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International Journal of Surgery Case... Dec 2023Traumatic embolization of pellets into the cerebral circulation is a rare complication following gunshot wounds to the neck, chest and abdomen. Foreign bodies enter the...
Air rifle wound to the chest and pellet embolism to the intracranial internal carotid artery with a middle cerebral artery territory infarct: A case report and review of literature.
INTRODUCTION
Traumatic embolization of pellets into the cerebral circulation is a rare complication following gunshot wounds to the neck, chest and abdomen. Foreign bodies enter the circulation from early direct puncture or delayed erosion of an artery or vein or directly through the heart.
PRESENTATION OF CASE
A previously well 13-year-old Sri Lankan boy who presented 2 h following an air rifle injury to the lower sternum with chest pain, developed seizures and left hemiparesis. Contrast CT angiogram showed the pellet at the base of the skull at the right carotid canal, with a middle cerebral artery (MCA) thrombus and evidence of MCA infarction. Decompressive craniectomy was performed. Cerebral angiography confirmed complete occlusion of the intracranial internal carotid artery (ICA) by the pellet, without cross circulation from the left ICA. Attempts at endovascular pellet retrieval failed. Open pellet embolectomy was not performed and the patient was managed conservatively.
DISCUSSION & CONCLUSION
Air rifle injury to the chest causing pellet embolism from the left ventricle to the right intracranial ICA with associated right MCA thrombus is a rare phenomenon. Missile embolism must be suspected when neurological findings are not in concordance with the site of injury especially in the absence of an exit wound and an inability to locate the pellet in the vicinity of the entry wound. Radiographs, CT and cerebral angiography are indicated to locate the pellet and associated injuries. The decision on surgical embolectomy, endovascular retrieval or expectant management is an individualized decision dependent on many factors.
PubMed: 37992670
DOI: 10.1016/j.ijscr.2023.109076 -
Journal of Cardiothoracic Surgery Nov 2023A single-center study was conducted to explore the association between STAS and other clinical features in surgically resected adenocarcinoma to enhance our current...
An individualized nomogram for predicting and validating spread through air space (STAS) in surgically resected lung adenocarcinoma: a single center retrospective analysis.
OBJECTIVE
A single-center study was conducted to explore the association between STAS and other clinical features in surgically resected adenocarcinoma to enhance our current understanding of STAS.
METHODS
We retrospectively enrolled patients with lung adenocarcinoma (n = 241) who underwent curative surgeries. Patients undergoing surgery in 2019 were attributed to the training group (n = 188) and those undergoing surgery in January 2022 to June 2022 were attributed to the validation (n = 53) group. Univariate and multivariate logistic regression analyses were used to identify predictive factors for STAS, which were used to construct a simple nomogram. Furthermore, ROC and calibration curves were used to evaluate the performance of the nomogram. In addition, we conducted decision curve analysis (DCA) to assess the clinical utility of this nomogram.
RESULTS
In our cohort, 52 patients were identified as STAS-positive (21.6%). In univariate analysis, STAS was significantly associated with age, surgical approach, CEA, CTR (Consolidation Tumor Ratio), TNM stage, tumor grade, gross tumor size, resection margin, vessel cancer embolus, pleural invasion, lymph node metastasis, high ki67 and positive PD-L1 staining (P < 0.05). Lower age, CTR > 0.75, vessel cancer embolus, high Ki67 and PD-L1 stain positive were significant predictors for STAS during multivariate logistics analysis. A simple nomogram was successfully constructed based on these five predictors. The AUC values of our nomogram for the probability of tumor STAS were 0.860 in the training group and 0.919 in the validation group. In addition, the calibration curve and DCA validated the good performance of this model.
CONCLUSION
A nomogram was successfully constructed to identify the presence of STAS in surgically resected lung adenocarcinoma patients.
Topics: Humans; Retrospective Studies; Nomograms; B7-H1 Antigen; Lung Neoplasms; Ki-67 Antigen; Neoplasm Staging; Adenocarcinoma of Lung; Adenocarcinoma; Embolism
PubMed: 37990253
DOI: 10.1186/s13019-023-02458-0 -
Medicine, Science, and the Law Jul 2024This is a case of a patient who underwent an esophageal dilatation for benign esophageal strictures. As a consequence of the procedure, she developed an esophageal...
