by Pramod Theetha Kariyanna, Jessica Celenza-Salvatore, Apoorva Jayarangaiah, George Jojo Punnakudiyil and Isabel M. McFarlane
Original Research
Pulmonary embolism is a cause of significant morbidity and mortality. Thrombus in transit is defined on ultrasound as mobile echogenic material, temporarily located in the right heart chambers making its way to the pulmonary vasculature, which is highly diagnostic of pulmonary embolism. Point-of-care ultrasound (POCUS) places significant role in early diagnosis of thrombus in transit. Point-of-care ultrasound also avoids the need for subsequent computed tomography angiogram for diagnosis of pulmonary embolism. We present the case of 53-year-old male who presented with shortness of breath and was noted to have sinus tachycardia; thrombus in transit was diagnosed by point-of-care ultrasound and was subsequently confirmed through computer tomography angiogram of the pulmonary artery.
American Journal of Medical Case Reports. 2020, 8(2), 67-69. DOI: 10.12691/ajmcr-8-2-7
Pub. Date: January 07, 2020
5903 Views909 Downloads
by Pramod Theetha Kariyanna, Lyudmila Aurora, Amog Jayarangaiah, Sushruth Das, Jose Casillas Gonzalez, Sudhanva Hegde and Isabel M. McFarlane
Original Research
Contrast media enhances the visualization of the anatomic structures in radiological studies, allowing internal tissues such as blood vessels, kidney, ureters, adrenals and other organs to be identified. The evolution of contrast media highlights the efforts to develop less toxic chemical agents that possess low viscosity and osmolality. However, adverse effects such as idiosyncratic reactions, and organ specific damage are well characterized. Neurotoxicity, an important and dose related effect, appears to be due to disruption of the blood-brain-barrier by the high osmolarity of the contrast agent. From devastating cortical blindness to paralysis and seizures, an array of neurological manifestations has been described. In this systematic review, we describe the contrast-induced neurologic injury following coronary angiography and discuss the proposed mechanisms of injury leading to neurotoxicity.
American Journal of Medical Case Reports. 2020, 8(2), 60-66. DOI: 10.12691/ajmcr-8-2-6
Pub. Date: January 07, 2020
5395 Views1016 Downloads
by Lyudmila Aurora, Abid Ullah, Pramod Theetha Kariyanna, Oleg Yurevich, Harshith Priyan Chandrakumar, Erdal Cavusoglu, Jonathan D. Marmur and Isabel M. McFarlane
Case Report
Vagal stimulation is common during angiographic procedures. A vasovagal reaction in the setting of coronary angiography most commonly presents as hypotension and/or bradycardia. While the array of signs and symptoms of vasovagal reactions are known, atrioventricular (AV) block maybe overlooked due to its intermittent nature. Below we describe a case of a 47 year-old female who presented with transient complete AV block, mediated by a vagal reaction due to bladder distention in the setting of an invasive coronary angiography procedure.
American Journal of Medical Case Reports. 2020, 8(2), 56-59. DOI: 10.12691/ajmcr-8-2-5
Pub. Date: January 06, 2020
7940 Views920 Downloads
by Jeffrey Song, Tariq Sharman and Khubaib Gondal
Case Report
Hepatic abscesses are the most common type of visceral abscesses. The annual incidence is estimated at 2.3 cases per 100,000 people and is more common in men than women. A considerable proportion of pyogenic liver abscesses are caused by hepatobiliary pathologies. However, it may also result from hematogenous seeding from the systemic circulation. Most pyogenic liver abscesses are polymicrobial in nature consisting of anaerobic and enteric gram-negative bacilli species. Less than 10% of cases are caused by Staphylococcus aureus. Of these, few are caused by Methicillin-resistant Staphylococcus aureus (MRSA) and even fewer from the community-acquired strain. The clinical manifestations of pyogenic liver abscesses usually include fever, abdominal pain and non-specific symptoms like nausea, vomiting, malaise, anorexia and weight loss. Treatment of pyogenic liver abscesses consists of source control with drainage and antibiotic therapy tailored to the isolated causative organism. We present a case of a 51-year-old Caucasian man who presented with severe right upper quadrant abdominal pain of 5 days in duration. Abdominal Computed Tomography (CT) showed a 7.7 by 6.0 centimeter multi-loculated mass in the right hepatic lobe with other scattered foci throughout the liver. The abscess was aspirated with a pigtail drain placed under CT guidance. The aspirated culture grew MRSA sensitive to Doxycycline and Trimethoprim/Sulfamethoxazole.
