Spontaneous splenic rupture

Spontaneous splenic rupture is a rare entity. It is usually associated with infectious, neoplastic, or hematologic diseases. Unlike traumatic splenic rupture, spontaneous rupture of the spleen is not often considered in the differential diagnosis of abdominal pain and can be easily confused with other abdominal pathology. Failure to consider splenic rupture can be catastrophic. We report a case of atraumatic splenic rupture in a patient with no underlying disease pathology. This illustrates the importance of keeping a broad differential in patients presenting with acute abdominal pain and should remind the physician to consider the diagnosis of spontaneous nontraumatic splenic rupture.     

Spontaneous rupture of renal angiomyolipoma with perinephric haemorrhage: sonographic findings

The sonographic findings observed in four patients with spontaneous rupture of a renal angiomyolipoma and perinephric haemorrhage are presented. In all cases, a hyperechoic renal mass surrounded by a large hypoechoic haematoma was identified. Furthermore, the actual site of rupture of the tumour could be seen in one case as a wedge-shaped hypoechoic structure extending from the periphery to the centre of the mass. CT has been suggested as the method of choice in the assessment of both the presence and extent of haemorrhagic complications of angiomyolipomas. However, since such lesions can be demonstrated and identified by ultrasound, which is often used as the first imaging procedure in abdominal complaints, the technique may also prove of value in planning further diagnostic tests and in choosing the appropriate therapeutic approach to these patients.     

Endovascular therapy for massive haemothorax caused by ruptured extracranial vertebral artery aneurysm with neurofibromatosis Type 1

Extracranial vertebral artery aneurysm is uncommon, and the common cause is penetrating trauma. Rupture of extracranial vertebral artery aneurysm into the thoracic cavity is extremely rare and fatal due to haemorrhagic shock by massive haemothorax. We report an intrathoracic rupture of the extracranial vertebral artery aneurysm with neurofibromatosis Type 1, successfully treated by coil and liquid embolisation.     

Spontaneous rupture of the extensor pollicis longus tendon in a professional skier

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is uncommon in sports activities. We report a rare case of a professional downhill skier presenting with a rupture of the EPL tendon. Repetitive motion of the wrist joint appeared to cause the rupture. The patient was treated successfully with tendon transfer of the extensor indicis proprius.     

Case report: primary mesenchymal chondrosarcoma of the brain.

We report an 11-year-old girl with a very rare tumour, mesenchymal chondrosarcoma of the brain, presenting as a haemorrhagic stroke, in whom angiography originally showed a distal arterial aneurysm. One month later MRI showed a solid tumour in addition to evidence of haemorrhage, and angiography then demonstrated pathological vascularity. The diagnosis was made following craniotomy.     

Bedside ultrasound in the diagnosis of uterine rupture following surgical abortion

Reports of uterine rupture following surgical abortion are rare but may result in hemorrhage, sepsis, and even death. In this unique case, we describe how a transabdominal pelvic ultrasound performed at the bedside by an emergency department physician identified uterine rupture with retained products of conception and led to an emergent laparotomy and hysterectomy. This case illustrates how bedside ultrasound may be used in patients presenting with abdominopelvic pain following surgical abortion to shorten the time to definitive treatment and ultimately lower the morbidity and mortality associated with a diagnosis of life-threatening uterine rupture.     

The use of real-time ultrasound in the management of scrotal trauma

27 patients were studied with real-time ultrasound following severe scrotal trauma. 22 (81.5%) had ultrasound features of scrotal trauma and, of these, five (18.5%) had signs of testicular rupture. Four of these five patients underwent surgery following ultrasound. This confirmed the diagnosis of rupture and the tests were repaired. Ultrasound should be offered to all patients presenting with scrotal trauma to select patients with testicular rupture for surgery.     

Cardiac hydatid disease: report of two cases

Cardiac involvement in hydatid disease is rare, occurring in less than 2% of cases of hydatid infection. It can occur as part of a widespread systemic infection or as an isolated event. It may be asymptomatic for a long period before presenting with a myriad of non-specific symptoms. Imaging plays an important role in the diagnosis, surgical planning and follow up of cases. Current treatment involves attempted surgical resection (cystopericystectomy) with long-term follow-up chemotherapy (Albendazole). Both the disease and its surgical treatment carry a high complication rate, including rupture leading to anaphylaxis and death.     

