Pseudoaneurisma humeral secundario a punción arterial inadvertida / Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture

RESUMEN Los pseudoaneurismas de la arteria humeral son infrecuentes, pero pueden asociarse a complicaciones de alta morbilidad como la isquemia de miembro superior. Comunicamos un caso de pseudoaneurisma humeral en el pliegue del codo, que se presentó como tumor pulsátil con leve disminución de la temperatura y parestesias en la mano homolateral de un año de evolución, debido a una punción arterial inadvertida durante la venopunción para extracción de sangre. Se trató con éxito mediante resección quirúrgica más reconstrucción vascular con bypass húmero-cubital y bypass húmero-radial ambos con vena safena. Se discuten las diversas opciones terapéuticas disponibles para los pseudoaneurismas humerales considerando las características anatómicas y la sintomatología del paciente.

ABSTRACT Brachial artery pseudoaneurysms are rare but can be associated with severe complications as ischemia of the upper extremity. We report a case of a brachial artery pseudoaneurysm in the crease of the elbow presenting as a pulsating mass with progressive growth over the past year. The ipsilateral hand was sightly cold and presented paresthesia. The lesion was due to inadvertent arterial puncture during venipuncture. The pseudoaneurysm was successfully treated with surgical resection and vascular reconstruction with a brachial to ulnar artery bypass and brachial to radial artery bypass with saphenous vein graft. The different therapeutic options available for brachial artery pseudoaneurysms are discussed, considering the anatomic characteristics and patients' symptoms.

Fractura de catéter implantable con reservorio por síndrome de pinch-off / Totally implantable venous access device fracture due to pinch-off syndrome

RESUMEN La fractura y embolización de un catéter implantable con reservorio es una complicación infrecuente, pero potencialmente grave. El síndrome pinch-off fue descripto en los accesos venosos subclavios, cuando la sección del catéter se produce por la compresión intermitente entre la primera costilla y la clavícula. Informamos el caso de una paciente oncológica a quien se le colocó un catéter implantable con reservorio por acceso percutáneo ecoguiado y control radioscópico en la vena subclavia. Luego de varias sesiones de quimioterapia comenzó con mal funcionamiento del catéter; la radiografía de tórax evidenció la fractura completa del catéter a nivel del espacio costoclavicular con embolia de un fragmento a las cavidades cardíacas. Se realizó la extracción endovascular del catéter fracturado me diante lazo de nitinol por acceso percutáneo femoral, sin complicaciones. Se analizan la incidencia, los factores de riesgo y las medidas para prevenir el síndrome de pinch- off en los catéteres implantables con reservorio.

ABSTRACT Fracture and migration of totally implantable venous access devices is a rare but potentially serious complication. Pinch-off syndrome was described in subclavian venous accesses when the intermittent compression of the catheter between the first rib and the clavicle produces catheter fracture. The report the case of a patient with cancer who underwent implantation of a totally implantable venous access device through the subclavian vein under ultrasound and radioscopy guidance. After several cycles of chemotherapy, the patient started with malfunctioning of the device. The chest X-ray showed a complete fracture of the catheter at the level of the costoclavicular space with migration of a fragment of the catheter to the right cardiac chambers. The fractured catheter was percutaneously removed via the right femoral vein using nitinol gooseneck snare without complications. The incidence of the pinch-off syndrome, risk factors and prevention measures in totally implantable venous access devices are analyzed.

Use of a dual lumen cannula for venovenous extra corporeal membrane oxygenation in a patient with acute respiratory distress syndrome and a previously inserted inferior vena cava filter: a case report.

Extracorporeal membrane oxygenation is used in refractory hypoxemia in many clinical settings. Thoracic trauma patients usually develop acute respiratory distress syndrome. Due to high risk of bleeding, thrombotic complications present in this context are particularly difficult to manage and usually require insertion of an inferior vena cava filter to prevent embolism from the distal veins to the pulmonary circulation. Here, we present a case of a thoracic trauma patient with severe acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation via a right internal jugular double lumen cannula due to a previously inserted inferior vena cava filter caused by distal bilateral calf muscle vein deep vein thrombosis.

Uso de cânula venovenosa com duplo-lúmen para oxigenação por membrana extracorpórea em paciente com síndrome de angústia respiratória aguda com prévia inserção de filtro na veia cava inferior: relato de caso / Use of a dual lumen cannula for venovenous extra corporeal membrane oxygenation in a patient with acute respiratory distress syndrome and a previously inserted inferior vena cava filter: a case report

RESUMO A oxigenação por membrana extracorpórea é utilizada em casos de hipoxemia refratária em diversas condições clínicas. Pacientes vítimas de traumatismo torácico geralmente desenvolvem síndrome da angústia respiratória aguda. Em razão do elevado risco de sangramentos, as complicações trombóticas que se apresentam neste contexto são particularmente difíceis de tratar e, geralmente, demandam a inserção de um filtro na veia cava inferior, com a finalidade de prevenir a migração de êmbolos oriundos das veias distais para a circulação pulmonar. Neste artigo, apresentamos o caso de um paciente com traumatismo torácico, que apresentou grave síndrome de angústia respiratória aguda, com necessidade de utilizar oxigenação por membrana extracorpórea aplicada por meio da introdução de uma cânula com duplo-lúmen na veia jugular interna direita. Este procedimento foi realizado tendo em vista a prévia inserção de um filtro na veia cava inferior, por conta da ocorrência de trombose venosa profunda em ambas as panturrilhas.

