Background: Spontaneous rupture of urinary bladder (SRUB) without trauma is an extremely rare pathology. The incidence is estimated to about 1/126,000. It is difficult to diagnose. Aim: To present an exceptional case ...Background: Spontaneous rupture of urinary bladder (SRUB) without trauma is an extremely rare pathology. The incidence is estimated to about 1/126,000. It is difficult to diagnose. Aim: To present an exceptional case report and emphasize on the difficulty of diagnosis. Case Presentation: We report the case of a 63-year-old man. The initial diagnosis of SRUB was obscured by a urinary retention. The pelvic ultrasound finally led to the diagnosis. We will pay particular attention to the circumstances of the diagnosis and the therapeutic measures applied. Conclusion: SRUB is exceptional and misdiagnosis is usual. Management is most of the time surgical.展开更多
Simulations of the spontaneous rupture of potential earthquakes in the vicinity of reservoir dams can provide accurate parameters for seismic resilience assessment,which is essential for improving the seismic performa...Simulations of the spontaneous rupture of potential earthquakes in the vicinity of reservoir dams can provide accurate parameters for seismic resilience assessment,which is essential for improving the seismic performance of reservoir dams.In simulations of potential spontaneous ruptures,fault geometry,regional stress fields,constitutive parameters of the fault friction law,and many other factors control the slip rate,morphology,and dislocation of the rupture,thereby affecting the simulated ground motion parameters.The focus of this study was to elucidate the effects of the background stress field on the nucleation and propagation of spontaneous ruptures based on the factors influencing potential M>7 earthquake events on the Leibo Middle Fault(LBMF)and the Mabian-Yanjing Fault(MB-YJF)in the Xiluodu dam(XLD)region.Our simulation results show that the magnitude of the regional background stress field plays a decisive role in whether a destructive earthquake exceeding the critical magnitude will occur.We found that the direction and magnitude of the regional stress significantly affect the range of rupture propagation on the fault plane,and fault geometry affects the spatial distribution of the rupture range.Under the same regional stress field magnitude and orientation,a more destructive,high-magnitude earthquake is more likely to occur on the LBMF than on the MB-YJF.展开更多
BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency...BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.展开更多
Background: Spontaneously ruptured hepatocellular carcinoma(rHCC) is a life-threatening condition. Transarterial chemoembolization(TACE) is a widely accepted treatment;however, it can lead to serious complications,esp...Background: Spontaneously ruptured hepatocellular carcinoma(rHCC) is a life-threatening condition. Transarterial chemoembolization(TACE) is a widely accepted treatment;however, it can lead to serious complications,especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.Methods: Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve(AUC). Delong’s test was used to compare predictive efficiency.Results: Sixty patients(19 and 41 in the liver failure and non-liver failure groups, respectively) were included.Multivariate analysis showed that preoperative prothrombin activity(PTA) level(odds ratio [OR], 0.956;95%confidence interval [CI], 0.920–0.994;P = 0.024) and Child-Pugh grade B(OR, 6.419;95% CI, 1.123–36.677;P= 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were0.783 and 0.764, respectively.Conclusion: Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.展开更多
Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical pr...Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.展开更多
Besides spontaneous rupture of achilles tendon is a rare condition which is usually associated with corticosteroid or fluoroquinolon usage, spontaneous rupture of Achilles tendon without any risk factors is extremely ...Besides spontaneous rupture of achilles tendon is a rare condition which is usually associated with corticosteroid or fluoroquinolon usage, spontaneous rupture of Achilles tendon without any risk factors is extremely rare. In this report we aimed to present clinical features of a case of bilateral spontaneous achilles tendon rupture and tried to investigate potential etiologic factors. A 54 year old man was admitted to our emergency department as complaining bilateral ankle pain at the retrocalcaneal region. He had no trauma, any comorbidities or any drug consumption history. Painful achilles tendon gaps proximal to his ankles had been palpated and bilateral Thompson’s test positivity had been noted (Figures 1 and 2). He was unable to rise upon his toes however he was able to walk. American Orthopedic Foot and Ankle Society Hindfoot Scoring was calculated as 78 points. The rupture had been verified with a magnetic resonance imaging and his laboratory findings were all within normal limits (Figures 3 and 4).The patient did not approve an operation so conservative treatment with dorsiflexion limiting brace was applied and strengthening and stretching exercises of gastrosoleus was suggested. Atraumatic and bilateral cases with achilles rupture should be well investigated whether any systemic factors are coexistent. Besides well known corticosteroids or fluoroquinolone exposure, endocrinologic and rheumatological diseases, hypercholesterolaemia should be evaluated in terms of predisposing causes. Patients who have to use corticosteroids or fluoroquinolone, should be informed about achilles tendon rupture and be suggested do regular physical exercises in order to reduce the rupture risk. Despite predisposing factors, sometimes nothing can be associated with achilles tendon rupture as in our case. Genetic predisposition or a degenerative process of a tendon due to age may be underlying cause like in rotator cuff tears.展开更多
Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,co...Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.展开更多
