JEM reports最新文献_第2页

Undifferentiated shock in the elderly: Hemorrhagic shock from a bleeding epiploic appendage varix 老年未分化性休克：由出血性大网膜附件静脉曲张引起的失血性休克

JEM reports

Pub Date : 2025-10-30 DOI: 10.1016/j.jemrpt.2025.100198

Daniel T. Secor , Max Watchmaker , Jordan R. Pollock , James S. Komara , Douglas E. Rappaport

Background

Undifferentiated hypotension with altered mental status in elderly patients poses a diagnostic challenge in the emergency department. Although fluid resuscitation may yield transient hemodynamic improvement, this response can obscure life-threatening pathology. Rarely, bleeding from an epiploic appendage can cause intra-abdominal hemorrhage and lead to sudden hemodynamic collapse.

Case report

An 83-year-old male presented with acute altered mentation and hypotension. He received 2 L of intravenous fluids with a transient improvement in symptoms. Broad-spectrum antibiotics were initiated for possible sepsis, and admission was planned. Hours later, while awaiting transfer, he developed worsening hypotension and new onset abdominal distension. Laboratory testing revealed a hemoglobin decline from 11.5 g/dL to 5.0 g/dL. Emergent imaging demonstrated free intraperitoneal air and hemoperitoneum. A massive transfusion protocol was activated, and the patient required intubation and vasopressor support. Emergency laparotomy identified a bleeding epiploic appendage with significant hemoperitoneum, which was surgically managed.

Why Should an Emergency Physician Be Aware of This?: This case highlights how a transient improvement in shock can mask intra-abdominal hemorrhage. Emergency physicians should maintain a broad differential in elderly patients with undifferentiated hypotension, reassess frequently after initial stabilization, and consider uncommon but life-threatening etiologies when abrupt decompensation occurs.

背景：老年低血压伴精神状态改变对急诊科的诊断提出了挑战。虽然液体复苏可能会产生短暂的血液动力学改善，但这种反应可能会掩盖危及生命的病理。极少数情况下，从网膜附属物出血可引起腹内出血，并导致突然的血流动力学塌陷。病例报告一名83岁男性表现为急性精神状态改变和低血压。他接受了2升静脉输液，症状短暂改善。对可能的败血症给予广谱抗生素治疗，并计划入院。几小时后，在等待转移期间，患者出现低血压加重和新发腹胀。实验室检查显示血红蛋白从11.5 g/dL下降到5.0 g/dL。急诊显像显示腹腔内自由空气和腹腔积血。大量输血方案被启动，病人需要插管和血管加压支持。紧急剖腹探查发现一个出血的大网膜附属物伴明显的腹膜出血，手术处理。急诊医生为什么要意识到这一点？本病例强调了休克的短暂改善如何掩盖腹内出血。急诊医师应对未分化性低血压的老年患者保持广泛的鉴别，在初始稳定后经常重新评估，并在突然失代偿发生时考虑不常见但危及生命的病因。

{"title":"Undifferentiated shock in the elderly: Hemorrhagic shock from a bleeding epiploic appendage varix","authors":"Daniel T. Secor , Max Watchmaker , Jordan R. Pollock , James S. Komara , Douglas E. Rappaport","doi":"10.1016/j.jemrpt.2025.100198","DOIUrl":"10.1016/j.jemrpt.2025.100198","url":null,"abstract":"<div><h3>Background</h3><div>Undifferentiated hypotension with altered mental status in elderly patients poses a diagnostic challenge in the emergency department. Although fluid resuscitation may yield transient hemodynamic improvement, this response can obscure life-threatening pathology. Rarely, bleeding from an epiploic appendage can cause intra-abdominal hemorrhage and lead to sudden hemodynamic collapse.</div></div><div><h3>Case report</h3><div>An 83-year-old male presented with acute altered mentation and hypotension. He received 2 L of intravenous fluids with a transient improvement in symptoms. Broad-spectrum antibiotics were initiated for possible sepsis, and admission was planned. Hours later, while awaiting transfer, he developed worsening hypotension and new onset abdominal distension. Laboratory testing revealed a hemoglobin decline from 11.5 g/dL to 5.0 g/dL. Emergent imaging demonstrated free intraperitoneal air and hemoperitoneum. A massive transfusion protocol was activated, and the patient required intubation and vasopressor support. Emergency laparotomy identified a bleeding epiploic appendage with significant hemoperitoneum, which was surgically managed.</div><div>Why Should an Emergency Physician Be Aware of This?: This case highlights how a transient improvement in shock can mask intra-abdominal hemorrhage. Emergency physicians should maintain a broad differential in elderly patients with undifferentiated hypotension, reassess frequently after initial stabilization, and consider uncommon but life-threatening etiologies when abrupt decompensation occurs.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473976","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}

引用次数: 0

Sodium of 106 in a 2-week-Old: An electrolyte crisis without a diagnosis 两周大的婴儿钠含量为106：没有诊断的电解质危机

JEM reports

Pub Date : 2025-10-30 DOI: 10.1016/j.jemrpt.2025.100199

Aleezay A. Khan , Alyssa M. Gill , Todd P. Chassee

Background

Neonatal electrolyte crises are rare yet potentially fatal. Hyponatremia in the neonatal population is associated with significant morbidity and mortality, with symptoms including vomiting, lethargy, seizures, and coma. Hyponatremia can co-occur with other electrolyte abnormalities such as hyperkalemia, which can induce life-threatening cardiac arrhythmias. We present the case of a neonate who appeared clinically stable but was discovered to have profound electrolyte disturbances requiring urgent intervention and extensive diagnostic evaluation.

