Venous air embolism (VAE) is a known neurosurgical complication classically and most frequently occurring in patients undergoing posterior cranial fossa or cervical spine surgery in a sitting or semi-sitting position. The authors present a case of VAE that occurred during posterior cervical spine surgery in a patient in the prone position, a rare intraoperative complication. The patient was a 65-year-old man who was undergoing a C1–2 fusion for a nonunion of a Type II dens fracture and developed a VAE. While VAE in the prone position is uncommon, it is a neurosurgical complication that may have significant clinical implications both intraoperatively and postoperatively. The aim of this review is 2-fold: 1) to improve the general knowledge of this complication among surgeons and anesthesiologists who may not otherwise suspect air embolism in patients positioned prone for posterior cervical spine operations, and 2) to formulate preventive measures as well as a plan for prompt diagnosis and treatment should this complication occur.
Retroperitoneal haematoma, a rare complication of transinguinal orchidectomy, may be clinically silent. The discovery of a mass on staging-computed tomography (CT) is often the first and only sign of its presence. This may be misinterpreted as representing involved lymph nodes. Recognition of this benign complication is vital if the patient is to be correctly staged.
Correct management of testicular tumours depends on precise determination of the extent of dissemination, and to that end, most patients who are found to have a malignant testicular mass are staged by CT. These tumours have a predilection for metastasis to lungs and lymph nodes, hence most patients receive a CT examination of the thorax as well as the abdomen and pelvis. Abnormal masses discovered in the pelvic or para-aortic lymph node chain are usually the result of lymph node enlargement.
We present three cases where a retroperitoneal haematoma, consequent upon orchidectomy, mimicked lymph node enlargement. The literature contains only single previous report (Kullmann & Lien, 1987).
A 33-year-old man with a past medical history of bilateral orchidopexy at the age of 12 years, presented with a 4 month history of painful swelling of the left testis. Clinical examination indicated the presence of a testicular neoplasm and orchidectomy was performed through the previous incision. Histological examination of the resected specimen confirmed seminoma. Several days after surgery he was noted to be clinically anaemic and his haemoglobin had fallen from 14.2 g/dl pre-operatively to 7.2 g/dl. Accordingly he was transfused and further haemoglobin estimations showed no further diminution.
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