The American journal of emergency medicine
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Case Reports
Extensive retroperitoneal air, pneumomediastinum, and subcutaneous air secondary to stercoral perforation.
Stercoral perforation is an uncommon cause of large intestinal perforation that is typically the result of chronic constipation. Historically, this disease process has a devastatingly high mortality rate, and recent evidence questions the incidence of the disease, once thought to be scarce. ⋯ She had minimal abdominal complaints and no history of chronic constipation. The emergency provider should be aware that this disease entity exists and should be cognizant that retroperitoneal pathology may present with complaints referable to the chest or even neck with a paucity of abdominal findings.
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Case Reports
Compartment syndrome as a complication of ileofemoral deep venous thrombosis:a case presentation.
A 22-year-old morbidly obese, nonpregnant woman presented with left ileofemoral deep vein thrombosis (DVT) presenting as low back pain and bilateral, left greater than right, leg swelling and pain for 2 days. While on heparin, she developed compartment syndrome in her left leg and had evidence of dead muscle tissue at the time of fasciotomy. Three options exist for treatment of ileofemoral DVT: catheter-directed thrombolysis (CDT), CDT plus pharmacomechanical thrombolysis or percutaneous mechanical thrombectomy, and surgical thrombectomy. ⋯ Standard anticoagulation alone is likely not a sufficient treatment for ileofemoral DVT. Other therapies including CDT, CDT plus pharmacomechanical thrombolysis or percutaneous mechanical thrombectomy, or surgical thrombectomy to address lysis of the clot should be attempted first or in conjunction with anticoagulation for appropriate patients. Catheter-directed thrombolysis with or without pharmacomechanical thrombolysis is the preferred initial treatment.
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Spontaneous coronary artery dissection (SCAD) is a very rare but potentially fatal condition, which often causes acute myocardial infarction and sudden cardiac death. Spontaneous coronary artery dissection associated with pseudoaneurysm has been rarely reported mostly managed with coronary artery bypass grafting. We report a female patient with SCAD and pseudoaneurysm who was treated by successful percutaneous coronary intervention.
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Benign acute childhood myositis is a rare postviral myositis seen in school-aged children after a common upper respiratory infection (URI), most commonly caused by influenza [J Microbiol Immunol Infect 2004;37:95-98]. Predominantly seen in boys, this condition causes bilateral calf tenderness and pain with ambulation, often presenting as a refusal to bear weight. To avoid activation within the gastroc-soleus complex, the child will frequently compensate with a “Frankenstein gait,” described as a stiff-legged posture with shuffling gait [CMAJ 2009;181:711-713]. ⋯ He had no progression or complications, and his symptoms resolved spontaneously with minimal supportive treatment. Benign acute childhood myositis should be considered within the broad differential that surrounds a limping child or one who refuses to bear weight. Having insight into the condition with its characteristic gait abnormalities and associated URI history can often prevent extensive workups and be treated supportively in the outpatient setting.
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Isolated splenic peliosis is an extremely uncommon condition that can present with atraumatic rupture and potential fatal outcome. We here report 1 such case that developed after a viperine bite in a 21-year-old woman. The case highlights the diagnostic findings on computed tomographic (CT) scan and its potential complications.