Introduction Vesico-peritoneal fistula (VPF) is a rare bladder-to-peritoneal communication that may present with urinary leakage, pelvic inflammation, or sepsis and can overlap clinically and radiologically with gynecologic infection. Case Presentation A 67-year-old woman, postmenopausal, was referred with persistent fever and lower abdominal pain after unsuccessful treatment for presumed tubo-ovarian abscess (TOA). CT showed a 46 × 32 mm complex right pelvic collection adjacent to the bladder, and blood cultures grew Pseudomonas aeruginosa . Despite broad-spectrum antibiotics, she deteriorated clinically. At laparotomy, 150 mL of clear pelvic fluid had a creatinine concentration of 65 mg/dL versus serum 0.5 mg/dL, confirming urinary leakage. A bladder-dome defect with a 2-cm base and an approximately 1-cm tract communicating with the peritoneal cavity was identified and repaired. TAH-BSO was performed for pelvic source control; histopathology demonstrated acute inflammation with abscess formation involving one fallopian tube and ovary. The patient improved rapidly postoperatively. Conclusion VPF and TOA may coexist, creating substantial diagnostic uncertainty. Integrating imaging, pelvic-fluid biochemistry, operative findings, and histopathology is essential for accurate diagnosis and individualized source control.
Vascular complications after kidney transplantation are uncommon but may threaten graft survival. Pseudoaneurysms involving the iliac vessels can present years after transplantation with nonspecific symptoms, making early diagnosis essential. We report a 32-year-old woman who developed a delayed, partially thrombosed pseudoaneurysm of the right internal iliac artery four years after kidney transplantation. She presented with right groin pain, severe worsening hypertension (170/150 mmHg), oliguria, and an increase in serum creatinine from a post-transplant baseline of approximately 1.0 mg/dL to 2.8 mg/dL. During hospitalization, her hypertension was difficult to control despite losartan and Valzamikis. Following covered stent placement, blood pressure progressively normalized, and antihypertensive medications were discontinued. Renal function also improved, with serum creatinine decreasing to 1.4 mg/dL two days after the intervention, accompanied by recovery of urine output to approximately 2.5 L/day. Doppler ultrasonography and CT angiography confirmed the diagnosis and guided treatment planning. The patient underwent successful endovascular covered stent placement, resulting in exclusion of the pseudoaneurysm and preservation of renal graft perfusion. This case highlights the importance of considering delayed vascular complications in transplant recipients. It also demonstrates the feasibility of covered stent placement for exclusion of a delayed internal iliac artery pseudoaneurysm while preserving renal graft perfusion, with confirmed stent patency and preserved graft perfusion at approximately one-year follow-up.
Subclinical hypothyroidism (SCH), defined by an elevated serum thyroid-stimulating hormone (TSH) concentration with a normal free thyroxine (FT4) concentration, has been associated with adverse cardiovascular remodeling and an increased risk of heart failure. We report the case of a 35-year-old woman from Tanzania with a five-year history of progressive multinodular goiter and hypothyroid symptoms who presented with heart failure with reduced ejection fraction (HFrEF), severe hypertension, and echocardiographic features of a dilated cardiomyopathic phenotype, including a left ventricular ejection fraction (LVEF) of 40%. She was treated with gradually titrated levothyroxine in conjunction with guideline-directed medical therapy for HFrEF and antihypertensive treatment. During 12 months of follow-up, she achieved biochemical euthyroidism, complete resolution of hypothyroid and heart failure symptoms, restoration of sinus rhythm, and objective reverse left ventricular remodeling with recovery of LVEF from 40% to 60%, fulfilling contemporary criteria for heart failure with improved ejection fraction. Although the relative contribution of thyroid hormone replacement, blood pressure control, and heart failure therapy cannot be determined, this case highlights the potential role of SCH as a reversible contributor to left ventricular systolic dysfunction and emphasizes the importance of early recognition, comprehensive cardiovascular evaluation, and multidisciplinary management in patients presenting with concomitant thyroid and cardiac disease.
Introduction The major arterial branches of the aortic arch supply blood to the head, neck, and upper extremities. Typically, the brachiocephalic trunk is the first branch, followed by the left common carotid artery and then the left subclavian artery. The current cadaveric case report describes a variation with an aberrant right subclavian artery (ARSA) and a bicarotid trunk (BCT) with a nonrecurrent right inferior laryngeal nerve. Case Presentation The anterior chest wall of the donor body of a 78-year-old woman was dissected to evaluate the branches of the aortic arch. An ARSA branched from the posterior surface of the aortic arch and coursed to the right, posterior to the trachea and esophagus. A BCT arose from the superior surface and bifurcated into right and left common carotid arteries. A nonrecurrent right inferior laryngeal nerve coursed directly to the larynx from the cervical portion of the right vagus nerve. Structures of interest were measured using a vernier dial caliper. Conclusion The presence of an ARSA with a BCT is clinically important because it increases risk for dysphagia and thoracic aortic disease. Better understanding of the characteristics and prevalence of aortic arch branching variations is important for surgeons and radiologists who may encounter an ARSA or BCT in practice. Similarly, a nonrecurrent right inferior laryngeal nerve may be injured during neck procedures. Given these anatomic variants are rare, more studies are necessary to characterize the course and anatomic relationships of these structures.
Irradiated wounds are notorious for poor healing. There are limited options for those who cannot undergo free flap surgeries. NovoSorb ® Biodegradable Temporizing Matrix (BTM) is a synthetic bilayer dermal matrix. We present a case of a scalp squamous cell carcinoma (SCC) arising from congenital sebaceous nevus that was initially managed with irradiation. Upon presentation, the wound was ulcerated and infected. BTM was successfully applied and eventually grafted without the patient needing to undergo a more complex surgery.
