查看更多>>摘要：? 2021Delayed small bowel obstruction is a rare complication of blunt abdominal trauma and is typically diagnosed by computed tomography (CT) imaging. A 22-year-old man initially presented to Emergency Department 12 h after a motor vehicle collision and CT imaging was unrevealing for any intra-abdominal injury. The patient returned 4 days later with new abdominal pain, vomiting, and watery stool. His exam demonstrated only suprapubic tenderness without guarding. A point-of-care ultrasound was performed by the emergency physician given recent abdominal trauma which showed dilated loop of small bowel with a “to-and-fro” sign raising the concern for small bowel obstruction. A repeat CT scan of the abdomen/pelvis confirmed the presence of small bowel obstruction with a transition point at the distal ileum caused by focal mesenteric edema. This case highlights a rare complication of blunt abdominal trauma that emergency physicians should consider in their differential diagnosis and not be misled by recent negative imaging. Additionally, the case illustrates the role of POCUS in evaluating not only intra-abdominal free fluid but also alternative traumatic abdominal pathology.
查看更多>>摘要：? 2021 Elsevier Inc.Myocardial bridging (MB) is a phenomenon that occurs when coronary arteries course through myocardial tissue rather than, as is normal, on the surface of the myocardium. Although often asymptomatic, contraction of the myocardium in the presence of a myocardial bridge can sometimes occlude the lumen of coronary arteries that penetrate the myocardium, resulting in symptoms, signs, and electrocardiographic changes indistinguishable from those associated with acute coronary syndromes (ACS) caused by intraluminal narrowing of coronary arteries or coronary artery plaque rupture. In this monograph, we present the case of a 45-year-old man who presented to the emergency department with typical chest pain accompanied by electrocardiographic changes consistent with acute occlusion of the left anterior descending artery. During percutaneous coronary intervention, fluoroscopically–obtained cine image loops revealed evidence of dynamic coronary artery narrowing due to myocardial bridging. There was no evidence of static coronary artery occlusion. Myocardial bridging is typically managed medically when symptomatic, although refractory cases may ultimately require invasive or surgical intervention. Given that emergency physicians are frequently the first providers to evaluate patients with acute coronary syndromes, myocardial bridging as an etiology for ACS is a clinical entity of which emergency physicians should be aware.
查看更多>>摘要：? 2021The authors regret an error in the affiliations. Pragati Shrestha is affiliated with Program in Public Health and Department of Radiology, Stony Brook University. Jessica Koos is affiliated with Health Sciences Library, Stony Brook University. The authors would like to apologise for any inconvenience caused.
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