Intramural duodenal hematoma (IDH) is a relatively rare condition typically managed conservatively. Although IDH frequently causes duodenal obstruction, the development of acute pancreatitis (AP) due to ampulla of Vater compression is uncommon. We report the case of non-traumatic IDH in a 90-year-old man receiving anticoagulant therapy, complicated by AP and persistent duodenal obstruction. Imaging studies revealed an intramural hematoma in the descending portion of the duodenum, without evidence of active bleeding. Despite five weeks of conservative management, the obstruction did not improve, and progressive malnutrition was a concern. Therefore, a gastrojejunostomy was performed without hematoma evacuation. The postoperative course was uneventful, and subsequent imaging confirmed spontaneous resolution of the hematoma. This case highlights that IDH can be associated with AP and that gastrojejunostomy without hematoma removal may be a viable surgical option in selected cases with persistent obstruction.
Abstract Calcaneal tuberosity avulsion fractures are rare injuries predominantly occurring in elderly women with osteoporosis. Although lag screw fixation has been widely employed, fixation failure remains a significant concern in osteoporotic bone, and no consensus on the optimal fixation method has been established. A 69-year-old woman sustained a right heel injury. Radiographs and computed tomography revealed a Beavis type I calcaneal tuberosity avulsion fracture. Osteosynthesis was performed using cannulated cancellous screw fixation combined with a knotless suture bridge (SpeedBridge). Weight-bearing was initiated at three weeks with an Achilles tendon boot, and the brace was removed at seven weeks. In Beavis type I fractures, reliable fixation with screws alone is difficult. The knotless suture bridge provides vertical compression force for fragment stabilization while eliminating knot prominence, potentially reducing soft-tissue complications. This dual fixation technique may represent a useful option for these fractures in osteoporotic patients.
Transient perivascular inflammation of the carotid artery (TIPIC) syndrome, formerly known as carotidynia, is a rare and benign condition characterized by acute unilateral neck pain and perivascular inflammation in the absence of arterial dissection or stenosis. We describe a woman in her 70s who presented with a 4-day history of right-sided neck and pharyngeal pain. Ultrasonography of the neck revealed eccentric wall thickening of the right common carotid artery with surrounding hypoechoic soft tissue, but without luminal narrowing. Because of her history of asthma, unenhanced magnetic resonance imaging was performed instead of contrast-enhanced computed tomography. Magnetic resonance angiography showed no stenosis or dissection. Fat-suppressed T2-weighted imaging demonstrated high signal intensity around the right common carotid artery, consistent with perivascular oedema, which was not present on imaging performed 7 months earlier; diffusion-weighted imaging revealed no restricted diffusion, supporting an inflammatory rather than ischaemic process. TIPIC syndrome was diagnosed based on her clinical symptoms and imaging findings. She was managed conservatively, and her symptoms resolved spontaneously within 1 week. Follow-up ultrasonography demonstrated complete resolution of the vascular wall thickening and perivascular changes. This case highlights the characteristic imaging features of TIPIC syndrome and emphasizes the importance of considering this entity in patients with unilateral neck pain.
This study assessed the association of pathological kidney lesions with cardiovascular events in biopsy-proven diabetic kidney disease (DKD) with type 2 diabetes. This multicenter, retrospective study involved 244 patients with no previous cardiovascular events before biopsy, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 at biopsy (baseline), and ≥ 1 year of observation after biopsy. The outcomes were the first occurrence of cardiovascular events (cardiovascular death, non-fatal myocardial infarction, coronary intervention, or non-fatal stroke), and non-cardiovascular deaths before cardiovascular events were considered competing events. The association between the severity of each pathological lesion and cardiovascular events was investigated. During follow-up (median: 6.4 years), 43 patients experienced cardiovascular events. The baseline clinical characteristics did not differ according to cardiovascular events. The cumulative incidence of cardiovascular events was higher in patients with mesangiolysis, global glomerulosclerosis ≥ 50
