RESUMO
Background: The development of Holmes tremor (HT) after a direct lesion of the midbrain has rarely been reported in the literature, although several etiologies have been linked with HT, such as stroke, brainstem tumors, multiple sclerosis, head trauma, or infections. Phenomenology Shown: A 31-year-old male, having been stabbed in the right eye, presented with a rest and action tremor in the left upper limb associated with left hemiparesis with corresponding post-contrast volumetric magnetic resonance imaging T1 with sagittal oblique reformation showing the knife trajectory reaching the right midbrain. Educational Value: Despite the rarity of the etiology of HT in the present case, clinicians working with persons with brain injuries should be aware of this type of situation.
Assuntos
Mesencéfalo/lesões , Tremor/etiologia , Ferimentos Perfurantes/complicações , Adulto , Traumatismos Oculares/complicações , Traumatismos Oculares/diagnóstico por imagem , Traumatismos Oculares/fisiopatologia , Humanos , Masculino , Mesencéfalo/diagnóstico por imagem , Mesencéfalo/fisiopatologia , Paresia/diagnóstico por imagem , Paresia/etiologia , Paresia/fisiopatologia , Tremor/diagnóstico por imagem , Tremor/tratamento farmacológico , Tremor/fisiopatologia , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/fisiopatologiaRESUMO
OBJECTIVE: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. METHOD: Comparison between the findings of different methods: autopsy and postmortem computed tomography. RESULTS: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. CONCLUSIONS: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations.
Assuntos
Autopsia/métodos , Homicídio , Tomografia Computadorizada Multidetectores/métodos , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/patologia , Adulto , Estudos de Viabilidade , Medicina Legal/métodos , Humanos , Imageamento Tridimensional/métodos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/patologiaRESUMO
The presence of retained foreign bodies in the maxillofacial region as a consequence of penetrating injuries from knives is poorly documented in the scientific literature. This manuscript reports the case of a 30-year-old Caucasian with a knife blade lodged in the maxillofacial skeleton. Following clinical and radiographic exams, it was determined that the object had penetrated through the left nostril and nasal septum, in the direction of the right maxillary sinus, and remained impacted without causing injury to important anatomical structures. After systemic assessment and determination of the exact location of the knife blade, the object was removed in an outpatient setting under local anaesthesia. This manuscript aims to report a rare case of a transfacial penetrating injury involving a knife blade that was removed in an outpatient setting while also discussing the proper conduct and treatment options for similar cases in the context of a brief literature review.
Assuntos
Anestesia Local , Traumatismos Faciais/cirurgia , Corpos Estranhos/cirurgia , Seio Maxilar/lesões , Ferimentos Perfurantes/cirurgia , Adulto , Traumatismos Faciais/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Radiografia , Síndrome , Ferimentos Perfurantes/diagnóstico por imagemRESUMO
We present a patient with an accidental self-inflicted stab wound to his right thigh in whom three-dimensional (3D) ultrasound was able to find two communications between the right femoral artery and the femoral vein, in contrast to two-dimensional (2D) peripheral ultrasound which could find only one communication between them, thereby showing an incremental value of 3D over 2D ultrasound.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Veia Femoral/diagnóstico por imagem , Imageamento Tridimensional , Coxa da Perna/irrigação sanguínea , Ultrassonografia/métodos , Ferimentos Perfurantes/diagnóstico por imagem , Acidentes de Trabalho , Adulto , Fístula Arteriovenosa/cirurgia , Artéria Femoral/cirurgia , Veia Femoral/cirurgia , Humanos , Masculino , Coxa da Perna/diagnóstico por imagem , Coxa da Perna/lesões , Ferimentos Perfurantes/cirurgiaRESUMO
PURPOSE: To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. MATERIALS AND METHODS: The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). RESULTS: Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. CONCLUSIONS: In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases.
