Proceedings (Baylor University. Medical Center)
-
Proc (Bayl Univ Med Cent) · Jul 2020
Case ReportsHydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression.
A 51-year-old man presented with pain in the region of his left patellar tendon and fibular head. He had previously undergone three L5 epidural steroid injections and physical therapy without relief. Prior magnetic resonance imaging was significant only for fat pad impingement, and electromyography and nerve conduction studies were negative. ⋯ Three ultrasound-guided hydrodissection procedures offered symptomatic improvement and identified an area posterior to the fibular head that was unable to be hydrodissected, indicating scar tissue causing peroneal nerve compression. The patient was referred for peroneal nerve decompression at the area of entrapment with complete symptom relief. This case is unique in describing the ability of hydrodissection to identify nerve compression not visualized with other diagnostic tests.
-
Drug reaction with eosinophilia and systemic symptoms, otherwise known as DRESS syndrome, is a rare, potentially life-threatening drug-induced hypersensitivity reaction that primarily involves a widespread skin rash, fever, hematological abnormalities, lymphadenopathy, and organ injury. Anti-epileptics, sulfonamides, and allopurinol are the most common triggers, but other offending medications have been reported in the literature. ⋯ The patient's clinical picture was initially consistent with recurring red-man syndrome that eventually became persistent after failing treatment with infusion rate reduction and diphenhydramine. This case highlights the need for a detailed review of medications taken within 2 months of the onset of the rash, as well as the importance of being cognizant of medications that incite multiple drug reactions.
-
Proc (Bayl Univ Med Cent) · Jul 2019
Case ReportsAir embolism following peripheral intravenous access.
Air embolism is a rare, often misdiagnosed, potentially fatal condition. It is most frequently associated with invasive vascular procedures and mechanical ventilation. ⋯ We present a case of symptomatic venous air embolism likely arising from peripheral intravenous access gained during an interventional pain procedure. This case highlights the need to consider air embolism in the differential diagnoses of patients presenting with neurological symptoms following vascular interventions.
-
Proc (Bayl Univ Med Cent) · Jul 2019
Case ReportsSurgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block.
We present a case in which surgical anesthesia was provided for revision of earlier total hip arthroplasty with quadratus lumborum and fascia iliaca blocks. We believe that this case is the first to be reported using this technique for this procedure. Our patient was a high-risk candidate for general and neuraxial anesthesia because of significant cardiac dysfunction and therapeutic anticoagulation.
-
Proc (Bayl Univ Med Cent) · Apr 2019
Case ReportsPatent foramen ovale and ascending aortic aneurysm causing the platypnea-orthodeoxia syndrome.
Patent foramen ovale (PFO) is present in about 25% of the population. Platypnea-orthodeoxia syndrome (POS), which is dyspnea and hypoxemia in the upright position that is relieved when supine, is a rare manifestation of PFO. ⋯ Symptoms were resolved after undergoing percutaneous PFO closure. This case highlights the mechanism by which an ascending aortic aneurysm can alter hemodynamics through an existing PFO, leading to symptoms of a previously clinically insignificant PFO, and emphasizes how early recognition of POS allows for appropriate intervention.