Pub Date : 2021-01-01DOI: 10.15406/mojcr.2021.11.00387
M. Abdulbasit
off-label 29mm Edwards Sapien 3 (S3) Transcatheter Heart Valve (THV). Immediate post valve deployment, mild Perivalvular Leak (PVL) was noticed at the septal aspect (area of incomplete annuloplasty ring). Eighteen months later, patient presented with recurrent right heart failure and paracentesis due to severe tricuspid PVL (Figure 1A-C, Video 1). Percutaneous PVL closure under general anesthesia, Trans-esophageal Echocardiography (TEE) was performed. Via femoral venous access, defect was easily crossed with Agilis steerable sheath, multipurpose catheter and 0.035” glide wire. Despite recurrent attempts, wire came through the PVL but then traversed through open cells of S3 into the right ventricle (Figure 2A), confirmed with Armada 6mm balloon waist at the S3 cage (Figure 2B) (despite inflating 28mm Z med balloon inside S3 cage, Figure 2C). We decided to partially deploy the plug and assess valve function. Using 7.5F Asahi Eaucath multipurpose guide, a 12mm AmplatzerTM Vascular plug II (AVP II) was advanced through the defect. The ventricular disc was opened inside the S3 cage while body in the PVL defect (outside the S3 cage) and atrial disc on the atrial side of PVL (Figure 3A-B). With S3 function unaffected, no central leak and minimal gradient, PVL reduced to mild severity (Figure 4A-D, Video 2); the AVP II was successfully deployed (Figure 5). At 3-month follow up, there was an excellent symptomatic improvement (NYHA functional class I), with no heart failure re-hospitalization or paracentesis. Deployment of plug disc inside the valve frame is not recommended due to fear of interference with leaflet function and possible injury in long term. There was no immediate issue with the valve function in this case (due to space between the leaflet and frame of S3 and depends on size of plug used). Valve-in-Valve (S3-in-S3) would have certainly sealed all open cells treating this PVL but is more expensive option.
{"title":"Tricuspid perivalvular leak closure through the open cells of Sapien 3 transcatheter heart valve","authors":"M. Abdulbasit","doi":"10.15406/mojcr.2021.11.00387","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00387","url":null,"abstract":"off-label 29mm Edwards Sapien 3 (S3) Transcatheter Heart Valve (THV). Immediate post valve deployment, mild Perivalvular Leak (PVL) was noticed at the septal aspect (area of incomplete annuloplasty ring). Eighteen months later, patient presented with recurrent right heart failure and paracentesis due to severe tricuspid PVL (Figure 1A-C, Video 1). Percutaneous PVL closure under general anesthesia, Trans-esophageal Echocardiography (TEE) was performed. Via femoral venous access, defect was easily crossed with Agilis steerable sheath, multipurpose catheter and 0.035” glide wire. Despite recurrent attempts, wire came through the PVL but then traversed through open cells of S3 into the right ventricle (Figure 2A), confirmed with Armada 6mm balloon waist at the S3 cage (Figure 2B) (despite inflating 28mm Z med balloon inside S3 cage, Figure 2C). We decided to partially deploy the plug and assess valve function. Using 7.5F Asahi Eaucath multipurpose guide, a 12mm AmplatzerTM Vascular plug II (AVP II) was advanced through the defect. The ventricular disc was opened inside the S3 cage while body in the PVL defect (outside the S3 cage) and atrial disc on the atrial side of PVL (Figure 3A-B). With S3 function unaffected, no central leak and minimal gradient, PVL reduced to mild severity (Figure 4A-D, Video 2); the AVP II was successfully deployed (Figure 5). At 3-month follow up, there was an excellent symptomatic improvement (NYHA functional class I), with no heart failure re-hospitalization or paracentesis. Deployment of plug disc inside the valve frame is not recommended due to fear of interference with leaflet function and possible injury in long term. There was no immediate issue with the valve function in this case (due to space between the leaflet and frame of S3 and depends on size of plug used). Valve-in-Valve (S3-in-S3) would have certainly sealed all open cells treating this PVL but is more expensive option.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083528","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00397
Chunhui Yang
A 76-year-old man presented with sudden behavioral changes and cognitive decline. His clinical presentation was characterized by impaired short-term memory, strange behavior, disorientation, impaired executive function, and withdrawal. MRI of the head showed an infarcted lesion in the right thalamus, confined to the anterior thalamic nucleus. According to the characteristics of the cognitive network and evidence from different clinical and experimental studies, infarction in this critical part of the anterior thalamic nucleus can cause disruption of basal ganglia-thalamo-prefrontal circuit, resulting in confusion and cognitive decline. The combination of clinical symptoms, neuroimaging and temporal findings led to the final diagnosis of strategic infarct vascular dementia (VaD) subtype (SIVaD).
