Localized massive staphylococcal pericardial abscess with atypical presentation.

Introduction and importance: Localized staphylococcal pericardial abscess (PA) is extremely rare and highly mortal complication of Staphylococcus aureus bacteremia with only a few reported cases in English-language medical literature. Clinical manifestations are fulminant, and early management is necessary. Case presentation: Here we report a case of end stage renal disease (ESRD) with isolated localized massive staphylococcal PA and had masked signs and symptoms of pericardial staphylococcal infection. Contrast-enhanced computed tomography scan suggested anterior massive localized pericardial cyst like image. Surgical drainage of the abscess with localized pericardiectomy conjugated with antibiotic therapy led to a successful management. Clinical discussion: Staphylococcus aureus is the leading cause of hemodialysis catheter-related bloodstream infections, contributing 33-80% of the organisms cultured from blood samples. Nature of staphylococcal pericardial infection is aggressive and life threatening with generalized involvement of the pericardium although our patient presented with masked signs and symptoms. Conclusion: CT image of localized pericardial lesion with masked signs and symptoms does not exclude the presence of live threating pericardial infection, especially in immunocompromised patients.

Radial artery pseudoaneurisma due to unintentional arterial puncture during cephalic vein cannulation: A rare case report.

Introduction and importance: Radial artery pseudoaneurysm is considered as an extremely rare and serious complication that usually follows after cardiac catheterizations with incidence of less than 0.05%, but in lesser frequency with arterial cannulation, trauma, and inflammation or hemodialysis therapy. On the other hand, venous access is clinically important, as it allows for blood sampling, administration of medications, fluids, nutrition, and chemotherapy. But its usage is associated with complications like catheter-associated infections, injuries to peripheral nerves, along with thrombosis and phlebitis of the vessel involved as well as arterial injury. Clinical presentation: in this report, we present a 67 years old healthy nonsmoker male patient with proximal radial artery pseudoaneurysm following several attempts of cephalic vein cannulation for intravenous access. Clinical discussion: Radial artery pseudo-aneurisms are very rare with reported incidence of 0.048%, and mainly due to arterial puncture in an attempt of cardiac intervention procedures, but to the authors knowledge this is one of the first reported cases of radial artery pseudoaneurysm caused by arterial puncture in an attempt of cephalic vein cannulation. Conclusion: Radial artery pseudoaneurysm can occur after attempts of cephalic vein cannulation and patients can be successfully managed with surgical removal of the false aneurism and radial arteriorrhaphy.