Diagnóstico posnatal de hematoma de cordón umbilical: reporte de un caso / Postnatal diagnosis of umbilical cord hematoma: case report

ANTECEDENTES: El hematoma espontáneo del cordón umbilical es una complicación rara del embarazo que representa una causa grave de morbilidad y mortalidad fetal. Se han descrito numerosos factores de riesgo, pero aún se desconoce su etiología exacta. CASO CLÍNICO: Mujer de 28 años, en su octava gestación, que consultó en urgencias por disminución de los movimientos fetales de varias horas de evolución tras una caída accidental traumática. La monitorización fetal mostró un patrón cardiotocográfico no tranquilizador, con disminución de la variabilidad y sin aceleraciones. Se realizó una cesárea urgente, sin complicaciones, con el nacimiento de un varón vivo de 4560 g, con Apgar 8/10/10 y pH de sangre de cordón umbilical 7.08, que precisó ingreso en la unidad de neonatología por hallazgo de un soplo cardíaco. Tras el alumbramiento se objetivó una gran colección hemática en el cordón umbilical. MÉTODO: Se aplicó una estrategia de búsqueda sistemática en Medline, PubMed y Cochrane de todos los artículos en inglés y español que tuvieran como palabras clave "Umbilical", "Cordón" y "Hematoma". RESULTADOS: Se encontraron 13 publicaciones de 15 casos de hematoma del cordón umbilical en los años 2008-2020. Se realizó una revisión sistemática de los informes de casos descritos en los últimos 12 años en la literatura para evaluar la epidemiología, los factores predisponentes, los resultados potenciales, el diagnóstico prenatal y el manejo clínico. CONCLUSIONES: Debido a la rareza de esta afección, se deben informar todos los casos nuevos de hematoma del cordón umbilical para mejorar el conocimiento de los factores predisponentes, el diagnóstico prenatal y el manejo clínico.

BACKGROUND: Spontaneous umbilical cord hematoma is a rare complication of pregnancy which represents a serious cause of fetal morbidity and mortality. There are many risk factors, but the exact etiology is still unknown. CASE REPORT: 28-year-old woman, eighth gestation, who consulted due to decreased fetal movements of several hours of evolution after traumatic accidental fall. Fetal monitoring showed a non-reassuring cardiotocographic pattern, with decreased fetal variability, without accelerations. An emergency cesarean section was performed without complications, with the birth of a living male weighing 4560 grams, with an 8/10/10 Apgar test, and an arterial pH of the umbilical cord 7.08, which required admission to the neonatology unit. After delivery, a large blood collection was observed in the umbilical cord. METHOD: A systematic search strategy was applied to several electronic bibliographic databases: Medline, PubMed and Cochrane. Key words used were "Umbilical", "Cord", "Hematoma". RESULTS: 13 publications of 15 cases of umbilical cord hematoma were reported in the years 2008-2020. A systematic review of the reports of cases, described in the last twelve years in the literature was carried out to evaluate the epidemiology, predisposing factors, potential results, prenatal diagnosis and clinical management of this phenomenon. CONCLUSIONS: Due to the rarity of this condition, every new case of umbilical cord hematoma should be reported in order to improve the knowledge of predisposing factors, prenatal diagnosis, and clinical management.

Hematoma de tabique: informe de dos casos pediátricos / Septal hematoma: Report of two pediatric cases

Los hematomas y abscesos septales constituyen una urgencia en rinología y requieren tratamiento quirúrgico temprano debido al riesgo de complicaciones infecciosas, funcionales y estéticas. Suelen aparecer como consecuencia de un traumatismo nasal, aunque también se han descrito en relación con otros desencadenantes. La acumulación de sangre o pus entre el mucopericondrio y el cartílago septal causa lesión por necrosis avascular en el cartílago y la destrucción de este.Desde el punto de vista clínico, se presenta como insuficiencia ventilatoria nasal y dolor facial. Con menor frecuencia, el motivo de consulta es deformidad del dorso nasal, epistaxis, rinorrea purulenta y fiebre.Se presentan en este trabajo dos casos clínicos con diagnóstico de hematoma septal que requirieron cirugía.

Hematomas and septal abscesses are an emergency in rhinology and require early surgical treatment due to the risk of infectious, functional, and aesthetic complications. They generally occur as a consequence of nasal trauma, although they have also been described in relation to other triggers. Accumulation of blood or pus between the mucoperichondrium and septal cartilage, causes avascular necrosis injury to the cartilage with cartilage destruction.Clinically it presents as nasal ventilatory insufficiency and facial pain. In a lower percentage, the reason for consultation was nasal dorsal deformity, epistaxis, purulent rhinorrhea and fever.We present two clinical cases with septal hematoma. Both required surgery.

Hematoma duodenal posvideoendoscopia digestiva alta para diagnóstico de enfermedad de injerto contra huésped en pediatría: a propósito de dos casos / Duodenal hematoma after upper gastrointestinal endoscopy in pediatric graft vs host disease: Report of two cases

La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.

Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.