Assuntos
Lesões das Artérias Carótidas/terapia , Procedimentos Endovasculares , Lesões do Sistema Vascular/terapia , Ferimentos por Arma de Fogo/terapia , Ferimentos Perfurantes/terapia , Adolescente , Adulto , Dissecção Aórtica/terapia , Falso Aneurisma/terapia , Fístula Arteriovenosa/terapia , Oclusão com Balão , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/mortalidade , Embolização Terapêutica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/mortalidade , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/mortalidade , Adulto JovemRESUMO
PURPOSE: The aim of this paper is to report a case of knife aggression with a spontaneous migration of a tip blade lodged in deep tissues 6 months after trauma. PATIENT: An 18-year-old woman that was a victim of impalement injury with a knife by her boyfriend on the glabella region with a blade fracture and tip lodging into middle-third facial tissues. RESULTS: After conservative management of a knife tip, a spontaneous migration occurred with its exposition on the zygomatic area, possibly due to a functional treatment to improve mouth opening. CONCLUSION: Fracture of knife blade with a tip retained deeply into the tissues is considered foreign body, and its removal must be considered. Nevertheless, the basis for this removal takes account the cost-benefit ratio, and if a conservative management was chosen, the clinical and radiological accompanying is mandatory to prevent and to treat its possible complications.
Assuntos
Traumatismos Faciais/complicações , Migração de Corpo Estranho/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Órbita/lesões , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações , Zigoma/diagnóstico por imagem , Adolescente , Cegueira/diagnóstico por imagem , Cegueira/etiologia , Brasil , Traumatismos Faciais/diagnóstico por imagem , Traumatismos Faciais/cirurgia , Feminino , Migração de Corpo Estranho/cirurgia , Humanos , Órbita/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Zigoma/cirurgiaRESUMO
BACKGROUND: toracostomy in thoracic trauma is a good opportunity for the digital exploration of pleural cavity. OBJECTIVES: To evaluate the utility of digital exploration during chest tube insertion in thoracic trauma. SETTING: Hospital de Urgencias. Córdoba. PATIENTS AND METHODS: patients with blunt and penetrating chest trauma by stab wound, who need chest tube insertion and treated by only one surgeon, were evaluated from July 10 to December 31st 2000. Previously to the thoracostomy with 24 french tube in 5th intercostal space, at the affected side, a digital exploration of pleural cavity was done, attempting to find intrathoracic injuries. RESULTS: in a six months period, 36 thoracostomy tubes were placed, due thoracic trauma (11 blunt trauma and 25 penetrating, by stab wound). Three patients had positive findings in the digital exploration, which forced to do another diagnostic or therapeutic procedures. CONCLUSIONS: digital thoracotomy is not considered a formal procedure, but as a part of a technique, in which, the previous exploration with the finger before chest tube insertion, allows to reach a diagnosis of the pleural space situation, to confirm suspicions, to modify a conduct, and to avoid greater morbidity to patients.
