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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

BACKGROUND Aortoesophageal fistula is a rare etiology of serious gastrointestinal bleeding. Most aortoesophageal fistulas resulted from thoracic aortic aneurysms, foreign bodies, or esophageal malignancy. To our knowledge, spontaneous aortoesophageal fistula due to dermatomyositis and high dose steroid therapy has not been reported. CASE REPORT A 46-year-old Asian female with a history of dermatomyositis and duodenal ulcers presented with black stool for one day. She was initially admitted for dermatomyositis flare-up and received high dose steroid therapy. Four weeks after discharge, she experienced gastrointestinal bleeding from multiple duodenal ulcers. Due to a continuous fall in hemoglobin level, she received angiography and embolization to the gastroduodenal artery. After the procedure, the patient developed another episode of dermatomyositis flare-up and required endotracheal intubation. During ventilator weaning, she developed recurrent gastrointestinal bleeding. Repeated esophagogastroduodenoscopy showed one esophageal ulcer with active bleeding. Epinephrine hemostasis therapy was performed but with poor therapeutic response. Angiography showed no visible extravasation. Chest computed tomography with intravenous contrast revealed contrast extravasation in esophageal lumen with blood clots consistent with an aortoesophageal fistula. Despite our attempt to arrange an emergent endovascular stent, the patient went into cardiac arrest from circulatory collapse. CONCLUSIONS Dermatomyositis leads to esophageal structural abnormalities through various mechanisms. Aortoesophageal fistula is a life-threatening etiology of gastrointestinal bleeding and should be suspected if bleeding from an esophageal ulcer responds poorly to hemostatic treatment. Abdomen computed tomography with intravenous contrast is the preferred image modality for diagnosing aortoesophageal fistula. Thoracic endovascular aortic repair is a reasonable procedure to stop bleeding in patients with unstable hemodynamic profiles.
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PMID:Aortoesophageal Fistula Causing Massive Gastrointestinal Bleeding and Death in a Patient with Dermatomyositis: A Case Report. 3015 Jun 7

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene. Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae. Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists. Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.
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PMID:Thoracic impalement injury: A survivor with large metallic object in-situ. 3034 73