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Vinayak Venu, Girish Bakhshi, Chandrakant Sabale, Apoorva M Raichur, Khadeija Hussain
This case report highlights an unusual manifestation of a giant subgaleal hematoma in a 15-year-old child, which progressed to a potentially life-threatening condition requiring surgical drainage. Subgaleal hematomas occur when the emissary veins between the periosteal and aponeurotic layers of the scalp rupture. In many cases, subgaleal hematomas undergo spontaneous absorption without intervention. However, in this particular case, the hematoma measured approximately 1300 ml, making it the largest documented in medical literature and necessitating surgical intervention...
March 2024: Curēus
#2
Danielle Markus, Andrew S Bi, William Neal, Benjamin Fiedler, Nirmal Tejwani
A 42-year-old male with no past medical history presented to an emergency room with increasing pain and swelling of his left lower extremity over 48 hours with no preceding trauma. A computed tomography scan demonstrated a hematoma (20 cm × 4 cm × 10 cm) present within the gastrocnemius-soleus complex. Acute compartment syndrome (ACS) was diagnosed clinically, confirmed intraoperatively with an arterial line transducer, and treated with emergent fasciotomy. Extensive workup found no evidence of coagulopathy or source of bleeding...
March 2024: Curēus
#3
JOURNAL ARTICLE
Mikael Levy, Esther Arfi Levy, Neelan J Marianayagama, Vladimir Frolov, Shimon Maimon, Ophira Salomon
OBJECTIVE: To determine the role of platelet counts in the context of the decision to treat patients with non-compounded, non-surgically-treated blunt traumatic brain injury (NCNS-bTBI) with anticoagulants/antiaggregants. METHODS: A retrospective analysis of 141 anticoagulants/antiaggregants-naïve patients with NCNS-bTBI. Changes in PT-INR and prolonged aPTT were examined and correlated with Marshall and Rotterdam scores, clinical and neuroradiological outcomes...
April 28, 2024: Brain Injury
#4
JOURNAL ARTICLE
Ned Farley, Joseph Faraj, Malindu Fernando, Tejas Singh, Aaron Powell, Senthil Kumar
BACKGROUND: Renal artery thrombosis is rare and limited reports exist in the young population. The most common aetiology is thromboembolic disease or abdominal trauma in this population and isolated occurrences are extremely rare. We present the case of an 18-year-old woman with spontaneous unilateral renal artery thrombosis and infarction for whom reperfusion was achieved through endovascular intervention. The aetiology of her thrombosis remains unclear and is under investigation with differential diagnoses being fibromuscular dysplasia, large and medium vessel vasculitis, and thromboembolic causes...
April 26, 2024: Vascular
#5
Ali M Hassan, Chad W Donley, Praveen Venkatachalam
BACKGROUND: Epistaxis is a frequent presenting complaint in the Emergency Department (ED). Roughly 60% of the population will suffer from epistaxis in their lifetime. The most common causes of epistaxis include nose picking, facial trauma, foreign bodies, and coagulopathies. There are other causes that are much less common, such as intracranial pseudoaneurysms. There are multiple causes that precipitate intracranial pseudoaneurysm formation, with head trauma accounting for less than 1% of inciting events...
2024: Open Access Emergency Medicine: OAEM
#6
Binoy Yohannan, Juan Carlos Martinez Gutierrez, Peng Roc Chen, Adan Rios
Intracerebral hemorrhage is a potentially fatal complication in patients with acute leukemia and contributing factors include thrombocytopenia and coagulopathy. Patients with acute leukemia may develop subdural hematoma (SDH) spontaneously or secondary to trauma. In patients with acute leukemia and SDH, the surgical evacuation of the hematoma causes significant morbidity and mortality. New approaches and strategies to reduce the need for surgical evacuation are needed to improve outcomes in patients with acute leukemia and intracerebral hemorrhage...
April 2024: Journal of Hematology (Brossard, Quebec)
#7
JOURNAL ARTICLE
Asanthi M Ratnasekera, Sirivan S Seng, Daniel Kim, Wenyan Ji, Christina L Jacovides, Elinore J Kaufman, Hannah M Sadek, Lindsey L Perea, Christina Monaco Poloni, Ilya Shnaydman, Alexandra Jeongyoon Lee, Victoria Sharp, Angela Miciura, Eric Trevizo, Martin G Rosenthal, Lawrence Lottenberg, William Zhao, Alicia Keininger, Michele Hunt, John Cull, Chassidy Balentine, Tanya Egodage, Aleem T Mohamed, Michelle Kincaid, Stephanie Doris, Robert Cotterman, Sara Seegert, Lewis E Jacobson, Jamie Williams, Melissa Moncrief, Brandi Palmer, Caleb Mentzer, Nichole Tackett, Tjasa Hranjec, Thomas Dougherty, Shawna Morrissey, Lauren Donatelli-Seyler, Amy Rushing, Leah C Tatebe, Tiffany J Nevill, Michel B Aboutanos, David Hamilton, Diane Redmond, Daniel C Cullinane, Carolyne Falank, Mark McMellen, Chris Duran, Jennifer Daniels, Shana Ballow, Kevin M Schuster, Paula Ferrada
BACKGROUND: In patients with severe traumatic brain injury (TBI), clinicians must balance preventing venous thromboembolism (VTE) with the risk of intracranial hemorrhagic expansion (ICHE). We hypothesized that low molecular weight heparin (LMWH) would not increase risk of ICHE or VTE as compared to unfractionated heparin (UH) in patients with severe TBI. METHODS: Patients ≥ 18 years of age with isolated severe TBI (AIS ≥ 3), admitted to 24 level I and II trauma centers between January 1, 2014 to December 31, 2020 and who received subcutaneous UH and LMWH injections for chemical venous thromboembolism prophylaxis (VTEP) were included...
