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Journal of the Irish Medical Association Aug 1970
Topics: Hematoma; Humans; Male; Mediastinal Diseases; Middle Aged; Neck
PubMed: 5506327
DOI: No ID Found -
Journal of Pediatric Hematology/oncology Jul 2005The authors describe an 11-year-old boy with hemophilia A and high titer inhibitor who developed a life-threatening mediastinal-retroperitoneal hemorrhage. Chest CT...
Life-threatening mediastinal-retroperitoneal hemorrhage in a child with moderate hemophilia A and high inhibitor titer: successful management with recombinant activated factor VII.
The authors describe an 11-year-old boy with hemophilia A and high titer inhibitor who developed a life-threatening mediastinal-retroperitoneal hemorrhage. Chest CT showed a large hematoma beginning in the retrotracheal area, filling the mediastinum, compressing the carina, and extending retroperitoneally up to the kidneys. As the surgical approach has a high mortality rate, the authors chose a more conservative approach initially and obtained excellent bleeding control with recombinant activated factor VII without the need for surgical intervention. As reported in other patients, the authors also showed a decrease in the factor III inhibitor while this patient was successfully treated with bypassing agents.
Topics: Adult; Factor VII; Hematoma; Hemoperitoneum; Hemophilia A; Humans; Male; Radiography, Thoracic; Recombinant Proteins; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 16012333
DOI: 10.1097/01.mph.0000174241.03038.b5 -
The Journal of Invasive Cardiology Mar 2023In this clinical image vignette, we illustrate the presentation and management of an extremely rare and lethal complica- tion of radial access percutaneous coronary...
In this clinical image vignette, we illustrate the presentation and management of an extremely rare and lethal complica- tion of radial access percutaneous coronary intervention. We present a case of perforation of a small collateral branch of the brachiocephalic artery with subsequent mediastinal hematoma formation and stridor presentation. We suspect the perforation was probably caused by the hydrophilic-coated guidewire. After a multidisciplinary heart team discussion, a percutaneous approach was recommended. We performed the procedure with a single coil embolization of the collateral branch perforation, achieving complete resolution of the hemorrhage.
Topics: Humans; Percutaneous Coronary Intervention; Hemorrhage; Hematoma; Arteries
PubMed: 36884361
DOI: No ID Found -
Medicinal Research Reviews Mar 2021One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial... (Review)
Review
One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram-negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.
Topics: Cardiac Surgical Procedures; Humans; Mediastinitis; Sternum; Surgical Wound Infection
PubMed: 33174619
DOI: 10.1002/med.21758 -
QJM : Monthly Journal of the... Oct 2019
Topics: Bronchoscopy; Diagnosis, Differential; Female; Hemoptysis; Humans; Lung Neoplasms; Mediastinitis; Mediastinoscopy; Middle Aged; Sclerosis; Tomography, X-Ray Computed
PubMed: 31368497
DOI: 10.1093/qjmed/hcz198 -
Chest Feb 1994In patients with blunt chest trauma, early diagnosis of mediastinal hematoma is important, because it could be associated with thoracic vessel injury. Mediastinal...
In patients with blunt chest trauma, early diagnosis of mediastinal hematoma is important, because it could be associated with thoracic vessel injury. Mediastinal hematoma is generally evoked because of a widened mediastinum on chest radiograph, but radiologic diagnosis may lead to excessive angiography being performed. Transesophageal echocardiography (TEE) provides accurate views of the mediastinum and can be rapidly performed at the bedside. Thus, we conducted a prospective study to define TEE signs of mediastinal hematoma. TEE was performed in 22 thoracic trauma patients (trauma group) and in 20 brain-dead patients without thoracic trauma (control group). The positive diagnosis of mediastinal hematoma was made using thoracic surgery or computed tomographic scan. The specificity of TEE was 75 percent and sensitivity was 100 percent. In the trauma group, there was only one false positive but angiography discovered a traumatic aneurysm of the proximal right subclavian artery. No false negative was noted. We described three different TEE signs of mediastinal hematoma: (1) an increased distance between the probe and the aortic wall; (2) a double contour of the aortic wall; and (3) visualization of the ultrasound signal between the aortic wall and the visceral pleura. The distance between the esophageal probe and the aortic wall was the most accurate sign because it could be easily obtained; the threshold value for this distance was 3 mm. TEE appears to be an accurate method to diagnose traumatic mediastinal hematoma.
