a year in review presentation

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Annual Review

It seems that you like this template, annual review presentation, free google slides theme, powerpoint template, and canva presentation template.

An annual review can be quite useful for companies, as they summarize all the accomplishments and goals met during last year. In this template we've focused on a modern and professional look. All the backgrounds contain photos of a city at night and the layouts are optimized for presenting data related to key events, employee reports, growth areas, product sales and the like. Edit the graphs too, since you'll be needing to show numbers and percentages!

Features of this template

• 100% editable and easy to modify
• 31 different slides to impress your audience
• Contains easy-to-edit graphics such as graphs, maps, tables, timelines and mockups
• Includes 500+ icons and Flaticon’s extension for customizing your slides
• Designed to be used in Google Slides, Canva, and Microsoft PowerPoint
• 16:9 widescreen format suitable for all types of screens
• Includes information about fonts, colors, and credits of the free resources used

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Year-End Review Presentation

When the year comes to an end, it’s time to reflect on what worked for your business and what didn’t. A year-end review presentation can help you find solutions for any issues, and implement a strategy for company growth moving forward. Your end of year review presentation is a vital tool for presenting your findings to investors, upper management, or employees during all-hands meetings. 

Use our year-end review presentation template to:

• Summarize how the company performed over the past year
• Set goals for the future
• Outline a strategy to meet future goals

Create a Memorable Year-End Review

Slides in your year-end review should clearly and easily explain high-level information to your audience. Add visual interest to our end of year review template by using graphs, timelines, tables, charts, and sales funnels to present your data. Each of these graphics are easy to add to your template, and customizable, too. Examples of slides to include in your presentation are:

Pro Tips for Your Year-End Review Presentation

Before putting together your year-end review presentation, consider these important tips.

At the beginning of your year-end review presentation, include an overall summary of the company’s mission, values, culture, and so on. It’ll provide context for the rest of your slides.

Celebrating company successes not only boosts morale, it gives you valuable insight into strategies you might use for the coming year.

Your end of year review presentation should begin with a company overview, talk about what you accomplished in the past year, then outline your goals for the coming year.

Even if your team didn’t meet the goals as expected, you can count those as learning experiences. Use them to adjust your plans and goals for the future.

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Year In Review Template

What do you think of this template.

Product details

The Year In Review has become increasingly popular over the years as notable brands such as Spotify, Apple and Google highlight stats, trends, and even content unique to your own use of their product during the past year. The year in review does not have an exact formula, so it might look a little different for each brand or organization. 

The most simple description of the year in review is as an overview of the happenings, milestones, and data points from the past year which you want to celebrate, recognize and share with the outside world. 

The year in review is most often shared in a few different formats from the infographic, letter-style, multi-page report, video, or a combination of all four. 

The year in review will take a lot of planning and development — from brainstorming, research, copywriting, design and execution. Make sure you leverage all of this work into a well-planned year in review marketing campaign and maximize the way you distribute and message the content. 

Give yourself lots of time to plan and create the year in review. From the moment you kick off the planning, you should build out your complete campaign timeline focused on all the tasks, due dates, stakeholders, and resources needed to complete the project.

Pull together your team and start brainstorming all the content items that you may want to include in the year in review. Topics for your year in review should include accomplishments, milestones, and data points of interest related to the organization. The topics can cover both internal and external topics since the audience for the year in review is also the company employees in addition to customers, members, and the general public. 

On the launch date, you should send a year in review email to your customer database and post it to your social media channels. Issuu also makes it easy to embed your year in review, upgrading your website to align with this year-end campaign. Keep the campaign fresh and unique by using the various derivative assets you created to message different aspects of your year in review. 

This template can be used by analysts and economists when preparing a company’s annual performance report. You can provide detailed data on the company’s profits and revenues, the number of new customers or new markets.

This template can also be used by startups when preparing an annual report on the company’s work. You can submit data by the number of products sold or the number of new customers. Also, this template will be useful for company executives in preparation for a strategic session with shareholders.

