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Complications of percutaneous intervention for femoral, popliteal, and infrapopliteal artery occlusive disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Renganaden Sooppan, Christopher J. Abularrage
Hemorrhage into the retroperitoneum is insidious, and hemodynamic instability is usually a late sign of ongoing bleeding. The retroperitoneal space can accommodate a large volume of blood before the patient shows the typical signs and symptoms of hemorrhagic shock, including hypotension and tachycardia. Patients may complain of back or flank pain. If RPH is suspected and the patient is hemodynamically stable, a computerized tomography (CT) scan of the abdomen and pelvis with intravenous contrast should be obtained to assess the retroperitoneum for active extravasation from the external iliac artery (Figure 7.3). Clinical diagnosis and prompt resuscitation with blood and fluid is the most important lifesaving intervention. Anticoagulation should be stopped when possible and serial hemoglobin checks should be ordered.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 35 year old male patient with no fixed abode is admitted with bilateral flank pain and haematuria. The flank pain is worse on the right side. An abdominal radiograph reveals no urinary tract calcification; however, there is coarse calcification in the left upper quadrant. The left femoral head is noted to be flattened and sclerotic.
Peripheral Vascular Disease
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Clinical Features➢ Most are asymptomatic: <50% detected on exam by a pulsatile and expansile mass in abdomen.➢ 40% detected incidentally on imaging for other reason.➢ There is an associated increased risk of peripheral aneurysms, particularly popliteal aneurysm➢ Symptoms arise from aneurysm expansion, rupture or peripheral embolism include: Abdominal/back/flank pain.Distal peripheral embolization or ischaemia.Upper G.I. Bleeding from aortoenteric fistula.Syncope or shock with large pulsatile mass, ecchymoses or death from a ruptured AAA.
Cardioembolic-related renal infarction
Published in Baylor University Medical Center Proceedings, 2022
Keven Zhang, Tushar Panisurya, Aswin Srinivasan, Harris Khawaja, Ahmed Qadri, Zuhair Ali
A 30-year-old man with no significant past medical history presented to the emergency department with sudden onset of right flank pain radiating to the groin with associated nausea and vomiting. The patient admitted to alcohol consumption and cocaine use. Initial vital signs were unremarkable. Urinalysis disclosed a creatinine of 1.2 mg/dL. Computed tomography (CT) of the abdomen was initially read as right pyelonephritis or nephronia (Figure 1). Telemetry showed AF with a ventricular rate of 63 beats/minute, which was later confirmed with an electrocardiogram. A transthoracic echocardiogram showed an ejection fraction of 30%, a dilated left atrium, and a mitral valve with a rheumatic appearance and increased velocities across the valve, a calcified annulus, and mild to moderate regurgitation. A transesophageal echocardiogram revealed an ejection fraction of 25% to 29%, a dilated left ventricle and left atrium, no thrombus in the atrial cavities, no evidence of vegetation, and mild stenosis of the mitral valve with a pressure of 1.7 cm2 and mean gradient of 5 mm Hg. The patient was successfully converted to sinus rhythm. His CHA2DS2-VASc score was zero, but given the current embolic event, the patient received therapeutic enoxaparin during his hospital stay. He did not want to be on warfarin; therefore, he was switched to oral apixaban for anticoagulation. He was discharged on apixaban, metoprolol succinate, lisinopril, aspirin, folic acid, and thiamin. The patient was requested to follow-up with cardiology for his AF and counseled to quit his substance abuse.
Idiopathic retroperitoneal fibrosis: a cross-sectional study of 142 Chinese patients
Published in Scandinavian Journal of Rheumatology, 2018
S Liao, Y Wang, K Li, J Zhu, J Zhang, F Huang
iRPF has no specific symptoms, and pain in the lower back, flank, and abdomen has been known to occur, which can track to the groin and hip region. Pain can be dull or sharp, and a large number of patients complained of acute pain that mimicked renal colic, which misled clinicians to look for signs of nephrolithiasis, resulting in a delay in diagnosis and inappropriate treatment. Flank pain (66.9%) was the most common presenting symptom in our cohort, in contrast to the highest incidence of having abdominal pain in other cohorts (18, 19) (Table 4). Flank pain was more common in male patients and in patients with a high smoking index. Hydronephrosis can develop before or after the onset of pain; in our cohort, abdominal ultrasound at a regular check-up revealed hydronephrosis without any other symptoms in about 10% of patients, suggesting that hydronephrosis could be an initial presentation.
Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases
Published in Acta Chirurgica Belgica, 2018
Ismail Cem Sormaz, Fatih Tunca, Arzu Poyanlı, Yasemin Giles Şenyürek
The potential complications of TAE during the embolization procedure include reflux of embolic agents into normal arteries and accidental nontarget embolization which can lead to ischemia [3]. The side effects of adrenal artery embolization are generally self-limited and can be treated conservatively [3]. Mild to moderate flank pain lasting less than 48 h and low-grade fever are the most common complications [2]. Adrenal insufficiency, pleural effusions, and transient hypertension are other potential risks associated with the procedure [3]. Persistent hiccups due to diaphragmatic irritation after inferior phrenic artery embolization has also been reported in one patient in a case series including nine patients who underwent adrenal arterial embolization [2]. In our patients, we observed no side effects of adrenal artery embolization such as pain or fever.