Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon : Not known vascular malformation of the brain or a posthemorrhagic entity?

The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure. The hypothesis whether a pre-existing arteriovenous fistula ruptured or a spontaneous haemorrhage has caused the fistulous connection is discussed.

UNUSUAL CASE OF RETROPHARYNGEAL HEMATOMA WITH USE OF ORAL ANTICOAGULANT THERAPY – CASE REPORT AND REVIEW OF LITERATURE

Retropharyngeal space is a rare site of spontaneous haemorrhage and the formation of a hematoma in this location is a rarer complication of therapy with anticoagulants. Airway compromise can occur in rapidly increasing retropharyngeal hematoma. Emergent airway stabilisation is the key to a successful management of such cases, apart from reversal of causative factor. W e r e p o r t a c a s e o f s p o n t a n e o u s retropharyngeal hematoma in an elderly female on anticoagulant therapy for Rheumatic heart disease, and has developed rapidly progressive swelling in neck, post bout of violent cough. She was successfully managed with emergent airway access and reversal of causative factors. Keywords: Retropharyngeal hematoma, Retropharyngeal space, Anticoagulant therapy

An unusual presentation of pancreatic serous cystadenoma

Pancreatic cystic neoplasms (PCNs) are predominantly benign entities which represent almost 50 percent of all cystic lesions of the pancreas. PCNs are often an incidental finding on abdominal imaging and are not indicated for surgical resection unless they show evidence of malignant transformation or become symptomatic due to mass effect. This report examines an unusual presentation of a PCN, in a 70 years old female with sudden onset abdominal pain, who was found to have spontaneous intraabdominal haemorrhage secondary to a benign PCN. Emergency laparotomy was performed and a distal pancreatectomy or splenectomy were required to achieve haemostasis. Incidence of spontaneous haemorrhage in a benign PCN is a rare but serious complication.

Spontaneous haemorrhage of an adrenal angiomyolipoma: case report

Background Angiomyolipomas are rare mesenchymal tumours arising from the perivascular epithelioid cells consisting of variable amounts of adipose, thick-walled blood vessels and smooth muscle cells. These benign tumours commonly occur in the kidney with only a few case reports of adrenal angiomyolipomas which have the potential to reach a large size and haemorrhage. Case presentation A 45-year-old lady presented with a 3-week history of right loin pain, nausea and vomiting. A CT scan revealed a right adrenal angiomyolipoma measuring 6.3 × 6.8 cm with associated haemorrhage. The lesion was successfully treated with right open adrenalectomy, and histology confirmed the diagnosis of adrenal angiomyolipoma. The patient remained well with no evidence of recurrence at the 36-month follow-up. Conclusion Adrenal angiomyolipomas are rare benign tumours that have the ability to reach a large size and potential to bleed. Here, we report the second case of spontaneous haemorrhage in an adrenal angiomyolipoma, which was successfully treated with open adrenalectomy.

Aggressive Surgical Management of Spontaneous Intramuscular Haematomas in Patients with Cirrhosis is an Important Therapeutic Option

One known medical complication in patients with cirrhosis of the liver is sudden onset gastrointestinal haemorrhage which is usually variceal in nature and can be life threatening [1]. On occasion spontaneous haemorrhage from varices in other locations may also occur [2]. In addition, episodes of either intraabdominal or intrapulmonary haemorrhage are also associated with poor clinical outcomes in cirrhotic patients [3,4]. In comparison relatively, few cases of spontaneous intramuscular haemorrhage in patients with cirrhosis have been reported up to now. This particular clinical entity has been predominantly the subject of sporadic case reports or case series. Apart from one small case series [5], the majority of the cases were summarised in a published review in 2015 [6]. Hence the most recent case report from Mongelli et al published recently in this journal [7], now becomes the 25th case. Keywords: Cirrhosis; Spontaneous; Haemorrhage; Intramuscular; Management; Surgery

Canine immune-mediated thrombocytopenia

Immune-mediated thrombocytopenia (IMT) is a common disease in dogs. Primary IMT is idiopathic, while secondary IMT can result from a variety of infectious agents or some treatments. Symptoms may include lethargy, anorexia and mild pyrexia, together with a low platelet count and associated bleeding disorders. Prognosis is generally positive, but reduced with presence of melena or raised blood urea nitrogen. Treatment will include some form of immunosuppressive therapy, such as prednisolone, which can have multiple side effects. Nursing the IMT patient will aim at monitoring and reducing spontaneous haemorrhage and managing treatment side effects. To ensure owner understanding and compliance, it is vital to discuss these side effects and any appropriate home adjustments so an achievable plan can be developed for home care.

Trans Arterial Embolization of Spontaneous Intra-Abdominal Haemorrhage from Omental Lipoma

We describe 3 cases of omental lipoma of whom 2 presented with symptomatic haemorrhage. Notably the haemorrhage in the 2 reported cases was from foregut arteries. Thorough knowledge of anatomy and embryology is critical in identifying the source of haemorrhage and differentiating this condition from other common causes of mesenteric haemorrhage. To the best of our knowledge, this is the first case series reporting this uncommon cause for abdominal haemorrhage. The successful management of this condition using superselective embolization is discussed. Clinicians need to exercise diligence and caution in omental lipomas presenting with spontaneous haemorrhage and this notion is exemplified in our reported cases.

Surveillance imaging for sporadic renal angiomyolipoma less than 40 mm: lessons learnt and recommendations from the experience of a large district general hospital

Introduction Sporadic renal angiomyolipomas, although benign in natural can cause life-threatening spontaneous haemorrhage. Surveillance of smaller lesions is recommended but there is no guidance on the surveillance interval or modality. Our aim was to study our sporadic angiomyolipoma population to determine the growth rate, factors that were associated with a higher growth rate and design a surveillance programme. Materials and methods All sporadic renal angiomyolipomas diagnosed between September 2009 and March 2015 were included. Patients with a diagnosis of tuberous sclerosis were excluded. Results A total of 217 sporadic renal angiomyolipomas were diagnosed. The median follow-up was 24 months (range 10–118 months). The median size at diagnosis was 9.00 mm with a mean growth rate of 0.13 mm/year (standard deviation 0.88). One hundred and fifty angiomyolipomas (69%) were shown to have negative or zero growth. In the remaining 67, 59 had a growth rate of less than 2.00 mm/year. Size of angiomyolipoma, tumour burden and age were not associated with a higher growth rate on multivariate analysis. Conclusion The majority of sporadic angiomyolipomas are small and do not grow. Our practice is to perform surveillance for those greater than 20 mm, with five-yearly ultrasound scans for 21–29 mm, and two-yearly surveillance for 30–39 mm tumours.