Case report

A 15-day-old full-term male presented to the pediatric emergency department (ED) with persistent emesis and poor weight gain, weighing 0.78 kg below birthweight. Birth history, newborn screening, and physical exam were unremarkable, though family history included Russell-Silver Syndrome (RSS). Laboratory testing revealed hyponatremia (106 mmol/L), hyperkalemia (6.8 mmol/L), and hypochloremia (75 mmol/L). He was managed with isotonic saline, furosemide, calcium gluconate, albuterol, and magnesium sulfate. The patient was admitted to the intensive care unit, where electrolytes stabilized over an 11-day hospitalization. A comprehensive workup initiated in the ED investigated congenital adrenal hyperplasia (CAH), pseudohypoaldosteronism (PHA), Addison's disease, aldosterone synthase deficiency (ASD), and RSS, though no definitive diagnosis was established.

Why should an emergency physician be aware of this?

Neonates with severe electrolyte abnormalities may appear deceptively well on exam. Subtle signs such as persistent emesis and inadequate weight gain are critical clues. Early recognition and empiric management are imperative, especially as newborn screening may not detect rarer adrenal disorders. Multidisciplinary collaboration between the ED and pediatric subspecialists is essential for timely evaluation and effective treatment.

背景新生儿电解质危机是罕见的，但可能致命。新生儿低钠血症与显著的发病率和死亡率相关，其症状包括呕吐、嗜睡、癫痫发作和昏迷。低钠血症可与其他电解质异常共同发生，如高钾血症，可诱发危及生命的心律失常。我们提出的情况下，新生儿谁表现出临床稳定，但被发现有严重的电解质紊乱，需要紧急干预和广泛的诊断评估。病例报告：一名15天大的足月男婴因持续呕吐和体重增加不佳被送到儿科急诊科（ED），体重比出生体重低0.78 kg。出生史、新生儿筛查和体格检查无显著差异，但家族史包括罗素-银综合征（RSS）。实验室检测显示低钠血症（106 mmol/L）、高钾血症（6.8 mmol/L）和低氯血症（75 mmol/L）。给予等渗盐水、速尿、葡萄糖酸钙、沙丁胺醇和硫酸镁治疗。患者被送入重症监护室，在11天的住院期间，电解质稳定下来。在急诊科进行了全面的检查，调查了先天性肾上腺增生症（CAH）、假性醛固酮减少症（PHA）、Addison病、醛固酮合成酶缺乏症（ASD）和RSS，尽管没有明确的诊断。急诊医生为什么要意识到这一点？有严重电解质异常的新生儿在检查时可能表现得很好。一些微妙的迹象，如持续呕吐和体重增加不足，都是关键的线索。早期识别和经验管理是必要的，特别是新生儿筛查可能无法发现罕见的肾上腺疾病。急诊科和儿科专家之间的多学科合作对于及时评估和有效治疗至关重要。

{"title":"Sodium of 106 in a 2-week-Old: An electrolyte crisis without a diagnosis","authors":"Aleezay A. Khan , Alyssa M. Gill , Todd P. Chassee","doi":"10.1016/j.jemrpt.2025.100199","DOIUrl":"10.1016/j.jemrpt.2025.100199","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal electrolyte crises are rare yet potentially fatal. Hyponatremia in the neonatal population is associated with significant morbidity and mortality, with symptoms including vomiting, lethargy, seizures, and coma. Hyponatremia can co-occur with other electrolyte abnormalities such as hyperkalemia, which can induce life-threatening cardiac arrhythmias. We present the case of a neonate who appeared clinically stable but was discovered to have profound electrolyte disturbances requiring urgent intervention and extensive diagnostic evaluation.</div></div><div><h3>Case report</h3><div>A 15-day-old full-term male presented to the pediatric emergency department (ED) with persistent emesis and poor weight gain, weighing 0.78 kg below birthweight. Birth history, newborn screening, and physical exam were unremarkable, though family history included Russell-Silver Syndrome (RSS). Laboratory testing revealed hyponatremia (106 mmol/L), hyperkalemia (6.8 mmol/L), and hypochloremia (75 mmol/L). He was managed with isotonic saline, furosemide, calcium gluconate, albuterol, and magnesium sulfate. The patient was admitted to the intensive care unit, where electrolytes stabilized over an 11-day hospitalization. A comprehensive workup initiated in the ED investigated congenital adrenal hyperplasia (CAH), pseudohypoaldosteronism (PHA), Addison's disease, aldosterone synthase deficiency (ASD), and RSS, though no definitive diagnosis was established.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Neonates with severe electrolyte abnormalities may appear deceptively well on exam. Subtle signs such as persistent emesis and inadequate weight gain are critical clues. Early recognition and empiric management are imperative, especially as newborn screening may not detect rarer adrenal disorders. Multidisciplinary collaboration between the ED and pediatric subspecialists is essential for timely evaluation and effective treatment.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473975","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}

引用次数: 0

A rare but life-threatening Emergency: Orolingual angioedema with tenectaplase therapy 罕见但危及生命的紧急情况：舌部血管性水肿与替纳普酶治疗

JEM reports

Pub Date : 2025-10-14 DOI: 10.1016/j.jemrpt.2025.100194

Kevin Koetters, Keri Furci, Marisa Van Buskirk, Kelly Mari, Alessandro Iliceto

Background

Orolingual angioedema is a rare but potentially life-threatening complication of intravenous thrombolytic therapy for acute ischemic stroke (AIS). While it is a well reported side effect of alteplase, reports involving Tenecteplase (TNK) are limited. Risk factors include concurrent use of angiotensin-converting enzyme (ACE) inhibitors and infarction involving the insular or frontal cortex.

Case report

A 58-year-old woman with history of hypertension on antihypertensive therapy with benazepril presented to the Emergency Department (ED) with acute aphasia and right-sided hemiplegia. Non-contrast head CT excluded hemorrhage, and she was treated with TNK. Shortly after administration, she developed right-sided upper lip and tongue swelling. Orolingual angioedema was promptly identified, and the patient was treated with intravenous methylprednisolone, diphenhydramine, and famotidine. She was monitored in the neurocritical care unit, and her symptoms gradually resolved without the need for intubation.