Hematoma subcapsular hepático y hemofilia neonatal / Hepatic subcapsular hematoma and neonatal hemophilia

INTRODUCCIÓN: el hematoma subcapsular hepático sangrante se presenta cada vez menos en el recién nacido, debido al mejoramiento de la atención prenatal y al seguimiento esmerado del trabajo de parto. La hemofilia es una enfermedad hemorrágica hereditaria ligada al cromosoma X, en la cual se produce una alteración en los genes que codifican para los factores de la coagulación, factor VIII (hemofilia A) o del factor IX (hemofilia B), que trae como consecuencia una proteína alterada cuantitativa, cualitativa o ambas. Se manifiesta raramente en la etapa neonatal, y cuando ocurre, se presenta como formas clínicas graves. El diagnóstico de la hemofilia se realiza por antecedentes familiares y manifestaciones clínicas, confirmándose con la dosificación de factores, situación clave que ofrece una ventana de oportunidad para que el médico de primer nivel de atención establezca un diagnóstico oportuno y eficiente. PRESENTACIÓN DEL CASO: se presenta cuadro clínico y ultrasonográfico, de neonato con 6 días de vida, al que se le consulta por palidez extrema y síndrome peritoneal, con antecedentes familiares de hemofilia sin diagnóstico prenatal. CONCLUSIONES: el diagnóstico precoz del hematoma subcapsular hepático sangrante, como complicación de la hemofilia, permite iniciar tratamiento médico apropiado para las dos entidades, lo cual genera un impacto positivo en la salud del paciente y la familia, y reduce los riesgos de mortalidad.

INTRODUCTION: bleeding hepatic subcapsular hematome is increasingly less frequent in the newborn as a result of better prenatal care and the careful follow-up of the labor. Hemophilia is an X chromosome-linked hereditary hemorrhagic disease in which there are altered gens that code for the coagulation factors, factor VIII (hemophilia A) or factor IX (hemophilia B), resulting in a quantitative, a qualitative protein or both. It is rarely seen at the neonatal phase and when it appears, it takes the severe clinical forms. The diagnosis of hemophilia is based on the family history and the clinical manifestations and is confirmed with factor dosing; a key situation that offers the opportunity for the primary level physician to set a timely efficient diagnosis. CASE PRESENTATION: clinical and ultrasonographic picture of a six days old neonate with signs of extreme pallor and peritoneal syndrome and family history of hemophilia with no prenatal diagnosis. CONCLUSIONS: the early diagnosis of the bleeding hepatic subcapsular hematoma, as a complication of hemophilia, allows starting the adequate medical treatment for the two problems, thus generating a positive impact on the patient´s and the family´s health and reducing the mortality risks.

Clinical Outcomes of Cryopreserved Arterial Allograft Used as a Vascular Conduit for Hemodialysis

This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.

Clinical Outcomes of Cryopreserved Arterial Allograft Used as a Vascular Conduit for Hemodialysis

This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.

Déficit adquirido de factor X en leucemia mielomonocítica crónica: reporte de un caso / Isolated factor X deficiency in chronic myelomonocytic leukemia: Report of one case

Bleeding disorders are commonly associated with hemato-oncologic diseases. We report a 68 years old male with a chronic myelomonocytic leukemia derived from a long lasting mielodysplastic syndrome that did not respond to treatment with Azacitidine. The patient was hospitalized due to tonic clonic seizures. A CAT scan showed a hematoma in the frontal lobe. A new assessment of hemostasis revealed an isolated deficiency of Factor X. We speculate that this deficit could be secondary to consumption due to the chronic Myelomonocytic Leukemia.

First report of hepatic hematoma after presumed Bothrops envenomation

ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

A Case of Spontaneous Bleeding of Multiple Lumbar Arteries in a Patient with Liver Cirrhosis / 대한소화기학회지

Esophageal and gastric varix, portal hypertensive gastropathy, Mallory-Weiss tear and gastric ulcer are common causes of bleeding in patients with liver cirrhosis. However, spontaneous arterial bleeding without a history of trauma is a rare cause of bleeding which can be fatal. We report a case of a 55-year-old woman with alcoholic liver cirrhosis who developed spontaneous bleeding of multiple right lumbar arteries and died in spite of repetitive transfusion and embolization.

Rectus sheath hematoma – An uncommon complication following caesarean delivery.

Rectus sheath hematoma is a well documented clinical entity, though uncommon and often clinically misdiagnosed cause of acute abdomen. The non-specific nature of presentation combined with a lower incidence of the disorder leads to difficulty in diagnosing. Our patient presented with rectus sheath hematoma, following caesarean section on 9th post-operative day. She presented with wound discharge and lower abdominal pain. The case report is presented to increase the awareness in considering this entity in the differential diagnosis and management of acute lower abdominal pain. Rectus sheath hematoma’s early diagnosis and appropriate treatment may help to prevent complications.