Objective:The goal of this work is to analyze the incidence,etiology,clinical characteristics,maternal and neonatal outcomes of complete uterine rupture during pregnancy.Methods:The information of complete uterine rup...Objective:The goal of this work is to analyze the incidence,etiology,clinical characteristics,maternal and neonatal outcomes of complete uterine rupture during pregnancy.Methods:The information of complete uterine rupture between June 2010 and May 2020 was investigated retrospectively at a tertiary center,and included demographic data,delivery characteristics,intraoperative findings,and maternal and neonatal outcomes.The prevalence rate of uterine rupture in the early group(hospitalized from June 2010 to May 2015)and late group(June 2015 to May 2020)was compared and analyzed.展开更多
BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy.In this article,we report 4 cases of intra-abdominal hemorrhage during pregnancy,including the spontaneous ruptu...BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy.In this article,we report 4 cases of intra-abdominal hemorrhage during pregnancy,including the spontaneous rupture of uterine veins,spontaneous rupture of liver,rupture of external iliac vessel branch,and rupture of right renal hamartoma.CASE SUMMARY The clinical manifestations of three patients lacked specificity,and the localization of the bleeding was not clear prior to surgery.All 4 pregnant women were successfully treated,while only one full-term infant survived.CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic,and it is clinically characterized by acute abdominal pain during pregnancy.Clear diagnosis before surgery is rather difficult.Early diagnosis,timely and appropriate treatment and surgery,and multidisciplinary cooperation are key to saving pregnant females’lives and improving the outcomes of perinatal infants.展开更多
BACKGROUND:Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract in adults.We treated surgically a man with acute abdomen caused by non-traumatic hemoperitoneum an...BACKGROUND:Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract in adults.We treated surgically a man with acute abdomen caused by non-traumatic hemoperitoneum and diagnosed by low grade gastric GIST.METHODS:A 51-year-old Caucasian man came to the hospital for abdominal pain for 3 hours.He had no history of abdominal trauma.On admission,he was conscious and alert,and he had hypotension(80/50 mmHg) and moderate tachycardia.Abdominal ultrasonography showed the presence of free peritoneal fluid.Abdominal magnetic resonance imaging(MRI) showed diffuse intraabdominal hemorrhage and solid mass lesion at the greater curvature of the stomach.At an emergency laparotomy,a pedunculated,fragile mass of 5x6 cm originating from the posterior wall of the stomach was seen.The tumor was resected.Histopathologically a gastrointestinal stromal tumor was detected.RESULTS:The patient had an uneventful postoperative course and was discharged on the sixth postoperative day.Follow-up showed no recurrence of the tumor 8 months after surgery.CONCLUSION:Intraabdominal bleeding is a rare presentation of gastrointestinal stromal tumors.The diagnosis of the tumor should be based on whether sudden abdominal pain occurs in patients with an intraabdominal mass.展开更多
BACKGROUND Spontaneous esophageal rupture or Boerhaave’s syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality.Here,we aimed to explore the clinical characteristics,diagnosis,treatm...BACKGROUND Spontaneous esophageal rupture or Boerhaave’s syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality.Here,we aimed to explore the clinical characteristics,diagnosis,treatment,and prognosis of spontaneous esophageal rupture,and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture.CASE SUMMARY The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature.The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours.Based on the computed tomography(CT)scan analysis,clinically,right pleural effusion was diagnosed.However,the patient was unwilling to undergo right closed thoracic drainage.The patient also had intermittent fevers against infection,and during the course of treatment,he complained of chest pain,following which,he was transferred to our hospital.Grapefruit-like residue drainage fluid was observed.Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus.Therefore,the patient underwent an urgent esophageal hiatus repair.Unfortunately,the patient died of infection and respiratory failure due to progressive dyspnea after surgery.CONCLUSION Spontaneous esophageal rupture is a rare disease associated with high fatality.The patients do not present typical clinical symptoms and the disease progresses rapidly.This case report highlights the importance of a dynamic review of chest CT scan,not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies.Moreover,we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites(upper-esophageal segment)through this case report of spontaneous esophageal rupture that caused the patient’s death.We have also summarized the reasons for the misdiagnosis and lessons learned.展开更多
We present an extremely rare case of caudate lobe intrahepatic pancreatic pseudocyst with spontaneous rupture into the inferior vena cava(IVC).A 58-year-old male,a chronic alcoholic,presented with features of pancreat...We present an extremely rare case of caudate lobe intrahepatic pancreatic pseudocyst with spontaneous rupture into the inferior vena cava(IVC).A 58-year-old male,a chronic alcoholic,presented with features of pancreatitis for which imaging was done.Ultrasound and contrast-enhanced computed tomography were carried out,which revealed intrahepatic pancreatic pseudocyst in the caudate lobe of the liver.There was suggestion of spontaneous rupture of the pseudocyst into the IVC,which was well delineated on imaging.展开更多
文摘Background: Spontaneous rupture of urinary bladder (SRUB) without trauma is an extremely rare pathology. The incidence is estimated to about 1/126,000. It is difficult to diagnose. Aim: To present an exceptional case report and emphasize on the difficulty of diagnosis. Case Presentation: We report the case of a 63-year-old man. The initial diagnosis of SRUB was obscured by a urinary retention. The pelvic ultrasound finally led to the diagnosis. We will pay particular attention to the circumstances of the diagnosis and the therapeutic measures applied. Conclusion: SRUB is exceptional and misdiagnosis is usual. Management is most of the time surgical.