Year In Review is a professional and modern template that contains four stylish and fully editable slides. You can change the type and size of the font, color and position of the infographic yourself. This template will be useful for project managers, startups, company executives, financial analysts. Year In Review template will complement your old presentations and will be a worthy addition to your collection of professional presentations.

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Year in Review Template

Celebrate achievements and reflect on experiences and learnings with the year-in-review template.

Trusted by 65M+ users and leading companies

About the Year in Review Template

As we navigate through the year, it's essential to reflect on the events, accomplishments, and experiences that have happened. The Year in Review template is a tool to capture, categorize, and communicate these moments, fostering a deeper understanding and appreciation of the year's journey.

What's a year-in-review template?

A Year in Review template is a structured visual representation that divides the year into twelve months. Each segment, corresponding to a month, provides a space for users to input highlights, notes, visuals, or any significant reminders from that time. Areas in the template can include:

Monthly frames : Clearly labeled sections for each month allow for organized input of events or experiences.

Asset library : A dedicated corner, like the one seen in the January example, provides a space for storing images, logos, or any other graphical assets that one might want to use throughout the year's review.

Colors and themes : The varying colors and designs can be tailored to represent each month's themes, moods, or significance.

How to use the year-in-review template

Editing : Easily click and edit each month's segment, adding text, images, or any other relevant content.

Expansion : Need more frames or spaces? Quickly expand the template with additional frames to accommodate more detailed reviews.

Incorporate artifacts : Any artifact or element present on the board can be effortlessly dragged and placed into the desired month.

Why should you use a year-in-review template?

Clarity and reflection : The template offers a clear snapshot of the year, enabling a concise reflection of the highs and lows.

Organized archiving : It systematically stores all memories, milestones, and significant events.

Collaborative tool : Multiple contributors can add their insights, creating a more holistic view of the year.

Versatility : It can be adapted for personal use, professional milestones, or project timelines.

Engaging presentation : Use the year recap template for presentations or discussions, providing a month-by-month walkthrough.

Is there a limit to how much I can customize the year recap template?

No. The template is fully customizable, allowing you to adjust it to suit your specific needs.

Can I share the filled-out template with others?

Of course! Sharing your review can provide valuable insights to colleagues, mentors, or any other interested parties.

Do I need any special skills to use the template?

Not at all. The template is designed to be intuitive and user-friendly, ensuring that anyone can dive in and start reflecting on their year.

Get started with this template right now.

Easter Egg Retrospective

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Annual business review presentation: The all-in-one guide

Learn to craft a compelling annual business review presentation that highlights your accomplishments, inspires stakeholders.

Raja Bothra

Building presentations

Welcome to the ultimate guide on creating an impactful annual business review presentation.

Whether you're a seasoned professional or new to the world of annual reviews, this guide will equip you with the expertise and tools to shine in your next presentation.

What is an annual business review?

An annual business review, often referred to as an annual review presentation, is a critical part of any successful enterprise's calendar. It's the moment to reflect on the past year's performance, set the stage for the upcoming year, and communicate your company's achievements, challenges, and goals to stakeholders. In essence, it's your opportunity to shine a spotlight on your company's journey.

Benefits of annual business review

An annual business review is not just a routine report; it's a comprehensive assessment that holds the power to shape the future of your company. This in-depth examination of your company's performance and goals over the past year offers a multitude of benefits that are vital for businesses of all sizes. Let's explore why the annual business review is an indispensable tool in your corporate arsenal:

1. Improved decision-making :

At its core, an annual business review provides a strategic overview of your company's journey over the past year. It unveils a treasure trove of insights, revealing the bright spots and the areas that need attention. These insights serve as guiding stars for informed decision-making. With this knowledge, you can chart a course towards more effective investments, refine marketing strategies, and fine-tune product development.

2. Enhanced communication :

Transparency is the cornerstone of trust. The annual report offers a unique opportunity to communicate openly with stakeholders. Whether it's investors, employees, or customers, sharing the results of the review demonstrates your commitment to accountability. It's a chance to build bridges, reinforce relationships, and showcase your company's dedication to transparency.

