The Fontan operation is a palliative procedure for patients with several forms of congenital heart disease unsuitable for biventricular circulation, especially tricuspid valve atresia. In this procedure, the vena cava flow is directed to the pulmonary arteries bypassing the ventricle. Pregnant patients with Fontan surgery in their post-surgical history have more maternal risks. We should counsel patients with saturations <85%, depressed ventricular function, refractory arrhythmia, or protein-losing enteropathy against pregnancy (mWHO; IV). In this study, we review a pregnant case that has successful pregnancy and Fontan palliation and lv systolic heart failure (LVEF: 35%) in her past medical history.
{"title":"Successful Pregnancy in A Patient with Fontan Surgery: A Case Report","authors":"Shadi Zamansaraei, Milad Nazari Sabet, Parvin Bahrami","doi":"10.18502/crcp.v7i5.11867","DOIUrl":"https://doi.org/10.18502/crcp.v7i5.11867","url":null,"abstract":"The Fontan operation is a palliative procedure for patients with several forms of congenital heart disease unsuitable for biventricular circulation, especially tricuspid valve atresia. In this procedure, the vena cava flow is directed to the pulmonary arteries bypassing the ventricle. Pregnant patients with Fontan surgery in their post-surgical history have more maternal risks. We should counsel patients with saturations <85%, depressed ventricular function, refractory arrhythmia, or protein-losing enteropathy against pregnancy (mWHO; IV). In this study, we review a pregnant case that has successful pregnancy and Fontan palliation and lv systolic heart failure (LVEF: 35%) in her past medical history.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48171320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-06DOI: 10.18502/crcp.v7i5.11870
P. Hafezimoghadam, Aydin Mohammadvalipoor, Nazanin Alaei Faradonbeh
Chest tube insertion is one of the common and critical procedures in emergency room. The most common tool for chest tube position confirmation is chest x-ray. The aim of this case report is to explain one of pitfalls of this tool in confirmation of chest tube position. The patient was a 36-year-old man who had been transferred to ED by EMS due to blunt chest trauma in a motor vehicle collision. After detecting pneumothorax in chest CT scan, chest tube has been inserted and chest x ray has been done for chest tube`s place confirmation. X-ray ascertains that the tube is in the right place but lung does not expand and dyspnea does not improve completely. In chest CT scan which will be done after 2 days, it reveals that chest tube was in subcutaneous tissue. Although chest x-ray is a useful modality to confirm chest tube placement, chest tube function can define important information and imaging should be interpreted beside clinical coarse. It should be noted that in the case of current report, the physical examination is used.
{"title":"Why the Lung Doesn’t Expand After Chest Tube Insertion?: Learning from Errors","authors":"P. Hafezimoghadam, Aydin Mohammadvalipoor, Nazanin Alaei Faradonbeh","doi":"10.18502/crcp.v7i5.11870","DOIUrl":"https://doi.org/10.18502/crcp.v7i5.11870","url":null,"abstract":"Chest tube insertion is one of the common and critical procedures in emergency room. The most common tool for chest tube position confirmation is chest x-ray. The aim of this case report is to explain one of pitfalls of this tool in confirmation of chest tube position. The patient was a 36-year-old man who had been transferred to ED by EMS due to blunt chest trauma in a motor vehicle collision. After detecting pneumothorax in chest CT scan, chest tube has been inserted and chest x ray has been done for chest tube`s place confirmation. X-ray ascertains that the tube is in the right place but lung does not expand and dyspnea does not improve completely. In chest CT scan which will be done after 2 days, it reveals that chest tube was in subcutaneous tissue. Although chest x-ray is a useful modality to confirm chest tube placement, chest tube function can define important information and imaging should be interpreted beside clinical coarse. It should be noted that in the case of current report, the physical examination is used.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48419822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-06DOI: 10.18502/crcp.v7i5.11869
Sepideh Paybast, A. Moghadasi
There are limited reports of oculomotor nerve palsy following vaccination. Herein, we aimed to report a case of acute oculomotor nerve palsy following the first dose of the Sinopharm vaccine. A 17-year-old woman presented with a history of acute painful diplopia and right ptosis within a week after receiving the first dosage of the Sinopharm vaccine. The neurological examination was compatible with acute right third nerve palsy sparing pupils. All the para-clinical tests were unremarkable. With a diagnosis of possible oculomotor nerve palsy as an adverse event of the COVID-19 vaccine, she was treated with steroids leading to a significant recovery. We reported the first case of acute oculomotor nerve palsy associated with the Sinopharm vaccine. However, our findings dose not conclude a causal association between oculomotor nerve palsy and COVID-19 vaccination.