{"title":"Sudden confusion and cognitive decline due to acute infarction of the anterior thalamic nucleus (ANT) - a case report","authors":"Chunhui Yang","doi":"10.15406/mojcr.2021.11.00397","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00397","url":null,"abstract":"A 76-year-old man presented with sudden behavioral changes and cognitive decline. His clinical presentation was characterized by impaired short-term memory, strange behavior, disorientation, impaired executive function, and withdrawal. MRI of the head showed an infarcted lesion in the right thalamus, confined to the anterior thalamic nucleus. According to the characteristics of the cognitive network and evidence from different clinical and experimental studies, infarction in this critical part of the anterior thalamic nucleus can cause disruption of basal ganglia-thalamo-prefrontal circuit, resulting in confusion and cognitive decline. The combination of clinical symptoms, neuroimaging and temporal findings led to the final diagnosis of strategic infarct vascular dementia (VaD) subtype (SIVaD).","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083835","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00405
Vibhor Sharma
Central venous access devices are commonly utilized in cancer patients. These devices include central venous catheters, peripherally inserted central catheter (PICC line), Hickman catheter and totally implantable central venous devices of the port-a-cath type (chemoport). These devices can be retained for a long time and may be used for administration of chemotherapy, blood products, total parenteral nutrition and frequent blood sampling. Complications associated with chemoport include vascular injury, hemothorax, pneumothorax, local site infection, sepsis, catheter thrombosis, drug extravasation and mechanical malfunction. Spontaneous fragmentation of chemoport catheter is a rare complication. We report a case of spontaneous fragmentation of chemoport catheter from its midway and its migration into the lower lobar branch of left pulmonary artery. It was retrieved using percutaneous endovascular approach under fluoroscopic guidance.
{"title":"Spontaneous fragmentation and embolization of chemoport catheter- a case report","authors":"Vibhor Sharma","doi":"10.15406/mojcr.2021.11.00405","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00405","url":null,"abstract":"Central venous access devices are commonly utilized in cancer patients. These devices include central venous catheters, peripherally inserted central catheter (PICC line), Hickman catheter and totally implantable central venous devices of the port-a-cath type (chemoport). These devices can be retained for a long time and may be used for administration of chemotherapy, blood products, total parenteral nutrition and frequent blood sampling. Complications associated with chemoport include vascular injury, hemothorax, pneumothorax, local site infection, sepsis, catheter thrombosis, drug extravasation and mechanical malfunction. Spontaneous fragmentation of chemoport catheter is a rare complication. We report a case of spontaneous fragmentation of chemoport catheter from its midway and its migration into the lower lobar branch of left pulmonary artery. It was retrieved using percutaneous endovascular approach under fluoroscopic guidance.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083947","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00369
Chunhui Yang
Otomycosis is a fungal ear infection, mostly a superficial mycotic infection of the outer ear canal. The infection may be either subacute or acute but chronic form is around 10%. The characteristic of otomycosis are discharge, pruritus, or more severe discomfort. Here we report a 46-year-old Asian woman presented with vertigo and was diagnosed as otomycosis with the complications of tympanic membrane perforation, otitis media and labyrinthitis of inner ear which was confirmed by IV-Gd 1.5 T MRI. This case is a chronic otomycosis related to cerumen removal two year before this onset. Our study supported the suggestion that otomycosis should include fungal infections of the middle and inner ear, furthermore the infection of the inner ear may be included as labyrinthitis with the symptom of vertigo.