Why should an emergency physician be aware of this?

TNK is increasingly being used as a preferred thrombolytic agent for AIS across many stroke centers in the United States. Though angioedema is a well-defined clinical entity and a known complication of alteplase, particularly for patients taking ACE inhibitors, there is limited literature describing its incidence in patients treated with TNK. ED providers should recognize that orolingual angioedema can occur with TNK. The condition, although often mild, can progress rapidly and become life threatening if the airway is compromised. Prompt identification, risk stratification, and early medical intervention are critical to mitigate the risk of life-threatening deterioration and potentially avoid challenging intubations and airway compromise.

背景：多舌血管性水肿是急性缺血性卒中（AIS）静脉溶栓治疗中一种罕见但可能危及生命的并发症。虽然阿替普酶的副作用有很好的报道，但有关Tenecteplase （TNK）的报道有限。危险因素包括同时使用血管紧张素转换酶（ACE）抑制剂和涉及岛叶或额叶皮质的梗死。病例报告一名有高血压病史的58岁妇女，接受苯那普利降压治疗，因急性失语和右侧偏瘫来到急诊科。头部CT造影排除出血，给予TNK治疗。服药后不久，患者出现右侧上唇及舌肿。口舌血管性水肿被及时发现，患者接受静脉注射甲泼尼龙、苯海拉明和法莫替丁治疗。她在神经重症监护病房接受监测，症状逐渐消失，无需插管。急诊医生为什么要意识到这一点？在美国的许多中风中心，TNK越来越多地被用作AIS的首选溶栓剂。尽管血管性水肿是一种定义明确的临床症状，也是阿替普酶的一种已知并发症，特别是对于服用ACE抑制剂的患者，但关于其在接受TNK治疗的患者中的发病率的文献有限。急诊科医生应该认识到，使用TNK可能会发生口舌血管性水肿。这种情况虽然通常是轻微的，但如果呼吸道受到损害，可能会迅速发展并危及生命。及时识别、风险分层和早期医疗干预对于减轻危及生命的恶化风险和潜在地避免插管和气道损害至关重要。

{"title":"A rare but life-threatening Emergency: Orolingual angioedema with tenectaplase therapy","authors":"Kevin Koetters, Keri Furci, Marisa Van Buskirk, Kelly Mari, Alessandro Iliceto","doi":"10.1016/j.jemrpt.2025.100194","DOIUrl":"10.1016/j.jemrpt.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>Orolingual angioedema is a rare but potentially life-threatening complication of intravenous thrombolytic therapy for acute ischemic stroke (AIS). While it is a well reported side effect of alteplase, reports involving Tenecteplase (TNK) are limited. Risk factors include concurrent use of angiotensin-converting enzyme (ACE) inhibitors and infarction involving the insular or frontal cortex.</div></div><div><h3>Case report</h3><div>A 58-year-old woman with history of hypertension on antihypertensive therapy with benazepril presented to the Emergency Department (ED) with acute aphasia and right-sided hemiplegia. Non-contrast head CT excluded hemorrhage, and she was treated with TNK. Shortly after administration, she developed right-sided upper lip and tongue swelling. Orolingual angioedema was promptly identified, and the patient was treated with intravenous methylprednisolone, diphenhydramine, and famotidine. She was monitored in the neurocritical care unit, and her symptoms gradually resolved without the need for intubation.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>TNK is increasingly being used as a preferred thrombolytic agent for AIS across many stroke centers in the United States. Though angioedema is a well-defined clinical entity and a known complication of alteplase, particularly for patients taking ACE inhibitors, there is limited literature describing its incidence in patients treated with TNK. ED providers should recognize that orolingual angioedema can occur with TNK. The condition, although often mild, can progress rapidly and become life threatening if the airway is compromised. Prompt identification, risk stratification, and early medical intervention are critical to mitigate the risk of life-threatening deterioration and potentially avoid challenging intubations and airway compromise.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324457","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}

引用次数: 0

Retropharyngeal abscess in a patient with Crohn's disease treated with risankizumab: A case report 利桑单抗治疗克罗恩病患者咽后脓肿1例

JEM reports

Pub Date : 2025-10-11 DOI: 10.1016/j.jemrpt.2025.100195

Nathan Rasmussen , Lauren Meloche , Mohamed Awadalla , Chris Dion , Douglas Rappaport

Background

Retropharyngeal abscesses are rare but potentially life-threatening infections in adults. Early symptoms may mimic benign musculoskeletal complaints, delaying diagnosis. Patients on immunosuppressive biologics, such as Interleukin-23 inhibitors, may present more indolently and with atypical features.

Case report

A 69-year-old man with a history of Crohn's disease on risankizumab presented to the emergency department (ED) with persistent neck pain after lifting a heavy object. Initial evaluation included computed tomography (CT) without contrast, which was negative, and he was discharged twice with symptomatic treatment. He later returned with worsening pain and new-onset dysphagia. Repeat CT and magnetic resonance imaging (MRI) were suspicious for inflammation or infection. Although initially afebrile, he developed sepsis with Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia during his hospitalization. Repeat MRI ultimately revealed a retropharyngeal abscess involving the longus colli muscles. He was treated with intravenous antibiotics and underwent surgical drainage. The postoperative course was uncomplicated, and he was discharged in a stable condition.

Why should an emergency physician be aware of this?

This case underscores the diagnostic challenge of deep space neck infections in adults, particularly in those receiving immunosuppressive therapies. The patient's immunomodulated state likely contributed both to the development of the abscess and the delayed appearance of imaging. Emergency physicians should maintain a high index of suspicion for deep space neck infections in immunosuppressed patients, even when early imaging is negative and symptoms appear musculoskeletal in origin. Awareness of biologics like risankizumab and their infection risks is critical as their use becomes more common in the ED population.

