PMC9451515_01
Abdominal CT scan (coronal view) showing (A) thrombosis of the infrarenal, suprarenal and hepatic segments of the inferior vena cava (red arrows) and (B) total occlusion of all hepatic veins but a patent portal vein (red arrows)
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An abdominal CT scan showed the iliac veins and the infrarenal, suprarenal, hepatic and suprahepatic segments of the IVC were occluded right up to the right atrium junction (Fig. 1A). The portal vein was patent, but filling was absent in the hepatic veins, and drainage occurred via the azygos system and collaterals (Fig. 1B).
Findings on physical examination showed ascites, abdominal distension, and diffuse subcutaneous venous collaterals around the umbilicus, possibly due to liver insufficiency
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Physical examination revealed ascites, diffuse superficial venous collaterals around the umbilicus (Fig. 2), and several testicular scars.
(A) Standard posteroanterior (PA) radiograph showing left pleural effusion and pulmonary infiltrate; (B) CT scan of the thorax revealing consolidation of the lingula and bilateral pleural effusion
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After the first cycle of anti-TNF treatment, the patient developed hospital-acquired pneumonia with bilateral parapneumonic effusion, and piperacillin/tazobactam was administered (Fig. 3).
(A) Pneumothorax developed as an iatrogenic complication after pigtail catheter insertion. (B) Persistent pneumothorax was observed following chest tube insertion, and trapped lung and bronchopleural fistula were diagnosed. (C) Specimen obtained following video-assisted thoracoscopic surgery with decortication
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Pneumothorax developed as an iatrogenic complication after the parapneumonic effusion was sampled with a pigtail catheter (Fig. 4A). The lung did not re-expand following chest tube insertion, and persistent pneumothorax was observed (Fig. 4B). Management consisted of decortication and fistula repair; Aspergillus fumigatus was isolated from the decortication material (Fig. 4C).
(A) Brain MRI shows juxtacortical lesions, one 8 mm in diameter, with hemosiderin rings in the right cerebellar and anterior temporal regions. (B) The patient's symptoms and ascites resolved following a dramatic response to infliximab
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Hemosiderin rings in the lesions' periphery with limited diffusion and peripheral enhancement were observed (Fig. 5A). For the past year he has been attending regular rheumatology outpatient clinics without disease relapse (Fig. 5B).