基金jointly funded by the National Key Research and Development Program of China(No.2017YFC0404901)the Special Scientific Research Fund of the Institute of Geophysics of China Earthquake Administration(Nos.DQJB19B27,DQJB19A0123,DQJB21X25,DQJB20X09)。
文摘Simulations of the spontaneous rupture of potential earthquakes in the vicinity of reservoir dams can provide accurate parameters for seismic resilience assessment,which is essential for improving the seismic performance of reservoir dams.In simulations of potential spontaneous ruptures,fault geometry,regional stress fields,constitutive parameters of the fault friction law,and many other factors control the slip rate,morphology,and dislocation of the rupture,thereby affecting the simulated ground motion parameters.The focus of this study was to elucidate the effects of the background stress field on the nucleation and propagation of spontaneous ruptures based on the factors influencing potential M>7 earthquake events on the Leibo Middle Fault(LBMF)and the Mabian-Yanjing Fault(MB-YJF)in the Xiluodu dam(XLD)region.Our simulation results show that the magnitude of the regional background stress field plays a decisive role in whether a destructive earthquake exceeding the critical magnitude will occur.We found that the direction and magnitude of the regional stress significantly affect the range of rupture propagation on the fault plane,and fault geometry affects the spatial distribution of the rupture range.Under the same regional stress field magnitude and orientation,a more destructive,high-magnitude earthquake is more likely to occur on the LBMF than on the MB-YJF.
文摘BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.
文摘Background: Spontaneously ruptured hepatocellular carcinoma(rHCC) is a life-threatening condition. Transarterial chemoembolization(TACE) is a widely accepted treatment;however, it can lead to serious complications,especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.Methods: Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve(AUC). Delong’s test was used to compare predictive efficiency.Results: Sixty patients(19 and 41 in the liver failure and non-liver failure groups, respectively) were included.Multivariate analysis showed that preoperative prothrombin activity(PTA) level(odds ratio [OR], 0.956;95%confidence interval [CI], 0.920–0.994;P = 0.024) and Child-Pugh grade B(OR, 6.419;95% CI, 1.123–36.677;P= 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were0.783 and 0.764, respectively.Conclusion: Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.
基金supported by Reina Sofía University Hospital,14004 Córdoba,Spain(Andalusia Public Health Service)
文摘Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.
文摘Besides spontaneous rupture of achilles tendon is a rare condition which is usually associated with corticosteroid or fluoroquinolon usage, spontaneous rupture of Achilles tendon without any risk factors is extremely rare. In this report we aimed to present clinical features of a case of bilateral spontaneous achilles tendon rupture and tried to investigate potential etiologic factors. A 54 year old man was admitted to our emergency department as complaining bilateral ankle pain at the retrocalcaneal region. He had no trauma, any comorbidities or any drug consumption history. Painful achilles tendon gaps proximal to his ankles had been palpated and bilateral Thompson’s test positivity had been noted (Figures 1 and 2). He was unable to rise upon his toes however he was able to walk. American Orthopedic Foot and Ankle Society Hindfoot Scoring was calculated as 78 points. The rupture had been verified with a magnetic resonance imaging and his laboratory findings were all within normal limits (Figures 3 and 4).The patient did not approve an operation so conservative treatment with dorsiflexion limiting brace was applied and strengthening and stretching exercises of gastrosoleus was suggested. Atraumatic and bilateral cases with achilles rupture should be well investigated whether any systemic factors are coexistent. Besides well known corticosteroids or fluoroquinolone exposure, endocrinologic and rheumatological diseases, hypercholesterolaemia should be evaluated in terms of predisposing causes. Patients who have to use corticosteroids or fluoroquinolone, should be informed about achilles tendon rupture and be suggested do regular physical exercises in order to reduce the rupture risk. Despite predisposing factors, sometimes nothing can be associated with achilles tendon rupture as in our case. Genetic predisposition or a degenerative process of a tendon due to age may be underlying cause like in rotator cuff tears.