April 9, 2024: Injury
#8
REVIEW
Angela Saviano, Cesare Perotti, Christian Zanza, Yaroslava Longhitano, Veronica Ojetti, Francesco Franceschi, Abdelouahab Bellou, Andrea Piccioni, Eugenio Jannelli, Iride Francesca Ceresa, Gabriele Savioli
Severe bleeding is the leading cause of death in patients with major trauma admitted to the emergency department. It is estimated that about 50% of deaths happen within a few minutes of the traumatic event due to massive hemorrhage; 30% of deaths are related to neurological dysfunction and typically happen within two days of trauma; and approximately 20% of patients died of multiorgan failure and sepsis within days to weeks of the traumatic event. Over the past ten years, there has been an increased understanding of the underlying mechanisms and pathophysiology associated with traumatic bleeding leading to improved management measures...
March 27, 2024: Diagnostics
#9
JOURNAL ARTICLE
David T Lubkin, Krislynn M Mueck, Gabrielle E Hatton, Jason B Brill, Mariela Sandoval, Jessica C Cardenas, Charles E Wade, Bryan A Cotton
OBJECTIVES: Some centers have recommended including concentrated fibrinogen replacement in massive transfusion protocols (MTPs). Given our center's policy of aggressive early balanced resuscitation (1:1:1), beginning prehospital, we hypothesized that our rates of hypofibrinogenemia may be lower than those previously reported. METHODS: In this retrospective cohort study, patients presenting to our trauma center November 2017 to April 2021 were reviewed. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen <150 or rapid thrombelastography angle <60...
2024: Trauma Surgery & Acute Care Open
#10
JOURNAL ARTICLE
Shin Hyuk Kang, Il Young Ahn, Han Koo Kim, Woo Ju Kim, Soo Hyun Woo, Seung Hyun Kang, Soon Auck Hong, Tae Hui Bae
Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy...
March 2024: Archives of Plastic Surgery
#11
Anthony V Thomas, Mackenzie L Johnson, Anna M Tincher, Saniya Zackariya, Hassaan Khan, Uzma Rizvi, Scott G Thomas, Timothy W Noveroske, Daniel H Fulkerson, Ernest E Moore, Mark M Walsh
An 18-year-old female presented to the emergency department after a motor vehicle collision. Initial imaging revealed a liver laceration. Subsequent labs showed significantly elevated prothrombin time, international normalized ratio, and activated partial thromboplastin time. Thromboelastography demonstrated a flatline tracing. The patient denied use of anticoagulation but admitted to synthetic cannabinoid use. It was believed the patient had taken synthetic cannabinoid contaminated by brodifacoum. She was therefore given prothrombin complex concentrate and vitamin K with blood products...
June 2024: Trauma Case Reports
#12
Nicholas Dietz, Meghan Blank, William Asaka, Brent G Oxford, Dale Ding, Emily Sieg, Heidi M Koenig
Hypothermia in a trauma patient has been associated with increased morbidity and mortality and is more frequently seen in those sustaining traumatic brain injuries (TBIs). Acidosis is an important consequence of hypothermia that leads to derangements across the spectrum of the coagulation cascade. Here, we present a case of a 31-year-old male presented after suffering a right parietal penetrating ballistic injury with an associated subdural hematoma and 7 mm midline shift requiring decompressive craniectomy and external ventricular drain (EVD) placement in the setting of severe hypothermia (28°C) and acidosis (pH 7...
March 2024: Curēus
#13
Varisha Shahzad, Katherine McDonald, Robert Murphy, Yvonne O'Meara
A 51-year-old woman presented to her local emergency department with acute onset right-sided flank pain and nausea. Her blood results on admission were largely unremarkable aside from leucocytosis and neutrophilia. Two days after admission, she developed the following: stage 3 AKI with oliguria, anaemia, thrombocytopenia, and acute derangement of liver function tests. A computed tomography of the kidney ureter bladder demonstrated a right-sided 4 mm obstructing vesicoureteric junction stone with associated hydronephrosis and hydroureter...
