The American journal of case reports
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Case Reports
Malposition of Peripherally Inserted Central Catheter Into the Right Inferior Thyroid Vein: A Case Report.
BACKGROUND A peripherally inserted central catheter (PICC) causes few serious complications but can be malpositioned. To avoid malpositioning, ultrasound guidance is widely used. Here, we report the case of a patient who received a PICC that was inserted under ultrasound guidance, but the catheter tip accidentally entered the right inferior thyroid vein. ⋯ However, the chest X-ray performed after the PICC insertion showed that the catheter had moved into the right inferior thyroid vein. CONCLUSIONS Malpositioning of a PICC can occur into any small vein. Ultrasound should be used not only to avoid malpositioning into the IJV, but also to confirm the proper position of the catheter tip during PICC insertion.
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Case Reports
Acute Lymphoblastic Leukemia Presenting with Liver Infiltration and Severe Lactic Acidosis.
BACKGROUND Type-B lactic acidosis is a rare complication of solid tumors and hematological malignancies. It occurs secondary to Warburg effect, when glucose metabolism in cancer cells switches from the oxidative pathway to the glycolytic pathway. Malignant lactic acidosis is a life-threatening condition if not promptly diagnosed and treated urgently. ⋯ Lactic acidosis normalized after initiation of chemotherapy. CONCLUSIONS Cancer, particularly hematological malignancy, should be considered as an etiology and differential diagnosis of type-B lactic acidosis. Prompt recognition and urgent initiation of specific therapy to control the underlying malignancy are critical to manage this serious metabolic complication.
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Case Reports
Left Upper-Quadrant Appendicitis in a Patient with Congenital Intestinal Malrotation and Polysplenia.
BACKGROUND Appendicitis is the most common cause of abdominal pain requiring emergent surgical intervention. Although typically presenting as right lower-quadrant pain, in rare cases it may present as left upper-quadrant pain secondary to abnormal position due to intestinal malrotation. Since atypical presentations may result in diagnostic and management delay, increasing morbidity and mortality, accurate and prompt diagnosis is important. ⋯ CONCLUSIONS Acute appendicitis may present with atypical symptoms due to unusual appendix locations, such as in malrotation. Most cases are asymptomatic until development of acute complications, requiring imaging for diagnosis. Clinicians and radiologists should have a high index of suspicion and knowledge of its clinical presentations to achieve early diagnosis and intervention.
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BACKGROUND Hiccup is a rare complication after a cervical epidural steroid injection used in the treatment of chronic pain. A few studies have reported on the physiological and pharmacological aspects of hiccups after epidural steroid injection and there have been some case reports published. ⋯ CONCLUSIONS Persistent hiccups after epidural injection is a serious complication. As the exact mechanism of hiccups is not yet known, regardless the level of epidural or the mixture of drugs used, and the incident of hiccups after epidural injection is not well-reported, we think that the etiology and the incident rate must be further evaluated.