ABSTRACT
Median arcuate ligament compression syndrome is an anatomical and clinical entity defined by a combination of extrinsic compression of the coeliac axis by the median arcuate ligament and clinical manifestations. The majority of patients with features of compression experience no symptoms. The most common clinical symptoms when present are epigastric pain, nausea, vomiting and weight loss. Hypertrophy of the median arcuate ligament is a rare cause of chronic abdominal pain. We present a case of an elderly male patient who presented with acute epigastric pain, and gastric and intrahepatic portal pneumatosis on CT imaging. Emphysematous gastritis, caustic ingestion and other causes of this imaging presentation were ruled out. Imaging also showed chronic compression of the coeliac axis with compensatory hypertrophy of the gastroduodenal artery. Gastric ischaemia is a rare presentation of this syndrome, which occurs owing to the failure of compensatory mechanisms and resultant ischaemic injury to a virtual watershed vascular territory of the gastric wall. Conservative management was performed, including volume restoration, intravenous proton pump inhibitor therapy, broad-spectrum antibiotic therapy and blood transfusion. No surgical or endovascular interventional procedures were carried out. The patient showed clinical improvement soon after the initiation of treatment. Disappearance of the imaging findings was documented 2 weeks after treatment. Complete endoscopic recovery and absence of clinical alterations were observed during follow-up after 3 months.
ABSTRACT
La osteoartropatía hipertrófica es una entidad caracterizada por la tríada de periostitis de huesos largos, acropaquias y artritis. Radiológicamente se distinguen 2 patrones; uno caracterizado por neoformación ósea que predomina en pacientes con patología pulmonar, y otro por acro-osteolisis que se asocia más frecuentemente con cardiopatías congénitas. Presentamos el caso de un varón de 30 años diagnosticado de hipertensión arterial pulmonar primaria desde los 2 años, que desarrolló una osteoartropatía hipertrófica con un patrón radiológico mixto (AU)
Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acro-osteolysis that is most frequently associated with congenital heart disease. We report the case of a 30-year-old man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed radiological pattern (AU)
Subject(s)
Humans , Male , Adult , Osteoarthropathy, Primary Hypertrophic/complications , Osteoarthropathy, Primary Hypertrophic/diagnosis , Acro-Osteolysis/complications , Acro-Osteolysis/diagnosis , Hypertension, Pulmonary/complications , Periostitis/complications , Hand , Foot , Osteoarthropathy, Primary Hypertrophic/physiopathology , Osteoarthropathy, Primary Hypertrophic , Osteolysis , Acro-Osteolysis , Periostitis/physiopathology , PeriostitisABSTRACT
Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acro-osteolysis that is most frequently associated with congenital heart disease. We report the case of a 30-year-old man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed radiological pattern.
Subject(s)
Hypertension, Pulmonary/complications , Osteoarthropathy, Secondary Hypertrophic/etiology , Adult , Autoantibodies/blood , Autoantigens/immunology , Calcium/therapeutic use , Citrulline/analysis , Diphosphonates/therapeutic use , Hand Bones/diagnostic imaging , Humans , Imidazoles/therapeutic use , Male , Osteoarthropathy, Secondary Hypertrophic/diagnostic imaging , Osteoarthropathy, Secondary Hypertrophic/drug therapy , Osteolysis/diagnostic imaging , Osteolysis/etiology , Peptides/chemistry , Peptides/immunology , Pregnenediones/therapeutic use , Radiography , Radius/diagnostic imaging , Vitamin D/therapeutic use , Wrist Joint/diagnostic imaging , Zoledronic AcidABSTRACT
Epiploic appendages are fat-filled, serosa-covered pediculated formations originating in the external wall of the bowel, toward the peritoneal cavity. Torsion of the epiploic appendages produces strangulation and infarction of the pedicle, initially venous and, when prolonged, ischemic, resulting in epiploic appendagitis. The main clinical manifestation is abdominal pain. Diagnosis is established through imaging techniques (ultrasound and computed tomography). Treatment is conservative and the prognosis is excellent.
Subject(s)
Appendicitis/diagnosis , Colonic Diseases , Torsion Abnormality , Abdominal Pain/etiology , Analgesics/therapeutic use , Anti-Bacterial Agents , Calcinosis/etiology , Colon/blood supply , Colon/diagnostic imaging , Colonic Diseases/complications , Colonic Diseases/diagnosis , Colonic Diseases/physiopathology , Colonic Diseases/therapy , Contraindications , Diagnosis, Differential , Hemoperitoneum/etiology , Humans , Infarction/etiology , Obesity/complications , Tomography, X-Ray Computed , Torsion Abnormality/complications , Torsion Abnormality/diagnosis , Torsion Abnormality/physiopathology , Torsion Abnormality/therapy , Weight LossABSTRACT
Los apéndices epiploicos son formaciones grasas, pediculadas, recubiertas de serosa que se encuentran en la superficie externa del colon, hacia la cavidad peritoneal. Cuando uno de estos apéndices se torsiona, se produce el estrangulamiento del pedículo y un infarto de éste, que al principio es venoso y, si se prolonga en el tiempo, se hace isquémico, lo que de lugar a la apendicitis epiploica. La manifestación clínica fundamental es el dolor. Su diagnóstico se realiza a través de las pruebas de imagen (ecografía, tomografía computarizada). El tratamiento es conservador y su pronóstico, excelente
Epiploic appendages are fat-filled, serosa-covered pediculated formations originating in the external wall of the bowel, toward the peritoneal cavity. Torsion of the epiploic appendages produces strangulation and infarction of the pedicle, initially venous and, when prolonged, ischemic, resulting in epiploic appendagitis. The main clinical manifestation is abdominal pain. Diagnosis is established through imaging techniques (ultrasound and computed tomography). Treatment is conservative and the prognosis is excellent