3. Competitive advantage :

In the ever-evolving business landscape, gaining a competitive edge is crucial. A yearly review acts as a spotlight, illuminating areas where you can enhance your performance. This might entail cost reduction strategies, elevating customer service, or innovating with new products or services. By leveraging the review's findings, you can carve out a distinctive place in your industry.

4. Increased employee engagement :

Your employees are the lifeblood of your organization, and their engagement is paramount. The yearly business review isn't just for stakeholders; it's an opportunity to engage your workforce. By sharing the review's results and inviting feedback, you empower your employees. You signal that their contributions matter and that they play an integral role in the company's success.

But that's not all. An annual business review also equips businesses to:

• Track progress towards long-term goals : It serves as a compass, helping you measure progress toward your long-term goals. It ensures that your company is on the right path to achieving its mission.
• Identify and address potential problems early on : By scrutinizing performance data, you can spot potential issues before they become crises. This proactive approach saves resources and minimizes disruptions.
• Develop strategies for growth and improvement : Armed with insights, you can craft robust strategies for growth and continuous improvement. It's your roadmap for the future.
• Improve communication and collaboration between different departments : The review's findings can foster collaboration among departments, breaking down silos and promoting a unified approach to achieving company objectives.
• Make better use of resources : It helps you optimize resource allocation by identifying areas where resources can be channeled more effectively.
• Increase overall business efficiency and profitability : Ultimately, the annual business review is a catalyst for enhancing overall business efficiency and profitability. It paves the way for a more successful and prosperous future.

The annual business review isn't just a routine corporate ritual; it's a powerhouse of insights and opportunities. It empowers you to make informed decisions, build trust with stakeholders, gain a competitive edge, and foster employee engagement. It's your compass, your crystal ball, and your key to unlocking a brighter future for your company.

Prepare yourself for the annual business review presentation

Now that we've grasped the significance of an annual business review, it's essential to equip yourself for the upcoming presentation. Here's your roadmap for a successful preparation:

1. Understand your audience

To deliver a presentation that truly resonates, start by understanding your audience inside out. What are their interests, needs, and expectations? What crucial information are they seeking? What are the burning questions on their minds? Knowing your audience is akin to having a treasure map, guiding you towards a successful presentation.

2. Gather your data

Data is the lifeblood of your annual business review presentation. It encompasses essential information about your company's performance, industry insights, and a comparative analysis of your competitors. Dive deep into the data ocean, extracting key metrics and insightful trends.

3. Set clear objectives

Before you craft a single slide, define your business presentations objectives with laser-like precision. Are you focusing on financial results, dissecting market analysis, or delving into the intricacies of company culture? Prezent offers templates for all aspects.

4. Craft a compelling narrative

Here's where the magic happens. Business storytelling is your secret weapon to captivate your audience. Instead of drowning your audience in numbers and statistics, weave a compelling narrative that paints a vivid picture of your company's journey. Share stories of triumph, resilience in the face of challenges, and the aspirations that drive your team. Presentation templates are meticulously designed to help you craft this narrative with finesse.

Specific steps for preparation:

• Review company goals : Begin by revisiting the company's objectives for the past year. What were the aspirations, and what was actually accomplished?
• Gather performance data : Collect comprehensive data on the company's performance. This encompasses financial metrics, sales figures, and customer satisfaction data.
• Competitive analysis : Gauge how your company stacks up against competitors in your industry. Highlight areas of strength and opportunities for improvement.
• Identify strengths and weaknesses : Delve into the heart of your company's performance to pinpoint strengths and weaknesses. Acknowledge achievements and areas that require enhancement.
• Chart a path forward : Develop a strategic plan for addressing weaknesses and steering the company toward improved performance in the coming year.

With this meticulous preparation, you're poised to deliver an annual business review presentation that informs, engages, and inspires. Your presentation is not just a report; it's the story of your company's journey, and you're the storyteller.

How to structure an effective annual business review presentation

To create a well-structured and effective annual business review presentation, follow these step-by-step guidelines:

1. Crafting an engaging introduction

• Begin by introducing yourself and your role within the company.
• Outline the key points of your presentation and emphasize their significance.
• Captivate your audience with a compelling story, a thought-provoking statistic, or a pertinent question to pique their interest.

