Zeitschrift für klinische Fallberichte

Background: Ventricular thrombosis represents a not uncommon complication of Acute Myocardial Infarction (AMI) and Left Ventricular (LV) thrombosis may complicate large anterior ST-elevation myocardial infarction with anteroapical aneurysm. Right ventricular thrombosis is a more rare complication of inferior infarction. Transthoracic echocardiogram is routinely performed in patients with AMI to assess left ventricular function and the occurrence of thrombotic complications. However, other imaging techniques are occasionally required to more clearly evaluate thrombus extent and endocardial border line.

Methods: We report a case of biventricular thrombosis firstly found at echocardiograph examination; the exact extension of biventricular thrombosis, however, was more clearly defined at CT scan.

Results: In case of large ventricular thrombosis, CT scan may be useful in the exact definition of thrombus extension when cardiac magnetic resonance is not feasible.

Conclusion: When transthoracic ultrasonography does not allow adequate characterization of the thrombus and cardiac magnetic resonance is not feasible, CT scan can provide additional definition of cardiac walls and the extent of the thrombus.

Cellulitis of the mouth floor can seldom be complicated by necrotizing fasciitis. Cellulitis of the mouth floor that has been identified in association with necrotizing fasciitis tends to arise in cervicofacial region of patients who have predisposing factors. But this article describes a rare case of cellulitis of the mouth floor causing necrotizing fasciitis in a healthy woman. The clinical features, diagnosis, and treatment are discussed in detail.

Objective: Febrile Infection-Related Epilepsy Syndrome (FIRES) is an immun-mediated epileptic encephalopathy presents as a febrile infection related super refractory status epilepticus with mortality rate of up to 30% in intensive care unit in spite of pharmacologically induced coma and immunotherapies. Early interventional ketogenic diet and cannabinoids are suggested for treatment with unknown mechanisms.

Case presentation: Here we report two concomitant FIRES cases treated with a “3 dimensional combined treatment protocol“ for FIRES including (1); super refractory status epilepticus treatment protocol with intravenous infusion of antiepileptic and anesthetic drugs, (2) immunomodulatory therapies and (3) early interventional anti-epileptogenic therapy (ketogenic diet plus cannabinoids). The therapeutic intensity of the treatment protocol was monitored with serial EEG monitoring and Functional Independence Scores-WeeFIM. Two previously healthy school children manifesting super refractory status epilepticus were treated with moderate success. Both patients recovered with drug refractory epilepsy and neurocognitive impairments (patient 1; WeeFIM Scores were: self-care: 17, motor: 24, cognition: 10 and patient 2; WeeFIM score remained totally dependent: self-care: 8, motor: 5, cognition: 5) at the 12 months of follow-up.

Conclusion: Febrile infection-related epilepsy syndrome is a devasting catastrophic epileptic encephalopathy. Early interventional treatment protocols should be applied in the early period of super refractory status epilepticus.

We report the case of sudden rupture of a radial artery small Pseudoaneurysm (PSA) occurring in a 63-years-old patient who had been hospitalized for COVID-19 pneumonia. A 63-years-old man was admitted to our hospital for SARS-CoV-2 infection causing progressive respiratory failure that required non-invasive mechanical ventilation. A 4 French catheter was placed in his right radial artery at the level of the wrist for repetitive arterial blood sampling for gas analysis. During the hospitalization, the patient recovered from the respiratory distress and the arterial line was removed, but he developed a focal ectasia of the radial artery (6 mm), which was treated with compression and antibiotics. However, after 2 days, a sudden hemorrhage from the wrist occurred, requiring emergent surgery. Intraoperatively, the radial artery was completely disrupted without any possibility of reconstruction due to the malacic wall. The artery was then ligated, and the postoperative course was uneventful. Small radial PSA following arterial catheterization may be complicated by sudden rupture in patients with COVID-19. Vascular surgeons should therefore be aware of such complication to prevent potentially serious consequences.

Enteroliths are generally classified as ‘true’ or ‘false’ enteroliths and most cases involve the latter, with ‘true’ enteroliths being rare. In addition, Enteroliths are often asymptomatic and unlikely to cause intestinal obstruction or perforations. The following is a very rare case of intestinal obstruction accompanied by true enteroliths suffered by a very elderly patient. We report the case of 96-year-old female with loss of appetite and abdominal pain. A Computed Tomography (CT) confirmed enteroliths and Press through Packages (PTP) near the terminal ileum. Moreover, the intestinal tract closest to the mouth was enlarged. A diagnosis was made of an intestinal obstruction caused by the enteroliths and so emergency surgery was carried out. We found the existence of stenosis with incarcerated enteroliths found in the intestinal tract adjacent to the mouth. A piece of the small intestine was therefore removed. Upon analysis of the sample, four intestinal stones plus PTP were found. The main component of the enteroliths was determined to be deoxycholic acid upon analysis of their makeup and we thought the sample stones as true enteroliths. The post-operative course went well and the patient was able to return home on the 37th day of hospitalization. Cases of intestinal obstruction due to true enteroliths have a low likelihood of the stones being passed naturally. Thus, it is advisable that surgery be performed as soon as the corresponding diagnosis is made.