耳真菌病是一种真菌性耳部感染，多为外耳道浅表真菌感染。感染可能是亚急性或急性，但慢性形式约占10%。耳真菌病的特征是分泌物、瘙痒或更严重的不适。我们在此报告一位46岁的亚洲女性，以眩晕为临床表现，诊断为耳真菌病，并发鼓膜穿孔、中耳炎和内耳迷路炎，经IV-Gd 1.5 T MRI证实。本病例为慢性耳真菌病，发病前两年曾切除耵聍。本研究支持耳真菌病应包括中耳和内耳真菌感染，内耳感染可包括伴有眩晕症状的迷路炎。
{"title":"Tympanic membrane perforation, otitis media and labyrinthitis caused by otomycosis confirmed by intravenous gadolinium 1.5 tesla MRI-a case report","authors":"Chunhui Yang","doi":"10.15406/mojcr.2021.11.00369","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00369","url":null,"abstract":"Otomycosis is a fungal ear infection, mostly a superficial mycotic infection of the outer ear canal. The infection may be either subacute or acute but chronic form is around 10%. The characteristic of otomycosis are discharge, pruritus, or more severe discomfort. Here we report a 46-year-old Asian woman presented with vertigo and was diagnosed as otomycosis with the complications of tympanic membrane perforation, otitis media and labyrinthitis of inner ear which was confirmed by IV-Gd 1.5 T MRI. This case is a chronic otomycosis related to cerumen removal two year before this onset. Our study supported the suggestion that otomycosis should include fungal infections of the middle and inner ear, furthermore the infection of the inner ear may be included as labyrinthitis with the symptom of vertigo.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083151","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00400
Rajaram Sharma
Hepatic tuberculosis (TB) is rare, but recently it is more frequently detected. On imaging, it presents with different appearances and can mimic a variety of other conditions. A high degree of suspicion combined with appropriate diagnostic modalities and image-guided tissue sampling examination greatly aid in the timely diagnosis of the disease. The sights of this case report are to illustrate and discuss the different presentation of hepatic TB on computed tomography. This entity is frequently related to caseous necrosis, which is the hallmark of this disease. However, our patient didn’t have any liver lesion in spite of deranged liver function tests.
{"title":"No lesion in the liver can also be hepatic tuberculosis - An important consideration","authors":"Rajaram Sharma","doi":"10.15406/mojcr.2021.11.00400","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00400","url":null,"abstract":"Hepatic tuberculosis (TB) is rare, but recently it is more frequently detected. On imaging, it presents with different appearances and can mimic a variety of other conditions. A high degree of suspicion combined with appropriate diagnostic modalities and image-guided tissue sampling examination greatly aid in the timely diagnosis of the disease. The sights of this case report are to illustrate and discuss the different presentation of hepatic TB on computed tomography. This entity is frequently related to caseous necrosis, which is the hallmark of this disease. However, our patient didn’t have any liver lesion in spite of deranged liver function tests.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083894","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00371
Rhett Orgeron
We present a 29-year-old male with a history of treatment resistant juvenile dermatomyositis (JDM). The patient was admitted for complaints of nausea, diarrhea and abdominal pain and was subsequently found to have intestinal perforation on imaging. The patient had also exhibited classic dermatologic findings alongside rare dermato-pathological manifestations of JDM on examination; likely consequences of his underlying disease process. This case serves to present these rare findings and analyze the similarities of JDM and adult dermatomyositis (DM). In addition, overall diagnosis and treatment of resistant/severe JDM is explored. High clinical suspicion alongside an interdisciplinary approach is warranted for such patients given their extensive risk factors for future complications.