2. Providing a comprehensive company overview

• Offer a succinct overview of your company, encompassing its history, products or services, and target market.
• Shine a light on the company's mission, vision, and core values to establish its identity.
• Illuminate what makes your company unique and distinguishes it from competitors.

3. Analyzing the past year's performance

• Delve into the company's financial performance review for the past year, delving into details such as revenue, profit, and expenses.
• Discuss sales results, encompassing unit sales, market share, and customer growth.
• Present customer satisfaction data and feedback to provide a holistic view of performance.

4. Comparative analysis with competitors

• Compare your company's performance to that of its competitors across key metrics including financial results, sales figures, and customer satisfaction.
• Identify areas where your company excels and pinpoint opportunities for improvement.

5. Evaluating strengths and weaknesses

• Embrace transparency by candidly acknowledging the company's weaknesses.
• Spotlight the company's strengths and elucidate how they contribute to achieving its objectives.
• Share the company's strategy for addressing identified weaknesses and leveraging its strengths.

6. Constructing a plan for progress

• Develop a concrete plan for addressing the company's weaknesses and enhancing its performance in the upcoming year.
• Specify the necessary resources required for successful plan implementation.
• Establish realistic goals and timelines to measure progress effectively.

7. Concluding with impact

• Recap the main takeaways from your presentation to reinforce key messages.
• Reiterate your call to action, clearly articulating what you expect from your audience.
• Extend gratitude to your audience for their valuable time and attention.

Throughout the presentation, remain attentive to your audience's needs and preferences. Tailor your content to address their specific interests and concerns.

Incorporating visuals is essential to enhance engagement and understanding. Utilize SWOT analysis, charts, graphs, and infographics to complement your presentation and make complex data more accessible and visually appealing.

Remember, a well-structured annual business review presentation not only informs but also inspires and guides stakeholders towards a future filled with growth and success.

Do's and don'ts on an annual business review presentation

Before we wrap up, here are some do's and don'ts to keep in mind:

• Be prepared : Thoroughly familiarize yourself with your audience, your data, and the content of your presentation. Confidence comes from preparation.
• Be clear and concise : Communicate with clarity and avoid using jargon or technical terms that may confuse your audience. Simplicity aids understanding.
• Be enthusiastic : Convey your passion for the topic and demonstrate your belief in the message you're delivering. Enthusiasm is contagious.
• Use visuals : Incorporate visuals like charts, graphs, and images to enhance engagement and facilitate comprehension.
• Tell a story : Weave your information into a narrative format. Stories are memorable and resonate with audiences.
• Be interactive : Encourage audience participation by asking questions and fostering engagement. Interaction fosters connection.
• End with a call to action : Clearly articulate what action you want your audience to take after hearing your presentation. A well-defined call to action drives results.

Don'ts:

• Don't be late : Respect your audience's time by being punctual. It sets a positive tone for the presentation.
• Avoid reading from slides : Reading directly from your slides can make your presentation monotonous and disengaging. Slides should support, not replace, your spoken words.
• Avoid extreme speaking paces : Find a comfortable speaking pace that your audience can easily follow. Avoid speaking too fast or too slow.
• Don't mumble or speak softly : Ensure your voice is clear and audible. Your audience should have no trouble understanding you.
• Use humor in moderation : While humor can be a valuable tool, excessive humor can detract from your message. Balance is key.
• Stay within allocated time : Practice your presentation to ensure it fits within the allotted time. Going over time can disrupt schedules and lose your audience's attention.

Following these do's and don'ts will help you deliver a compelling and effective Annual Business Review Presentation that engages your audience and leaves a lasting impression.