输卵管妊娠与妊娠黄体的三维能量多普勒超声鉴别

目的:应用经阴道的三维能量多普勒超声比较输卵管妊娠与其自身妊娠黄体的声像图差异,以提高输卵管妊娠的诊断。方法:输卵管妊娠患者24例纳入研究,年龄20~39岁,平均27岁,术前行阴道超声检查,使用三维能量多普勒超声观察输卵管妊娠声像图、血流分布的同时,对其妊娠黄体进行对比观察。采集三维能量多普勒血流图、血流分布,并测量相应的血管参数,包括血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)。结果:输卵管妊娠以团块型多见,血流信号稀少,明显低于妊娠黄体,输卵管妊娠血管参数VI、FI、VFI值明显低于妊娠黄体(P<0.05)。结论:输卵管妊娠多普勒超声表现为低血流团块,其血流分布和血管参数明显不同于妊娠黄体,可资鉴别,帮助早期诊断输卵管妊娠。     

上臂“大力水手”畸形:磁共振影像评价及临床意义

目的探讨肱二头肌长头腱断裂形成上臂远端屈侧"大力水手"畸形的MRI特征,并结合临床病史和体征,提高对该损伤的诊断。方法搜集2014年4月至2018年5月共31例肱二头肌长头腱断裂导致"大力水手"畸形患者的临床和MRI影像资料,回顾性分析患者的上臂MRI影像特征和临床特点。结果 31例"大力水手"畸形患者MRI上均可清晰分辨出断裂的二头肌长头腱远端位置、形态,冠矢状面T₂WI上,断裂肌腱呈弹簧状回缩低信号带,周边环绕高信号水肿区,呈典型的"飘带征";横断面T₂WI上,中央圆形低信号代表断裂肌腱残端,周边伴环形水肿高信号,呈"靶环征"。回缩的二头肌肌腹无明显信号异常,上臂伸直状态下MRI检查影像上形态改变不明显。患者和接诊医师常忽略数月前二头肌长头腱断裂致肩痛病史,临床上容易误诊为肿瘤或肿瘤样病变。结论肱二头肌长头腱断裂导致的上臂远端屈侧"大力水手"畸形,在常规磁共振影像上具有典型的特征。认识该典型特征,结合患者的临床病史和体征,对该损伤的诊断十分关键。     

探讨彩色超声在妇产科急腹症中的诊断价值

目的：探讨彩色超声检查对妇产科急腹症的诊断价值。方法对178例妇产科急腹症患者行腹部及阴道彩色超声检查,以临床诊断及病理检查结果作为诊断的金标准,将超声诊断结果与临床诊断结果进行对照。结果178例妇产科急腹症患者经彩超诊断168例,彩超与临床、病理检查结果诊断符合率为94.38％。其中异位妊娠发生率最高占81例,其次是卵巢黄体破裂出血29例、卵巢肿瘤蒂扭转28例。结论彩色超声检查诊断妇产科急腹症准确率高,且具有无创、简便、快速、可反复操作的特点,可作为妇产科急腹症的首选检查方法。     

Utility of the caput succedaneum in the forensic investigation of neonaticide: a case report

Suspicion of neonaticide often leads to a request for a forensic autopsy. In that setting, it is important to correlate autopsy findings with the history given by the mother. So far, caput succedaneum has not raised interest in forensic pathology. A caput succedaneum is a haemorrhagic oedema involving the skin and superficial fascia of the head that results from circulatory stasis caused by compression exerted by the uterus or cervix on the presenting part. It is usually seen with prolonged labour. We report a case of caput succedaneum in a forensic autopsy that overturned the mother's history of giving birth suddenly, consequently increasing the evidence of neonaticide.     

Angiosarcoma: unusual cause of acute abdominal pain and hemoperitoneum

Spontaneous rupture of primary angiosarcoma of the spleen is an uncommon cause of acute abdominal pain and hemoperitoneum. Clinical findings and presentation are nonspecific and variable. CT is frequently used as a first-line imaging modality in the evaluation of acute abdominal pain; however, findings are not specific for angiosarcoma. We report a case of primary splenic angiosarcoma with spontaneous rupture, hemoperitoneum, and hepatic metastases in a patient presenting to the emergency department with acute left upper quadrant pain and fever.     

