Ruptured angiosarcoma of the liver treated by emergency catheter-directed embolization

Angiosarcoma is a rare primary malignant neoplasm of the liver with a poor prognosis. Here, we report a case of a patient with a ruptured hepatic angiosarcoma which was treated by emergency catheter-directed embolization, followed by left-sided hemihepatectomy.     

Hypertrophic obstructive cardiomyopathy complicated by ruptured chordae tendinea to the posterior mitral leaflet and severe congestive heart failure

A 63-year-old woman with hypertrophic obstructive cardiomyopathy developed rapidly progressive fatigue, shortness of breath and congestive heart failure. A transesophageal echocardiogram demonstrated ruptured chordae to the posterior mitral valve leaflet with severe mitral regurgitation. Mitral valve replacement eliminated the outflow gradient. Acute or subacute hemodynamic deterioration in a patient with hypertrophic obstructive cardiomyopathy should lead to a search for associated lesions.     

Hepatectomy for ruptured hepatocellular carcinoma classified as Barcelona Clinic Liver Cancer stage 0/A: The optimal treatment

Background and aimsRuptured hepatocellular carcinoma (rHCC) generally has a very poor prognosis and is currently classified as T4 in the tumor–node–metastasis (TNM) staging system. In this study, we aimed to demonstrate the actual impact of rHCC, as well as the positive effect of hepatectomy in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0/A rHCC.MethodsWe enrolled 86 patients with rHCC after surgery and 526 patients with non-rHCC after surgery or transcatheter arterial chemoembolization (TACE). Survival curves were plotted using the Kaplan–Meier method to compare the postoperative prognosis of patients with rHCC with that of patients with non-rHCC. Univariate and multivariate Cox regression analyses were used to identify the risk factors affecting patient survival.ResultsBCLC stage 0/A rHCC treated with surgery had a worse prognosis than BCLC stage 0/A non-rHCC treated with surgery (overall survival [OS]: hazard ratio [HR] = 3.12 [2.24–4.34], P < 0.001; recurrence-free survival [RFS]: HR = 2.26 [1.65–3.09], P < 0.001). Rupture was an independent prognostic factor in patients with BCLC stage 0/A rHCC (OS: HR = 1.685 [1.416–2.006], P < 0.001; RFS: HR = 1.484 [1.267–1.737], P < 0.001), and patients with BCLC stage 0/A rHCC who underwent surgery had a comparable prognosis to patients with BCLC stage B HCC who underwent surgery or TACE (OS: P = 0.78).ConclusionsPatients classified as having BCLC stage 0/A rHCC can achieve comparable outcomes to patients with BCLC stage B HCC after hepatectomy. However, not all patients with rHCC should be classified as T4 in the TNM staging system.     

Traumatic displacement of stomach – A case report

These days we have fast paced traffic on our roads to help us keep up with our fast paced life. But every boon has a down side and our high velocity traffic is no exception. Here is a case report of a blunt abdominal injury following a road traffic accident. Externally the deceased had only a few grazed abrasions on the forehead and right forearm. But on internal examination of abdomen, it was noticed that the left hemi-diaphragm was torn and the stomach and intestines were found displaced into the left thoracic cavity.     

An overview of penetrating ocular trauma with retained intraocular foreign body

Penetrating trauma is one of the common causes of ocular morbidity world wide. Violation of the globe integrity, also known as a ruptured globe is an ocular emergency that universally threatens vision. Prompt recognition and management is prudent. Here we report a case of a 26-year-old-female, university teacher, who presented with pain and sudden loss of vision in the left eye of 2 h duration subsequent to a test tube blast in the chemical laboratory. Examinations revealed a ruptured globe with vitreous haemorrhage and an intraocular glass foreign body in the left eye. Primary repair was done with good post operative visual recovery. We report this case to emphasize that protective measures should be taken to prevent such eye traumas.     