{"title":"Complications of refractory juvenile dermatomyositis: a case report and literature review","authors":"Rhett Orgeron","doi":"10.15406/mojcr.2021.11.00371","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00371","url":null,"abstract":"We present a 29-year-old male with a history of treatment resistant juvenile dermatomyositis (JDM). The patient was admitted for complaints of nausea, diarrhea and abdominal pain and was subsequently found to have intestinal perforation on imaging. The patient had also exhibited classic dermatologic findings alongside rare dermato-pathological manifestations of JDM on examination; likely consequences of his underlying disease process. This case serves to present these rare findings and analyze the similarities of JDM and adult dermatomyositis (DM). In addition, overall diagnosis and treatment of resistant/severe JDM is explored. High clinical suspicion alongside an interdisciplinary approach is warranted for such patients given their extensive risk factors for future complications.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"15 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083169","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00372
S. Berrad
Ovarian cancer is a malignant tumor that usually develops from the surface coating of the ovaries. The most common form is epithelial carcinoma. As a result of its location, and its silent nature responsible for a delay in diagnosis that makes the prognosis rather poor. The usual metastatic sites are the peritoneal cavity, liver and lung. Secondary biliary localization is a rare, even exceptional site. We report the observation of a patient who presented with abdominal pain in the right hypochondrium and progressive vomiting. Abdominal ultrasound revealed a 21 mm gallbladder lithiasis with hepatic steatosis. Abdominal CT scan revealed a large heterogeneous mass with engulfed gallstones. The patient underwent cholecystectomy. Histological study showed moderately differentiated adenocarcinoma and acute cholecystitis. Immunohistochemical staining revealed that the tumor cells were positive for antibodies against CK7, WT1, PAX8 and p53 and negative for CK20 and ER. These results suggest that the tumor was a metastasis of serous ovarian adenocarcinoma. Medical imaging done with abdominal CT showed an ovarian mass with peritoneal carcinosis, serum CA125 was elevated at 97U/ml. Carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) levels were normal. The patient received first-line chemotherapy with carboplatin and paclitaxel. After 6 courses of therapy, she achieved a partial clinical, biological and radiological response, in our medical oncology department of the CHU Hassan II from Fez. The interest of the subject is to report the rarity of this entity as well as the radiological, histopathological, prognostic and therapeutic characteristics.
{"title":"Metastatic ovarian cancer to the gallbladder indicative of the diagnosis","authors":"S. Berrad","doi":"10.15406/mojcr.2021.11.00372","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00372","url":null,"abstract":"Ovarian cancer is a malignant tumor that usually develops from the surface coating of the ovaries. The most common form is epithelial carcinoma. As a result of its location, and its silent nature responsible for a delay in diagnosis that makes the prognosis rather poor. The usual metastatic sites are the peritoneal cavity, liver and lung. Secondary biliary localization is a rare, even exceptional site. We report the observation of a patient who presented with abdominal pain in the right hypochondrium and progressive vomiting. Abdominal ultrasound revealed a 21 mm gallbladder lithiasis with hepatic steatosis. Abdominal CT scan revealed a large heterogeneous mass with engulfed gallstones. The patient underwent cholecystectomy. Histological study showed moderately differentiated adenocarcinoma and acute cholecystitis. Immunohistochemical staining revealed that the tumor cells were positive for antibodies against CK7, WT1, PAX8 and p53 and negative for CK20 and ER. These results suggest that the tumor was a metastasis of serous ovarian adenocarcinoma. Medical imaging done with abdominal CT showed an ovarian mass with peritoneal carcinosis, serum CA125 was elevated at 97U/ml. Carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) levels were normal. The patient received first-line chemotherapy with carboplatin and paclitaxel. After 6 courses of therapy, she achieved a partial clinical, biological and radiological response, in our medical oncology department of the CHU Hassan II from Fez. The interest of the subject is to report the rarity of this entity as well as the radiological, histopathological, prognostic and therapeutic characteristics.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083177","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 : 2021-01-01DOI: 10.15406/MOJCR.2021.11.00377
N. Hassan
Acute abdominal pain is a common symptom and often inconsequential. It can represent a wide spectrum of conditions from benign to surgical emergencies. The association of two diseases as a cause of acute abdominal pain is uncommon. It may cause a delay in the diagnosis. Here we are reporting an unusual coexistence of herpes zoster and acute cholecystitis in a previously healthy 55-year-old female patient.
