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British Medical Journal Nov 1971The diagnosis of primary cancer of the liver was reviewed in 75 patients. A definitive diagnosis was made during life in 63% and in a further 20% this condition was...
The diagnosis of primary cancer of the liver was reviewed in 75 patients. A definitive diagnosis was made during life in 63% and in a further 20% this condition was suspected though histological confirmation was obtained only at necropsy. The most common presenting complaints were abdominal pain and weight loss and the most frequent findings hepatomegaly and ascites. Less than one-half of the patients were jaundiced and when present it was usually mild. An arterial bruit was heard over the liver in 25% of the patients. A sudden and unexplained deterioration in a patient known to have cirrhosis or haemochromatosis should raise the possibility of a primary hepatic tumour; this occurred in 24% of our patients.Alpha-fetoprotein was found in the serum of 11 out of 18 cases. The presence of a mass in the liver was frequently confirmed by liver scan, portal venography, or hepatic arteriography, but these showed no features diagnostic of a primary tumour. Liver scan also proved useful in localizing the lesion for biopsy purposes. Definitive diagnosis is dependent on the histological demonstration of the features of the tumour. This can frequently be achieved by percutaneous needle biopsy, which was positive in 38 out of 57 patients. Wedge biopsies were positive in a further nine patients.
Topics: Abdomen; Adolescent; Adult; Aged; Alkaline Phosphatase; Angiography; Ascites; Auscultation; Autopsy; Biopsy; Body Weight; Child; Female; Fetal Proteins; Hemochromatosis; Hepatomegaly; Humans; Jaundice; Lipid Metabolism, Inborn Errors; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Pain; Phlebography; Radionuclide Imaging
PubMed: 5124443
DOI: 10.1136/bmj.4.5784.408 -
Radiologia Sep 2013The middle aortic syndrome (MAS) is caused by stenosis of the abdominal aorta, often accompanied by concomitant stenosis of the renal or visceral arteries. Although MAS... (Review)
Review
The middle aortic syndrome (MAS) is caused by stenosis of the abdominal aorta, often accompanied by concomitant stenosis of the renal or visceral arteries. Although MAS is uncommon (0.5-2%), it is an important cause of hypertension in children and adolescents. It is thought to originate in a failure of the two dorsal aortas to fuse during embryological development, and a high percentage of cases are idiopathic. MAS affects the segment of the aorta between the renal arteries in 54% of cases. Clinically, it courses with symptomatic or asymptomatic arterial hypertension. On physical examination, findings include an abdominal bruit, diminished or absent femoral pulses, and a difference between the arterial pressure of the upper and lower limbs. Angiography is the technique of choice, although noninvasive MR angiography and CT angiography have similar diagnostic accuracy. Ultrasonography is the primary screening technique. Medical treatment consists of a combination of different antihypertensives. Surgical treatment can be curative.
Topics: Aorta, Abdominal; Aortic Diseases; Arterial Occlusive Diseases; Child; Child, Preschool; Humans; Male; Syndrome
PubMed: 21724214
DOI: 10.1016/j.rx.2010.12.016 -
Cureus Sep 2021Celiac artery compression syndrome (CACS), also known as median arcuate ligament syndrome, can sometimes represent a diagnostic challenge. Here, we present the case of a...
Celiac artery compression syndrome (CACS), also known as median arcuate ligament syndrome, can sometimes represent a diagnostic challenge. Here, we present the case of a 29-year-old man who presented with recurrent diabetic ketoacidosis (DKA), abdominal pain, and vomiting thought to be due to cyclical vomiting syndrome. However, the lack of a clear precipitant for DKA, the presence of chronic gastrointestinal symptoms, and a revealing physical examination of abdominal bruit led to clinical suspicion of CACS and its diagnosis after appropriate investigations. While angiography has traditionally been considered the gold standard diagnostic test, hemodynamic and geometric ultrasound criteria can, however, be diagnostic. The patient was managed by releasing the celiac artery through robotic surgery and serial monitoring as an outpatient revealed resolution of his symptoms and no further readmissions for DKA. This case highlights how a presumptive and erroneous diagnosis (cyclical vomiting syndrome) can misguide clinicians, especially when dealing with a rare diagnosis of exclusion.