Summarizing key takeaways

• An annual business review presentation is a pivotal moment for reflecting on the past year's performance, setting goals, and communicating accomplishments, challenges, and objectives to stakeholders.
• Benefits of an annual business review include improved decision-making, enhanced communication, gaining a competitive advantage, and increasing employee engagement.
• The presentation equips businesses to track progress, address potential issues early, develop growth strategies, enhance inter-departmental communication, optimize resources, and increase efficiency and profitability.
• Preparation for the presentation involves understanding your audience, gathering data, setting clear objectives, and crafting a compelling narrative that tells the story of your company's journey.
• The structure of an effective end of year review presentation includes engaging introduction, company overview, past year's performance analysis, competitive analysis, strengths and weaknesses evaluation, a plan for progress, and a impactful conclusion.

1. What is the significance of using a PowerPoint template in an annual business review presentation?

A PowerPoint template is a valuable tool that allows you to create a professional and visually appealing presentation. It provides a beautiful design and modern, professional look that enhances the overall impression. By using a customizable PowerPoint template, you can easily customize your presentation to meet your specific needs, ensuring that it reflects your company's unique style and branding.

2. How can I effectively showcase quarterly and annual performance using PowerPoint presentation slides?

PowerPoint presentation slides are ideal for summarizing quarterly and annual performance data. You can use these slides to present key performance indicators, such as revenue, profit, and customer satisfaction, in a clear and organized manner. By selecting a PowerPoint template that provides slide themes and graphic elements, you can create a cohesive and visually engaging presentation that effectively communicates your company's performance throughout the year.

3. Can you explain the concept of "select 4 stages" in an annual business review presentation?

In an annual business review presentation, "select 4 stages" refers to the process of choosing and highlighting four key milestones or significant events that occurred during the year in review. These stages represent critical points in your company's journey and can be illustrated using PowerPoint slides. By customizing the slides with the number of divisions or graphic elements, you can visually depict these stages and provide a clear narrative of your company's growth and progress.

4. How can I engage team members in the annual business review presentation process?

Engaging team members in the annual business review presentation is crucial for fostering collaboration and ensuring that everyone feels involved. You can encourage participation by using an editable business review PowerPoint template that allows team members to contribute their insights and data. By refining the results together and setting a list of goals for the upcoming year, you create a sense of ownership and shared responsibility. This collaborative approach can lead to a more comprehensive and insightful presentation.

5. What are the benefits of using Google Slides themes and PowerPoint in an annual business review presentation?

Google Slides themes and PowerPoint are powerful tools for creating and delivering annual business review presentations. These platforms offer a wide range of templates and designs, making it easy to create beautiful and professional presentations. They also provide the flexibility to customize the content to meet your specific needs. Additionally, the seamless integration of graphics, charts, and text allows you to convey key information effectively. By leveraging the capabilities of Google Slides and PowerPoint, you can present a cohesive and engaging annual business review that showcases your company's growth and outlines the path for future growth moving forward.

Create your annual business review presentation with Prezent

Ready to get started? Prezent offers a wide range of customizable, editable templates, including annual business review presentation templates, year-end review templates, quarterly business review and more. Elevate your presentations, save time, and make a lasting impression with Prezent. Begin your journey to presentation excellence today!

Remember, your annual business review presentation is not just a report; it's an opportunity to inspire, inform, and influence. Let Prezent help you make it extraordinary.

Sign up for our free trial or book a demo today with Prezent!

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Year In Review

You'll have an attractive presentation when you get started on your design with venngage's year-in-review creative presentation template.

• Design style modern
• Colors light
• Size Custom (1024 x 576 px)
• File type PNG, PDF, PowerPoint
• Plan business

The best way to keep your company on track is by reviewing its progress year to year with a report. Now you can transform that report into a presentation you can share with your staff or investors. The Year In Review Creative Presentation is a great way to stay organized and compare how your business is doing each year. With the Year In Review Creative Presentation template, you can alter the text, font style, bullet points, icons, and color scheme. You’ll find a wide selection of images, icons, and background designs in the Venngage gallery. The Year In Review Creative Presentation template can also let you upload photos and insert tables, graphs, and charts.

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How to Make visual End-year Review presentation

The last quarter is the time to prepare a summary of the company’s yearly performance. Answering whether the yearly objectives are valid and whether the sale quotas were done. And looking slowly into next year’s plans.

