The American journal of emergency medicine
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Case Reports
Spontaneous carotid-cavernous fistula: challenges in clinical and radiologic diagnosis.
We present a 47-year-old female patient with spontaneous carotid-cavernous fistula without comorbidities. The symptoms of a carotid-cavernous fistula may be confused with other pathology in the region of the orbit and cavernous sinus such as cavernous sinus thrombosis. Carotid-cavernous fistulas most commonly result from direct injury to the internal carotid artery, as with skull base or surgical trauma, but it can also result from weakness in the arterial wall, as with an aneurysm. ⋯ Magnetic resonance angiography sequence can reveal aneurysms communicating with the cavernous sinus, and magnetic resonance venography will define thrombosis within the cavernous sinus. Differentiating between cavernous sinus thrombosis and carotid-cavernous fistula can be clinically difficult, and a team approach including emergency physicians, neurosurgeons, ophthalmologists, and otolaryngologists will be called upon to assist in diagnosis. Prompt diagnosis and management can allow for potentially vision and lifesaving interventions.
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Case Reports
Spontaneous hepatic rupture caused by hemolysis, elevated liver enzymes, and low platelet count syndrome.
The causes of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome or hepatic hemorrhage as a serious complication of HELLP are not known. Although spontaneous hepatic rupture associated with HELLP syndrome is a rare complication of pregnancy, hepatic rupture results in life-threatening complications. ⋯ Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension. We report a case of 30-year-old primigravida female with spontaneous hepatic rupture caused by HELLP syndrome as a presenting symptom of right upper quadrant abdominal pain.
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Stroke has been rarely associated with carbon monoxide (CO) intoxication. We report a symptomatic internal carotid artery (ICA) thrombosis in a patient with acute CO intoxication.
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Case Reports
Primary umbilical endometriosis presenting as umbilical drainage in a nulliparous and surgically naive young woman.
Endometriosis is well known as a chronic condition associated with significant morbidity. Umbilical endometriosis, however, may go unrecognized because of its rarity, leading to multiple medical visits and a delayed diagnosis. Chronic umbilical drainage is an unusual presentation for umbilical endometriosis. ⋯ There are very few published case reports about primary umbilical endometriosis. A 24-year-old nulliparous African American woman presents to the emergency department with a complaint of chronic umbilical drainage of 3-year duration and undergoes a computed tomographic scan and subspecialty referral, which lead to the diagnosis of primary abdominal wall endometriosis and a new left ovary endometrioma. Although this is an unusual occurrence, it may be considered in patients with chronic umbilical drainage without other cause.