PubMed: 34660028
DOI: 10.7759/cureus.17818 -
Journal of Surgical Case Reports Feb 2023Iatrogenic arteriovenous fistula (IAVF) is an unusual and potentially fatal complication of lumbar spinal surgery. A 62-year-old patient presented with a history of...
Iatrogenic arteriovenous fistula (IAVF) is an unusual and potentially fatal complication of lumbar spinal surgery. A 62-year-old patient presented with a history of dyspnea, left lower limb edema and coughing. A physical exam showed bilateral basal rales in the lungs, abdominal bruit and bilateral lower limb pitting edema. A computed tomography angiograph revealed an arteriovenous communication between the right internal iliac artery and the left common iliac vein. The patient was diagnosed with an IAVF, which developed post-lumbar disc surgery. The patient underwent a successful endovascular treatment by using covered stent at the common iliac artery with embolism of lumbar artery. The patient's symptoms were relieved 2 months after surgery.
PubMed: 36755932
DOI: 10.1093/jscr/rjac576 -
The Korean Journal of Thoracic and... Dec 2018Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are...
Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.
PubMed: 30588451
DOI: 10.5090/kjtcs.2018.51.6.406 -
Journal of Medical Cases Feb 2020Takayasu arteritis (TA) is a chronic inflammatory disease characterized by granulomatous vasculitis that predominantly manifests as panaortitis. This occlusive...
Takayasu arteritis (TA) is a chronic inflammatory disease characterized by granulomatous vasculitis that predominantly manifests as panaortitis. This occlusive thromboaortopathy lacks pathognomonic features often resulting in a diagnostic dilemma leading to its under-recognition, misdiagnosis and delayed management. Although neurological manifestations are not uncommon in TA, convulsive syncope as an initial clinical presentation is extremely rare. We report a case of convulsive syncope as a manifesting symptom of TA. A 17-year-old male patient of African origin was referred to us from an upcountry regional hospital with a diagnosis of medically intractable epilepsy for cardiovascular review. He presented with a 28-week history of generalized tonic-clonic seizures followed by loss of consciousness. He denied history of recurrent headaches, fever, visual disturbances, arthralgias, claudication or unintentional weight loss. Physical examination revealed feeble left-sided brachial and radial pulses, elevated blood pressure, differences in blood pressure between arms and left-sided carotid and vertebral bruits. Computed tomography angiogram of his thoracic and abdominal aorta revealed changes suggestive of a diffuse arteritis. Additionally, magnetic resonance angiogram of the brain revealed total occlusion of the left common carotid, left internal carotid, left external carotid and left vertebral arteries. Based on the physical examination and radiological findings, we reached a diagnosis of TA. He was prescribed dexamethasone, methotrexate, acetylsalicylic acid and amlodipine. He had a remarkable recovery and was seizure-free for the last 5 months after discharge. TA may manifest with convulsive syncope mimicking epilepsy. Despite its rarity, presentations of this nature continue to challenge clinicians resulting in delayed diagnosis with irreversible life-threatening consequences to patients. In view of this, physicians should strive to take detailed history and perform thorough physical examination so as to timely pick the characteristic signs of TA especially in patients presenting with unanticipated symptoms.
