Compartment Syndrome Secondary to Group A Streptococcus Infection in the Presence of a Congenital Hemangioma.

OBJECTIVES: Nontraumatic compartment syndrome is frequently difficult to diagnose but this is especially troublesome in infants. Pain is the most sensitive sign and is characteristically severe and refractory to routine analgesia. Failure to diagnose and treat can lead to disability, multiorgan failure, and death. Surgical intervention is crucial and includes emergent fasciotomy, debridement, nerve decompression, and later skin grafting. Streptococcal myositis causing compartment syndrome is more likely in the immunocompromised patient.Congenital hemangiomas are rare, benign vascular tumors that present fully grown at birth. METHODS: Case report and literature review. RESULTS: This case report details a healthy child, with a resolving congenital hemangioma of the forearm, presenting with toxic shock syndrome and a streptococcal myositis creating a compartment syndrome in the same forearm after an upper respiratory tract infection. The child underwent an emergent fasciotomy and debridement of the arm. Profound systemic effects necessitated transfer to intensive care unit and continuing postoperative mechanical ventilation, inotropic support, intravenous antibiotics, and immunoglobulin administration. Postoperatively, blood cultures and wound biopsies were all positive for Beta Hemolytic Group A Streptococci. Several days later, after a course of antibiotics, the volar forearm was closed with meshed split thickness skin grafts with good graft take. In our patient, we concluded that the hemangioma may have acted as a locus to attract the hematogenous spread of the streptococcal infection from the throat and caused a soft tissue infection that led to massive edema of the limb and consequently to compartment syndrome.

Unusual intercoronary communication of possible traumatic origin: a case report.

INTRODUCTION: The normal coronary circulation is physiologically interconnected by intercoronary and intracoronary anastomoses that are functionally insignificant and cannot be visualized by conventional coronary angiography due to their small size. The development of significant coronary stenosis increases the flow through these anastomoses and hence their size, making them readily visible. Large intercoronary communications in the absence of obstructive coronary artery disease constitute a very rare coronary artery anomaly, which is thought to be congenital in origin and located in specific anatomic locations. CASE PRESENTATION: A 62-year-old man was admitted to our department due to typical anginotic pain. Coronary angiography revealed a subtotal occlusion of the proximal circumflex and a very unusual tortuous intercoronary communication between the left main coronary artery and the left anterior descending artery. A drug eluting stent was successfully deployed at the circumflex and the patient's symptoms resolved. Medical history was retaken revealing that he suffered a strong blunt trauma of the chest as an adolescent, which we believe could be a possible alternative explanation for the formation of the intercoronary communication. Comparison to a previous angiogram performed 4 years earlier showed that the intercoronary communication was already present and remained unchanged over the years. DISCUSSION: It is suggested that intercoronary communication arising from unusual locations and developing in disorganized fashion can be suspected as being of traumatic origin. We believe that there is no need for intervention to treat this type of anomaly.