If you are involved in preparing such a business review presentation, here are a few suggestions on how you can make the review visually engaging.

How to show  financial results ,  sales or production quotas,  and other  KPIs  in eye-catching form.

Make key data visualization attractive

Presenting pure numbers can be attractive for the presenter who knows the story behind, it but less engaging for your staff. Especially if you have a whole bunch of data slides to show. Your audience can suffer a famous  death by PowerPoint 🙂 . Fight it with good story-telling and professional design of your presentation.

Make your presentation more visually engaging. Add a few simple shapes – and change plain numbers to colorful, simple infographics:

Enhance financial tables

For accounting topics – enrich your finances data tables with icons for revenue, profit, and costs. Make visual column titles by adding a simple rectangle with text, or adding illustrations for table rows, in case you have a place for an icon:

In case your tables are too dense to add any new graphics there, at least take care the cell margins are properly set – numbers are not too close to table borders. Consider removing table borders at all. This will improve the readability of your financial slides a lot.

Showing a year event timeline

If you are presenting a history of this year’s campaigns or projects, show it on a graphical timeline:

Using shapes instead of plain text to illustrate events makes such a timeline visually more attractive.

You can create a timeline from puzzle shapes (read my article how to design such jigsaw puzzle yourself in PowerPoint ).

Making sure your message comes through

Finishing the presentation, make sure you will summarize what was done well and what can be improved. So your team is motivated to work on new challenges.

See a few tips on how you can make visually this message stand out on my LinkedIn post .

More examples of how you can make your Annual Review presentations good-looking are on my Slideshare:

A quick survey

I wonder which of the slides above are the most frequently used by you? Financial report? Key data slide? Timeline?

Enjoy your end-year parties.

PS. Need help with your end-year presentation? I will gladly help with slide design – contact me here .

1 thought on “ How to Make visual End-year Review presentation ”

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How to Create Your Own “Year in Review”

• Helen Tupper
• Sarah Ellis

A three-step exercise to pause and reflect on what worked — and what didn’t — over the past 12 months.

While the reality of work can feel especially overwhelming at the end of the year, reflection is the key to doing things differently in the year to come. Taking the time to pause and review your year increases your self-awareness and provides insights to improve. The authors present three steps to conduct your own learning “year in review.”

As the year comes to a close, it’s easy to get distracted by deadlines and miss out on valuable opportunities to accelerate our growth. If we don’t take the time to reflect on what’s gone before, we’re more likely to make the same mistakes and less able to apply what we’ve learned going forward.

• Helen Tupper is the co-founder and CEO of Amazing If , a company with an ambition to make careers better for everyone. Together with her business partner Sarah Ellis, she is the author of two Sunday Times bestsellers, The Squiggly Career  and Y ou Coach You . Sarah and Helen are also hosts of the podcast Squiggly Careers, which has had 4m downloads, and their TED talk, The best career isn’t always a straight line , has been watched by almost 2m people.
• Sarah Ellis is the co-founder of Amazing If , a company with a mission to make careers better for everyone. Together with her business partner Helen, she is the author of two Sunday Times bestselling books, The Squiggly Career and You Coach You. Sarah and Helen are also hosts of the podcast Squiggly Careers, which has had 4m downloads, and their TED talk, The best career isn’t always a straight line , has been watched by almost 2m people.

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Free - Annual Review PowerPoint Template and Google Slides

Free - Portfolio Annual Review PPT Template

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• The best PowerPoint theme template.
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Year in review presentation powerpoint presentation

All you need is our Year in Review Presentation PowerPoint Presentation to analyze your company’s yearly output. This slide has been extensively used by entrepreneurs, project managers or department heads across the globe to present a summary of their yearly performance that invariably reflects the overall performance of a company. This annual review PPT has been divided into 6 parameters whose numbers decide the performance of a company. In the options given, you can fill up your company’s annual turnover in comparison to the previous years, total app downloads on Google Play/App Store, testimonials, reviews by sites like GoodFirms and Clutch, followers on social media platforms, website/app traffic information, ongoing and delivered projects, awards & recognition, etc. Graphics are there to complement your company’s performance; you just need to add your company’s annual stats. Moreover, the slide will answer whether the yearly objectives are still valid, whether the sale targets were achieved, and will glance slowly into next year's plans. Empower folks to fight bacteria with our Year In Review Presentation Powerpoint Presentation. Identify the causes of infection.

