Fatal hemorrhage following trans-sphenoidal resection of a pituitary adenoma: a case report and review of the literature

A 58-year-old woman with acromegaly developed massive epistaxis 7 days following trans-sphenoidal resection of a growth hormone-secreting pituitary adenoma. At autopsy, it was determined that the source of the hemorrhage was a rupture of the intracavernous segment of the internal carotid artery secondary to a bacterial arteritis. We describe the gross dissection and histologic examination undertaken in this unusual case, discuss the possible etiology of the infection and review the potential complications of this surgical approach with a view to improving forensic examination of these patients.     

Bilateral asymmetric hip dislocation: case report and literature review

Simultaneous anterior and posterior hip dislocation is an unusual injury. A unique case is presented, consisting of bilateral asymmetric hip dislocation with associated femoral head, femoral shaft, and acetabular fractures resulting from a motorcycle collision. The mechanisms of injury, management, role of imaging, and complications of this injury complex are discussed, with a review of the relevant literature.     

Post-traumatic posterior sternoclavicular dislocation: case report and review of the literature

Injuries to the sternoclavicular joint are an uncommon problem, but can be life-threatening if not diagnosed and treated properly. Both anterior and posterior sternoclavicular dislocations or subluxations can occur, the latter being a rare injury. In this case report we report the imaging findings of both conventional radiography and multidetector CT on a 16-year-old man who developed a posterior sternoclavicular dislocation while participating in a football match. The current literature regarding this subject is also reviewed. Electronic Publication     

Fatal injury by an unmodified blank pistol: a case report and review of the literature

In this paper, we report a fatal neck injury of suicidal origin of a 29-year-old man. A 9-mm blank pistol and several blank cartridges in a plastic bag were discovered near the victim. There was an irregular and contuse oval contact-entrance wound of 25?mm?×?20?mm with a muzzle imprint on its upper medial part on the right side of the neck. The cause of death was exsanguination due to injuries to the right external carotid artery and the right jugular vein. This case confirms that blank pistols, contrary to public opinion, are dangerous and may inflict potentially fatal injuries when fired at close or contact range. In addition, previously reported 18 fatal injuries by blank cartridges caused by unmodified blank pistols between 1990 and 2009 are reviewed and summarized. It is concluded that as blank pistols may cause fatal injuries even without any modification, it is necessary to develop new standards for their production.     

Ischemic complication of a cerebral developmental venous anomaly: case report and review of the literature

We report a case of a nonhemorrhagic infarct associated with a thrombosed developmental venous anomaly (DVA), with secondary gliosis and Wallerian degeneration. The initial MRI scan showed an acute ischemic infarct in the region of the DVA, seen as a region of restricted diffusion on diffusion-weighted imaging (DWI), with later development of encephalomalacia and Wallerian degeneration on follow-up MRI. No blood products were seen. We believe that thrombosis of the collector vein of a DVA with associated infarction is a rare but possible complication that should be considered within the proper clinical setting and can be easily and confidently diagnosed by means of DWI.     

Psychogenic coma following upper endoscopy: a case report and review of the literature

BACKGROUND: Failure to regain consciousness after general anesthesia has a multitude of life-threatening causes, including neurological injury, metabolic derangements, or drug effects. Failure to promptly recognize the cause of unconsciousness after anesthesia can result in significant patient morbidity or mortality, costly laboratory and radiographic evaluation, and physician anxiety. Rarely, patients fail to awaken after anesthesia due to a psychiatric cause. The early recognition of psychogenic coma can result in reduced iatrogenic complications, hospital cost, and physician anxiety. CASE: We present a case of a 28-year-old female who became unresponsive after general anesthesia for an upper endoscopy. Physical, laboratory, and radiographic examination after the procedure revealed no apparent organic cause for her failure to awaken. The patient spontaneously awoke after 16 hours without neurological deficit. DISCUSSION: We reviewed the literature and identified 10 previously reported cases of postanesthesia psychogenic coma. We have compared and contrasted our case with the 10 previous reports and propose bedside clues to assist the physician with diagnosing this unusual condition.     