{"title":"A rare case of acute abdominal pain: an association between herpes zoster and cholecystitis","authors":"N. Hassan","doi":"10.15406/MOJCR.2021.11.00377","DOIUrl":"https://doi.org/10.15406/MOJCR.2021.11.00377","url":null,"abstract":"Acute abdominal pain is a common symptom and often inconsequential. It can represent a wide spectrum of conditions from benign to surgical emergencies. The association of two diseases as a cause of acute abdominal pain is uncommon. It may cause a delay in the diagnosis. Here we are reporting an unusual coexistence of herpes zoster and acute cholecystitis in a previously healthy 55-year-old female patient.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083344","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00378
J. Tay
Internal iliac artery aneurysms are rare, representing less than 2% of all aneurysms. Nonetheless, the mortality is high at up to 60% when ruptured. Ruptured internal iliac artery aneurysms commonly present with overt abdominal pain and systemic instability. They can also present with symptoms of pelvic organ dysfunction, such as urinary retention or obstipation. This report describes the first case of a ruptured internal iliac artery (IIA) aneurysm masquerading as a reducible inguinal hernia. It was diagnosed on a Computed Tomography scan, which showed a large contained ruptured right IIA aneurysm with extension of haemorrhage through the hernia sac. He underwent an endovascular procedure to exclude the aneurysm that was uncomplicated, and he had an uneventful recovery. It highlights the importance of considering IIA aneurysms as differentials for abdominal masses, groin lumps or vague symptoms of pelvic organ dysfunction. Thorough exploration of the history and careful examination will help flag these diagnoses in our clinical assessment.
{"title":"Ruptured internal iliac artery aneurysm masquerading as an inguinal hernia","authors":"J. Tay","doi":"10.15406/mojcr.2021.11.00378","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00378","url":null,"abstract":"Internal iliac artery aneurysms are rare, representing less than 2% of all aneurysms. Nonetheless, the mortality is high at up to 60% when ruptured. Ruptured internal iliac artery aneurysms commonly present with overt abdominal pain and systemic instability. They can also present with symptoms of pelvic organ dysfunction, such as urinary retention or obstipation. This report describes the first case of a ruptured internal iliac artery (IIA) aneurysm masquerading as a reducible inguinal hernia. It was diagnosed on a Computed Tomography scan, which showed a large contained ruptured right IIA aneurysm with extension of haemorrhage through the hernia sac. He underwent an endovascular procedure to exclude the aneurysm that was uncomplicated, and he had an uneventful recovery. It highlights the importance of considering IIA aneurysms as differentials for abdominal masses, groin lumps or vague symptoms of pelvic organ dysfunction. Thorough exploration of the history and careful examination will help flag these diagnoses in our clinical assessment.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083349","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 : 2021-01-01DOI: 10.15406/mojcr.2021.11.00384
J. Naschitz
Admitted to hospital with an ischemic stroke, a 63-year-old male was diagnosed with a left ventricular mural thrombus. Enoxaparin treatment was started. Over 6 weeks there were two episodes of major hemorrhage needing brief discontinuation of anticoagulation. A previously normal prothrombin time (PT) became prolonged upon which vitamin K deficiency was diagnosed. The deficiency was caused by enteral feeding using a formula which did not contain the required daily dose of vitamin K. A triple message emerges from this observation: theneed for monitoring the PT in patients receiving enteral feeding, more so in those receiving anticoagulant along with enteral feeding, and the appeal to fortify feeding formulas with vitamin K.
{"title":"Major bleeding under enoxaparin treatment. An unexpected second offender","authors":"J. Naschitz","doi":"10.15406/mojcr.2021.11.00384","DOIUrl":"https://doi.org/10.15406/mojcr.2021.11.00384","url":null,"abstract":"Admitted to hospital with an ischemic stroke, a 63-year-old male was diagnosed with a left ventricular mural thrombus. Enoxaparin treatment was started. Over 6 weeks there were two episodes of major hemorrhage needing brief discontinuation of anticoagulation. A previously normal prothrombin time (PT) became prolonged upon which vitamin K deficiency was diagnosed. The deficiency was caused by enteral feeding using a formula which did not contain the required daily dose of vitamin K. A triple message emerges from this observation: theneed for monitoring the PT in patients receiving enteral feeding, more so in those receiving anticoagulant along with enteral feeding, and the appeal to fortify feeding formulas with vitamin K.","PeriodicalId":93339,"journal":{"name":"MOJ clinical & medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67083425","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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