ABSTRACT
Contrast blush (CB) is an area with a density higher than the organ parenchyma in the arterial phase of contrast-enhanced computed tomography (CT). CB may be a sign of contrast medium extravasation, pseudoaneurysm, arteriovenous fistula, or other conditions; however, the indications for treatment remain unclear. Nevertheless, CB could be used to indicate a fatal scenario, such as delayed splenic rupture. Here, we present two multiple-injury cases of fatal delayed splenic rupture following the nonoperative management of a minor splenic injury. In both cases, despite morphological CT findings being minor on admission, CB was observed, and both patients could not rest owing to factors such as older age, a head injury, and drunkenness. Furthermore, in the CB case that indicated pseudoaneurysm, delayed splenic rupture occurred much earlier after the injury compared to the other case without the possibility of pseudoaneurysm. In conclusion, we recommend transcatheter arterial embolization be urgently performed in a case wherein the presence of a pseudoaneurysm is highly probable and factors such as multiple injuries and inability to rest are involved.
Subject(s)
Aneurysm, False , Embolization, Therapeutic , Splenic Rupture , Wounds, Nonpenetrating , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/therapy , Embolization, Therapeutic/methods , Extravasation of Diagnostic and Therapeutic Materials/complications , Extravasation of Diagnostic and Therapeutic Materials/therapy , Humans , Retrospective Studies , Splenic Rupture/diagnostic imaging , Splenic Rupture/etiology , Splenic Rupture/therapy , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/therapyABSTRACT
We report the case of a 62-year-old man who used approximately one can of waterproofing spray in an enclosed room and, then, smoked a cigarette. He developed a fever of 39°C with respiratory distress and was transported by ambulance to his usual doctor. Since his respiratory state was very severe, he was transferred to our hospital. The patient had a smoking habit of 20 cigarettes per day for approximately 42 years. Chest computed tomography (CT) on arrival showed ground glass opacity (GGO) in the bilateral lungs with emphysematous change. We diagnosed the patient with acute respiratory distress syndrome (ARDS) because of severe hypoxemia. Based on the symptoms' progress, the cause of ARDS was thought to be lung injury due to waterproofing spray inhalation, and treatment was accordingly initiated. Several reports have described lung injury caused by waterproofing spray inhalation; however, severe cases that progress to ARDS are rare. We believe that the aggravation was caused by smoking after inhaling the waterproofing spray and pre-existing pulmonary lesions, such as emphysema. Education regarding the precautions to be taken when using waterproofing spray is necessary.
Subject(s)
Acute Lung Injury/etiology , Fluorocarbon Polymers/adverse effects , Inhalation Exposure/adverse effects , Respiratory Distress Syndrome/etiology , Smoking/adverse effects , Acute Lung Injury/diagnostic imaging , Aerosols , Emphysema/complications , Humans , Male , Middle Aged , Pulmonary Surfactants/adverse effects , Radiography, Thoracic , Respiratory Distress Syndrome/diagnostic imaging , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
An 86-year-old woman was transported by ambulance after jumping from the second floor of a building. Upon arrival, the blood pressure was stable; however, computed tomography indicated the presence of an anterior mediastinal hematoma. Eight hours after arrival, the patient exhibited shock. The blood pressure increased with rapid infusion. Emergency angiography was performed. Extravasation from the musculophrenic artery, which branches off from the left internal mammary artery, was observed. Transcatheter arterial embolization was performed and bleeding was controlled. This is the first report of musculophrenic artery injury caused by blunt trauma to the best of our knowledge. Findings suggested that if an anterior mediastinal hematoma develops, bleeding must be rapidly controlled. If the patient responds to rapid infusion and injury of the internal mammary artery or one of its branches is suspected, transcatheter arterial embolization is considered appropriate.