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Presenting a PPT named Year in Review Presentation PowerPoint Presentation. If you want to prepare such an informative and eye-catching business review presentation, download it for free in formats like PPT, PDF, and JPG. You can edit this slide in numerous ways, i.e., change the color, font size, categories, graphics, background, and text as per your needs. The presentation is compatible with Google Slides and can be viewed in different aspect ratios (4:3, 16:9).

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Content of this Powerpoint Presentation

The term Year in review has become increasingly popular nowadays as it is essential for analyzing a company’s annual output. It refers to a summary of the critical events, challenges, and achievements encountered throughout a particular year to provide a reflective evaluation of progress and outcomes. It is advantageous for companies to assess employee performance and show employees areas of improvement that align with the company's mission.

If you are an entrepreneur, project manager, or department head, present the summary of your company’s yearly performance that reflects the overall performance of your company through a professionally crafted “Year in Review PPT “template deck. Moreover, year reviews are widely used by organizations, businesses, and individuals covering sectors, as they provide insights into operational success, financial performance, future outlook, and strategic initiatives.

Apart from companies, individuals and educational institutions also conduct these yearly reviews. Personal reviews help evaluate personal growth and accomplishments, whereas educational institutions assess the achievements of faculty and students alongside setting goals. So, it can be said that annual reviews lead to a more committed workforce if implemented successfully.

Click here to access the best PPT templates for the company year in review and help yourself assess the productivity of your work.

Year in Review PowerPoint Templates

Our “Year in Review’ PPT templates offer professionally designed slides with relevant visual content. Each slide is easily customizable and accessible to provide you with the best experience ever. The infographics PPT templates let you highlight all the crucial points and facts and describe your company’s routine effectively and quickly in a visually skilled approach. Furthermore, you can modify the slides with your images, precise information, color, text, and more to fit your business requirements.

Click here and take a deeper dig into the year in review business PPT ideas and develop your business strategies more efficiently for the upcoming years.  

Template 1: Year in Review Presentation

Analyze your company’s overall performance by deploying our explanatory annual review presentation. This PowerPoint layout has been divided into six parameters showing numbers that indicate the performance of a company. In the given option, you can key in multiple information related to your company, such as annual turnover (in comparison with previous years), reviews by various websites (Clutch, GoodFirms, etc.), total app downloads on App Store/ Google Play, delivered and ongoing projects, testimonials, app/site traffic information, awards and recognition, etc. So, you need to add your company’s statistics and complement your company’s performance with our well-designed templates. Moreover, a single glance at the slide can help you understand some vital points, such as whether the sales targets are achieved, if yearly objectives are valid, and so on. Just grab it and impress your audience with its modern design and attention-grabbing graphics.

A SERIOUS ANALYTICAL EFFORT

Conducting an annual review for your business is more than just presenting a summary of its performance. It is considered a crucial tool for the growth and expansion of a business. It acts as a roadmap that enables you to learn from the past, make future strategies, and keep your business flexible enough to cope with ever-changing market scenarios. Our "Year in Review" templates help users create beautiful summaries and enable effective communication among stakeholders.

PS A business must consider all its past activities for growth. Click here to download your business year-in-review presentation templates showcasing steps, starting from project initiation to product development.

Year in review presentation powerpoint presentation with all 5 slides:

Ensure your ideas get included for discussion with our Year In Review Presentation Powerpoint Presentation. Be able to influence the agenda.

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June 29, 2021

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Home » Crafting a Unique Year-End Recap: Beyond Season’s Greetings & GPTS

Crafting a Unique Year-End Recap: Beyond Season’s Greetings & GPTS

by Olivia Marlowe-Giovetti

You know the moment: You’re going through your mail when you catch the hint of a red envelope. A snowflake stamp. “So it begins,” you think. You open the envelope and the single sheet of green paper that was clearly at the end of an ink cartridge. “ Season’s greetings to our friends and family!!! ” it reads at the top. It’s hard to get that image out of your head when it comes time to recapping the year your organization’s followers. And yet, this is the friends and family that actually wants to hear from you. So how do you send a year-in-review to your supporters that avoids the humblebrag cliches?