American Journal of Medical Case Reports. 2020, 8(2), 53-55. DOI: 10.12691/ajmcr-8-2-4
Pub. Date: January 03, 2020
4276 Views508 Downloads
by Maya Srinivasan, Pramod Theetha Kariyanna, Jeremy Smith, Sushruth Das, Amog Jayarangaiah, Sudhanva Hegde, Jessica L. Perez Perez and Isabel M. McFarlane
Case Report
Vascular Closure Devices (VCD) are routinely used in cardiac catheterization and other endovascular procedures in order to achieve immediate post-procedural hemostasis and sealing of the femoral artery puncture site. Unlike manual compression, VCD encompass a broad range of devices, with varying mechanisms, that offer the advantage of achieving rapid hemostasis, increased patient comfort and mobility, decreased reliance on hospital staff resources, and facilitate earlier hospital discharge. Complications of VCD have been well-described and include embolization, arterial occlusion, infection, or vascular obstruction. Here, we describe a case in which the Angio-Seal device was utilized during an elective cardiac catheterization resulted in acute lower extremity ischemia.
American Journal of Medical Case Reports. 2020, 8(2), 49-52. DOI: 10.12691/ajmcr-8-2-3
Pub. Date: December 25, 2019
5151 Views1119 Downloads
by Sharad Samson Rajamani, Neeraj Salhotra, Samit Biniwale, Bashar Al Tunbi, Fahad Al Kheder and Faraz Qayyum Khan
Case Report
Endoscopic surgery has truly revolutionized the surgical management of colloid cysts. Their central and deep location within the third ventricle has historically demanded a great degree of surgical skill and demand on the patient. Until the last two decades the treatment options for patients with colloid cysts included a traditional craniotomy (opening the skull for removal of the cyst), stereotactic cyst aspiration, or placement of a shunt for hydrocephalus.
American Journal of Medical Case Reports. 2020, 8(2), 44-48. DOI: 10.12691/ajmcr-8-2-2
Pub. Date: December 18, 2019
8101 Views747 Downloads
by Pramod Theetha Kariyanna, Benjamin Ramalanjaona, Mohammed Al-Sadawi, Apoorva Jayarangaiah, Sudhanva Hegde and Isabel M. McFarlane
Literature Review
Coronary embolism is a cause of acute myocardial infarction (AMI)in which obstructive foci enter the coronary circulation, block normal blood flow and precipitate ischemia. Precise studies focusing on patient population affected, pathophysiological mechanisms, and treatment strategies are scanty, in spite of a reported prevalence estimated at 2.9%. As the understanding of myocardial infarction without evidence of coronary artery disease continues to grow, an in-depth review of this previously seldomly reported subtype of coronary ischemia was in order. Patients suffering coronary embolism are 15 to 20 years younger than traditional AMI patients with a slight predominance towards male sex, which resembles the gender data of the populations affected by non-traditional myocardial infarction in published reports. While the expected prevalence rate of cardiovascular disease risk factors such as hypertension and hyperlipidemia are present, this population also has a relatively high prevalence of atrial fibrillation and valve pathology, especially endocarditis. Initial presentation is indistinguishable from other causes of myocardial infarction however fever is commonly present, when endocarditis with valvular involvement is the primary cause of the coronary embolism. Mechanical thrombectomy is the mainstay of treatment, followed by percutaneous coronary intervention. Mortality is the highest in patients who do not receive targeted treatment for the coronary embolism, particularly if only antimicrobial agents or anticoagulation without thrombolytic agents are employed. The unique features of coronary embolism highlighted in this historical study justify further examination in contemporary patient populations.
American Journal of Medical Case Reports. 2020, 8(2), 31-43. DOI: 10.12691/ajmcr-8-2-1
Pub. Date: December 17, 2019
8429 Views1197 Downloads