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Introduction: Takayasu arteritis (TA) is a chronic inflammatory arteriopathy of unknown etiology that affects the aorta and its branches. Inflammation leads to arterial stenosis, thrombosis, and aneurysm formation. Management strategies for TA include medical therapy and revascularization procedures after inflammation is controlled. Presentation of the case: We report the case of a 12-year-old female patient, who presented with dyspnea and growth retardation. Initial clinical and radiological evaluations revealed hypertension and congestive heart failure. After controlling the inflammatory phase of the disease and blood pressure partially (with three antihypertensive agents), the patient underwent percutaneous balloon angioplasty of both renal arteries, with angiographic and clinical success. At the 2-year follow-up, she presented with re-stenosis of the right renal artery and progression of the supra-renal aortic stenosis. She was subjected to a second balloon angioplasty of the right renal artery and aortic balloon angioplasty. Discussion: After controlling the inflammatory phase of the disease, stenotic and/or aneurysmal lesions can be addressed. Percutaneous revascularization of renal arteries is reasonable for patients with hemodynamically significant renal artery stenosis. Conclusion: TA with renal involvement must be considered as an etiologic factor for secondary hypertension in young patients, even if there is no blood pressure difference between the upper extremities. In this case, renal and aortic stenosis were performed with low perioperative morbidity.
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Introduction: The Seldinger technique for implanting central venous catheters is the most used in the world. A metallic guidewire is employed in it, introduced through the lumen of a venipuncture needle, which serves as a path for the introduction of the central venous catheter. Complications directly related to this technique are of several types, such an insertion of a long-winded segment of the guidewire, which can lead to venous perforation, cardiac perforation, arrhythmias or even guidewire retention/embolization. Presentation of the case: We report the case of a patient with a late diagnosis of a guidewire retained in her venous system. The distal end of the guidewire pierced the pulmonary artery, crossed the chest wall and remained in the left breast tissue. It was removed by laparotomy, through an extra-peritoneal access to the right common iliac vein. Discussion: Different factors have been identified as responsible for the increase in the number of guidewires retained after central venous catheterizations. Lack of supervision, in procedures performed by training physicians, has been identified as one of the most important risk factor in the cases reported in the literature. Conclusion: The present report demonstrates that central venous catheterization, despite being a relatively straight forward procedure, should not be underestimated and should be performed by properly trained physicians or by training physicians under supervision.
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INTRODUCTION: Extrapulmonary tuberculosis may develop in any organ system, including the spine. The affection of spinal cord is called Pott's disease and it is the most frequent set. Pott's disease can present as back pain and be related to complications such psoas muscle abscess. CASE PRESENTATION: We report a case of 23-year-old Brazilian woman, natural from Amazonas, presenting with psoas abscess associated to Pott's disease treated with surgical debridement and drainage and extended tuberculosis scheme. DISCUSSION: Psoas abscess is rare and the main agents related to psoas abscess are Staphylococcus aureus, followed by Streptococcus and Escherichia coli. Retrofascial abscesses usually originate from bone lesions, including spine tuberculosis as our case, or due to contiguity of the retroperitoneal space. CONCLUSION: Psoas abscess related to Pott's disease is a difficult diagnosis, requiring high suspicious and proper investigation through good anamnesis, CT scan and culture.
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INTRODUCTION: Diaphragmatic rupture is an uncommon trauma complication and it is associated with chronic diaphragmatic herniation, especially in the left side. Chronic diaphragmatic herniation is usually due to white weapon injury and as consequence of low suspicious and absence of proper investigation. CASE REPORT: We report a chronic diaphragmatic herniation after three years of a stab in the left thoracoabdominal transition, managed through laparotomy. DISCUSSION: Traumatic diaphragmatic rupture is a rare trauma consequence, most common in the left side. The herniation occurs gradually because of negative pressure of the thoracic cavity that works as a suction of the abdominal organs. CONCLUSION: Traumatic diaphragmatic ruptures diagnosis is difficult and might go unnoticed without high suspicious and proper investigation. Chronic herniation is associated with higher morbimortality.