PubMed: 34434357
DOI: 10.14740/jmc3424 -
Romanian Journal of Morphology and... 2018Resistant hypertension is defined by the inability to maintain within normal limits the blood pressure values of an individual, while he is under treatment with maximal... (Review)
Review
Resistant hypertension is defined by the inability to maintain within normal limits the blood pressure values of an individual, while he is under treatment with maximal tolerated doses of three antihypertensive agents. One of the most common types of resistant hypertension is renovascular hypertension (RVH), which is caused by the narrowing of the renal arteries, in the context of existing atherosclerotic plaques at that level. We are presenting the case of a hypertensive 56-year-old man admitted in the Clinic of Cardiology for a sudden rise of his blood pressure values, despite undergoing the scheduled treatment. The abdominal bruit discovered at the clinical examination and the hypokalemia, together with the mild impairment of the renal function raised the suspicion of an existing stenosis of the main renal blood vessels. Simple grey scale kidney ultrasound, Doppler ultrasound of the renal arteries, abdominal computed tomography and magnetic resonance angiography of the renal arteries, along with invasive renal angiography demonstrated a smaller right kidney, adrenal incidentalomas, reduced vascular diameter of renal arteries due to atheromatous lesions, thrombosis of the infrarenal segment of the abdominal aorta, and reduced vascular hemodynamics in the same territories. After the renal arteries revascularization and with minimal antihypertensive treatment, the patient had a favorable outcome, with normalization of blood pressure and renal function. Atherosclerotic disease causing renal artery stenosis is essential to be taken into consideration in the etiopathogenesis of resistant hypertension especially because RVH is a potentially curable disease.
Topics: Humans; Hypertension; Kidney; Male; Middle Aged; Renal Artery Obstruction
PubMed: 29940645
DOI: No ID Found -
Cureus Sep 2019A 55-year-old African American man with a history of abdominal aortic pseudoaneurysm repair presented to the ED with complaints of black-colored stools mixed with fresh...
A 55-year-old African American man with a history of abdominal aortic pseudoaneurysm repair presented to the ED with complaints of black-colored stools mixed with fresh blood and fever for three days duration. The exam was unremarkable except for abdominal bruits and pallor. CT angiogram showed perigraft fluid collection, bowel wall thickening, and loss of normal fat planes between the aorta and adjacent bowel at the level of the third portion of the duodenum. Polymicrobial infection was noted in the aortic graft and blood cultures grew Candida. The patient underwent urgent removal of the infected graft, duodenal repair along with appropriate antimicrobial therapy. He did well postoperatively and was discharged in a stable condition. Our case highlights the importance of maintaining a high index of suspicion of aortoenteric fistula (AEF) when a patient with a prior abdominal aortic graft develops gastrointestinal (GI) bleeding as this condition is universally fatal if unrecognized.
PubMed: 31695994
DOI: 10.7759/cureus.5575 -
Mayo Clinic Proceedings Jul 2010
Topics: Adult; Angioplasty, Balloon; Auscultation; Diagnosis, Differential; Female; Headache; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Hypertension, Renovascular; Nephrectomy; Patient Selection; Radioisotope Renography; Recurrence; Renal Artery Obstruction; Smoking
PubMed: 20592173
DOI: 10.4065/mcp.2009.0330 -
World Journal of Gastroenterology Sep 2013Takayasu's arteritis (TA) and Crohn's disease (CD) are two rare autoimmune disorders; however some reports describe the presence of both diseases in the same patient....
Takayasu's arteritis (TA) and Crohn's disease (CD) are two rare autoimmune disorders; however some reports describe the presence of both diseases in the same patient. This finding has suggested the possibility that both diseases could share some common etiologic origin. We describe a case of a 13-year-old male affected by CD characterized by fever, diarrhea, weight loss, abdominal pain and elevation of inflammatory markers. Clinical and histological features from colonic specimens were consistent with CD. Treatment with steroids and azathioprine was started, however disease flared every time steroids were tapered. One year later, while still on treatment, he came back to our attention for dyspnea at rest and at night, tiredness and weakness. At physical examination a diastolic heart murmur was found as well as a left carotid artery bruit. A transthoracic echocardiography showed mild aortic valve insufficiency, left ventricular hypertrophy and a dilated ascending aorta with same findings at the aortic arch. A computed tomography scan showed abdominal aorta thickening, dilated thoracic aorta and the presence of a thoracic aortic aneurysm. TA associated with CD was diagnosed and medical treatment with cyclophosphamide, steroids and aminosalicylic acid was started, with good clinical response at 6 mo follow-up. We discuss the presence of possible common causes for the two diseases and the importance of differential diagnosis in those patients characterized for intractable disease.
Topics: Adolescent; Crohn Disease; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Male; Steroids; Takayasu Arteritis; Treatment Outcome
PubMed: 24124342
DOI: 10.3748/wjg.v19.i35.5933