Melita Kukuljan

CSF liver pseudocyst as a complication of a ventriculoperitoneal shunt

ZusammenfassungWir berichten über eine 30-jährige Patientin, die an einem sekundären Hydrocephalus litt. Nach Ruptur und erfolgreicher Klippung eines Aneurysmas der Arteria communicans anterior war ihr ein Ventrikel-peritonealer Shunt (VPS) gesetzt worden. 3 Wochen später traten respiratorische und abdominelle Probleme, sowie Fieber auf. Durch Ultraschall und Computertomographie diagnostizierten wir eine mit cerebrospinaler Flüssigkeit (CSF) gefüllte Pseudozyste in der Leber. Nachdem wir in der CSF Bakterien feststellten, wandelten wir den VPS in einen externen Ventrikeldrain um. Danach wurde eine Ultraschall gezielte Punktion und Drainage der CSF-Leber Pseudozyste durchgeführt. Die Kontroll-CT des Abdomens zeigte eine Regression der zystischen Formation. Die Patientin verstarb 1 Monat nach der Diagnose der CSF – gefüllten Leber Pseudozyste im Sepsisbedingten Multiorganversagen. Die Perforation parenchymatöser abdomineller Organe durch das distale Ende des VPS stellt eine seltene Komplikation dar. Sie ist wahrscheinlich Folge einer Infektion des Shunts und einer immunologischen Reaktion, die während der Lokalisierung der Infektion stattfand.SummaryWe have a 30-year-old female patient suffering from secondary hydrocephalus. She has had a ventriculoperitoneal shunt (VPS) implanted following a rupture and a successful clipping of the aneurysm of the anterior communicating artery (ACoA). Three weeks after implanting of the VPS, respiratory and abdominal difficulties with febrility appeared. We diagnosed cerebrospinal fluid liver pseudocyst using ultrasound (US) and computer tomography scan (CT). Given that we found bacteria in the cerebrospinal fluid (CSF), we converted VPS into an external ventricular drain (EVD). After that, we conducted a US-guided punction and drainage of the CSF liver pseudocyst. The subsequent CT of abdomen showed a regression of the cystic form. The patient died following the septic condition with multiple organ failures (MOF) a month after the cerebrospinal fluid liver pseudocyst diagnosis.The perforation of parenhimatose abdominal organs with distal part of VPS is a rare complication which is most likely a consequence of a shunt infection and of an immunological reaction that took place during the process of localizing an infection.

A case report of occupational middle ear tuberculosis in a nurse.

A Case Report of Occupational Middle Ear Tuberculosis in a Nurse This article presents a case of a 40-year-old female patient with a right-side middle ear tuberculosis. The patient was a nurse, who had worked at the Department of Pulmology, Clinical Hospital Rijeka for 17 years. The cause was infection with Mycobacterium tuberculosis while she assisted in bronchoscopy. The patient was referred to occupational medicine (OM) for confirmation of occupational disease immediately after surgery. The disease was confirmed as occupational by the Croatian Institute for Health Insurance of Health Protection at Work. During surgery a sample was taken for microbiological analysis. We did initial and control multislice computed tomography (MSCT) and control magnetic resonance imaging (MRI) of temporal bones 6 months after the surgery. The initial MSCT showed total mastoid cell shadowing without destruction, while the control image showed almost full recovery save for a few remaining shadowed cells. Adequately taken occupational history by an OM specialist can significantly shorten the time to diagnosis of a rare occupational illness that is often manifested by non-specific symptoms. Profesionalna tuberkuloza srednjeg uha u medicinske sestre: prikaz slučaja Tuberkuloza srednjeg uha kao primarna bolest je rijetka. U ovom radu prikazana je 40-godišnja pacijentica, medicinska sestra, koja je radila 17 godina na Odjelu za pulmologiju Kliničkoga bolničkog centra u Rijeci, u Hrvatskoj, i oboljela je od desnostrane tuberkulozne upale srednjeg uha. Razlog je bio kontakt s Mycobacterium tuberculosis za vrijeme asistiranja kod bronhoskopije. Cilj je rada upozoravanje na važnost medicine rada koja je odmah nakon primitka pacijentice započela proces priznavanja profesionalne bolesti. Nakon dobivanja suglasnosti Hrvatskog zavoda za zdravstveno osiguranje zaštite zdravlja na radu pacijentica je dobila status profesionalno oboljele osobe i sva prava koja joj iz toga proizlaze. Za vrijeme operacije srednjeg uha uzet je obrisak na mikrobiološku analizu. Učinjena je inicijalna i kontrolna višeslojna kompjutorizirana tomografija (MSCT) te magnetska rezonancija (MR) temporalnih kostiju nakon 6 mjeseci liječenja. Mikrobiološka analiza bila je pozitivna na M. tuberculosis. Inicijalni MSCT pokazao je potpuno zasjenjenje celula mastoida bez destrukcije, a kontrolna snimka gotovo potpunu sanaciju sa zasjenjenjem tek pokoje celule, dok MR pokazuje porast signala kod malobrojnih celula. Dobro uzeta radna anamneza od strane medicine rada može znatno skratiti vrijeme dijagnosticiranja rijetkih profesionalnih bolesti, koje često imaju nespecifične simptome. Nadalje, pokretanje postupka te priznavanje profesionalne bolesti značajno je za adekvatni status i liječenje osoba oboljelih na radu.

