Traumatic subdural hematoma in the lumbar spine

Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits.     

Laparoscopic drainage of an intramural duodenal hematoma

A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football. A diagnosis of intramural hematoma of the duodenum was made using computed tomography and upper gastrointestinal tract contrast radiography. The hematoma caused obstructive jaundice by compressing the common bile duct. The contents of the hematoma were laparoscopically drained. A small perforation was then found in the duodenal wall. The patient underwent laparotomy and repair of the injury. Laparoscopic surgery can be used as definitive therapy in this type of abdominal trauma. (Received Nov. 12, 1997; accepted Aug. 21, 1998)     

Esophageal submucosal hematoma: a case report and review of the literature

The patient was a 75-year-old man. Under a diagnosis of angina pectoris, he was being treated with aspirin and ticlopidine hydrochloride at a local clinic. Severe postprandial pharyngeal/thoracic pain and hematemesis occurred. Upper digestive tract endoscopy revealed an extensive submucosal hematoma involving the esophageal orifice and cardia. Computed tomography (CT) scan did not show aortic dissociation or mediastinal emphysema. Antiplatelet therapy was discontinued, and follow-up was continued by fasting and conservative treatment with an H₂-blocker. Ten days after onset, endoscopy showed the disappearance of the hematoma, and ingestion was started. Twenty-two days after onset, endoscopy revealed regeneration and cicatrization of the esophageal mucosa. In a detailed examination of heart diseases, angina pectoris was ruled out; therefore, antiplatelet therapy was discontinued. There has been no recurrent esophageal submucosal hematoma for 4 years of follow-up.     

Esophageal Hematoma Complicating Catheter Ablation for Atrial Fibrillation

Significant injury to the esophagus during ablation for atrial fibrillation is rare but may be devastating. Esophageal fistulas and injury to branches of the vagus nerve resulting in gastric stasis have previously been described. In this case report, we describe another type of esophageal injury associated with catheter ablation for atrial fibrillation. The patient experienced chest pain and vomiting on recovery from anesthesia. Echocardiography and computerized tomography were used to identify a large esophageal hematoma. The hematoma was treated conservatively and the patient recovered fully after several weeks.     

Esophageal hematoma

We report four cases of esophageal hematoma and emphasize that endoscopically and radiographically it may simulate a neoplasm. After a review of 26 cases, we found that patients with normal hemostasis often had esophageal hematoma occur distally after vomiting. Most of these hematomas probably originated from a Mallory-Weiss laceration. In contrast, patients with impaired hemostasis had esophageal hematoma occur proximally or at multiple sites. Many of these hematomas occurred spontaneously, without a history of vomiting, and probably resulted from impaired coagulation. Regardless of etiology most esophageal hematomas were associated with a benign course.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army of Department of Defense.     

Effects of STC on postoperative recovery of disturbance of consciousness in traumatic multiple intracranial hematoma patients

Objective:The study explored the therapeutic value of standard trauma craniectomy (STC) for the treatment of traumatic multiple intracranial hematoma.Methods:Clinical data of traumatic multiple intracranial hematoma patients who underwent surgical treatment in 2014 and 2015 were collected. The STC group and a control group according to the surgical mode, 48 and 30 cases were randomly selected from each group, respectively. Statistical analysis was performed on the change in the Glasgow coma scale (GCS) score from before the operation to 1 day, 1 week and 1 month postoperatively through repeated analysis of variance and Wilcoxon rank-sum analysis.Results:Significant differences in the GCS were observed at different time points for the two operative modes (P < .01), and an interaction was observed between time and treatment groups (P < .05). The rates of change of the GCS score for the two surgical modes were most obviously different at 3 days and 1 week postoperatively (P ≤ .001, P < .01). No statistically significant differences were observed in the rates of change of the GCS at 1 month postoperatively (P > .05).Conclusions:Compared to conventional craniotomy, STC has obvious effects on the recovery after disturbance of consciousness at 1 week postoperatively but does not result in a significant improvement in recovery at 1 month postoperatively.     