{"title":"Isolated Painful Oculomotor Nerve Palsy as a Rare Complication of the Sinopharm COVID-19 Vaccine: A Case Report and Review of the Literature","authors":"Sepideh Paybast, A. Moghadasi","doi":"10.18502/crcp.v7i5.11869","DOIUrl":"https://doi.org/10.18502/crcp.v7i5.11869","url":null,"abstract":"There are limited reports of oculomotor nerve palsy following vaccination. Herein, we aimed to report a case of acute oculomotor nerve palsy following the first dose of the Sinopharm vaccine. A 17-year-old woman presented with a history of acute painful diplopia and right ptosis within a week after receiving the first dosage of the Sinopharm vaccine. The neurological examination was compatible with acute right third nerve palsy sparing pupils. All the para-clinical tests were unremarkable. With a diagnosis of possible oculomotor nerve palsy as an adverse event of the COVID-19 vaccine, she was treated with steroids leading to a significant recovery. We reported the first case of acute oculomotor nerve palsy associated with the Sinopharm vaccine. However, our findings dose not conclude a causal association between oculomotor nerve palsy and COVID-19 vaccination.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48724781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-06DOI: 10.18502/crcp.v7i5.11860
F. Ulutaş, F. Ufuk, Aslı Bozdemir, V. Çobankara
A syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) is a rare autoimmune disease. It occurs in genetically predisposed individuals by immune activation triggered by possible infectious agents. A 60-year-old man was presented with musculoskeletal and cutaneous manifestations. After exclusion of differential diagnoses, he was diagnosed with SAPHO and successfully treated with adalimumab. He had a typical image defined as a bull’s head sign in bone scintigraphy with 99mTcmethylene diphosphonate. Positron emission tomography also revealed increased inflammatory activity in related anterior chest joints and soft tissue. We want to emphasize diagnostic radiological images in patients with SAPHO to increase the awareness of clinicians.
{"title":"A Bull’s Head Sign in SAPHO","authors":"F. Ulutaş, F. Ufuk, Aslı Bozdemir, V. Çobankara","doi":"10.18502/crcp.v7i5.11860","DOIUrl":"https://doi.org/10.18502/crcp.v7i5.11860","url":null,"abstract":"A syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) is a rare autoimmune disease. It occurs in genetically predisposed individuals by immune activation triggered by possible infectious agents. A 60-year-old man was presented with musculoskeletal and cutaneous manifestations. After exclusion of differential diagnoses, he was diagnosed with SAPHO and successfully treated with adalimumab. He had a typical image defined as a bull’s head sign in bone scintigraphy with 99mTcmethylene diphosphonate. Positron emission tomography also revealed increased inflammatory activity in related anterior chest joints and soft tissue. We want to emphasize diagnostic radiological images in patients with SAPHO to increase the awareness of clinicians.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47898442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-06DOI: 10.18502/crcp.v7i5.11858
A. Golbabaei, M. Naemi, Maasoumeh Saleh
Double inlet left ventricle (DILV) is a rare congenital cardiac malformation that is defined as an anomaly with univentricular atrioventricular (AV) connection, and single ventricular morphology. This variation can be associated with the inlet and outlet cardiac abnormalities. In the current report, we present a case of Holms heart, as a rare variant of double-inlet left ventricle.
