Hydatid cyst was commonly found in the liver followed by lungs and brain. Cardiac hydatid cysts are less common compared to hepatic ones. We report a case of intramural hydatid cyst that is incidentally found during t...
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Hydatid cyst was commonly found in the liver followed by lungs and brain. Cardiac hydatid cysts are less common compared to hepatic ones. We report a case of intramural hydatid cyst that is incidentally found during the work-up of a hepatic hydated cyst.
A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer(T3N2M0 Stage Ⅲ) 11 years earlier. Endoscopic examination revealed an anastomotic strict...
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A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer(T3N2M0 Stage Ⅲ) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation,including redness,erosion,edema,bleeding,friability,and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine,gastrografinfilled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly,endoscopic balloon dilatation was performed and antifungal therapy was started in the hospital. Seven weeks later,endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently,the patient was discharged. At the latest follow-up,the patient was symptomfree and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.
Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitt...
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Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers?elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1?week later with significant improvement. However she remained hypotensive.
intramural hematoma of the esophagus is a rare but well described type of acute injury of the esophageal wall and it is more frequently being recognized throughout the world. Patients usually present with acute retros...
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intramural hematoma of the esophagus is a rare but well described type of acute injury of the esophageal wall and it is more frequently being recognized throughout the world. Patients usually present with acute retrosternal or epigastric pain, minor hematemesis and dysphagia. The condition is mostly seen in women with abnormal coagulation and it can either occur spontaneous or induced by trauma or transesopha-geal procedures. It is associated with food impaction and vomiting. Esophageal intramural hematoma has also been reported in young and healthy patients. Case reports with coexisting achalasia are limited. Management is conservative and its course is benign.
Nontraumatic intramural duodenal hematoma(IDH) is rare disease and it is generally related to coagulation *** of nontraumatic IDH associated with pancreatic disease are relatively rare,and various conditions including...
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Nontraumatic intramural duodenal hematoma(IDH) is rare disease and it is generally related to coagulation *** of nontraumatic IDH associated with pancreatic disease are relatively rare,and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic ***,the association between IDH and acute pancreatitis remains *** report the case of a 45-year-old man who presented with vomiting and right hypochondrial *** had no medical history,but was a heavy *** diagnosis of IDH was established by computed tomography,ultrasonography and endoscopy,and it was complicated by acute *** lesions resolved with conservative *** discuss this case in the context of previously reported cases of IDH concomitant with acute *** our patient,acute pancreatitis occurred concurrently with hematoma,probably due to obstruction of the duodenal papilla,or compression of the pancreas caused by the *** present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.
Acute aortic syndrome includes classic aortic dissection,aortic intramural hematoma,and penetrating atherosclerotic ulcer– a group of conditions that are defined by their dynamic evolution and similar clinical *** di...
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Acute aortic syndrome includes classic aortic dissection,aortic intramural hematoma,and penetrating atherosclerotic ulcer– a group of conditions that are defined by their dynamic evolution and similar clinical *** diagnosis and prompt treatment are essential as all the aforementioned conditions are a signifi cant threat to a patient’s ***,acute aortic syndrome and especially aortic intramural hematoma may be challenging diagnostic *** ultrasound imaging is a diagnostic method that can be useful for more thorough evaluation of the aortic lesion and can particularly aid in discerning the different forms of acute aortic *** present a case of a patient with aortic intramural hematoma that was missed by conventional imaging studies but was successfully visualized with intravascular ultrasound imaging.
BACKGROUND Oesophageal cancer is the fourth most common cause of cancer-related deaths in *** squamous cell carcinomas(ESCCs)arise from the epithelial layer,and commonly present as polypoidal,ulcerative or ulceroproli...
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BACKGROUND Oesophageal cancer is the fourth most common cause of cancer-related deaths in *** squamous cell carcinomas(ESCCs)arise from the epithelial layer,and commonly present as polypoidal,ulcerative or ulceroproliferative growth in the oesophageal *** contrast,oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme(examples include leiomyoma,fibrovasculoma,lipoma,granular cell tumour or carcinoid),and mostly do not breach the *** submucosal tumours are a distinct group of tumours arising from the mesenchyme,and mostly do not breach the *** intramural growth of an advanced primary ESCC is an exceedingly rare presentation,with only six cases reported in the literature thus *** herein report a case of primary ESCC with complete intramural invasion that endoscopically mimics a submucosal *** SUMMARY A 50 year old male presented with a progressive mechanical type of dysphagia for one *** history was significant,including squamous cell carcinoma of the tongue that was treated with surgery and chemoradiation 1 year *** gastrointestinal endoscopy revealed a large,hemispherical lesion with normalappearing overlying mucosa about 4 cm×5 cm in size extending from 30-34 cm from *** patient underwent endoscopic ultrasound(EUS),and a fineneedle biopsy was performed,which was suggestive for squamous cell *** herein report a case of primary ESCC with complete intramural invasion,endoscopically mimicking a submucosal *** diagnosis could be established only by a EUS-guided *** This case report highlights that intramural ESCC may look like a submucosal lesion in endoscopy,and EUS biopsy is needed for final diagnosis.
AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardi...
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AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of *** Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.
Plexiform angiomyxoid myofibroblastic tumor(PAMT) is a rare benign mesenchymal tumor of stomach. Rarity of this kind of tumors and scarce review articles may cause underrecognition of this entity and pose a real diagn...
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Plexiform angiomyxoid myofibroblastic tumor(PAMT) is a rare benign mesenchymal tumor of stomach. Rarity of this kind of tumors and scarce review articles may cause underrecognition of this entity and pose a real diagnostic challenge to gastroenterologists, pathologists and surgeons when encountering such patients and differentiating PAMT from other gastric intramural tumors. We report a case of 28-year-old woman, who presented with epigastric pain after meals, iron-deficiency anaemia and weight loss. Upper gastrointestinal endoscopy revealed submucosal tumorlike elevated lesion in the anterior wall of the antrum with intact overlying mucosa. Endoscopic ultrasound showed a 3-cm hypoechoic homogenous mass, originating from the third layer of the gastric wall. Endoscopic ultrasound-guided fine needle aspiration was not informative. Endoscopic buttonhole biopsy was performed to obtain specimens. Following this, the unexpected prolapse of the tumor occurred into the lumen of the stomach, causing gastric outlet obstruction- the biopsy was obtained. Pathomorphological features suggested the diagnosis of PAMT. Gastric resection of the Billroth I type was performed. Diagnosis was confirmed by histological analysis of the surgical specimen.
Warfarin is the most common oral anticoagulant prescribed around the world. Adverse drug interactions with warfarin are a huge problem especially in the elderly and in patients who take multiple medications. Most adve...
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Warfarin is the most common oral anticoagulant prescribed around the world. Adverse drug interactions with warfarin are a huge problem especially in the elderly and in patients who take multiple medications. Most adverse drug interactions involve concomitantly prescribed oral or intravenous medications. Occasionally, topical or mucosally absorbed drugs can interact, leading to fluctuations in warfarin levels with adverse consequences. In this case report, we describe a case of intestinal intramural hematoma, a rare but known consequence of a supra therapeutic international normalized ratio (INR). The supra therapeutic INR was a consequence of mucosally absorbed miconazole, prescribed for vaginal candidiasis. We wish to highlight this rare and potentially fatal drug interaction, along with the need for frequent INR monitoring when new drugs are added or removed in patients taking warfarin.
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