June 2024: Radiology Case Reports
#14
REVIEW
Julia R Coleman, Richard Gumina, Thomas Hund, Mitchell Cohen, Matthew D Neal, Kristy Townsend, Bryce A Kerlin
Trauma-induced coagulopathy (TIC) is one of the leading causes of preventable death in injured patients. Consequently, it is imperative to understand the mechanisms underlying TIC and how to mitigate this mortality. An opportunity for advancement stems from the awareness that coagulation demonstrates a strong sex-dependent effect. Females exhibit a relative hypercoagulability compared to males, which persists after injury and confers improved outcomes. The mechanisms underlying sex dimorphisms in coagulation and its protective effect after injury have yet to be elucidated...
April 3, 2024: American Journal of Hematology
#15
JOURNAL ARTICLE
Ryosuke Nobe, Shunichiro Nakao, Yuko Nakagawa, Hiroshi Ogura, Takeshi Shimazu, Jun Oda
AIM: Organ tissue damage, including the lungs, may lead to acute coagulopathy. This study aimed to evaluate the association between lung contusion volume and serum fibrinogen level during the acute phase of trauma. METHODS: We conducted an observational study using electronic medical records at a tertiary-care center between January 2015 and December 2018. We included patients with lung contusions on hospital arrival. We used three-dimensional computed tomography to calculate lung contusion volumes...
2024: Acute Medicine & Surgery
#16
JOURNAL ARTICLE
Ali Hassan, Zainab Habbash, Mahdi Aljawad, Faris Alnemer, Ali Alzayer, Aqil AlZaher
BACKGROUND Small bowel hematoma is a rare yet clinically significant condition characterized by the accumulation of blood within the mucosa and submucosa layers of the small intestine wall. It can lead to complications such as bowel obstruction, ischemia, perforation, and even hemorrhagic shock. The etiology of intramural small bowel hematoma is diverse, encompassing factors such as anticoagulant therapy, coagulopathies, vascular disorders, trauma, and underlying systemic conditions. CASE REPORT We present the case of a 67-year-old man with a history of aortic valve replacement who presented with intense abdominal pain...
April 1, 2024: American Journal of Case Reports
#17
JOURNAL ARTICLE
J Cole Gwin, Niyati Rangnekar, Glenn P Murray, Saskya Byerly, Andrew M Fleming, Thomas S Easterday, Andrew J Kerwin, Isaac W Howley
BACKGROUND: Despite improving understanding of trauma-induced coagulopathy (TIC), mortality and morbidity due to exsanguinating trauma remain high. Increased complications due to hemorrhage have been reported in blood group O, possibly due to reduced levels of von Willebrand factor (vWF). METHODS: An urban level 1 adult trauma center registry was retrospectively queried. Patients receiving ≥6 units of pRBC within 4 h of presentation were included...
March 26, 2024: American Journal of Surgery
#18
JOURNAL ARTICLE
Ryan Chae, Christopher Nguyen, Chad Archdeacon, Lindsey Wattley, Stephanie Sisak, Adam Price, Emma Perez, Rebecca Schuster, Alex Lentsch, Charles Caldwell, Michael Goodman, Timothy Pritts
INTRODUCTION: Whole blood resuscitation for hemorrhagic shock in trauma represents an opportunity to correct coagulopathy in trauma while also supplying red blood cells. The production of microvesicles in stored whole blood and their effect on its hemostatic parameters have not been described in previous literature. We hypothesized that microvesicles in aged stored whole blood are procoagulant and increase thrombin production via phosphatidylserine. METHODS: Whole blood was obtained from male C57BL/6 male mice and stored in anticoagulant solution for up to 10 days...
March 27, 2024: Journal of Trauma and Acute Care Surgery
#19
JOURNAL ARTICLE
Emily A Grimsley, Michelle Lippincott, Meagan D Read, Steven Lorch, Sandra M Farach, Paul C Kuo, Jose J Diaz
Pre-existing cirrhosis is associated with increased mortality in blunt liver injury. Despite widespread use of nonoperative management (NOM) for blunt liver injury, there is a relative paucity of data regarding how pre-existing cirrhosis impacts the success of NOM. Herein, we perform a retrospective cohort study using ACS TQIP 2017-2020 data to assess the relationship between cirrhosis and failure of NOM for adult patients with blunt liver injury. 37,176 patients were included (342 cirrhosis and 36,834 without cirrhosis)...
March 26, 2024: American Surgeon
#20
JOURNAL ARTICLE
Mats L Moskopp, Dag Moskopp, Lennart W Sannwald
INTRODUCTION: Initial management of traumatic brain injury (TBI) without immediate need for surgical therapy varies across centers. The additional value of routine repeat cranial computerized tomography (CT) to neurological monitoring is controversial. This retrospective study investigates the impact of routine follow-up CT after 6 h (CT6h) in initially conservatively managed TBI on surgical decision making. Furthermore, the impact of coagulopathy on lesion size and progression was examined...
March 26, 2024: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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