ABSTRACT
Spontaneous renal pelvic haematomas are rare, often mimicking symptoms of other pathologies such as a renal tumour or renal calculi. Spontaneous renal haematoma was first reported by Bonet in 1679 and later described by Wunderlich in 1856. We present the case of a young female patient with no known comorbidities who presented with spontaneous renal pelvis haematoma. Misinterpretation of this finding can lead to erroneous diagnoses.
ABSTRACT
Objectives: SSc-pulmonary arterial hypertension (SSc-PAH) is associated with worse response to therapy and survival when compared with idiopathic PAH. It is suggested that the vasculopathy in SSc may involve postcapillary pulmonary venules resulting in pulmonary veno-occlusive disease (PVOD). This may underlie the lower gas transfer and worse outcome on therapy. We sought to test whether CT signs of PVOD (CTS-PVOD) were frequent in SSc-PAH and whether they were associated with pulmonary oedema on therapy and worse survival. Methods: CT thorax of 66 SSc patients with precapillary pulmonary hypertension (PH) were blindly scored by two radiologists for CTS-PVOD (⩽1 or ⩾ 2). Case note and radiograph review determined the presence of pulmonary oedema on therapy. Results: Fifty-nine patients (89%) had ⩽1 CTS-PVOD and only 7 (11%) had ⩾2 CTS-PVOD. Pulmonary oedema on therapy was relatively common in those with ⩾2 CTS-PVOD. On univariate analysis ⩾2 CTS-PVOD were associated with a trend towards worse survival. Conclusion: CTS-PVOD were less frequent in this SSc-PAH cohort than in previous reports but the presence of at least two of these signs is associated with pulmonary oedema on therapy and a trend towards worse survival on univariate analysis.
Subject(s)
Hypertension, Pulmonary/diagnostic imaging , Pulmonary Veno-Occlusive Disease/diagnostic imaging , Scleroderma, Systemic/complications , Tomography, X-Ray Computed/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Humans , Hypertension, Pulmonary/complications , Lung/diagnostic imaging , Male , Middle Aged , Prognosis , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/etiology , Pulmonary Veno-Occlusive Disease/etiology , Tomography, X-Ray Computed/methodsABSTRACT
We present a unique case of intercostal muscle flap (ICMF) ossification mimicking an intrathoracic rib diagnosed 3 years after oesophageal perforation repair. A 58-year-old male presented with complaints of mild chest discomfort. Three years ago he had undergone left thoracotomy and primary repair of post-emetic oesophageal perforation. An ICMF had been used to strengthen the repair. Chest X-ray identified a linear calcific density within the left hemithorax. Subsequent thoracic CT characterized the anomaly as ossification of the ICMF. The lesion had the appearance of a well-differentiated intrathoracic rib coursing through the left lower lobe. We discuss the typical appearances of ossified ICMFs and the potential complications resulting from this ossification.