Assuntos
Tubos Torácicos , Drenagem/métodos , Palpação/métodos , Derrame Pleural/terapia , Traumatismos Torácicos/diagnóstico por imagem , Toracostomia/métodos , Humanos , Cavidade Pleural/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Estudos Prospectivos , Intensificação de Imagem Radiográfica , Radiografia Torácica/métodos , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgiaRESUMO
Antecedentes: la toracostomIa para el drenaje pleural en el trauma de tórax es una inmejorable oportunidad para la exploración digital de la cavidad. Objetivos: evaluar la utilidad de la exploración digital en oportunidad del avenamiento pleural en trauma torácico. Lugar de realización: Hospital de Urgencias de Córdoba. Diseño: estudio prospectivo. Pacientes y métodos: se evaluaron los pacientes con trauma cerrado o penetrante de tórax por herida de arma blanca con indicación de avenamiento pleural y que fueron asistidos por un solo operador, entre ello de julio hasta el30 de diciembre de 2000. Previo a la toracostomía con tubo de 24 french al nivel del 5to espacio intercostal del lado afectado, se efectuó la exploración digital, intentando ubicar lesiones en la cavidad pleural. Resultados: se realizaron en el periodo de 6 meses 36 avenamientos pleurales, 11 por traumatismo cerrado de tórax y 25 por herida de arma blanca. Tres pacientes tuvieron hallazgos positivos en la exploración digital lo que motivo a realizar nuevos procedimientos diagnósticos o terapéuticos. Conclusión: La toracostomía digital no es considerada habitualmente como una operación formal, sino parte de una técnica, en la cual, la inserción del dedo previo a la colocación del tubo de toracostomIa, nos permite acceder a un diagnóstico de situación en el espacio pleural, confirmar una sospecha, modificar la conducta a seguir y evitar mayor morbilidad para el paciente.(AU)
Background: thoracostomy in thoracic trauma is a good opportunity for the digital exploration of pleural cavity. Objectives: To evaluate the utility of digital exploration during chest tube insertion in thoracic trauma. Setting: Hospital de Urgencias. Córdoba. Patients and methods: patients with blunt and penetrating chest trauma by stab wound, who need chest tube insertion and treated by only one surgeon, were evaluated from July 10 to December 31st 2000. Previously to the thoracostomy with 24 French tube in 5th intercostals space, at the affected side, a digital exploration of pleural cavity was done, attempting to find intrathoracic injuries. Results: in a six months period, 36 thoracostomy tubes were placed, due thoracic trauma (11 blunt trauma and 25 penetrating. by stab wound). Three patients had positive findings in the digital exploration, which forced to do another diagnostic or therapeutic procedures...(AU)
Assuntos
Humanos , Traumatismos Torácicos/diagnóstico por imagem , Derrame Pleural/terapia , Toracostomia/métodos , Fraturas Fechadas/diagnóstico por imagem , Drenagem/métodos , Tubos Torácicos , Traumatismos Torácicos/cirurgia , Derrame Pleural/diagnóstico por imagem , Fraturas Fechadas/cirurgia , Cavidade Pleural/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Radiografia Torácica/métodosRESUMO
PURPOSE: To determine the usefulness of different radiological methods in the diagnoses of wooden foreign bodies (FB). METHODS: Eleven adult chickens were used. Each thigh received a puncture wound and in one of them a wooden splinter was introduced and left in place while in the contralateral it was introduced and removed (control group). After 7 days the animals where killed and the legs removed to be analyzed with conventional radiography (CR), ultrasonography (US), magnetic resonance and computed tomography. The results were viewed by 2 independent senior radiologists. RESULTS: Sensitivity was: CR--13.6%; US--63.6%; MR--59.1%; and CT--72.7%, with specificity of 100%, 100%, 95.5%, and 95.5%, respectively. The positive predictive value for CR and US was 100%, 95% for CT 95% and 93.8% for MR. CT had a negative predictive value of 78.3%, while US, MR, and CR had 73.7%, 70.1%, and 53.7%, respectively. The accuracy for CT was 84.1%, followed by US--81.8%, RM--77.3%, and CR--56.8%. Inflammatory reaction was histologically demonstrated in all thighs containing FB. CONCLUSION: CR showed a poor performance to detect wooden FB in chickens, while US and CT seem to be the best option, followed by RM.
