Pulmonary artery pseudoaneurysms are uncommon and can cause severe, life-threatening haemoptysis. We present a case of a 74-year-old gentleman who was being treated for COVID-19 pneumonitis and a concomitant segmental pulmonary artery thrombus with conventional treatment and anticoagulation. The patient developed significant haemoptysis during admission. A repeat computed tomography pulmonary angiogram revealed an 8 mm left upper lobe pulmonary artery pseudoaneurysm. Anticoagulation was withheld and the pseudoaneurysm was successfully treated with endovascular embolisation with an Amplatzer® IV plug, leading to resolution of the haemoptysis. To our knowledge this is the first case of a pulmonary artery pseudoaneurysm secondary to COVID-19.
Background The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in fewer emergency presentations of many acute medical and surgical conditions. The purpose of this study was to assess the severity of disease at presentation and quantify the change in number of presentations during this period. Methods This retrospective study includes all patients diagnosed with acute diverticulitis on abdominopelvic computerised tomography (CT) between March 1, 2020 and June 30, 2020, compared to the same period in 2019. Follow up scans on the index admission were excluded. Hinchey grade was assessed for all CT scans. Inflammatory markers were analysed, along with outcome measures including length of stay and mortality. Results Acute diverticulitis was diagnosed in 52 CT scans in the acute pandemic period – a decrease of 51.4%. Average age at presentation was unchanged (63.3 ± 14.3 vs. 62.8 ± 13.8, P = .848). The number of Hinchey II, III and IV presentations were significantly higher in the acute pandemic period (28.8% vs. 11.2%, P = .005) and significantly more emergency operations were carried out (7.69% vs. .93%, P = .04). Mortality was not significantly increased, nor were serum levels of C-reactive protein, white cell count and lactate. Discussion During the COVID-19 pandemic, fewer patients presented and were diagnosed with acute diverticulitis. A significantly greater proportion presented at a more advanced stage and required emergency surgery, suggesting late presentation. Our findings support the need for maintaining acute surgical services and the provision of early radiological and surgical input in patients presenting with signs and symptoms of acute diverticulitis in future pandemics.
Superior ophthalmic vein thrombosis is a very rare condition, known to have a profound negative impact on vision and eye movement function and is usually associated with orbital infections, inflammation, tumors or carotid cavernous fistulae. There is an increased risk of arterial and venous thrombosis associated with COVID-19, the presence of which is related to a significantly increased risk of mortality. We report an index case of superior ophthalmic vein thrombosis in a 61-year-old male patient who was diagnosed with COVID-19 pneumonitis and a concomitant saddle pulmonary embolus. He was swiftly treated with low molecular weight heparin which led to the resolution of the thrombosis within 3 weeks. This case highlights the importance of considering this entity in the context of COVID-19 as well as providing prompt treatment to reduce the risk of complications.
How to cite this article
: Srinivasan A, Naidu V, Dhivya P. Arterial Line Placement Using Modified Seldinger Technique: A Novel Approach. Indian J Crit Care Med 2023;27(7):515–516.
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