背景：咽咽脓肿在成人中是罕见但可能危及生命的感染。早期症状可能类似于良性肌肉骨骼疾病，延误诊断。使用免疫抑制生物制剂（如白细胞介素-23抑制剂）的患者可能表现出更多的惰性和不典型特征。病例报告：一名69岁男性，有克罗恩病史，接受利桑单抗治疗，在举起重物后持续颈部疼痛，被送往急诊室（ED）。初步评估包括无对比的计算机断层扫描（CT），结果为阴性，经对症治疗出院两次。他后来返回时疼痛加重，并伴有新发吞咽困难。重复CT和磁共振成像（MRI）怀疑有炎症或感染。虽然最初不发烧，但在住院期间，他出现了甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症的败血症。重复MRI最终显示咽后脓肿累及颈长肌。他接受了静脉注射抗生素治疗，并进行了手术引流。术后过程简单，出院时病情稳定。急诊医生为什么要意识到这一点？该病例强调了成人深空颈部感染的诊断挑战，特别是那些接受免疫抑制治疗的患者。患者的免疫调节状态可能导致了脓肿的发展和影像的延迟出现。对于免疫抑制患者的深空颈部感染，急诊医生应保持高度的怀疑指数，即使早期影像学呈阴性，症状表现为肌肉骨骼起源。随着利桑单抗等生物制剂在ED人群中的使用越来越普遍，对其感染风险的认识至关重要。

{"title":"Retropharyngeal abscess in a patient with Crohn's disease treated with risankizumab: A case report","authors":"Nathan Rasmussen , Lauren Meloche , Mohamed Awadalla , Chris Dion , Douglas Rappaport","doi":"10.1016/j.jemrpt.2025.100195","DOIUrl":"10.1016/j.jemrpt.2025.100195","url":null,"abstract":"<div><h3>Background</h3><div>Retropharyngeal abscesses are rare but potentially life-threatening infections in adults. Early symptoms may mimic benign musculoskeletal complaints, delaying diagnosis. Patients on immunosuppressive biologics, such as Interleukin-23 inhibitors, may present more indolently and with atypical features.</div></div><div><h3>Case report</h3><div>A 69-year-old man with a history of Crohn's disease on risankizumab presented to the emergency department (ED) with persistent neck pain after lifting a heavy object. Initial evaluation included computed tomography (CT) without contrast, which was negative, and he was discharged twice with symptomatic treatment. He later returned with worsening pain and new-onset dysphagia. Repeat CT and magnetic resonance imaging (MRI) were suspicious for inflammation or infection. Although initially afebrile, he developed sepsis with Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia during his hospitalization. Repeat MRI ultimately revealed a retropharyngeal abscess involving the longus colli muscles. He was treated with intravenous antibiotics and underwent surgical drainage. The postoperative course was uncomplicated, and he was discharged in a stable condition.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>This case underscores the diagnostic challenge of deep space neck infections in adults, particularly in those receiving immunosuppressive therapies. The patient's immunomodulated state likely contributed both to the development of the abscess and the delayed appearance of imaging. Emergency physicians should maintain a high index of suspicion for deep space neck infections in immunosuppressed patients, even when early imaging is negative and symptoms appear musculoskeletal in origin. Awareness of biologics like risankizumab and their infection risks is critical as their use becomes more common in the ED population.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324458","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}

引用次数: 0

When retrograde menstruation becomes dangerous: A case of hemodynamic instability from a necrotic leiomyoma 当月经逆行变得危险：坏死性平滑肌瘤引起的血流动力学不稳定1例

JEM reports

Pub Date : 2025-10-11 DOI: 10.1016/j.jemrpt.2025.100196

Shreya Suresh, Eric Shipley

Background

Retrograde menstruation is a common gynecologic occurrence that is typically associated with development of extrauterine endometriosis. However, in rare cases, it may result in life-threatening complications, particularly when compounded by underlying pathology. Case Report: We report a rare and severe presentation of retrograde menstruation due to a necrotic submucosal leiomyoma, resulting in profound anemia and hemoperitoneum in a 29-year-old female. The patient presented with vaginal bleeding, persistent suprapubic and left lower quadrant abdominal tenderness, and an episode of syncope in the emergency department (ED). Imaging results revealed hemoperitoneum and a necrotic intracavitary fibroid. Laboratory findings showed a rapidly declining hematocrit from vaginal and intra abdominal bleeding, that ultimately necessitated emergent surgical intervention. Initial stabilization included blood transfusions, tranexamic acid administration, and pain control. Then, a laparoscopy and hysteroscopic myomectomy was performed that showed retrograde menstruation with copious amounts of old and fresh blood in the anterior and posterior cul de sacs. Blood was seen in the upper abdomen where the blood had tracked around the liver. Why Should an Emergency Physician Be Aware of This? This case underscores the diagnostic challenge when retrograde menstruation occurs in atypical presentations involving necrotic fibroids and hemorrhagic complications. The unusual severity of this case, marked by active paradoxical abdominal bleeding and hemodynamic instability highlights the importance of timely, multidisciplinary intervention to prevent life-threatening complications. This report contributes to the limited literature on complications involving retrograde menstruation and emphasizes the importance of a high suspicion in similar clinical scenarios.