基金supported by grants from the National Natural Science Foundation of China (No. 81371652)the Science and Technology Planning Project of Guangdong Province (No. 2012B031800120)
文摘Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.
基金This work was supported by the National Key Research and Development Program of China(No.2016YFC1000405).
文摘Objective:The goal of this work is to analyze the incidence,etiology,clinical characteristics,maternal and neonatal outcomes of complete uterine rupture during pregnancy.Methods:The information of complete uterine rupture between June 2010 and May 2020 was investigated retrospectively at a tertiary center,and included demographic data,delivery characteristics,intraoperative findings,and maternal and neonatal outcomes.The prevalence rate of uterine rupture in the early group(hospitalized from June 2010 to May 2015)and late group(June 2015 to May 2020)was compared and analyzed.
文摘BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy.In this article,we report 4 cases of intra-abdominal hemorrhage during pregnancy,including the spontaneous rupture of uterine veins,spontaneous rupture of liver,rupture of external iliac vessel branch,and rupture of right renal hamartoma.CASE SUMMARY The clinical manifestations of three patients lacked specificity,and the localization of the bleeding was not clear prior to surgery.All 4 pregnant women were successfully treated,while only one full-term infant survived.CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic,and it is clinically characterized by acute abdominal pain during pregnancy.Clear diagnosis before surgery is rather difficult.Early diagnosis,timely and appropriate treatment and surgery,and multidisciplinary cooperation are key to saving pregnant females’lives and improving the outcomes of perinatal infants.
文摘BACKGROUND:Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract in adults.We treated surgically a man with acute abdomen caused by non-traumatic hemoperitoneum and diagnosed by low grade gastric GIST.METHODS:A 51-year-old Caucasian man came to the hospital for abdominal pain for 3 hours.He had no history of abdominal trauma.On admission,he was conscious and alert,and he had hypotension(80/50 mmHg) and moderate tachycardia.Abdominal ultrasonography showed the presence of free peritoneal fluid.Abdominal magnetic resonance imaging(MRI) showed diffuse intraabdominal hemorrhage and solid mass lesion at the greater curvature of the stomach.At an emergency laparotomy,a pedunculated,fragile mass of 5x6 cm originating from the posterior wall of the stomach was seen.The tumor was resected.Histopathologically a gastrointestinal stromal tumor was detected.RESULTS:The patient had an uneventful postoperative course and was discharged on the sixth postoperative day.Follow-up showed no recurrence of the tumor 8 months after surgery.CONCLUSION:Intraabdominal bleeding is a rare presentation of gastrointestinal stromal tumors.The diagnosis of the tumor should be based on whether sudden abdominal pain occurs in patients with an intraabdominal mass.
基金Supported by the Natural Science Foundation of Hubei Province,No.2019CFB798。
文摘BACKGROUND Spontaneous esophageal rupture or Boerhaave’s syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality.Here,we aimed to explore the clinical characteristics,diagnosis,treatment,and prognosis of spontaneous esophageal rupture,and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture.CASE SUMMARY The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature.The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours.Based on the computed tomography(CT)scan analysis,clinically,right pleural effusion was diagnosed.However,the patient was unwilling to undergo right closed thoracic drainage.The patient also had intermittent fevers against infection,and during the course of treatment,he complained of chest pain,following which,he was transferred to our hospital.Grapefruit-like residue drainage fluid was observed.Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus.Therefore,the patient underwent an urgent esophageal hiatus repair.Unfortunately,the patient died of infection and respiratory failure due to progressive dyspnea after surgery.CONCLUSION Spontaneous esophageal rupture is a rare disease associated with high fatality.The patients do not present typical clinical symptoms and the disease progresses rapidly.This case report highlights the importance of a dynamic review of chest CT scan,not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies.Moreover,we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites(upper-esophageal segment)through this case report of spontaneous esophageal rupture that caused the patient’s death.We have also summarized the reasons for the misdiagnosis and lessons learned.
文摘We present an extremely rare case of caudate lobe intrahepatic pancreatic pseudocyst with spontaneous rupture into the inferior vena cava(IVC).A 58-year-old male,a chronic alcoholic,presented with features of pancreatitis for which imaging was done.Ultrasound and contrast-enhanced computed tomography were carried out,which revealed intrahepatic pancreatic pseudocyst in the caudate lobe of the liver.There was suggestion of spontaneous rupture of the pseudocyst into the IVC,which was well delineated on imaging.
