Ruptured celiac artery aneurysm mimicking Boerhaave syndrome.

Ruptured celiac artery aneurysm is a rare cause for epigastric pain and is usually detected incidentally. Atypical presentation with postemetic epigastralgia and pleural effusion usually leads physicians to make the diagnosis of Boerhaave syndrome. Herein, we report a 32-year-old woman who was diagnosed with Boerhaave syndrome initially after presenting with acute postemetic epigastralgia and predominant left side pleural effusion. Diagnostic left thoracentesis yielded bloody fluid with similar amylase level to serum. The chest computed tomographic scan showed no evidence of esophageal rupture. However, a ruptured celiac artery aneurysm with retroperitoneal hematoma extending to the posterior mediastinum and bilateral pleural space was found incidentally. Although ruptured celiac artery aneurysm is an uncommon cause for postemetic epigastralgia, acute vascular events such as the previously stated cause should be the first impression rather than Boerhaave syndrome if the patient also presents with isolated pleural effusion containing unelevated amylase.

Identification of painless aortic dissection before thrombolytic treatment for acute ischemic stroke.

Early detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians, especially when under the stress of the 3-hour golden time window for thrombolytic therapy. We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided. We suggest that cerebral CT angiography, covering from the aortic arch to intracranial arteries, should be performed in acute ischemic stroke patients, particularly in those with watershed CT perfusion deficits, to exclude the possibility of aortic dissection before thrombolytic treatment.

Periportal edema and ascites: computed tomographic signs of traumatic cardiac tamponade.

Multislice spiral computed tomography (MSCT) is becoming an increasingly common choice for evaluation of patients with suspected multiple trauma. Here, we present a trauma patient presenting with hypotension. Pericardial fluid and ascites in Morrison pouch were found via focused assessment with sonography for trauma. After pericardiocentesis, MSCT showed pericardiac fluid, periportal low attenuation, and peritoneal ascites. She received pericardiotomy and laparatomy. Numerous blood clots were evacuated from the pericardial space, but no intra-abdominal injury was found. The findings indicate the importance of computed tomographic (CT) signs of cardiac tamponade in avoiding negative laparatomy in patients with trauma (Fig. 1).