{"title":"Holms Heart in a Fetus with Maternal Anticonvulsant Drug Exposure: A Case Report","authors":"A. Golbabaei, M. Naemi, Maasoumeh Saleh","doi":"10.18502/crcp.v7i5.11858","DOIUrl":"https://doi.org/10.18502/crcp.v7i5.11858","url":null,"abstract":"Double inlet left ventricle (DILV) is a rare congenital cardiac malformation that is defined as an anomaly with univentricular atrioventricular (AV) connection, and single ventricular morphology. This variation can be associated with the inlet and outlet cardiac abnormalities. In the current report, we present a case of Holms heart, as a rare variant of double-inlet left ventricle.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47988398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.18502/crcp.v7i4.11599
A. Amin, Mozhgan Parsaee, Homa Ghaderian, Fatemeh Zohrian, A. Mohamadifar
Aortopulmonary window is a rare congenital anomaly which is commonly associated with other lesions such as patent ductus arteriosus, interrupted aortic arch, Atrial Septal Defect (ASD), and Ventricular Septal Defect (VSD). Aortic aneurysm and dissection have not been reported as an associated anomaly in AP window. A 44 -year-old male, with inoperable AortoPulmonary Window (AP window) and Eisenmenger syndrome presented to our Emergency Department with back pain and shortness of breath. Transthoracic echocardiography and aortic CT angiography depicted aneurysmal dilatation of ascending aorta with a dissection flap which was extended to main pulmonary artery. Any intervention was very high risk, due to the risk of imminent RV failure. The patient was hemodynamically stable and the symptoms seemed to be chronic, so we decided to manage him medically. AP window is a rare congenital anomaly which is commonly associated with other anomalies. In this report, we represent a rare case of AP window and Eisenmenger syndrome with aortic aneurysm and dissecting flap in ascending aorta and pulmonary artery who was managed medically.
{"title":"A Rare Case with Dissection of Pulmonary and Aorta in Aortopulmonary Window","authors":"A. Amin, Mozhgan Parsaee, Homa Ghaderian, Fatemeh Zohrian, A. Mohamadifar","doi":"10.18502/crcp.v7i4.11599","DOIUrl":"https://doi.org/10.18502/crcp.v7i4.11599","url":null,"abstract":"Aortopulmonary window is a rare congenital anomaly which is commonly associated with other lesions such as patent ductus arteriosus, interrupted aortic arch, Atrial Septal Defect (ASD), and Ventricular Septal Defect (VSD). Aortic aneurysm and dissection have not been reported as an associated anomaly in AP window. A 44 -year-old male, with inoperable AortoPulmonary Window (AP window) and Eisenmenger syndrome presented to our Emergency Department with back pain and shortness of breath. Transthoracic echocardiography and aortic CT angiography depicted aneurysmal dilatation of ascending aorta with a dissection flap which was extended to main pulmonary artery. Any intervention was very high risk, due to the risk of imminent RV failure. The patient was hemodynamically stable and the symptoms seemed to be chronic, so we decided to manage him medically. AP window is a rare congenital anomaly which is commonly associated with other anomalies. In this report, we represent a rare case of AP window and Eisenmenger syndrome with aortic aneurysm and dissecting flap in ascending aorta and pulmonary artery who was managed medically.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42344687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.18502/crcp.v7i4.11592
Nesva Pilaparambil Hamza, S. Sureshkumar, A. A. Francis
Cysticercosis is an infection caused by Taenia Solium whose larval stage (cysticerci) can affect various human tissues. In this study, we present the case of a 32-year-old male who presented with a neck swelling of 2 months duration. High resolution ultrasonography of neck showed features suggestive of cysticercosis of sternocleidomastoid muscle. He was managed conservatively with oral albendazole 400 mg twice daily for 4 weeks. Review of the patient after 4 weeks showed complete resolution of the swelling and a repetitive ultrasonography did not show any evidence of cysticercosis. Although a rare entity and isolated cysticercosis of skeletal muscle should come into consideration among the differential diagnoses of head and neck swellings.
{"title":"Cysticercosis of Sternocleidomastoid Muscle Presenting as Neck Swelling – A Case Report","authors":"Nesva Pilaparambil Hamza, S. Sureshkumar, A. A. Francis","doi":"10.18502/crcp.v7i4.11592","DOIUrl":"https://doi.org/10.18502/crcp.v7i4.11592","url":null,"abstract":"Cysticercosis is an infection caused by Taenia Solium whose larval stage (cysticerci) can affect various human tissues. In this study, we present the case of a 32-year-old male who presented with a neck swelling of 2 months duration. High resolution ultrasonography of neck showed features suggestive of cysticercosis of sternocleidomastoid muscle. He was managed conservatively with oral albendazole 400 mg twice daily for 4 weeks. Review of the patient after 4 weeks showed complete resolution of the swelling and a repetitive ultrasonography did not show any evidence of cysticercosis. Although a rare entity and isolated cysticercosis of skeletal muscle should come into consideration among the differential diagnoses of head and neck swellings.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46786434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal cell carcinoma (RCC) accounts for 2-3% of the malignant tumors in adult patients. The most common sites of metastasis are the lung, bone, liver and brain respectively. Unusual metastatic sites require attention during follow-up of renal cell carcinoma. The duodenum and pancreas are uncommon sites for metastasis from renal cell carcinoma. We describe here a 62-year-old man with metastastic renal cell carcinoma to the duodenum and pancreas. The patient presented with melena and bowel obstruction, 10 years after nephrectomy for renal cell carcinoma, then with initial diagnosis of ampula vater adenocarcinoma undergo an exploratory laparotomy and a mass was found in duodenum, vater ampulla and pancreas, then pancreaticoduodenectomy was performed. histopathological examination of mass showed a metastatic renal cell carcinoma with sarcomatoid component. In conclusion, patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Gastrointestinal metastasis from Renal cell carcinoma should be considered in nephrectomized patients with gastrointestinal symptoms.