背景：月经逆行是一种常见的妇科现象，通常与子宫内膜异位症的发生有关。然而，在极少数情况下，它可能导致危及生命的并发症，特别是当合并潜在的病理。病例报告：我们报告一个罕见和严重的月经逆行，由于坏死性粘膜下平滑肌瘤，导致深度贫血和腹膜出血的29岁女性。患者表现为阴道出血，持续耻骨上和左下腹压痛，并在急诊科（ED）晕厥发作。影像结果显示腹膜充血及坏死的腔内肌瘤。实验室结果显示阴道和腹腔内出血导致红细胞压积迅速下降，最终需要紧急手术干预。最初的稳定包括输血、氨甲环酸和疼痛控制。然后行腹腔镜和宫腔镜子宫肌瘤切除术，发现月经逆行，前后囊末有大量旧血和新鲜血。在肝脏周围的上腹部发现了血液。急诊医生为什么要意识到这一点？这个病例强调了当月经逆行发生在不典型的表现，包括坏死性肌瘤和出血性并发症时的诊断挑战。该病例的严重程度不同寻常，表现为活动性腹部矛盾出血和血流动力学不稳定，这突出了及时、多学科干预以预防危及生命的并发症的重要性。本报告补充了有关月经逆行并发症的有限文献，并强调了在类似临床情况下高度怀疑的重要性。

{"title":"When retrograde menstruation becomes dangerous: A case of hemodynamic instability from a necrotic leiomyoma","authors":"Shreya Suresh, Eric Shipley","doi":"10.1016/j.jemrpt.2025.100196","DOIUrl":"10.1016/j.jemrpt.2025.100196","url":null,"abstract":"<div><h3>Background</h3><div>Retrograde menstruation is a common gynecologic occurrence that is typically associated with development of extrauterine endometriosis. However, in rare cases, it may result in life-threatening complications, particularly when compounded by underlying pathology. Case Report: We report a rare and severe presentation of retrograde menstruation due to a necrotic submucosal leiomyoma, resulting in profound anemia and hemoperitoneum in a 29-year-old female. The patient presented with vaginal bleeding, persistent suprapubic and left lower quadrant abdominal tenderness, and an episode of syncope in the emergency department (ED). Imaging results revealed hemoperitoneum and a necrotic intracavitary fibroid. Laboratory findings showed a rapidly declining hematocrit from vaginal and intra abdominal bleeding, that ultimately necessitated emergent surgical intervention. Initial stabilization included blood transfusions, tranexamic acid administration, and pain control. Then, a laparoscopy and hysteroscopic myomectomy was performed that showed retrograde menstruation with copious amounts of old and fresh blood in the anterior and posterior cul de sacs. Blood was seen in the upper abdomen where the blood had tracked around the liver. Why Should an Emergency Physician Be Aware of This? This case underscores the diagnostic challenge when retrograde menstruation occurs in atypical presentations involving necrotic fibroids and hemorrhagic complications. The unusual severity of this case, marked by active paradoxical abdominal bleeding and hemodynamic instability highlights the importance of timely, multidisciplinary intervention to prevent life-threatening complications. This report contributes to the limited literature on complications involving retrograde menstruation and emphasizes the importance of a high suspicion in similar clinical scenarios.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324459","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}

引用次数: 0

Stewart-Treves syndrome post radical mastectomy: A case report 乳房根治术后Stewart-Treves综合征1例

JEM reports

Pub Date : 2025-10-11 DOI: 10.1016/j.jemrpt.2025.100197

Jack Golder , Luminita Rezeanu , Lindsay Tjiattas-Saleski

Background

Stewart-Treves Syndrome (STS) is a rare but serious complication observed in breast cancer patients who have undergone axillary lymph node radiation and developed postmastectomy lymphedema. STS typically presents as a purple-red cutaneous lesion, advancing over time to ulceration, edema, and hemorrhage. Its asymptomatic onset and inconspicuous presentation often delay diagnosis, complicating treatment and worsening prognosis.

Case description

This case report describes a 58-year-old female with a history of unilateral mastectomy and chronic lymphedema, who presented with a hemorrhagic wound on her upper extremity. Following multidisciplinary referrals, she was diagnosed with STS through biopsy and MRI, revealing angiosarcoma of the arm, forearm, and chest wall. The patient's treatment plan included forequarter amputation and chemotherapy.

Why should an emergency physician be aware of this?: Despite advancements in treatment modalities, the prognosis for STS remains poor, emphasizing the importance of early diagnosis. Clinicians must maintain vigilance when encountering unusual skin lesions in breast cancer survivors, especially those with a history of radiation and lymphedema, to prevent delayed diagnosis and metastasis.

背景：stewart - treves综合征（STS）是一种罕见但严重的并发症，发生在接受腋窝淋巴结放疗并发生乳房切除术后淋巴水肿的乳腺癌患者中。STS通常表现为紫红色皮肤病变，随着时间的推移发展为溃疡、水肿和出血。其无症状发作和不明显的表现往往延误诊断，复杂化治疗和恶化预后。病例描述：本病例报告描述了一位58岁女性，有单侧乳房切除术和慢性淋巴水肿的病史，她的上肢有出血性伤口。经过多学科转诊，她通过活检和MRI诊断为STS，显示手臂、前臂和胸壁血管肉瘤。患者的治疗方案包括前肢截肢和化疗。急诊医生为什么要意识到这一点？尽管治疗方式取得了进步，但STS的预后仍然很差，这强调了早期诊断的重要性。临床医生在遇到乳腺癌幸存者的异常皮肤病变时必须保持警惕，特别是那些有放疗和淋巴水肿病史的人，以防止延误诊断和转移。