This is a case of a patient who underwent an esophageal dilatation for benign esophageal strictures. As a consequence of the procedure, she developed an esophageal rupture and multiple cerebral and cerebellar air emboli resulting in infarction. The patient died after being placed on comfort care measures. The postmortem examination revealed focal breach of the esophageal mucosa but no sites of cardiac or vascular shunting that could account for the transit of air from the esophagus to the central nervous system. The phenomenon of vascular air entry as a consequence of upper gastrointestinal endoscopic intervention is an uncommon but very serious complication of balloon dilatation therapy. Instances of progression to intracranial arterial gas embolism are even less common, but are well described in a small number of case reports. We present a fatal case of central nervous system air embolism post-balloon dilatation therapy with associated antemortem imaging, autopsy, and microscopic images followed by a discussion of potential mechanisms of entry of air into the brain.
Topics: Humans; Embolism, Air; Female; Fatal Outcome; Intracranial Embolism; Esophageal Stenosis; Esophagoscopy; Forensic Pathology; Middle Aged
PubMed: 37960837
DOI: 10.1177/00258024231212878 -
European Heart Journal. Case Reports Nov 2023Coronary air embolism (CAE) is a rare and life-threatening complication of endovascular procedures, mostly due to procedure-related causes.
BACKGROUND
Coronary air embolism (CAE) is a rare and life-threatening complication of endovascular procedures, mostly due to procedure-related causes.
CASE SUMMARY
A 70-year-old man with severe respiratory disorder presented with patent foramen ovale (PFO)-related platypnea-orthodeoxia syndrome (POS). Transcatheter PFO closure was performed under local anaesthesia and intracardiac echocardiographic guidance. After a 5-Fr catheter was passed through the PFO via a 7-Fr femoral vein sheath, the patient suddenly coughed and breathed deeply. Thereafter, intracardiac echocardiography showed massive microbubbles in all cardiac chambers and the ascending aorta, and an electrocardiogram showed ST-segment elevations in the anterior and inferior leads. Emergency coronary angiography confirmed occlusion of the mid-left anterior descending artery, suggesting CAE. As the intracoronary infusion of saline, nitroglycerine, and nicorandil was ineffective, we performed air aspiration using a thrombectomy device, achieving coronary blood flow improvement and ST-segment resolution. Thereafter, positive pressure support using manual bag-valve-mask ventilation under intravenous sedation supported successful transcatheter PFO closure without further air embolization.
DISCUSSION
In this case with severe respiratory dysfunction, spontaneous deep breathing (spontaneous Valsalva manoeuvre) caused negative intrathoracic pressure and large drops in intravascular pressure. This phenomenon might have induced air contamination during device advancement, either by entrapping or leaving residual air in the gaps between the catheter and the sheath. Additionally, PFO with right-to-left shunts is more likely to cause paradoxical air embolization. Thus, the spontaneous Valsalva manoeuvre should be avoided with appropriate respiratory management to prevent paradoxical air embolization, including CAE, during transcatheter PFO closure under local anaesthesia in severe respiratory dysfunction patients.
PubMed: 37942356
DOI: 10.1093/ehjcr/ytad521 -
Frontiers in Immunology 2023
Topics: Humans; Thrombosis; Inflammation
PubMed: 37920472
DOI: 10.3389/fimmu.2023.1303385 -
Journal of Clinical Medicine Oct 2023The safety and efficacy of an uninterrupted direct anticoagulation (DOAC) strategy during catheter ablation (CA) for atrial fibrillation (AF) has not been fully...
BACKGROUND
The safety and efficacy of an uninterrupted direct anticoagulation (DOAC) strategy during catheter ablation (CA) for atrial fibrillation (AF) has not been fully investigated with different ablation techniques.
METHODS
We evaluated consecutive AF patients undergoing catheter ablation with three different techniques. All patients were managed with an uninterrupted DOAC strategy. The primary endpoint was the rate of periprocedural thromboembolic and bleeding events. The secondary endpoints of the study were the rate of MACE and bleeding events at one-year follow-up.
RESULTS
In total, 162 patients were enrolled. Overall, 53 were female and the median age was 60 [55.5-69.5] years. The median CHADS-VASc and HAS-BLED scores were 2 [1-4] and 2 [1-2], respectively. In total, 16 patients had a past stroke or TIA while 11 had a predisposition or a history of bleeding. The CA procedure was performed with different techniques: RF 43%, cryoballoon 37%, or laser-balloon 20%. Overall, 35.8% were on rivaroxaban, 20.4% were on edoxaban, 6.8% were on apixaban, and 3.7% were on dabigatran. All other patients were all naïve to DOACs; the first anticoagulant dose was given before the ablation procedure. As for periprocedural complications, we found three groin hematomas not requiring interventions, one ischemic stroke, and one systemic air embolism (the last two likely due to several catheter changes through the transeptal sheath). Five patients reached the secondary endpoints: one patient for a myocardial infarction while four patients experienced minor bleeding during 1-year follow-up.
