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Aneurysmal rupture of the costo-cervical trunk in a patient with neurofibromatosis type 1: A case report.

Hoonjan B, Thayur N, Abu-Own A - Int J Surg Case Rep (2013)

Bottom Line: Rupture of blood vessels associated with neurofibromatosis type 1 (NF-1) is a rare but life threatening complication.A repeat CT scan showed a reduction in the original cervical haematoma.Ruptured aneurysms require urgent CT angiography, if haemodynamically stable, and further input from the vascular surgeons and vascular radiologists.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, Colchester General Hospital, Colchester CO4 5JL, UK. Electronic address: pinderhoonjan@hotmail.com.

No MeSH data available.


Related in: MedlinePlus

CXR demonstrating complete ‘whiteout’ of the left hemithorax.
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fig0020: CXR demonstrating complete ‘whiteout’ of the left hemithorax.

Mentions: A repeat CT scan of the neck and thorax performed four days post embolisation confirmed no evidence of further bleeding in the neck and a reduction in the size of the original left cervical haematoma; now 10 cm × 8 cm × 7 cm. The size of the left haemothorax however had increased. Extensive pulmonary embolisms were also incidentally noted and a caval filter (Cook Celect IVC filter) was placed in the infra-renal IVC, via the right internal jugular vein approach. The patient was not on pharmacological venous thromboembolism prophylaxis due to the haemorrhage but was wearing stockings in addition to intermittent pneumatic compression. In light of the CT results, therapeutic low molecular weight heparin was commenced. Whilst awaiting transfer for possible thoracic decortication at a cardiothoracic centre, a central venous catheter (CVC) was inserted via the right internal jugular vein approach for inotropic support during transfer. Upon positioning of the CVC, the patient's systolic blood pressure immediately dropped to 50 mmHg and heart rate increased to 150 beats per minute. A chest radiograph showed a very large haemothorax with complete whiteout of the left hemithorax (Fig. 4). The patient quickly lost cardiac output and cardio-pulmonary resuscitation (CPR) was commenced. Thoracic drainage of the left haemothorax was then performed, draining 2.5 L of blood. Five units of blood were transfused during CPR but the patient did not survive. Haemoglobin and haematocrit levels were 6.4 g/dL and 0.19 L/L, respectively, at the time of cardiac arrest. Autopsy revealed the direct cause of death to be a soft tissue haemorrhage.


Aneurysmal rupture of the costo-cervical trunk in a patient with neurofibromatosis type 1: A case report.

Hoonjan B, Thayur N, Abu-Own A - Int J Surg Case Rep (2013)

CXR demonstrating complete ‘whiteout’ of the left hemithorax.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921660&req=5

fig0020: CXR demonstrating complete ‘whiteout’ of the left hemithorax.
Mentions: A repeat CT scan of the neck and thorax performed four days post embolisation confirmed no evidence of further bleeding in the neck and a reduction in the size of the original left cervical haematoma; now 10 cm × 8 cm × 7 cm. The size of the left haemothorax however had increased. Extensive pulmonary embolisms were also incidentally noted and a caval filter (Cook Celect IVC filter) was placed in the infra-renal IVC, via the right internal jugular vein approach. The patient was not on pharmacological venous thromboembolism prophylaxis due to the haemorrhage but was wearing stockings in addition to intermittent pneumatic compression. In light of the CT results, therapeutic low molecular weight heparin was commenced. Whilst awaiting transfer for possible thoracic decortication at a cardiothoracic centre, a central venous catheter (CVC) was inserted via the right internal jugular vein approach for inotropic support during transfer. Upon positioning of the CVC, the patient's systolic blood pressure immediately dropped to 50 mmHg and heart rate increased to 150 beats per minute. A chest radiograph showed a very large haemothorax with complete whiteout of the left hemithorax (Fig. 4). The patient quickly lost cardiac output and cardio-pulmonary resuscitation (CPR) was commenced. Thoracic drainage of the left haemothorax was then performed, draining 2.5 L of blood. Five units of blood were transfused during CPR but the patient did not survive. Haemoglobin and haematocrit levels were 6.4 g/dL and 0.19 L/L, respectively, at the time of cardiac arrest. Autopsy revealed the direct cause of death to be a soft tissue haemorrhage.

Bottom Line: Rupture of blood vessels associated with neurofibromatosis type 1 (NF-1) is a rare but life threatening complication.A repeat CT scan showed a reduction in the original cervical haematoma.Ruptured aneurysms require urgent CT angiography, if haemodynamically stable, and further input from the vascular surgeons and vascular radiologists.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, Colchester General Hospital, Colchester CO4 5JL, UK. Electronic address: pinderhoonjan@hotmail.com.

No MeSH data available.


Related in: MedlinePlus