ABSTRACT
We report the case of a 29-year-old patient who presented in the emergency room with severe abdominal pain. After initially inconspicuous medical history and laboratory evaluation, repeated focused history taking led to the correct diagnosis: a paintball projectile had left its mark. The patient had suffered a third-degree rupture of the spleen with delayed manifestation two weeks after the trauma. He could be successfully managed with an organ-preserving non-operative approach.
Subject(s)
Abdominal Injuries/complications , Splenic Rupture/etiology , Wounds, Nonpenetrating/complications , Abdominal Injuries/diagnosis , Abdominal Injuries/therapy , Abdominal Pain/etiology , Adult , Diagnosis, Differential , Hematoma/diagnosis , Hematoma/etiology , Hematoma/therapy , Humans , Magnetic Resonance Imaging , Male , Splenic Rupture/diagnosis , Splenic Rupture/therapy , Tomography, X-Ray Computed , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapyABSTRACT
BACKGROUND AND PURPOSE: The intima-media thickness (IMT) of the common carotid artery (CCA) is well correlated with the degree of arteriosclerosis and is a predictor of cardiovascular morbidity and mortality. The (hemodynamic) resistive index (RI) of the internal carotid artery (ICA) correlates with the degree of arteriosclerosis just as well as IMT. The aim of the study was to compare the predictive values of RI and IMT with regard to cardiovascular morbidity and mortality. METHODS: A total of 146 patients with cardiovascular risk factors or established arteriosclerosis were included. Duplex sonography of the CCA and ICA was performed, and the IMT and RI were measured in both vessels. During follow-up for a median of 36 months, the occurrence of cardiovascular events (myocardial infarction, stroke, or cardiovascular death) was assessed. RESULTS: Thirty-nine cardiovascular events occurred in 28 patients (19.2%). The relative risk for a cardiovascular event per increase of the IMT by 1 SD (0.16 mm) was 1.53 (95% CI, 1.07 to 2.18) and 1.91 (95% CI, 1.34 to 2.73) for RI ICA (0.08). The event rate in patients with IMT <0.79 mm (mean) and RI ICA <0.66 (mean) was 11.8% and 12.7% compared with 25.6% (P=0.03) and 25.0% (P=0.06) in patients with IMT > or =0.79 mm and RI ICA > or =0.66, respectively. Log rank analysis showed a continuous increase in the risk of cardiovascular event with increasing range of the IMT (P=0.029) and RI ICA (P<0.001). CONCLUSIONS: The RI ICA is a predictor of cardiovascular mortality and morbidity, at least comparable to the well-established IMT.