Ruptured arteriovenous malformation secondary to placental site trophoblastic tumor: A diagnostic dilemma and its successful management

Placental site trophoblastic tumor is a very rare neoplasm and is a subtype of gestational trophoblastic neoplasm. Owing to its rarity and varied clinical manifestations, it can lead to a diagnostic dilemma. We report a very rare case of PSTT presenting as massive hemoperitoneum caused by rupture of secondary arteriovenous malformation. MR angiogram revealed the presence of arteriovenous malformation and the diagnosis of the neoplasm was confirmed on histopathology and immunohistochemistry. Hysterectomy was done and the patient was managed successfully.     

Forniceal rupture secondary to ureterocele and increased urine flow

A case of a simple ureterocele presenting with spontaneous forniceal rupture is described. Rupture followed hypophysectomy for Cushing's disease and high urine outflow. This presentation has not been reported previously.     

Forniceal rupture secondary to ureterocele and increased urine flow

A case of a simple ureterocele presenting with spontaneous forniceal rupture is described. Rupture followed hypophysectomy for Cushing’s disease and high urine outflow. This presentation has not been reported previously.     

超声显像在妇产科急腹症诊断中的应用价值

目的探讨超声在妇产科急腹症中的诊断价值。方法对269例妇产科急腹症患者行超声检查,并与临床病理检查结果进行对照。结果异位妊娠78例,卵巢囊肿扭转26例,子宫内膜异位症(巧克力囊肿)44例,黄体破裂33例,急性盆腔炎性包块69例,卵巢囊肿破裂6例,子宫浆膜下肌瘤蒂扭转2例,卵巢畸胎瘤5例,卵巢泡膜纤维瘤2例,子宫肌瘤红色变性4例。超声诊断符合率分别为:83.3%、84.6%、81.8%、72.7%、82.6%、66.7%、50%、60%、50%、50%。结论方便快速的超声检查在妇科急症占重要地位。     

Delayed rupture of the spleen. A case report

The diagnosis of delayed rupture of the spleen is demonstrated and discussed by presenting a case in which the patient had significant thoracoabdominal trauma with an initially normal liver/spleen scintigram and benign hospital course. Twenty-three days after the trauma, the patient developed an acute abdominal crisis that brought him to the emergency room where an emergency ultrasound revealed hemoperitoneum and a subcapsular hematoma. At laparotomy, a splenic rupture was found. A splenectomy was not performed. Postoperative liver/spleen scintigram showed a persistent defect which was not present on the initial liver/spleen scintigram.     

Chest CT scanning for clinical suspected thoracic aortic dissection: beware the alternate diagnosis

The aim of the study was retrospectively to evaluate the spectrum of chest diseases in patients presenting with clinical suspicion of thoracic aortic dissection in the emergency department. We performed a retrospective medical records review of 86 men and 44 women (ages ranging between 23 and 106 years) with clinically suspected aortic dissection, for CT scan findings and final clinical diagnoses dating between January 1996 and September 2001. All images were obtained by using a standard protocol for aortic dissection. We found aortic dissection in 32 patients (24.6%), 22 of which were Stanford classification type A and 10 Stanford type B. In 70 patients (53.9%), chest pain could not be explained by the CT scan findings. However, in 28 patients (21.5%), CT scanning did reveal an alternate diagnosis that, along with the clinical impression, probably explained the patients' presenting symptoms, including: hiatal hernia (7), pneumonia (5), intrathoracic mass (4), pericardial effusion/hemopericardium (3), esophageal mass/rupture (2), aortic aneurysm without dissection (2), pulmonary embolism (2), pleural effusion (1), aortic rupture (1), and pancreatitis (1). In cases where there is clinical suspicion of aortic dissection, CT scan findings of an alternate diagnosis for the presenting symptoms are only slightly less common than the finding of aortic dissection itself. Although the spectrum of findings will vary depending upon your patient population, beware the alternate diagnosis. Electronic Publication     

Spontaneous splenic rupture during infection of cytomegalovirus. A case report

Splenic rupture is most commonly encountered after blunt abdominal trauma. Spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. We report the case of a 27-year-old female patient without pathological history. Admitted to the emergency department for the sudden onset of left hypochondrial pain associated with vomiting, rapidly progressing to hypovolemic shock. She had reported an influenza-like illness a week earlier for which her COVID-19 PCR was negative. Emergency abdominal ultrasound and CT-scan revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy with good clinical evolution. Despite the rarity of this condition, physicians should consider the diagnosis of spontaneous non traumatic splenic rupture when encountering healthy patients presenting with nonspecific left hypochondrial abdominal pain and hypovolemia. Mortality is essentially related to the delay in diagnosis and treatment and to the severity of the underlying pathology. Treatment often consists of splenectomy.