Prenatal detection of pulmonary hypoplasia in giant omphalocele

Respiratory insufficiency has sometimes been reported in giant omphalocele. To determine whether ultrasonic fetal lung measurements including lung/thorax transverse area ratio (L/T) and chest/trunk length ratio (C/T) may be useful in predicting associated pulmonary hypoplasia, 28 fetuses with abdominal wall defects between 1991 and 2003 were reviewed. Nine patients with gastroschisis and 19 with omphalocele were classified into three groups. A group with neonatal death and postmortem lung/body weight ratio below 0.012, which was defined as pulmonary hypoplasia (PH group), included two ruptured giant omphaloceles and two giant omphaloceles with intact covering membrane in utero. A group with artificial ventilation more than 3 months, which was defined as prolonged ventilation (PV group), included one ruptured giant omphalocele and three giant omphaloceles with intact covering membrane. Others were defined as ordinary group. In 12 fetuses with giant omphalocele, the evisceration rate of the liver (LER) was measured in the fetal transverse abdominal dimension including the base of the liver. The L/T in PH group was significantly decreased to other groups. The C/T in PH group was significantly increased to ordinary group. There was no significant difference in the LER among three groups. A measurement of L/T may be useful in predicting associated pulmonary hypoplasia in giant omphalocele. However, antenatal detection of patients required prolonged ventilation may be difficult and require further study.     

眶上外侧入路与翼点入路手术治疗急性期颅内前循环破裂动脉瘤的临床对比分析

目的 探讨眶上外侧入路与经典翼点入路手术治疗急性期颅内前循环破裂动脉瘤的临床效果。方法 2012年11月至2014年5月收治74例急性期前循环破裂动脉瘤,采用眶上外侧入路手术37例（眶上外侧组）,采用经典翼点入路37例（翼点组）。结果 眶上外侧组手术时间[（138.9±15.9）min]、切口长度[（9.4±1.6）cm]、术中出血量[（52.6±5.9）ml]较翼点组均明显减少[分别为（174.8±22.6）min、（15.7±2.6）cm、（236.8±25.8）ml;P<0.05]。眶上外侧组术中动脉瘤破裂率（16.2%,6/37）和翼点组（18.9%,7/37）无明显差异（P>0.05）。结论 相比经典翼点入路,眶上外侧入路手术治疗急性期前循环破裂动脉瘤手术创伤较小。     

To see or not to see – Ambiguous findings on post-mortem cross-sectional imaging in a case of ruptured abdominal aortic aneurysm

We present a case of a ruptured abdominal aortic aneurysm (AAA) with ambiguous accessory findings on post-mortem computed-tomography (PMCT), post-mortem magnetic resonance (PMMR) imaging, and PMCT-angiography (PMCTA) suggestive of thoracic aortic dissection. The diagnosis of ruptured AAA was confirmed by autopsy; however, there was no aortic dissection. The imaging findings that mimicked the presence of aortic dissection might have been an atypical presentation of post-mortem clotting or sedimentation. This case is an ideal example to illustrate benefits, limitations, and challenges of post-mortem cross-sectional imaging. It serves as a reminder that both, training as well as correlation of imaging findings with autopsy are fundamental to improve our understanding of radiologic findings on post-mortem cross-sectional imaging.     

Report of a case with a spontaneous mesenteric hematoma that ruptured into the small intestine

IntroductionA spontaneous mesenteric hematoma is a rare condition. Furthermore, it is extremely rare that the mesenteric hematoma caused gastrointestinal bleeding with an unknown etiology. We experienced a case with a spontaneous mesenteric hematoma that ruptured into the jejunum.Presentation of caseA 75-year-old man was referred to our hospital because of anal bleeding and anemia. Abdominal computed tomography (CT) showed a low density mass measuring 3.0 cm in diameter, including an enhanced spot. This finding suggested that a pseudo-aneurysm or mesenteric hematoma caused active bleeding into the jejunum. He underwent emergent laparotomy and partial resection of the jejunum and the mesentery including the tumor. A histological examination of the jejunum indicated no pathogenic findings causing active bleeding. And there were no findings suggesting the mesenteric aneurysm had developed.The patient had no history related to the development of a mesenteric hematoma, such as trauma, labor, surgery, or anticoagulant treatment. Therefore, we finally diagnosed that a spontaneous mesenteric hematoma had ruptured into the jejunum.Discussion and conclusionWe reported extremely rare condition that the mesenteric hematoma was developed and ruptured into the jejunum without definitive etiology.