Authors: Cze Ci Chan, Chia-Pin Lin, Chi-Jen Chang, Pao-Hsien Chu
Journal: Front Cardiovasc Med (2022)
Keywords: covid-19 chadox1 ncov-19 vaccine, covid-19 vaccination adverse effect, cardiovascular adverse events, case report, coronary artery disease, sudden collapse
MeSH terms: Case Reports

Since 2020, new vaccines were developed to fight the coronavirus disease 2019 (COVID-19). Vaccination is important in preventing mortality and achieving herd immunity. However, due to vast vaccination, fatal adverse events could be seen. We report a case of a previously healthy, young male who had a cardiopulmonary arrest 2 min after receiving the Oxford- AstraZeneca (ChAdOx1 nCoV-19) COVID-19 vaccination. After targeted temperature management, a coronary angiogram was performed after neurological recovery and showed severe stenosis at the proximal left anterior descending artery. Stenting was done and he was discharge. No similar case of sudden cardiorespiratory collapse immediately after COVID-19 vaccination has been reported. Our patient did not have any effort-related angina or dyspnea on exertion before this event. The sudden cardiorespiratory collapse was probably related to underlying coronary artery disease, complicated with a vasovagal event. We stress the importance of coronary angiography in out of hospital cardiac arrest patients after neurological recovery. In the era of COVID-19 vaccination, even though fatal adverse events following immunization are rare, heightened awareness of severe side effects needing medical attention is very important.
Look away: arterial and venous intravascular embolisation following shotgun injury
Authors: John Vedelago, Elizabeth Dick, Robert Thomas, Brynmor Jones, Olga Kirmi, Jennifer Becker, Afshin Alavi, Wladyslaw Gedroyc
Journal: J Trauma Manag Outcomes (2014)
Keywords: ballistic trauma, computed tomography, firearm trauma, pellet embolisation, shotgun, trauma management, vascular injuries
MeSH terms: Case Reports

We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.