RESUMO
Acute aortic syndromes (AAS) remain one of the most challenging medical emergencies. Making a prompt and accurate diagnosis is a race against time, where delay may be disastrous for the patient's life. Prompt and accurate diagnosis using imaging modalities has been available for many years, but the major concern is how the clinician's suspicion should be aroused concerning the possibility of an acute aortic syndrome, especially in cases of atypical clinical presentation and/or poor signs during clinical examination. Since the first case report publication in 1995, novel biochemical markers have been used for the rapid diagnosis of AAS, such as smooth muscle myosin heavy chains, serum soluble elastin fragments, and d-dimers, with the latter being the most widely used in clinical trials. Despite their potential, all these substances need to be re-evaluated in large randomized trials before they can be included as biomarkers of high sensitivity and specificity in clinical practice.
Assuntos
Aorta Torácica/patologia , Biomarcadores/sangue , Doença Aguda , Animais , Elastina/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Cadeias Pesadas de Miosina/sangue , Sensibilidade e Especificidade , SíndromeRESUMO
CONTEXT: N-methyl carbamate insecticides are widely used in homes, gardens and agriculture. They share the capacity to inhibit cholinesterase enzymes with organophosphates and therefore share similar symptomatology during acute and chronic exposures. One of the serious effects of organophosphate and carbamate intoxication is the development of acute pancreatitis and subsequent intrapancreatic fluid formation. CASE REPORT: An 18-year old Caucasian man was admitted to our Intensive Care Unit with cholinergic crisis symptomatology, after the ingestion of an unknown amount of a carbamate insecticide (methomyl). Pseudocholinesterase levels were 2 kU/L on the day of admission (reference range: 5.4-13.2 kU/L). Two days after admission, an abdominal CT scan revealed blurring of the peripancreatic fat planes, inflammation and swelling of the pancreas, and a substantial amount of ascitic fluid in the left anterior pararenal space and pelvis. Paracentesis and analysis of the ascitic fluid demonstrated findings diagnostic of pancreatic ascites. There had been no other evident predisposing factors for acute pancreatitis, other than methomyl intoxication. Eleven days after admission, pseudocholinesterase levels returned to normal, while a new abdominal CT scan revealed the formation of intrapancreatic fluid collection. The patient was discharged in good physical condition two weeks after admission. A follow up abdominal CT scan performed one month later showed a significant reduction in the size of the intrapancreatic fluid. DISCUSSION: Acute pancreatitis is not uncommon after organophosphate intoxication and carbamates share the same risk as organophosphorus pesticides. The development of acute pancreatitis and subsequent intrapancreatic fluid collection after methomyl intoxication has not previously been reported. This is the first case reported of acute pancreatitis and pancreatic ascite formation after anticholinesterase insecticide ingestion.