{"title":"Stewart-Treves syndrome post radical mastectomy: A case report","authors":"Jack Golder , Luminita Rezeanu , Lindsay Tjiattas-Saleski","doi":"10.1016/j.jemrpt.2025.100197","DOIUrl":"10.1016/j.jemrpt.2025.100197","url":null,"abstract":"<div><h3>Background</h3><div>Stewart-Treves Syndrome (STS) is a rare but serious complication observed in breast cancer patients who have undergone axillary lymph node radiation and developed postmastectomy lymphedema. STS typically presents as a purple-red cutaneous lesion, advancing over time to ulceration, edema, and hemorrhage. Its asymptomatic onset and inconspicuous presentation often delay diagnosis, complicating treatment and worsening prognosis.</div></div><div><h3>Case description</h3><div>This case report describes a 58-year-old female with a history of unilateral mastectomy and chronic lymphedema, who presented with a hemorrhagic wound on her upper extremity. Following multidisciplinary referrals, she was diagnosed with STS through biopsy and MRI, revealing angiosarcoma of the arm, forearm, and chest wall. The patient's treatment plan included forequarter amputation and chemotherapy.</div><div><strong>Why should an emergency physician be aware of this?</strong>: Despite advancements in treatment modalities, the prognosis for STS remains poor, emphasizing the importance of early diagnosis. Clinicians must maintain vigilance when encountering unusual skin lesions in breast cancer survivors, especially those with a history of radiation and lymphedema, to prevent delayed diagnosis and metastasis.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324460","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}

引用次数: 0

Not shooting blanks: A case of foreign body urinary retention 非空白弹：一例异物尿潴留

JEM reports

Pub Date : 2025-09-25 DOI: 10.1016/j.jemrpt.2025.100193

Sarah Spelsberg, Benjamin McMichael, Brianna Crosby, Katherine Fredlund

Background

Bullet and other foreign body migration after penetrating trauma is rare. There is potential for delayed movement and migration over time. A migrating retained foreign body can cause serious complications.

Case report

A 51-year-old male sustained a gunshot wound to the abdomen and pelvis. The bullet initially lodged in the abdomen. Trauma imaging identified cancer and the patient required surveillance scans. The position of the bullet remained unchanged for 11 months. From 11 to 15 months, imaging showed the bullet migrating across the abdomen, into the bladder, and through the prostate, ultimately causing acute urinary retention in the urethra. The patient presented with severe pain and was found to have bladder distention and the bullet 5 mm from the urethral meatus. It was successfully removed under sedation using alligator forceps followed by Foley catheter placement.

Why should an emergency physician be aware of this

This case illustrates the rare but significant risk of delayed bullet migration and the need for long-term monitoring in penetrating trauma with retained foreign body.

背景：穿透性创伤后子弹和其他异物的迁移是罕见的。随着时间的推移，迁移和迁移可能会延迟。迁移的异物会引起严重的并发症。病例报告一名51岁男性腹部和骨盆中枪。子弹最初射入腹部。创伤成像识别癌症，病人需要监视扫描。子弹的位置在11个月内保持不变。从11个月到15个月，成像显示子弹穿过腹部，进入膀胱，穿过前列腺，最终导致尿道急性尿潴留。患者表现为剧烈疼痛，发现膀胱膨胀，子弹距尿道道5mm。在镇静下使用鳄鱼钳成功取出，随后放置Foley导管。急诊医生为什么要注意这个？这个病例说明了子弹延迟迁移的罕见但重要的风险，以及穿透性创伤伴异物残留的长期监测的必要性。

{"title":"Not shooting blanks: A case of foreign body urinary retention","authors":"Sarah Spelsberg, Benjamin McMichael, Brianna Crosby, Katherine Fredlund","doi":"10.1016/j.jemrpt.2025.100193","DOIUrl":"10.1016/j.jemrpt.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>Bullet and other foreign body migration after penetrating trauma is rare. There is potential for delayed movement and migration over time. A migrating retained foreign body can cause serious complications.</div></div><div><h3>Case report</h3><div>A 51-year-old male sustained a gunshot wound to the abdomen and pelvis. The bullet initially lodged in the abdomen. Trauma imaging identified cancer and the patient required surveillance scans. The position of the bullet remained unchanged for 11 months. From 11 to 15 months, imaging showed the bullet migrating across the abdomen, into the bladder, and through the prostate, ultimately causing acute urinary retention in the urethra. The patient presented with severe pain and was found to have bladder distention and the bullet 5 mm from the urethral meatus. It was successfully removed under sedation using alligator forceps followed by Foley catheter placement.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>This case illustrates the rare but significant risk of delayed bullet migration and the need for long-term monitoring in penetrating trauma with retained foreign body.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220602","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}

引用次数: 0

Bilateral anterior shoulder dislocations after ground-level fall 地面坠落后双侧前肩脱位

JEM reports

Pub Date : 2025-09-15 DOI: 10.1016/j.jemrpt.2025.100192

Priya Shil, Courtney Mariner, Scott Gutovitz

Background

Despite being the most routinely encountered joint dislocation, bilateral anterior shoulder dislocation is a rare finding in a common Emergency Department complaint of mechanical ground level fall. High energy mechanisms of injury such as trauma, seizures, and electrocution are the most common causes of bilateral shoulder dislocation.

Case report

A 72-year-old male presents with simultaneous anterior dislocations of both shoulders after a fall while walking his dog. He arrived in the Emergency Department with arms above his head and xray imaging identified bilateral shoulder dislocations. After procedural sedation, the shoulders were successfully reduced without any evidence of neurovascular injuries and later discharged.

Why should an emergency physician be aware of this

?This mechanism of injury is rare among those who are diagnosed with bilateral shoulder dislocation and therefore, more likely to be missed. Where symmetry generally represents a person's normal anatomy, the apparent symmetric appearance in bilateral shoulder dislocation is misleading. Due to the infrequent occurrence, there is low clinical suspicion among emergency physicians leading to delayed diagnosis and associated complications.