CONCLUSIONS
Our results corroborate the safety and the efficacy of uninterrupted DOAC strategy in patients undergoing CA for AF, regardless of the ablation technique.
PubMed: 37892671
DOI: 10.3390/jcm12206533 -
Asian Journal of Surgery Jan 2024
Topics: Humans; Embolism, Air; Craniocerebral Trauma; Tomography, X-Ray Computed
PubMed: 37879992
DOI: 10.1016/j.asjsur.2023.10.027 -
Quantitative Imaging in Medicine and... Oct 2023
PubMed: 37869310
DOI: 10.21037/qims-23-216 -
Cureus Sep 2023Compared to operative hysteroscopy, diagnostic hysteroscopy rarely leads to issues. However, one very uncommon yet potentially fatal complication is air embolism, with...
Compared to operative hysteroscopy, diagnostic hysteroscopy rarely leads to issues. However, one very uncommon yet potentially fatal complication is air embolism, with an incidence rate of three in 17,000 cases. This report describes an unexpected complication discovered during diagnostic hysteroscopy surgery. In the course of routine infertility testing, a 29-year-old woman underwent a diagnostic hysteroscopy under general anesthesia. Intraoperatively, her end-tidal carbon dioxide (EtCO2) levels decreased, oxygen saturation dropped, and heart rate increased, leading the anesthesiologists and critical care team to terminate the procedure and manage her further. Subsequent transesophageal echocardiography confirmed the diagnosis of air embolism. She was managed with 100% oxygen and inotropes and cardiopulmonary resuscitation but despite aggressive medical interventions, her condition did not improve, and she unfortunately passed away. To diagnose, prevent, and manage the potentially devastating consequences associated with diagnostic hysteroscopy, gynecologists and surgical teams must maintain vigilance. The focus should be on proper patient selection, optimal surgical techniques, and the use of high-quality equipment to mitigate the risk of air embolism.
PubMed: 37842363
DOI: 10.7759/cureus.45069 -
The Egyptian Heart Journal : (EHJ) :... Oct 2023Despite the fact that injectable filler usage in the gluteal region has not been recommended in formal medical institutions, illegal procedures are performed in many...
BACKGROUND
Despite the fact that injectable filler usage in the gluteal region has not been recommended in formal medical institutions, illegal procedures are performed in many clinics and beauty centers across Egypt. This case report illustrates the illegal practice culminating in a fatal complication.
CASE PRESENTATION
A 26-year-old female with no relevant medical history presented to the ER with acute onset shortness of breath. The complaint started 16 h before, with a rapidly progressive course, shortly after undergoing a gluteal filler injection at a center in Cairo. At ER, the patient was severely distressed, yet fully conscious and oriented. She was shocked (BP 70/40 mmHg), tachycardic (130 BPM), and tachypneic (30/min) with normal temperature. She had congested pulsating neck veins with positive Kussmaul sign. Chest auscultation revealed normal vesicular breathing with equal air entry and no adventitious sounds. Her O2 saturation was 60% on room air that improved to 85% on O2 mask. ECG showed sinus tachycardia. Echocardiography showed dilated right side, D-shaped septum with systolic flattening, dilated IVC, mild tricuspid regurgitation and estimated RV systolic pressure 53 mmHg. Her ABG showed compensated metabolic acidosis with elevated lactate level. At the ICU, CVP was 18 mmHg. Saline infusion was continued along with noradrenaline infusion initiation. A provisional diagnosis of high-risk pulmonary embolism was made, though CT pulmonary angiography was not available. Accordingly, thrombolytic therapy was initiated with alteplase (100 mg) over 2 h. Also, a dose of pulse steroids (methylprednisolone 200 mg) was given. Chest X-ray showed bilateral heterogenous opacity and ABG showed deteriorating hypoxia and combined metabolic and respiratory acidosis. The patient was intubated upon deterioration of conscious level and was put on mechanical ventilation. Her ET tube showed frequent blood-tinged secretions. Echocardiography showed more right-side dilatation that was consistent with deterioration of clinical status. Three hours after admission the patient developed cardiac arrest and died 2 h later.
CONCLUSIONS
This case report highlights the dangers associated with injectable filler usage in the gluteal region. Physicians and patients should be aware of the possible complications and how to avoid it.
PubMed: 37816906
DOI: 10.1186/s43044-023-00415-9