Subject(s)
Amaurosis Fugax/etiology , Carotid Artery Diseases , Endarterectomy, Carotid/methods , Plaque, Atherosclerotic , Ultrasonography/methods , Aged , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/physiopathology , Carotid Artery Diseases/surgery , Carotid Artery, Internal/diagnostic imaging , Humans , Male , Plaque, Atherosclerotic/diagnostic imaging , Plaque, Atherosclerotic/pathologyABSTRACT
A 54-year-old woman presented with atypical chest pain, fever and malaise. She was immunosuppressed with three agents following a living-donor kidney transplant 1 year previously. Her native kidney failure was secondary to biopsy-demonstrated crescentic IgA nephropathy, with systemic involvement. A CT pulmonary angiogram revealed an inflammatory cuff of soft tissue around the descending thoracic aorta suggesting aortitis. Inflammatory markers were elevated. Given her immunosuppression, the patient was screened extensively for infective causes and was empirically commenced on intravenous meropenem. After 72 hours of no clinical or serological response to antibiotic therapy, negative microbiological investigations and worsening inflammation on serial imaging, she was commenced on high-dose methylprednisolone for presumed inflammatory aortitis. Symptoms and inflammatory markers rapidly normalisedand the patient was discharged home on oral prednisolone. A clinical diagnosis of IgA-related aortitis was made. Imaging 3 months later showed complete resolution of the aortitis.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Aortitis/diagnosis , Aortitis/drug therapy , Glomerulonephritis, IGA/complications , Methylprednisolone/administration & dosage , Angiography , Anti-Bacterial Agents/therapeutic use , Aorta, Thoracic/diagnostic imaging , Aortitis/etiology , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Meropenem , Middle Aged , Thienamycins/therapeutic use , Transplant RecipientsABSTRACT
We report the case of a 45-year-old woman who presented with a lump in the mid-third of the left clavicle, which had recently increased in size to 10 cm in diameter. Plain X-ray, computed tomography and bone scans suggested that the lump was a parosteal osteosarcoma. Due to the expected 30% functional loss from claviculectomy [Wood in The results of total claviculectomy. Clin Orthop Relat Res 1986; 207: :186-90.], the patient opted for excision of the tumour plus the adjacent clavicle, irradiation and reimplantation of the bone with internal fixation. On 2-year follow-up, there was no evidence of recurrence or complications, with a good range of movement of the joint. On 4-year follow-up, the patient was found to have discomfort, and X-rays showed that the clavicle had fractured, which was managed symptomatically.