A Rare Case of Localized Esophageal Amyloidosis

A 72-year-old man without any symptoms was referred to our hospital. Esophagogastroduodenoscopy revealed an elevated esophageal lesion that was covered with normal mucosa. The examination of biopsy specimens from the lesion revealed amyloid light-chain (AL) (λ) type amyloid deposits, but there were no amyloid deposits elsewhere in the gastrointestinal tract. Further examinations did not indicate systemic amyloidosis. Thus, this case was diagnosed as a localized esophageal amyloidosis. As the clinical outcome of localized amyloidosis is favorable, this case was scheduled for close follow-up. Localized amyloidosis should be considered in the differential diagnosis of esophageal submucosal tumors.     

A case of spontaneous mesenteric hematoma and a review of 17 cases in Japan

A 47 year-old male was admitted to Miyazaki Medical college Hospital for further evaluation of an abdominal mass in the left upper quadrant. Abdominal ultrasound (US) and abdominal computed tomography (CT) showed two cystic masses in the mesenterium, which were suspected to be hematomas, but were not related to the pancreas, kidney or spleen. Superior mesenteric artery angiography and galluim (GA)-scintigraphy showed no definite findings. The patient underwent laparotomy on a suspicion of mesenteric hematoma. Two 4 × 3 × 3cm soft tumors were found in the small intestinal mesenterium. These masses were histopathologically hematomas and surrounded by thick collageneous granulation tissue. The patient had no recent history of abdominal trauma, taking drugs capable of producing bleeding tendency, and/or vascular disease. The case was diagnosed as spontaneous mesenteric hematoma.     

Pelvic hematoma after intercourse while on chronic anticoagulation

A 41-year-old anticoagulated woman presented with increasing pelvic pain that had begun two days prior during intercourse. An ultrasound and computerized tomographic (CT) scan confirmed the diagnosis of pelvic hematoma. The hematoma resolved spontaneously with normalization of clotting studies. The emergency physician should consider this rare cause of pelvic pain in selected anticoagulated patients. The need for a thorough history in emergency patients is emphasized, as well as the value of ultrasound and CT scan in the diagnosis of this disorder.     

Esophageal achalasia secondary to mesothelioma

Summary Achalasia secondary to malignancy is rare, with most cases associated with gastric adenocarcinoma of the gastroesophageal junction. This report describes the clinicopathologic features of a 64-year-old man found to have mesothelioma as the cause of secondary achalasia. To our knowledge, this is the first case of secondary achalasia produced by a mesothelioma. We reviewed the English literature in regard to achalasia induced by tumors.This work was supported by the Veterans Administration.     

Pericardial hematoma mimicking pericardial abscess

A 26-year-old man, with human immunodeficiency virus infection, on hemodialysis, was hospitalized due to infective endocarditis. A mechanical prosthetic mitral valve was implanted. During postoperative period, he maintained signs suggestive of infection. The transthoracic echocardiograms (TTE) revealed a pericardial effusion. One week later was visible a circumscribed collection compatible with a pericardial abscess. He was refused for cardiac surgery; however, inflammatory parameters elevation persisted. The TTE showed a periprosthetic mitral leak, and cardiac surgery was performed. The pericardial drainage revealed a hematoma. This case highlights the difficulty on echocardiographic differential diagnosis between a pericardial hematoma and pericardial abscess in clinical practice.     

老年外伤性颅内血肿患者的临床特点

对１４６例老年颅内血肿患者的致伤原因,临床表现,影像学检查结果,治疗方法及预后等因素进行了回顾性分析,结果表明,致伤原因中坠落伤占４９％、车祸伤占２５％,打伤占１１％,原因不明占１５％。临床表现轻重不一,在各种血肿中,慢性硬膜下血刀性硬膜外血肿１１例,硬膜下血肿９例,急性脑内血肿１４例,急性硬膜下血肿俣并脑内血肿２５例,亚急性硬下血肿７例,颅脑ＣＴ扫描均发现颅内有不同密度的阴影。１３６例行手术治疗     

Aortic root subadventitial hematoma

A 51-year-old woman was operated on for aortic valve regurgitation 3 months after experiencing chest tightness awakening her from sleep. Intraoperative findings included turbid dark brown pericardial fluid and a nipple-shaped protrusion on the external aspect of the noncoronary sinus of Valsalva. Histologically, the lesion was enclosed by intact media and adventitia, and represented an organized hematoma. Dilated venules noted adjacent to the lesion were suggestive of an intramural hemangioma. The etiology of this lesion is unclear, but it might be an unusual type of intramural hematoma (IMH) and gives us a hint of an origin of IMH.     