{"title":"Metastatic Renal Cell Carcinoma to Duodenum and Pancreas 10 Years After Nephrectomy: A Case Report","authors":"Mahsa Akbari Oryani, Azade Zare, Mohsen Soltani Sabi, Mohammad Taghi Mashhadi-Rajabi","doi":"10.18502/crcp.v7i4.11598","DOIUrl":"https://doi.org/10.18502/crcp.v7i4.11598","url":null,"abstract":"Renal cell carcinoma (RCC) accounts for 2-3% of the malignant tumors in adult patients. The most common sites of metastasis are the lung, bone, liver and brain respectively. Unusual metastatic sites require attention during follow-up of renal cell carcinoma. The duodenum and pancreas are uncommon sites for metastasis from renal cell carcinoma. We describe here a 62-year-old man with metastastic renal cell carcinoma to the duodenum and pancreas. The patient presented with melena and bowel obstruction, 10 years after nephrectomy for renal cell carcinoma, then with initial diagnosis of ampula vater adenocarcinoma undergo an exploratory laparotomy and a mass was found in duodenum, vater ampulla and pancreas, then pancreaticoduodenectomy was performed. histopathological examination of mass showed a metastatic renal cell carcinoma with sarcomatoid component. In conclusion, patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Gastrointestinal metastasis from Renal cell carcinoma should be considered in nephrectomized patients with gastrointestinal symptoms.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48671752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.18502/crcp.v7i4.11597
E. Zaboli, S. Heydari, R. Alizadeh-Navaei, Seyed Muhammad Mehdi Ghaffari Hamedani
Mature cystic teratoma of the ovary (MCTO) is the most common ovarian germ cell tumor. Its malignant transformation is a rare complication that occurs in almost 2% of the MCTs. MCTO is benign and usually appears between 30 and 40 years of age, but patients with malignant ovarian MCT are 10–15 years older than those with benign MCT. The most common malignant transformation in MCTO is Squamous Cell Carcinoma (SCC) which is rarely diagnosed with pre-operative imaging. We report the case of a postmenopausal woman, presenting with severe abdominal pain and a large palpable mass in her abdomen. She was diagnosed postoperatively with SCC arising from MCTO which was confirmed histopathologically. The patient received postoperative chemotherapy and was well at 6-month follow-up after chemotherapy. MCTO is benign, but can rarely become malignant in older ages. So MCTO-arising SCC should be considered in elderly women with abdominal pain and mass, and also some other evident features such as large tumor diameter, elevated serum markers, and solid components in Magnetic resonance imaging (MRI).