Topics: Adolescent; Adult; Brain Death; Echocardiography, Transesophageal; Female; Hematoma; Humans; Injury Severity Score; Male; Mediastinal Diseases; Mediastinum; Middle Aged; Prospective Studies; Sensitivity and Specificity; Thoracic Injuries; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 8306731
DOI: 10.1378/chest.105.2.373 -
Progress in Cardiovascular Diseases 1973
Review
Topics: Aortic Aneurysm; Aortography; Dihydroxyphenylalanine; Guanethidine; Hematoma; Hemorrhage; Humans; Hydrochlorothiazide; Hypertension; Kentucky; Mediastinum; Pleural Effusion; Propranolol; Prospective Studies; Reserpine; Trimethaphan
PubMed: 4577246
DOI: 10.1016/0033-0620(73)90006-6 -
Pediatric Critical Care Medicine : a... Jan 2018We aimed to systematically describe, via a scoping review, the literature reporting strategies for prevention and management of mediastinal bleeding post pediatric... (Review)
Review
OBJECTIVE
We aimed to systematically describe, via a scoping review, the literature reporting strategies for prevention and management of mediastinal bleeding post pediatric cardiopulmonary bypass surgery.
DATA SOURCES
MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL Register.
STUDY SELECTION
Two authors independently screened publications from 1980 to 2016 reporting the effect of therapeutic interventions on bleeding-related postoperative outcomes, including mediastinal drain loss, transfusion, chest re-exploration rate, and coagulation variables. Inclusions: less than 18 years, cardiac surgery on cardiopulmonary bypass.
DATA EXTRACTION
Data from eligible studies were extracted using a standard data collection sheet.
DATA SYNTHESIS
Overall, 299 of 7,434 screened articles were included, with observational studies being almost twice as common (n = 187, 63%) than controlled trials (n = 112, 38%). The most frequently evaluated interventions were antifibrinolytic drugs (75 studies, 25%), blood products (59 studies, 20%), point-of-care testing (47 studies, 16%), and cardiopulmonary bypass circuit modifications (46 studies, 15%). The publication rate for controlled trials remained constant over time (4-6/yr); however, trials were small (median participants, 51; interquartile range, 57) and overwhelmingly single center (98%). Controlled trials originated from 22 countries, with the United States, India, and Germany accounting for 50%. The commonest outcomes were mediastinal blood loss and transfusion requirements; however, these were defined inconsistently (blood loss being reported over nine different time periods). The majority of trials were aimed at bleeding prevention (98%) rather than treatment (10%), nine studies assessed both.
CONCLUSIONS
Overall, this review demonstrates small trial sizes, low level of evidence, and marked heterogeneity of reported endpoints in the included studies. The need for more, higher quality studies reporting clinically relevant, comparable outcomes is highlighted. Emerging fields such as the use of coagulation factor concentrates, goal-directed guidelines, and anti-inflammatory therapies appear to be of particular interest. This scoping review can potentially guide future trial design and form the basis for therapy-specific systematic reviews.
Topics: Adolescent; Blood Component Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Child, Preschool; Hemostasis, Surgical; Humans; Infant; Mediastinum; Postoperative Hemorrhage
PubMed: 29189637
DOI: 10.1097/PCC.0000000000001387 -
The American Journal of the Medical... May 1989A patient with long-standing, asymptomatic, primary hyperparathyroidism developed pain in the anterior neck area, with cough, dysphagia and increasing shortness of... (Review)
Review
A patient with long-standing, asymptomatic, primary hyperparathyroidism developed pain in the anterior neck area, with cough, dysphagia and increasing shortness of breath. This led to respiratory insufficiency, which required endotracheal intubation and respirator assistance. During the ensuing hours the patient developed an area of ecchymosis on the anterior chest. Chest x-ray showed widening of the superior mediastinum, and CT scan showed a large mass with a fluid level. Surgery revealed a large hematoma originating from a mediastinal parathyroid adenoma with a hemorrhagic infarct. Serum calcium, previously elevated, decreased to normal with the onset of neck pain, and the patient remains normocalcemic. Previous reported cases of this rare complication of parathyroid adenomas are reviewed. Hemorrhagic infarct of a parathyroid adenoma may present with a rapidly enlarging mediastinal mass, and/or hypercalcemic crisis. Surgical removal of the infarcted adenoma can return the serum calcium to normal.
Topics: Adenoma; Aged; Female; Hematoma; Humans; Infarction; Mediastinal Diseases; Parathyroid Neoplasms
PubMed: 2655447
DOI: 10.1097/00000441-198905000-00012 -
Journal of the Royal College of... Aug 1991
Topics: Aged; Aged, 80 and over; Female; Hematoma; Humans; Mediastinal Diseases; Radiography
PubMed: 1941752
DOI: No ID Found