Esophageal adenocarcinoma in a patient with surgically treated achalasia

Summary Although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia, esophageal adenocarcinoma has been considered rare in this condition. We report a patient with long-standing achalasia in whom adenocarcinoma of the esophagus occurred many years after Heller esophagomyotomy, presumably related to Barrett's esophagus complicating gastroesophageal reflux disease.     

A Case of Esophageal Spasms in Amyloidosis

ABSTRACT. Impairment of esophageal peristalsis in amyloidosis is well known. A patient in whom esophageal spasms and orocricopharyngeal dyscoordination accompanied myeloma-associated amyloidosis is presented below. The different possible mechanisms producing these abnormalities are discussed.     

Mediastinal and neck hematoma after cardiac catheterization.

Vascular complications after cardiac catheterization are rare and usually occur at the access sites. However, vessels along the tract of the catheter can also be injured, causing bleeding and hematoma formation. We present a 57-year-old male who underwent cardiac catheterization via the radial approach, later developing neck and mediastinal hematoma, which was managed conservatively. This complication has only been reported once in the English literature.     

Coronary artery perforation with subepicardial hematoma

Coronary artery perforation is a relatively rare complication in coronary angioplasty. We report the case of a 71-year-old male, who was salvaged by emergency surgery, for cardiogenic shock due to subepicardial hematoma associated with balloon angioplasty. Such a case has not yet previously been reported. Cathet. Cardiovasc. Diagn. 41:59–61, 1997. © 1997 Wiley-Liss, Inc.     

Esophageal hematoma associated with thrombocytopenia.

Esophageal hematoma secondary to thrombocytopenia has only recently been described in the literature in a single case report. This article presents the clinical manifestations and radiographic findings of 4 additional cases of esophageal hematoma secondary to thrombocytopenia. Three patients were receiving treatment for leukemia, and the other patient had aplastic anemia. Previously reported cases of esophageal hematomas from other causes are reviewed.     

Esophageal motility disorders in HIV patients

Opportunistic esophageal infections (Candida, cytomegalovirus, herpes simplex virus) and idiophatic esophageal ulcerations are commonly found in HIV patients. However, motility disorders of the esophagus have seldom been investigated in this population. The aim of this prospective study was to determine the presence of motility disorders in HIV patients with esophageal symptoms (with or without associated lesions detected by endoscopy) and in HIV patients without esophageal symptoms and normal esophagoscopy. Eigthteen consecutive HIV patients (10 male, 8 female, ages 20–44 years, mean age 33.5; 8 HIV positive and 10 AIDS) were studied prospectively. Nine patients complained of esophageal symptoms, e.g, dysphagia/odynophagia (group 1) and 9 had symptoms not related to esophageal disease, such as diarrhea, abdominal pain, or gastrointestinal bleeding (group 2). All patients underwent upper endoscopy; mucosal biopsies were taken when macroscopic esophageal lesions were identified or when the patients were symptomatic even if the esophageal mucosa was normal. Esophageal manometry was performed in the 18 patients, using a 4-channel water-perfused system according to a standardized technique. Sixteen of the 18 patients (88.8%) had baseline manometric abnormalities. In group 1, 8/9 patients had esophageal motility disorders: nutcracker esophagus in 1, hypertensive lower esophageal sphincter (LES) with incomplete relaxation in 2, nonspecific esophageal motility disorders (NEMD) in 3, diffuse esophageal spasm in 1, esophageal hypocontraction with low LES pressure in 1. Six of these 9 patients had lesions detected by endoscopy: CMV ulcers in 2, idiopathic ulcers in 1, candidiasis in 1, idiopathic ulcer + candidiasis in 1, nonspecific esophagitis in 1; and 3/9 had normal endoscopy and normal esophageal biopsies. In group 2, 8/9 patients had abnormal motility: hypertensive LES with incomplete relaxation in 1, nutcracker esophagus in 2, esophageal hypocontraction in 3, and NEMD in 2. All these patients had a normal esophageal mucosa at endoscopy. In conclusion, our findings suggest that HIV patients have esophageal motility disorders independent of esophageal symptoms and/or the presence of mucosal esophageal lesions.