Superior dislocation of the patella with early onset patellofemoral arthritis: a case report and literature review

Among the traumatic patellar dislocations, superior dislocation of patella without patellar ligament injury is very rare. We present in this article, a case of superior dislocation of the patella trapped by interlocked osteophytes in a 38-year-old female who had concurrent bilateral knee arthrosis. Succesful reduction was achieved by closed manipulation without anesthesia. Neither redislocation nor symptoms of instability was seen after 36 months of follow-up, although some progression of arthritis was observed. A new classification including all traumatic patellar dislocation was also proposed.     

闭合性距骨全脱位致皮肤坏死的治疗1例并文献复习

距骨全脱位是指距骨从胫距关节、距下关节、距舟关节3个关节中全部脱位,通常伴有距骨及距骨周围骨折,多数为开放性。距骨位于足踝深部解剖位置,是下肢唯一一块无肌肉附着的骨头[1],有强力的韧带附着,其使距骨全脱位变得十分罕见。既往的研究多为个案报道,且多数是开放性损伤,闭合性距骨全脱位发生率更低。本文分析中国人民解放军第401医院收治1例闭合性距骨全脱位致皮肤坏死患者,采取距下关节融合联合腓肠神经营养皮瓣移植治疗,疗效满意。     

Intracranial haemorrhage following lumbar myelography: case report and review of the literature

We describe a subacute intracranial subdural haematoma following lumbar myelography. This rare but potentially life-threatening complication has been reported both after lumbar myelography and following lumbar puncture for spinal anaesthesia. We review 16 previously reported cases of intracranial haemorrhage following lumbar myelography, and discuss the pathogenesis. In all reported cases post-puncture headache was the leading symptom and should therefore be regarded as a warning sign. Received: 5 March 1999/Accepted: 3 June 1999     

Posterior atlantoaxial dislocation complicating odontoid fracture without neurologic deficit: a case report and review of the literature

Traumatic posterior atlantoaxial dislocation associated with odontoid fracture is extremely rare, with only eight cases reported thus far in the English literature. This report concerns a 47-year-old female who presented with considerable pain and stiffness in the neck without a neurologic deficit after injury due to a fall. Radiographs, computed tomography, and magnetic resonance imaging demonstrated a posterior dislocation of the atlas with respect to the axis with an odontoid fracture. No cord compression or intramedullary cord signal abnormalities were detected at the level of the atlantoaxial dislocation. A pedicle screw fixation/fusion was performed via a posterior approach following successful closed reduction.     

Epidural hematoma as a complication of sphenoid sinusitis and epidural abscess: a case report and literature review

Imaging is of paramount importance in early diagnosis of epidural abscess and its intracranial complications. Typical CT imaging features of an epidural abscess include a hypodense lentiform extra-axial collection with rim enhancement. We present a case of epidural abscess that was hyperdense on CT scan due to the presence of associated epidural hematoma. The literature is reviewed regarding this unusual complication of epidural abscess.     

Anterior subluxation after reduction of a posterior traumatic sterno-clavicular dislocation: a case report and a review of the literature

Sternoclavicular dislocations represent a rare injury. Based on our clinical experience with a patient showing an anterior subluxation after reduction of a posterior traumatic dislocation, we review the literature. The emergent reduction of the dislocation is mandatory, always keeping in mind the potentially devastating neurovascular complications. If the treatment of a residual anterior instability remains controversial, a residual posterior instability should be treated by a surgical procedure. The optimal treatment depends mainly on each surgeons choice and practice.     

Gastric pneumatosis following nasogastric tube placement: a case report with literature review

We report a case of gastric emphysema following placement of nasogastric (NG) tube. Gas in the wall of the stomach is a rare finding seen in various clinical situations. The reported cases fall into two different categories: “gastric emphysema” and “emphysematous gastritis”. Differentiating these two entities is important, as the first one is usually a benign condition, but the second one carries a poor prognosis.     

Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review

Radiation-induced pneumonitis (RP) is a rare complication of radioembolization with yttrium-90 ((90)Y) microspheres. The present report describes a case of RP in a patient with liver metastases from a gastrointestinal stromal tumor after radioembolization with (90)Y glass microspheres. This patient developed clinical, functional, and radiographic findings consistent with RP, with near-complete pulmonary parenchymal recovery and no clinical evidence of relapse or progressive decline in pulmonary function over a 9-month period. As clinical use of radioembolization expands, rare adverse events such as RP may become more frequent. It is essential that interventional radiologists, radiation/medical oncologists, and nuclear medicine physicians recognize this potential complication.     

Posterior dislocation of the long head of biceps tendon: case report and review of the literature

Posterior or lateral dislocation of the long head of biceps is a rare complication of shoulder dislocation that can result in inability to relocate the humerus. The diagnosis should be suspected when certain radiographic features are present at the initial presentation. Other imaging modalities can aid diagnosis when clinical management is unsuccessful or protracted. We present a case of surgically proven posterior dislocation of the biceps tendon with conventional radiographic, computed tomography and magnetic resonance imaging assessment. The literature on this subject is reviewed, and imaging features associated with the diagnosis are described.     

Fatal subarachnoid hemorrhage caused by rupture of variant anterior communicating artery: a case report and literature review

Fatal subarachnoid hemorrhage (SAH) caused by anterior communicating artery (ACoA) rupture is a rare event in medicolegal practice. Anatomical variations of the ACoA tend to make its anatomical structure, and as a result, blood flow through it, more complicated, which may increase hemodynamic stress and cause weak spots in the affected blood vessels. Variant ACoAs are prone to rupture in the event of a blunt-force trauma. Here, we report a fatal case of SAH caused by the rupture of a variant ACoA when the victim’s head was struck from behind, causing the head to rotate and the victim to fall forward onto the ground. A medicolegal autopsy revealed diffuse basal SAH and ACoA duplication. The smaller of the two variant ACoA branches had ruptured near its junction with the right anterior cerebral artery. No basal aneurysms or other fatal diseases or injuries were found. This case highlights the significance of anatomical variation in forensic pathology.     

心脏血管瘤1例并文献复习

目的 探讨心脏血管瘤的临床表现、影像特征和病理特点,以提高对心脏血管瘤的认识和鉴别诊断能力。 方法 回顾性分析1例经手术病理证实的心脏血管瘤病人的影像及病理资料并行文献复习。 结果 超声心动图上可见胸腔内主动脉根部右后方、腹主动脉膈肌水平左前方一实性为主的中等回声团,内部可见低、无回声区,周边可见强回声的钙化,血流未见异常。CT显示心脏肿物位于左室下壁,密度欠均匀,内部及边缘可见明显钙化;增强后病变轻度强化。MRI显示左室下壁基底段肿物明显向腔外突出,信号不均匀,增强后呈不均匀轻度强化。选择性冠状动脉造影可见肿瘤供血动脉来源于右冠状动脉。PET/CT显示病灶呈糖代谢缺失。正电子发射计算机断层扫描（PET/CT）显示病灶呈糖代谢缺失。 结论 心脏血管瘤可发生于心脏肌层,如发现心脏肌层肿物存在冠状动脉供血及明显蛋壳样钙化时,即使不具有典型强化表现,也需考虑血管瘤的诊断。     

Xanthoma disseminatum: a case report and literature review

This case report describes the neuro-opthalmologic and respiratory manifestations of xanthoma disseminatum, a rare histiocytosis syndrome characterized by disseminated lesions in a young male adult. Multimodality management of this disease, including the role of local radiotherapy, is discussed accompanied by a review of the literature.