{"title":"Ovarian Squamous Cell Carcinoma Arising from Mature Cystic Teratoma: A Case Report","authors":"E. Zaboli, S. Heydari, R. Alizadeh-Navaei, Seyed Muhammad Mehdi Ghaffari Hamedani","doi":"10.18502/crcp.v7i4.11597","DOIUrl":"https://doi.org/10.18502/crcp.v7i4.11597","url":null,"abstract":"Mature cystic teratoma of the ovary (MCTO) is the most common ovarian germ cell tumor. Its malignant transformation is a rare complication that occurs in almost 2% of the MCTs. MCTO is benign and usually appears between 30 and 40 years of age, but patients with malignant ovarian MCT are 10–15 years older than those with benign MCT. The most common malignant transformation in MCTO is Squamous Cell Carcinoma (SCC) which is rarely diagnosed with pre-operative imaging. We report the case of a postmenopausal woman, presenting with severe abdominal pain and a large palpable mass in her abdomen. She was diagnosed postoperatively with SCC arising from MCTO which was confirmed histopathologically. The patient received postoperative chemotherapy and was well at 6-month follow-up after chemotherapy. MCTO is benign, but can rarely become malignant in older ages. So MCTO-arising SCC should be considered in elderly women with abdominal pain and mass, and also some other evident features such as large tumor diameter, elevated serum markers, and solid components in Magnetic resonance imaging (MRI).","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42282043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.18502/crcp.v7i4.11596
Ghazaleh Salehabadi, Ali Shamsedini
Refractory vasospastic angina (RVSA) is a rare condition leading to several episodes of constriction of coronary arteries which eventually leads to myocardial ischemia. Calcium-channel blockers (CCBs) and nitrates are usually used, however, sometimes the vasospasm is refractory and recurrent leading to high morbidity and mortality. A 35-year-old man known case of hypertension underwent two times operation due to T9-T10 discopathy and decompressive laminectomy of three segments T8/T9/ T10 following a previous car accident 4 months before this admission. Three days postoperatively he developed chest pain, dyspnea and diaphoresis. Electrocardiography showed inverted T wave in leads I, II and ST elevation in pericardial leads of V1-V4. Left anterior descending (LAD) artery stenosis was present (99%) at mid part that resolved after Trinitroglycerin (TNG) injection during angiography. Totally, he underwent 3 times coronary angiography due to recurrent chest pain refractory to conventional management of Prinzmetal’s angina. Coronary stent could not be placed due to severe spasm. Finally, he developed refractory chest pain and dyspnea and cardiac arrest in the CCU despite receiving intravenous high dose TNG, Diltiazem, Nicorandil and Hydrocortisone. He expired after several times of cardiopulmonary resuscitation. Refractory VSA after spine surgery has not been reported in the literature yet. This patient was resistant to available medications. There is no consensus regarding the treatment unfortunately. Randomized clinical trials have to be done to find ways regarding unconventional treatment options such as alpha-2-agonists, Corticosteroids, rho-kinase-inhibitors, statins and magnesium. Despite the fact, some surgical interventions with sympathetic denervation like left-stellate-ganglion denervation must be assessed.
{"title":"Refractory Coronary Vasospasm After Spine Surgery; A Rare Case Report","authors":"Ghazaleh Salehabadi, Ali Shamsedini","doi":"10.18502/crcp.v7i4.11596","DOIUrl":"https://doi.org/10.18502/crcp.v7i4.11596","url":null,"abstract":"Refractory vasospastic angina (RVSA) is a rare condition leading to several episodes of constriction of coronary arteries which eventually leads to myocardial ischemia. Calcium-channel blockers (CCBs) and nitrates are usually used, however, sometimes the vasospasm is refractory and recurrent leading to high morbidity and mortality. A 35-year-old man known case of hypertension underwent two times operation due to T9-T10 discopathy and decompressive laminectomy of three segments T8/T9/ T10 following a previous car accident 4 months before this admission. Three days postoperatively he developed chest pain, dyspnea and diaphoresis. Electrocardiography showed inverted T wave in leads I, II and ST elevation in pericardial leads of V1-V4. Left anterior descending (LAD) artery stenosis was present (99%) at mid part that resolved after Trinitroglycerin (TNG) injection during angiography. Totally, he underwent 3 times coronary angiography due to recurrent chest pain refractory to conventional management of Prinzmetal’s angina. Coronary stent could not be placed due to severe spasm. Finally, he developed refractory chest pain and dyspnea and cardiac arrest in the CCU despite receiving intravenous high dose TNG, Diltiazem, Nicorandil and Hydrocortisone. He expired after several times of cardiopulmonary resuscitation. Refractory VSA after spine surgery has not been reported in the literature yet. This patient was resistant to available medications. There is no consensus regarding the treatment unfortunately. Randomized clinical trials have to be done to find ways regarding unconventional treatment options such as alpha-2-agonists, Corticosteroids, rho-kinase-inhibitors, statins and magnesium. Despite the fact, some surgical interventions with sympathetic denervation like left-stellate-ganglion denervation must be assessed.","PeriodicalId":34254,"journal":{"name":"Case Reports in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44951129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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