Assuntos
Corpos Estranhos/diagnóstico , Modelos Animais , Coxa da Perna/lesões , Madeira , Ferimentos Perfurantes/diagnóstico , Animais , Galinhas , Corpos Estranhos/diagnóstico por imagem , Reação a Corpo Estranho/patologia , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/diagnóstico por imagem , Estatísticas não Paramétricas , Coxa da Perna/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Ferimentos Perfurantes/diagnóstico por imagemRESUMO
PURPOSE: To evaluate the usefulness of computed tomography (CT) and ultrasonography (US) for the initial assessment of penetrating abdominal stab wounds in patients who presented to the emergency department without indication for immediate laparotomy. MATERIALS AND METHODS: During 36 months, 32 patients with a penetrating stab wound to the abdomen were examined with serial US (at admission and 12 hours later) and helical CT, with contrast material administered orally, intravenously, and rectally. Presence of hemoperitoneum and integrity of solid and hollow viscera were evaluated with both methods. Sonograms were interpreted by the radiologist who performed the examination, and CT images were independently evaluated by two radiologists. Findings of both techniques were compared with clinical outcome and/or surgical findings. RESULTS: One (3.1%) of 32 patients required surgery: Surgical findings were massive hemoperitoneum and an extensive hepatic laceration. Both US and CT depicted these abnormalities. Thirty-one (96.9%) patients were treated conservatively, without surgery, and remained asymptomatic during 28 days of clinical follow-up after discharge from the hospital. US and/or CT showed intraperitoneal abnormalities in 21 of these patients. In 11 patients, both methods showed no evidence of visceral injury or hemoperitoneum, and none of these patients required surgery. CONCLUSION: Serial US and CT help guide treatment for stable patients with penetrating stab injuries to the abdomen.
Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico por imagem , Traumatismos Abdominais/terapia , Adolescente , Adulto , Meios de Contraste/administração & dosagem , Emergências , Feminino , Seguimentos , Hemoperitônio/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Ferimentos Perfurantes/terapiaRESUMO
The authors report a case of thoracic spinal cord stab injury with neurologic impairment that was treated surgically after injury. A literature review and case analysis indicate that surgical extraction of foreign bodies retained within the spinal canal is indicated to avoid infection, delayed myelopathy, and neurologic loss. The amount of motor and functional recovery for incomplete injuries after spinal cord stab wound can be strikingly good despite pathologic changes to severely damaged areas, and removal of retained intraspinal metallic fragment can improve this neurologic outcome. Open removal of the knife seems preferable to avoid bleeding and infection.
Assuntos
Traumatismos da Medula Espinal/cirurgia , Ferimentos Perfurantes/cirurgia , Adulto , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Sistema Nervoso/fisiopatologia , Paraplegia/etiologia , Período Pós-Operatório , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagemRESUMO
BACKGROUND: Neck perforations by foreign bodies are uncommon. The surgical approach depends on the extension of visceral wounds and the development of cervical or mediastinal infection. PURPOSE: The objective of this paper is to report a neck perforation trauma by a piece of wire, with associated laryngeal and hypopharyngeal wounds and extensive cervico-mediastinal emphysema. Anatomic and clinical correlations are discussed, as well as the management of the case. MATERIAL AND METHODS: A 28-year-old male patient suffered a perforating trauma in his neck by a piece of wire. This foreign body was laid in the retropharyngeal space, at the level of the sixth cervical vertebra, after perforating the larynx and hypopharynx. There are no similar cases previously reported. The imaging tests are presented. Despite the potential severity of the lesions, the patient had a favorable outcome, and no surgical approach was necessary. CONCLUSIONS: This case illustrates, by the imaging tests, the complex anatomy of the cervical fasciae and deep neck spaces, and confirms the possibility of conservative management in a great number of laryngeal and hypopharyngeal traumatic lesions.
Assuntos
Vértebras Cervicais/lesões , Corpos Estranhos/complicações , Ferimentos Perfurantes/complicações , Adulto , Vértebras Cervicais/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/terapiaRESUMO
Laparoscopy in trauma is useful in diagnosing but limited in treatment. We report the case of a patient with a stab wound in the right upper quadrant and gallbladder perforation who underwent diagnostic and laparoscopic treatment. The therapeutic opportunities in abdominal trauma are scant for laparoscopic surgery; the isolated gallbladder injury is one of them, it being possible to apply the usefulness of this less invasive technique in this case.