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Retroperitoneal Hemorrhage from Adrenocortical Carcinoma as a Poor Prognostic Factor  [cached]
Anna A. Kasperlik-Zaluska,Wojciech Zgliczynski,Rafal Z. Slapa,Andrzej Cichocki
International Journal of Biomedical Science , 2008,
Abstract: In most patients, adrenocortical carcinoma is diagnosed at an advanced stage of the disease. A sudden retroperitoneal hemorrhage may sometimes be the first symptom of the adrenal cancer. We describe four patients with adrenocortical carcinoma diagnosed during a retroperitoneal hemorrhage. A clinical analysis suggests that such a complication is a poor prognostic factor.
An unusual complication of polyarteritis nodosa with massive retroperitoneal hemorrhage: a case report
Prashanth Peddi, Jagadeesh K Kalavakunta, Madhavi Annakula, John R Armstrong
International Archives of Medicine , 2010, DOI: 10.1186/1755-7682-3-31
Abstract: Prognosis of untreated PAN is very poor with 20% 5 year survival rate, therefore early recognition of the disease will prevent catastrophic complications and improves survival.A 78-year-old woman presented with fever, anorexia and significant (34 pound) weight loss of three months duration. Three weeks prior to the presentation, she noticed pain and bluish discoloration of her finger tips, which later turned to black with worsening pain. Her past history was significant for hypertension and 35 pack years of smoking. She was febrile with temperature of 100.4°F and other vital signs were stable.Physical examination demonstrated blackish discoloration of her finger tips involving right index, right and left middle finger [Figure 1]. She also had black lesion on her hard palate [Figure 2]. All peripheral pulses were felt symmetrically. Rest of the examination was unremarkable. Her white cell count was elevated at 13,000/mm3 and erythrocyte sedimentation rate was also elevated at 66 mm/hour. Three sets of blood cultures were drawn and empirical antibiotic therapy was begun with piperacillin tazobactum and vancomycin for possible septic embolism.Workup for endocarditis with transesophageal echocardiogram showed no vegetations. Serologic evaluation for vasculitis with Anti nuclear antibody (ANA), C and P-Anti neutrophil cytoplasmic antibody (ANCA), Anticardiolipin antibody, Rheumatoid factor, and Hepatitis panel did not reveal any abnormality. All three sets of blood cultures showed no growth.On 3rd day of hospitalization, she developed severe pain and distension of the left side of the abdomen; in association with hypotension and tachycardia. Emergent computer tomography (CT) scan of abdomen showed large retroperitoneal hemorrhage. Further evaluation with mesenteric angiogram revealed multiple visceral artery aneurysms and bleeding from inferior pancreatic duodenal artery aneurysm that was successfully embolized [Figure 3]. She received three units packed red blood cells
Spontaneous Retroperitoneal Hemorrhage in a Patient with Prolymphocytic Transformation of Chronic Lymphocytic Leukemia  [PDF]
Gwynivere A. Davies,Alejandro Lazo-Langner,Michael Shkrum,Leonard Minuk
Case Reports in Hematology , 2013, DOI: 10.1155/2013/802376
Abstract: Prolymphocytic transformation of chronic lymphocytic leukemia is a rare but recognized entity. We present the case of a 76-year-old gentleman with a previous diagnosis of chronic lymphocytic leukemia who presented with fatigue, fever, and a white blood cell count of 500?000 with prolymphocytes on peripheral blood examination. Chlorambucil and dexamethasone were initiated. He developed progressive anemia during his admission with no clear cause on initial CT examination. Bilateral hip pain began several days later and he was unfortunately diagnosed with a large spontaneous retroperitoneal hemorrhage postmortem. This condition is rare and generally occurs in those receiving therapeutic anticoagulation or dialysis, with known bleeding disorders or vascular malformation, none of which were present in our patient. Pathology revealed marked leukemoid engorgement of the vessels of many organs with prolymphocytes. We discuss the potential etiologies and relationships between these critical diagnoses. 1. Introduction Chronic lymphocytic leukemia (CLL) is a hematologic disorder characterized by overproduction of circulating B cells [1]. These lymphocytes are small, mature cells that are clonal in nature, and express a characteristic flow cytometric pattern. CLL is generally a slowly progressive disease that is monitored without therapy until symptoms develop; however Richter’s transformation to aggressive histology lymphoma can occur. More rarely, transformation to Hodgkin’s disease, lymphoblastic lymphoma, small noncleaved cell lymphoma, hairy cell leukemia, T-cell leukemia, and prolymphocytic leukemia (PLL) has been reported [2]. 2. Case Presentation We describe the case of a 76-year-old gentleman diagnosed with Rai stage 0 CLL 10 months prior who presented with fatigue and fever. Past medical history included nephrolithiasis, repaired right hydrocele, hypertension, osteoarthritis, remote gastric ulcer, and prostate adenocarcinoma for which he received 35 fractions of external beam radiation in early 2011. In addition, the patient worked as a farmer and had frequent exposure to various pesticides and herbicides. During urologic followup in September 2011 he was found to have a mild thrombocytopenia and asymptomatic lymphocytosis of /L. Flow cytometry demonstrated 91% lymphocytes with a monoclonal B-cell population composing 85% of total leukocytes that were CD19/CD5, CD20, CD23, and FMC7 positive expressing dim kappa light chains; CD38 was positive on 90% of CD19/CD5+ cells. FISH showed a typical CLL deletion at 13q14.3 only. During subsequent visits,