ABSTRACT Extracorporeal membrane oxygenation is used in refractory hypoxemia in many clinical settings. Thoracic trauma patients usually develop acute respiratory distress syndrome. Due to high risk of bleeding, thrombotic complications present in this context are particularly difficult to manage and usually require insertion of an inferior vena cava filter to prevent embolism from the distal veins to the pulmonary circulation. Here, we present a case of a thoracic trauma patient with severe acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation via a right internal jugular double lumen cannula due to a previously inserted inferior vena cava filter caused by distal bilateral calf muscle vein deep vein thrombosis.

Aneurisma micótico de la aorta abdominal por Streptococcus pneumoniae / Mycotic Abdominal Aortic Aneurysm due to Streptococcus pneumoniae

El aneurisma micótico o infeccioso de la aorta es infrecuente y, dadas la recurrencia de la infección, la sepsis fulminante o la rotura aórtica, posee una morbimortalidad elevada. En esta presentación se describe un caso de aneurisma micótico de la aorta abdominal por Streptococcus pneumoniae en una paciente con múltiples factores de riesgo de inmunodepresión, que fue tratada exitosamente en forma quirúrgica y con antibioticoterapia sistémica prolongada.

Mycotic or infectious aortic aneurysm is rare and presents high morbidity and mortality rates given the infection recurrence, fulminant sepsis or aortic rupture. We report a case of mycotic abdominal aortic aneurysm due to Streptococcus pneumoniae in a female patient with multiple immunosuppressive risk factors, who was successfully treated with surgery and prolonged systemic antibiotic therapy.

Aneurisma micótico de la aorta abdominal por Streptococcus pneumoniae / Mycotic Abdominal Aortic Aneurysm due to Streptococcus pneumoniae

El aneurisma micótico o infeccioso de la aorta es infrecuente y, dadas la recurrencia de la infección, la sepsis fulminante o la rotura aórtica, posee una morbimortalidad elevada. En esta presentación se describe un caso de aneurisma micótico de la aorta abdominal por Streptococcus pneumoniae en una paciente con múltiples factores de riesgo de inmunodepresión, que fue tratada exitosamente en forma quirúrgica y con antibioticoterapia sistémica prolongada.(AU)

Mycotic or infectious aortic aneurysm is rare and presents high morbidity and mortality rates given the infection recurrence, fulminant sepsis or aortic rupture. We report a case of mycotic abdominal aortic aneurysm due to Streptococcus pneumoniae in a female patient with multiple immunosuppressive risk factors, who was successfully treated with surgery and prolonged systemic antibiotic therapy.(AU)

Vólvulo de ciego / Volvulus of the caecum

Valvulus of the caecum constitutes an uncommon cause of surgical obstructive acute abdomen. It is originated in the torsion of a mobile segment of the colon, surrounding its mesenteric axis. The caecum is the second most frequent localization, after the sigmoid colon. The usual picture of volvulus of the caecum is of an acute, complete intestinal obstruction with enormous abdominal distention. Patients who develop this form of volvulus possess a caecum and ascending colon with a free mesenterium. Unless this entity is early recognized, it can progress to a colonic ischemia, perforation, sepsis and death. The definitve surgical treatment is the right hemicolectomy. An illustrative case is reported, with a complete description of the clinical features and the surgical management performed.

Vólvulo de ciego / Volvulus of the caecum

Valvulus of the caecum constitutes an uncommon cause of surgical obstructive acute abdomen. It is originated in the torsion of a mobile segment of the colon, surrounding its mesenteric axis. The caecum is the second most frequent localization, after the sigmoid colon. The usual picture of volvulus of the caecum is of an acute, complete intestinal obstruction with enormous abdominal distention. Patients who develop this form of volvulus possess a caecum and ascending colon with a free mesenterium. Unless this entity is early recognized, it can progress to a colonic ischemia, perforation, sepsis and death. The definitve surgical treatment is the right hemicolectomy. An illustrative case is reported, with a complete description of the clinical features and the surgical management performed.(AU)

Torsión primaria de epiplón en paciente HIV / Primary omental torsion in a patient with HIV infection

Primary or idiopathic torsion of the greater omentum, without preexistent abdominal disease, in an uncommon cause of acute abdomen. On account of its raraness and absence of specific symptomatology, the diagnosis usually is performed at laparoscopy. This condition can be mistaken for appendicitis and in women the alternative diagnosis is usually a twisted ovarian cyst. The twisted omentum may become gangrenous and give rise to peritonitis. We report a patient with an acute abdomen with HIV infection with primary torsion fo the greater omentum. This torsion with primary infarction of the greater omentum is an infrequent cause of acute abdomen as much as in immunocompetent patients the same as in HIV positives. The elective treatment is the surgical removal.

Torsión primaria de epiplón en paciente HIV / Primary omental torsion in a patient with HIV infection

Primary or idiopathic torsion of the greater omentum, without preexistent abdominal disease, in an uncommon cause of acute abdomen. On account of its raraness and absence of specific symptomatology, the diagnosis usually is performed at laparoscopy. This condition can be mistaken for appendicitis and in women the alternative diagnosis is usually a twisted ovarian cyst. The twisted omentum may become gangrenous and give rise to peritonitis. We report a patient with an acute abdomen with HIV infection with primary torsion fo the greater omentum. This torsion with primary infarction of the greater omentum is an infrequent cause of acute abdomen as much as in immunocompetent patients the same as in HIV positives. The elective treatment is the surgical removal.(AU)