背景：尽管双侧肩关节前脱位是最常见的关节脱位，但在机械性地面坠落的常见急诊科投诉中，双侧肩关节前脱位是罕见的发现。高能量损伤机制，如创伤、癫痫发作和触电是双侧肩关节脱位最常见的原因。病例报告：一名72岁男性在遛狗时跌倒，同时出现双肩前位脱位。他被送到急诊科时双臂举过头顶，x光成像显示双侧肩膀脱臼。手术镇静后，肩关节复位成功，无任何神经血管损伤迹象，随后出院。急诊医生为什么要意识到这一点？这种损伤机制在诊断为双侧肩关节脱位的患者中很少见，因此更有可能被遗漏。对称通常代表一个人的正常解剖结构，双侧肩关节脱位的明显对称外观是误导。由于不常见，急诊医生的临床怀疑度低，导致诊断延误和相关并发症。

{"title":"Bilateral anterior shoulder dislocations after ground-level fall","authors":"Priya Shil, Courtney Mariner, Scott Gutovitz","doi":"10.1016/j.jemrpt.2025.100192","DOIUrl":"10.1016/j.jemrpt.2025.100192","url":null,"abstract":"<div><h3>Background</h3><div>Despite being the most routinely encountered joint dislocation, bilateral anterior shoulder dislocation is a rare finding in a common Emergency Department complaint of mechanical ground level fall. High energy mechanisms of injury such as trauma, seizures, and electrocution are the most common causes of bilateral shoulder dislocation.</div></div><div><h3>Case report</h3><div>A 72-year-old male presents with simultaneous anterior dislocations of both shoulders after a fall while walking his dog. He arrived in the Emergency Department with arms above his head and xray imaging identified bilateral shoulder dislocations. After procedural sedation, the shoulders were successfully reduced without any evidence of neurovascular injuries and later discharged.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>?This mechanism of injury is rare among those who are diagnosed with bilateral shoulder dislocation and therefore, more likely to be missed. Where symmetry generally represents a person's normal anatomy, the apparent symmetric appearance in bilateral shoulder dislocation is misleading. Due to the infrequent occurrence, there is low clinical suspicion among emergency physicians leading to delayed diagnosis and associated complications.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105705","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}

引用次数: 0

Teaching pediatric emergency department agitation management using a clinical pathway combined with simulation scenarios 运用临床路径结合模拟情景教学儿科急诊科躁动管理

JEM reports

Pub Date : 2025-08-21 DOI: 10.1016/j.jemrpt.2025.100191

Neehar Kundurti , Rachel Tuuri , Lynne Fullerton , Priya Gupta , Brittany Ebbing , Sara Skarbek-Borowska

Background

Agitation is a common cause for pediatric emergency department (ED) visits. Despite consensus guidelines and recent educational toolkits, opportunities exist to improve provider knowledge and patient care by utilizing novel teaching modules.

Objectives

This study aimed to develop and test a teaching module (intervention) using two clinical case simulations and a pediatric agitation pathway (decision aid). We hypothesized that the module would improve provider knowledge and comfort in managing acutely agitated pediatric patients.

Methods/Design

This single-center, pre-post intervention study used a multidisciplinary-developed pathway based on consensus guidelines and two simulation case scenarios.

Subjects and Setting

Participants, all trainees in emergency medicine, completed a knowledge test and comfort survey prior to the training. They then attended a brief teaching session on the pathway, participated in two simulation case scenarios, and subsequently repeated the test and survey. Outcome measures were the difference between knowledge and comfort scores before and after the training.

Results

Sixteen participants completed the module. Knowledge improved significantly, with mean test scores increasing from 4.5 out of 10 (IQR 3–5) to 8 out of 10 (IQR 7–9) (P < .001). Comfort improved with using chemical (P = .002) and physical (P = .001) restraints.

Conclusion

The findings suggest that a teaching module for pediatric agitation which uses a decision aid in simulation scenarios is feasible and effective in improving overall knowledge and comfort associated with pediatric chemical and physical restraint use. It fills a well-known gap in pediatric agitation training and has the potential to be replicated in teaching programs for other emergent conditions.

背景：躁动是儿科急诊科（ED）就诊的常见原因。尽管有一致的指导方针和最近的教育工具包，但通过利用新的教学模块，仍然存在改善提供者知识和患者护理的机会。目的本研究旨在开发和测试一个教学模块（干预），使用两个临床病例模拟和一个儿科躁动路径（决策辅助）。我们假设，该模块将提高服务提供者的知识和舒适度管理急性躁动儿科患者。方法/设计这项单中心、干预前后研究采用了基于共识指南和两个模拟病例情景的多学科发展途径。受试者和背景：所有急诊医学受训人员在培训前完成了知识测试和舒适度调查。然后，他们参加了一个关于路径的简短教学课程，参与了两个模拟案例场景，随后重复了测试和调查。结果测量训练前后知识和舒适评分的差异。结果16名参与者完成了模块。知识显著提高，平均考试成绩从4.5分（满分10分）（IQR 3-5）提高到8分（满分10分）（P < .001）。使用化学（P = .002）和物理（P = .001）约束改善了舒适性。结论在模拟场景中使用决策辅助的躁动教学模块对提高儿童化学和物理约束使用的整体知识和舒适度是可行和有效的。它填补了儿童躁动训练中一个众所周知的空白，并有可能在其他紧急情况的教学项目中得到复制。