Normal Bicaudate Index by Aging

The aim of our study was to determine the normal ventricular size of the intracranial cavity based on the bicaudate index (BCI) calculation which was obtained through the computed tomography. We reviewed consecutive CT examinations in 1406 patients with symmetrical intracranial ventricular system and normal density of the white and gray matter, and without neurological deficits or psychiatric disorders. Our series included 711 female and 695 male examinees ; aged from 3 months to 89 years, mean age 46, 3 ± 23, 9 years. The positive correlation between age and bicaudate indexes was significant (p < 0.01). In our series, upper limit of the BCI (99th percentile) was 0.13 for the first three decades. In the fourth and fifth decade it increases to 0.15 and 0.19, respectively. After the age of 50, BCI progressively increases and rises to levels that are nearly double those found in the age group of 30 or younger. This is important in CT assessments of potential developments of hydrocephalus in older patients.

Locked-in syndrome in a patient with acute obstructive hydrocephalus, caused by large unruptured aneurysm of the basilar artery (BA)

Abstract We describe a case of acute obstructive hydrocephalus as a consequence of compression of the brainstem by a large aneurysm of the basilar artery (BA) in a 62-year-old male. After the insertion of the ventriculoperitoneal shunt (VPS), we encountered the “locked-in syndrome” clinical condition. “Locked-in syndrome” is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.

Nonfatal Systemic Air Embolism: A Grave Complication of Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

Transthoracic computed tomography-guided core needle biopsy (TTNB) is a well-established method for diagnosing focal pulmonary lesions. However, the dangers associated with this method as well as the significant number of complications caused by it cannot be ignored. Systemic air embolism is a rare but potentially fatal complication that can accompany transthoracic needle biopsies of pulmonary lesions. In this study, we report nonfatal systemic air embolism as a complication of a transthoracic needle core biopsy of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis. Although extremely rare, the complication may result in a transient myocardial ischemia, which is presented with a transient depression of the ST segment.