Use of the novel hemostatic textile Stasilon? to arrest refractory retroperitoneal hemorrhage: a case report
Preston B Rich, Christelle Douillet, Valorie Buchholz, David W Overby, Samuel W Jones, Bruce A Cairns
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-20
Abstract: A 39-year-old Caucasian man presented with severe necrotic pancreatitis that failed multiple aggressive attempts to control associated bleeding with electrocautery, suture ligation, and sequential anatomic packing with cotton-based sponges. Subsequent retroperitoneal packing with Stasilon? produced a non-adherent wound-dressing interface and resulted in the achievement of persistent hemostasis in the operative field.In our patient, Stasilon? was demonstrated to be effective in the arrest of refractory hemorrhage.Uncontrolled hemorrhage is a major contributor to both trauma-associated and intra-operative morbidity and mortality [1,2]. Achieving hemostasis is crucial in avoiding distributive shock and interrupting the progressive physiologic compromise that is often marked by dilutional coagulopathy, metabolic acidemia, and the sequelae of microcirculatory malperfusion [3,4]. Cotton-fiber-based dressings have traditionally been used liberally in wound management, but the minimally thrombogenic nature of their blood-matrix interface, the inherently adhesive nature of their surfaces to the wound bed, and their highly absorptive qualities make them less than ideal dressings. Modern textile sciences have enabled the development of novel hemostatic materials that have been specifically engineered to incorporate many of the most desirable qualities of the ideal dressing [5,6]. Stasilon? is a novel hemostatic woven textile composed of allergen-free fibers of continuous filament fiberglass and bamboo yarn. The goal of this report is to document our experience with the use of Stasilon? in a case of persistent retroperitoneal hemorrhage that could not be controlled by traditional means of securing hemostasis.A 39-year-old Caucasian man presented to our emergency department with a 1-day history of nausea, vomiting, and severe peri-umbilical pain that radiated to the mid-scapular region of his back. The patient had a history of muscular dystrophy, hypertension, and transient rena
Symptomatic hemorrhage after alteplase therapy not due to silent ischemia
Michael D Hill, Philip A Barber, Andrew M Demchuk, Robert J Sevick, Richard Frayne, Alastair M Buchan
BMC Neurology , 2001, DOI: 10.1186/1471-2377-1-1
Abstract: A patient suffered a disabling stroke affecting the right cerebral hemisphere. He was treated with intravenous alteplase and underwent extensive early imaging with multimodal MRI. Several hours after treatment he developed a brainstem hemorrhage despite having no evidence of ischemia on DWI MRI in the brainstem.Not all occurrences of remote ICH after stroke thrombolysis are secondary to multiple emboli with silent ischemia.A 66-year-old right-handed man awoke from sleep feeling well. At 06:55, while having breakfast, he developed sudden onset of painless weakness of his left arm associated with left facial droop and a subtle change in sensation over the left face and arm. He went directly to his local Emergency room where a diagnosis of stroke was made. He was transferred immediately to our centre for consideration of thrombolytic therapy, arriving at 08:28 (1 h 33 min from onset). He had a past history of a minor stroke with full recovery 3 years previously and longstanding hypertension. He was taking no medication having elected to discontinue his anti-hypertensive therapy two years earlier.On examination, he was alert with no hemi-neglect or aphasia. He had a left facial droop and slight dysarthria. He was proximally weak but able to hold his left arm up against gravity, but had completely absent left distal hand function. He had reduced left leg power but was able to walk unsteadily. There was a reduction in pinprick sensation over the left arm and face. He was in normal sinus rhythm with a blood pressure of 200/115. A brain CT scan was performed, which demonstrated a small old right anterior parietal infarct which was interpreted as consistent with his previous minor stroke. There were no other acute changes. His National Institutes of Health Stroke Scale Score was 3.Based on his clinical syndrome of severe distal weakness, it was postulated that his stroke involved the primary motor cortex or underlying fibres. After careful discussion with the patient includi
Hemorrhagic Transformation (HT) and Symptomatic Intracerebral Hemorrhage (sICH) Risk Prediction Models for Postthrombolytic Hemorrhage in the Stroke Belt  [PDF]
James E. Siegler,Muhammad Alvi,Amelia K. Boehme,Michael J. Lyerly,Karen C. Albright,Reza Bavarsad Shahripour,Pawan V. Rawal,Niren Kapoor,April Sisson,J. Thomas Houston,Anne W. Alexandrov,Sheryl Martin-Schild,Andrei V. Alexandrov
ISRN Stroke , 2013, DOI: 10.1155/2013/681673
