ABSTRACT
Abdominal compartment syndrome is a rare emergency condition characterized by the development of organ dysfunction due to increased intra-abdominal pressure. Gynecologic conditions are an uncommon etiology of abdominal compartment syndrome. We report a case of a 35-year-old woman who presented with severe abdominal pain and vomiting. The patient had a history of long-standing gastroesophageal reflux disease. On physical examination, the abdomen was distended and tense, suggestive of acute abdomen. Computed tomography revealed a large abdominopelvic cystic lesion, arising from the ovary, causing a significant pressure effect on the abdominal viscera. The patient's condition deteriorated and had an altered level of consciousness with hemodynamic instability. She was intubated and received inotropic support. Subsequently, a life-saving emergency surgical decompression was performed. The ovarian cyst was evacuated and yielded 10 liters of fluid. Histopathological examination confirmed the diagnosis of ovarian cystadenoma. The patient remained in the intensive care unit postoperatively and was discharged in a good condition after 14 days of hospitalization. The case emphasizes the importance of considering abdominal compartment syndrome in patients with a clinical picture of acute abdomen. Failure to recognize this condition can lead to multiorgan failure and death.
ABSTRACT
Introduction Thyroid nodules are very common. However, the majority of thyroid nodules are benign. Ultrasound is the first-line imaging investigation of choice for thyroid nodules. Certain sonographic features are associated with an increased risk of malignancy. Recent studies suggested that the location of the nodule may be associated with the malignancy risk. Hence, this study aims to investigate this association. Methods After obtaining approval from the ethics committee, we conducted a retrospective study that involved all patients who attended our hospital, and who underwent fine-needle aspiration cytology for the evaluation of suspicious thyroid nodules (TR3-5). Electronic medical records were used to obtain data about the ultrasound and cytology reports. A multivariable binary logistic regression analysis model was conducted to identify the independent factors significantly associated with malignant thyroid nodules. Results The study included 366 patients who underwent fine-needle aspiration cytology for suspicious nodules on thyroid ultrasound. In total, 52 (14.2%) nodules were found to be malignant on cytology. By far, the most common thyroid malignancy was papillary carcinoma. The multivariable analysis model revealed that women were 24% less likely to have malignant thyroid nodules compared with men. After adjusting for the age, gender, and Thyroid Imaging Reporting and Data System (TI-RADS) group, the nodules located within the isthmus were four times more likely to be malignant compared to those located in the right or left lobes. Conclusions The study demonstrates that the isthmus location of thyroid nodules is associated with a higher risk of malignancy. Physicians should have a lower threshold to biopsy such nodules. Further studies are needed to confirm this interesting finding.