CSF liver pseudocyst aa a complication of a ventriculoperitoneal shunt

ZusammenfassungWir berichten über eine 30-jährige Patientin, die an einem sekundären Hydrocephalus litt. Nach Ruptur und erfolgreicher Klippung eines Aneurysmas der Arteria communicans anterior war ihr ein Ventrikel-peritonealer Shunt (VPS) gesetzt worden. 3 Wochen später traten respiratorische und abdominelle Probleme, sowie Fieber auf. Durch Ultraschall und Computertomographie diagnostizierten wir eine mit cerebrospinaler Flüssigkeit (CSF) gefüllte Pseudozyste in der Leber. Nachdem wir in der CSF Bakterien feststellten, wandelten wir den VPS in einen externen Ventrikeldrain um. Danach wurde eine Ultraschall gezielte Punktion und Drainage der CSF-Leber Pseudozyste durchgeführt. Die Kontroll-CT des Abdomens zeigte eine Regression der zystischen Formation. Die Patientin verstarb 1 Monat nach der Diagnose der CSF – gefüllten Leber Pseudozyste im Sepsisbedingten Multiorganversagen. Die Perforation parenchymatöser abdomineller Organe durch das distale Ende des VPS stellt eine seltene Komplikation dar. Sie ist wahrscheinlich Folge einer Infektion des Shunts und einer immunologischen Reaktion, die während der Lokalisierung der Infektion stattfand.SummaryWe have a 30-year-old female patient suffering from secondary hydrocephalus. She has had a ventriculoperitoneal shunt (VPS) implanted following a rupture and a successful clipping of the aneurysm of the anterior communicating artery (ACoA). Three weeks after implanting of the VPS, respiratory and abdominal difficulties with febrility appeared. We diagnosed cerebrospinal fluid liver pseudocyst using ultrasound (US) and computer tomography scan (CT). Given that we found bacteria in the cerebrospinal fluid (CSF), we converted VPS into an external ventricular drain (EVD). After that, we conducted a US-guided punction and drainage of the CSF liver pseudocyst. The subsequent CT of abdomen showed a regression of the cystic form. The patient died following the septic condition with multiple organ failures (MOF) a month after the cerebrospinal fluid liver pseudocyst diagnosis.The perforation of parenhimatose abdominal organs with distal part of VPS is a rare complication which is most likely a consequence of a shunt infection and of an immunological reaction that took place during the process of localizing an infection.

CSF liver pseudocyst as a complication of a ventriculoperitoneal shunt@@@Mit cerebro-spinaler Flüssigkeit gefüllte Pseudozyste der Leber als Komplikation eines Ventrikel-Peritoneal Shunts

ZusammenfassungWir berichten über eine 30-jährige Patientin, die an einem sekundären Hydrocephalus litt. Nach Ruptur und erfolgreicher Klippung eines Aneurysmas der Arteria communicans anterior war ihr ein Ventrikel-peritonealer Shunt (VPS) gesetzt worden. 3 Wochen später traten respiratorische und abdominelle Probleme, sowie Fieber auf. Durch Ultraschall und Computertomographie diagnostizierten wir eine mit cerebrospinaler Flüssigkeit (CSF) gefüllte Pseudozyste in der Leber. Nachdem wir in der CSF Bakterien feststellten, wandelten wir den VPS in einen externen Ventrikeldrain um. Danach wurde eine Ultraschall gezielte Punktion und Drainage der CSF-Leber Pseudozyste durchgeführt. Die Kontroll-CT des Abdomens zeigte eine Regression der zystischen Formation. Die Patientin verstarb 1 Monat nach der Diagnose der CSF – gefüllten Leber Pseudozyste im Sepsisbedingten Multiorganversagen. Die Perforation parenchymatöser abdomineller Organe durch das distale Ende des VPS stellt eine seltene Komplikation dar. Sie ist wahrscheinlich Folge einer Infektion des Shunts und einer immunologischen Reaktion, die während der Lokalisierung der Infektion stattfand.SummaryWe have a 30-year-old female patient suffering from secondary hydrocephalus. She has had a ventriculoperitoneal shunt (VPS) implanted following a rupture and a successful clipping of the aneurysm of the anterior communicating artery (ACoA). Three weeks after implanting of the VPS, respiratory and abdominal difficulties with febrility appeared. We diagnosed cerebrospinal fluid liver pseudocyst using ultrasound (US) and computer tomography scan (CT). Given that we found bacteria in the cerebrospinal fluid (CSF), we converted VPS into an external ventricular drain (EVD). After that, we conducted a US-guided punction and drainage of the CSF liver pseudocyst. The subsequent CT of abdomen showed a regression of the cystic form. The patient died following the septic condition with multiple organ failures (MOF) a month after the cerebrospinal fluid liver pseudocyst diagnosis.The perforation of parenhimatose abdominal organs with distal part of VPS is a rare complication which is most likely a consequence of a shunt infection and of an immunological reaction that took place during the process of localizing an infection.