{"title":"Teaching pediatric emergency department agitation management using a clinical pathway combined with simulation scenarios","authors":"Neehar Kundurti , Rachel Tuuri , Lynne Fullerton , Priya Gupta , Brittany Ebbing , Sara Skarbek-Borowska","doi":"10.1016/j.jemrpt.2025.100191","DOIUrl":"10.1016/j.jemrpt.2025.100191","url":null,"abstract":"<div><h3>Background</h3><div>Agitation is a common cause for pediatric emergency department (ED) visits. Despite consensus guidelines and recent educational toolkits, opportunities exist to improve provider knowledge and patient care by utilizing novel teaching modules.</div></div><div><h3>Objectives</h3><div>This study aimed to develop and test a teaching module (intervention) using two clinical case simulations and a pediatric agitation pathway (decision aid). We hypothesized that the module would improve provider knowledge and comfort in managing acutely agitated pediatric patients.</div></div><div><h3>Methods/Design</h3><div>This single-center, pre-post intervention study used a multidisciplinary-developed pathway based on consensus guidelines and two simulation case scenarios.</div></div><div><h3>Subjects and Setting</h3><div>Participants, all trainees in emergency medicine, completed a knowledge test and comfort survey prior to the training. They then attended a brief teaching session on the pathway, participated in two simulation case scenarios, and subsequently repeated the test and survey. Outcome measures were the difference between knowledge and comfort scores before and after the training.</div></div><div><h3>Results</h3><div>Sixteen participants completed the module. Knowledge improved significantly, with mean test scores increasing from 4.5 out of 10 (IQR 3–5) to 8 out of 10 (IQR 7–9) (P < .001). Comfort improved with using chemical (P = .002) and physical (P = .001) restraints.</div></div><div><h3>Conclusion</h3><div>The findings suggest that a teaching module for pediatric agitation which uses a decision aid in simulation scenarios is feasible and effective in improving overall knowledge and comfort associated with pediatric chemical and physical restraint use. It fills a well-known gap in pediatric agitation training and has the potential to be replicated in teaching programs for other emergent conditions.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 4","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916371","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}

引用次数: 0

Right atrial compression secondary to diaphragmatic rupture and liver displacement: A case report 右心房压迫继发于膈破裂和肝移位1例

JEM reports

Pub Date : 2025-08-07 DOI: 10.1016/j.jemrpt.2025.100190

Carlos Rodriguez, Elizabeth Reynolds, Brian Chang

Background

Diaphragmatic rupture, a rare condition, can be categorized as traumatic or nontraumatic in origin. Traumatic diaphragmatic rupture (TDR) occurs in 0.8–5 % (Rossetti et al., 2005) of cases involving high-impact blunt or penetrating trauma to the chest or abdomen. Nontraumatic etiologies include congenital defects, acute elevations in intra-abdominal pressure, endometriosis, diaphragmatic abscess, or diaphragmatic eventration. Early recognition and management are critical due to its potential complications, including obstructive shock and organ herniation (Rossetti et al., 2005; Keyes et al., 2024).

Case report

We report a case of a 70-year-old woman presenting to the emergency department (ED) following cardiac arrest. Imaging revealed a diaphragmatic rupture with herniation of the liver into the thoracic cavity, causing right atrial compression and obstructive shock. Definitive management required transfer to a center with specialized cardiothoracic services for potential surgical repair after hemodynamic stabilization.

Why should an emergency physician be aware of this

Diaphragmatic rupture is an uncommon diagnosis that can mimic other conditions, delaying lifesaving treatment. Prompt imaging with CT is essential for accurate diagnosis, as chest radiography has low sensitivity. Emergency physicians must maintain a high index of suspicion in cases of undifferentiated shock to avoid fatal outcomes.

背景横膈膜破裂是一种罕见的疾病，可分为创伤性和非创伤性。创伤性膈破裂（TDR）发生率为0.8 - 5% (Rossetti et al., 2005)，涉及胸部或腹部的高冲击力钝性或穿透性创伤。非创伤性病因包括先天性缺陷、急性腹内压升高、子宫内膜异位症、膈脓肿或膈脱出。由于其潜在的并发症，包括阻塞性休克和器官疝，早期识别和治疗至关重要(Rossetti等，2005；Keyes等人，2024)。病例报告我们报告一例70岁的妇女在心脏骤停后出现在急诊科（ED）。影像学显示膈破裂伴肝疝入胸腔，引起右心房压迫和阻塞性休克。最终的治疗需要在血流动力学稳定后转移到一个有专门心胸外科服务的中心进行潜在的手术修复。为什么急诊医生应该意识到膈肌破裂是一种罕见的诊断，它可以模仿其他疾病，延误挽救生命的治疗。由于胸部x线摄影的敏感性较低，CT及时成像对于准确诊断至关重要。急诊医生必须对未分化性休克病例保持高度的怀疑，以避免致命的后果。

{"title":"Right atrial compression secondary to diaphragmatic rupture and liver displacement: A case report","authors":"Carlos Rodriguez, Elizabeth Reynolds, Brian Chang","doi":"10.1016/j.jemrpt.2025.100190","DOIUrl":"10.1016/j.jemrpt.2025.100190","url":null,"abstract":"<div><h3>Background</h3><div>Diaphragmatic rupture, a rare condition, can be categorized as traumatic or nontraumatic in origin. Traumatic diaphragmatic rupture (TDR) occurs in 0.8–5 % (Rossetti et al., 2005) of cases involving high-impact blunt or penetrating trauma to the chest or abdomen. Nontraumatic etiologies include congenital defects, acute elevations in intra-abdominal pressure, endometriosis, diaphragmatic abscess, or diaphragmatic eventration. Early recognition and management are critical due to its potential complications, including obstructive shock and organ herniation (Rossetti et al., 2005; Keyes et al., 2024).</div></div><div><h3>Case report</h3><div>We report a case of a 70-year-old woman presenting to the emergency department (ED) following cardiac arrest. Imaging revealed a diaphragmatic rupture with herniation of the liver into the thoracic cavity, causing right atrial compression and obstructive shock. Definitive management required transfer to a center with specialized cardiothoracic services for potential surgical repair after hemodynamic stabilization.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>Diaphragmatic rupture is an uncommon diagnosis that can mimic other conditions, delaying lifesaving treatment. Prompt imaging with CT is essential for accurate diagnosis, as chest radiography has low sensitivity. Emergency physicians must maintain a high index of suspicion in cases of undifferentiated shock to avoid fatal outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841734","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}

引用次数: 0