Síndrome aórtico agudo: Revisión de la literatura y actualización del tema / Acute aortic syndrome

Acute aortic syndrome (AAS) is a term that describes interrelated aortic emergencies with similar clinical characteristics and challenges. These are aortic dissection (AD), intramural hematoma (IH), and penetrating atherosclerotic ulcer (PAU). The incidence of AAS is three cases per 100.000 persons per year. Diverse genetic disorders and acquired conditions have been related to the pathogenesis of this disease. Clinical features of patients with any of the three conditions comprising AAS are very similar. A high degree of clinical suspicion and imaging studies are necessary for an accurate diagnosis. Prognosis is clearly related to underlying diagnosis and appropriate surgical repair, in the case of proximal involvement of the aorta. Involvement of distal segments of the aorta may require medical or endovascular therapy according to the presence of complications. After hospital discharge, patients require lifelong follow-up.

Laparoscopic excision of a renal subcapsular abscess presenting as a subcapsular haematoma / Extirpación laparoscópica de un absceso renal subcapsular que se presenta como un hematoma subcapsular

Renal subcapsular abscess is a very rare entity that is defined by a suppurative process localized to a space between the renal capsule and the renal parenchyma. The pathogenesis and aetiology of this entity remain speculative. To our knowledge, only five cases have been reported in the English literature. We describe a 74-year old woman with renal subcapsular abscess treated with laparoscopic removal and do a review of the literature.

El absceso renal subcapsular es una entidad muy rara que se define por un proceso supurativo localizado en un espacio entre la cápsula renal y el parénquima renal. La patogénesis y la etiología de esta entidad siguen siendo asunto de especulación. Hasta donde sabemos, solamente cinco casos han sido reportados en la literatura inglesa. Describimos aquí a una mujer de 74 años de edad con un absceso renal subcapsular tratado con extirpación laparoscópica y hacemos a la par una revisión de la litera-tura

Aortic intramural hematoma after thrombolysis in a patient with acute massive pulmonary embolism

No abstract available.

A case of ruptured renal cortical arteriovenous malformation of the right testicular vein in hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage, and renal failure. Among the various hemorrhagic complications of HFRS, the spontaneous rupture of an arteriovenous malformation of the testicular vessels with a retroperitoneal hematoma is a rare finding. Here, we report a case of HFRS complicated by a massive retroperitoneal hematoma that was treated with transcatheter arterial embolization.

Hematoma hepático subcapsular en el puerperio / Subcapsular hepatic hematoma during postpartum period

El hematoma hepático subcapsular es una complicación infrecuente y grave durante la gestación o el período puerperal. Esta patología generalmente se relaciona con preeclampsia o síndrome de HELLP. Su diagnóstico debe confirmarse por tomografía axial computarizada. La precocidad del diagnóstico y tratamiento es importante para evitar la ruptura del hematoma.

Subcapsular hepatic hematoma is a rare and severe complication during pregnancy or postpartum period. This condition is usually related to preeclampsia or HELLP syndrome. Its diagnosis must be confirmed by abdominal computed tomography. An early diagnosis and treatment are important to avoid hematoma rupture.

Hematoma intramural esofágico / Esophageal intramural hematoma

The most common presentation of esophageal hematoma is pain, dysphagia and hematemesis. We report two patients with the condition. A 77 years old female presenting with retrosternal pain and odynophagia after ingesting a pig bone. An upper gastrointestinal endoscopy showed a lineal hematoma, protruding to the lumen in the upper portion of the esophagus. The patient was managed with nil per os (NPO) and parenteral hydration and discharged 72 hours later. An 87 years old male presenting with two episodes of hematemesis and weight loss, an upper gastrointestinal endoscopy showed a dissecting hematoma involving the entire esophageal wall. The patient was managed with NPO and hydration and discharged in good conditions 11 days after admission.

El hematoma intramural esofágico es infrecuente, existiendo pocos casos registrados en la literatura. Generalmente se presenta posterior a un trauma, por ejemplo asociado a procedimientos endoscópicos (escleroterapia), o en forma espontánea. La presentación clínica más frecuente es la tríada de dolor torácico, odinofagia/disfagia y/o hematemesis. Generalmente el tratamiento consiste en un manejo expectante con medidas de soporte habitual. Se exponen 2 casos clínicos presentados en nuestro centro durante el año 2009 y se realiza una revisión de la literatura.

Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.

The First Case of Postpartum Acquired Hemophilia A in Korea

Acquired hemophilia A (AHA) is a rare coagulopathy caused by autoantibodies to coagulation factor VIII (FVIII). Most patients with AHA have been previously healthy; however, a variety of morbidities have been associated with the condition including pregnancy. A 40-yr-old woman visited our institution with extensive hematoma on the right hip area. Her medical history revealed no personal or familial history of bleeding diathesis. Her coagulation tests showed markedly prolonged aPTT (117 sec), markedly decreased level of FVIII activity (0.4%) and high-titer FVIII inhibitor (77 BU). Collectively, she was diagnosed as having postpartum AHA and was treated with bypassing agents and corticosteroids. Her aPTT was normalized on the 174th postpartum day and FVIII inhibitor showed negative conversion on the 224th postpartum day. This is the first case of postpartum AHA with high-titer FVIII inhibitor in Korea. Timely diagnosis and management can reduce morbidity and mortality of this potentially life-threatening condition.