Abstract: Background. Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states. Methods and Results. We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008–2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07–34.1, ) when patients were dichotomized by score. Conclusions. In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region. 1. Background Despite multiple acute stroke treatment trials, thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) remains the only FDA-approved acute treatment for ischemic stroke with proven long-term benefit [4, 5]. This treatment, while highly effective when administered in the appropriate setting, is not without risk. As many as 6% of patients treated with IV tPA for ischemic stroke were found to clinically deteriorate in the earliest randomized trial [5]; however current rates of symptomatic intracranial hemorrhage (sICH) are lower [6] and hemorrhagic transformation (HT) rates are around 9% [7]. These differences may be explained by differences in criteria used to define sICH [8]. Due to provider concern for sICH, early efforts at minimizing these adverse events focused on identifying sICH risk factors. Elevated serum glucose [9–11] or ferritin [12] on admission, history of diabetes mellitus [13], older age [10], greater baseline stroke severity [10, 14–16], and current tobacco use [14, 17] have all been identified as potential risk factors for sICH. In an effort to more accurately predict which patients are at the greatest risk of postthrombolytic hemorrhagic transformation (HT) [1, 18, 19] and/or sICH [2, 18–20],
Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report
Stavros I Daliakopoulos, Andreas Bairaktaris, Dimitrios Papadimitriou, Perikles Pappas
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-162
Abstract: We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4), which was treated conservatively.Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.Hemorrhage is the most important complication of unfractionated heparin in patients with atrial fibrillation (AF) treated with oral vitamin K antagonist (VKA) during hospitalization or among those receiving anticoagulants in terms of emergency or elective cardiac surgery [1,2] or in the initial treatment of deep venous thrombosis [3,4].Analysis of the data presented by the European AF Trial Study Group [5] shows that as the international normalized ratio (INR) increased, there was an increase in the risk of major bleeding, such that at INR ≥ 5.0, the risk of bleeding increased 3.6-fold relative to INR ≤ 2. The optimal intensity of anticoagulation that achieved maximum therapeutic effect with minimum risk was determined to be at INR = 3.0. These data, along with recommendations from the recent American College of Chest Physicians (ACCP) guidelines, indicate that the optimal intensity of anticoagulation for balancing efficacy in presenting stoke, while minimizing the risk of bleeding, is within the range INR = 2.0–3.0 (see [6]). Among outpatients receiving oral anticoagulants those with INR ≥ 6.0 face a significant risk of major hemorrhage [7].Retroperitoneal hemorrhage is most frequently seen after femoral artery catheterization or pelvic and lumbar trauma [8-10]. In the absenc
Traumatic rupture of adrenal pseudocyst leading to massive hemorrhage in retroperitoneum
Favorito, Luciano A.;Lott, Felipe M.;Cavalcante, André G.;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000100008
Abstract: we present the case of a patient who had a large pseudocyst in the right adrenal gland, which was ruptured following blunt abdominal trauma, leading to a voluminous hemorrhage in retroperitoneum. a 29-year old female patient was admitted in the emergency room following a fall from stairs with trauma in right flank. she underwent a computerized tomography that evidenced a large retroperitoneal collection, with no apparent renal damage. she was submitted to surgery, where a large ruptured cyst was observed, originating from the upper portion of the right adrenal gland. cystic diseases of adrenal gland are rare. highly voluminous cysts can be damaged in cases of blunt trauma to the lumbar region leading to large hematomas in retroperitoneum.
Traumatic rupture of adrenal pseudocyst leading to massive hemorrhage in retroperitoneum  [cached]
Favorito Luciano A.,Lott Felipe M.,Cavalcante André G.
International braz j urol , 2004,
Abstract: We present the case of a patient who had a large pseudocyst in the right adrenal gland, which was ruptured following blunt abdominal trauma, leading to a voluminous hemorrhage in retroperitoneum. A 29-year old female patient was admitted in the emergency room following a fall from stairs with trauma in right flank. She underwent a computerized tomography that evidenced a large retroperitoneal collection, with no apparent renal damage. She was submitted to surgery, where a large ruptured cyst was observed, originating from the upper portion of the right adrenal gland. Cystic diseases of adrenal gland are rare. Highly voluminous cysts can be damaged in cases of blunt trauma to the lumbar region leading to large hematomas in retroperitoneum.
Fibrosis retroperitoneal
Claudio Orlich-Castelán,Jaime Gutiérrez-Góngora
Acta Médica Costarricense , 2005,
Abstract: Se reporta el caso de una mujer de 61 a os de edad, con antecedente de tuberculosis pélvica en la adolescencia, que se presentó con insuficiencia renal aguda y dolor lumbar y a quien se le diagnosticó fibrosis retroperitoneal. Se revisa la bibliografía reciente y los principales aspectos de esta enfermedad Retroperitoneal fibrosis. is an uncommon disease complicated by ureteral entrapment causing hydronephrosis and obstructive renal failure. We herein report a case recently diagnosed at our institution and review the literature on this topic
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