Or how about that moment, right about 2 sentences into a note and you can just SMELL the GPTs generated pros? 

Read on for our tips on writing a year-in-review recap that your fans and friends (and family) will actually want to read…

One sure-fire way to make supporters know it wasn’t just a GPT is to actually record this message. The other benefit here is that you will actually get more data on watch time and engagement. The bar video depends on the medium, but the authenticity of a mobile 9:16 video is accessible for every nonprofit. 

Show, don’t tell

Instead of spelling out for your supporters each way their donation dollars kept the needle moving forward for your organization, make your recap dynamic and visual. You can even consider it a preview of what your annual report will look like in the new year. Email marketing, design, and testing tool Litmus played to its strengths with its year-end email in 2016. The result looks like an infographic for the company’s year in data with a link to its website for more highlights, including what their most popular email was for the year. Likewise, retail platform Big Cartel had some seasonal fun with its year-end email in 2015, turning their year of accomplishments into a board-game style timeline.

Big Cartel’s 2015 Year-in-Review Email

Focus on their accomplishments, not yours

Don’t be like Taylor Swift. Flip the script from “ Look what you made me do ” to “Look what you did.” Chances are your organization’s successes in the past year were thanks to the support of countless donors and advocates. The ACLU recently marked the one-year anniversary of the 2016 U.S. presidential election with an email campaign that was all about making the political, personal: They used a first-name call-out in the subject line (“Olivia’s year of fighting back”). They also tailored the language of the body text to focus on supporters versus the organization itself: “You blocked the Muslim ban. You saved our health care. You’ve defended Dreamers and their families.” The campaign ended with a call for users to share their activism stories , bringing traffic back to the ACLU site. Regardless of your cause, now is the perfect time to say, “Thanks for giving.”

ACLU’s Year-in-Review, one year after Election Day 2016

Make them dig a little deeper

Creating an information gap between what you outline in your email and what you say on another platform (i.e., your website) will pique user interest and, as seen above with examples from both Litmus and the ACLU, give users a reason to revisit your site. As Campaign Monitor notes , this information gap has been proven to cognitively induce a feeling of deprivation, thereby motivating humans to act. So go ahead, make your supporters curious to know what’s in the box. But in order to tear off the wrapping paper, get them to take that one extra step.

Give them something to do

Don’t be afraid to ask for a little something extra in your recap: According to Network for Good’s research, 12% of annual giving occurs in the last 3 days of December . For users who have donated in the past year, ask them to consider a recurring donation as a New Year’s resolution. For users who have not donated in the past year (or ever), let them know that there is still time to make a difference before the clock strikes 12. You can even get creative in this department, either with a matching gift or asking users to help crowdfund for a promotion, as charity: water did on a 2015 campaign for the BioSand Filter — adding a little seasonal touch to get people further into the spirit.

charity: water’s 2015 holiday campaign

Have a holly jolly headline

Don’t forget your subject line and preheader text! Consider how you’d like to frame the theme of your year in review and think of subject lines and preheaders as the wrapping and bows to go with it. Play with the suite of holiday- and winter-themed emojis, focus on the positive highlights of both the year that has passed and the year to come, and remind people that they can still make a difference in your cause sphere. For more on crafting a winning subject line , check out our guide.

Don’t just ChatGPT this…

The temptation to use chatgpt to just write this email is strong. Please don’t, AI is fine for first drafts but your audience is becoming savvy to emails and content written with lazy use of chatgpt. That said, if you want a little help from AI, here is a trusted, custom-built end-of-year AI writer from CauseWriter.ai.   

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End of Year Campaign Guide

Make sure your next giving season is better than the last with our guide to end-of-year fundraising.

Home Blog Business How to Write and Present a Performance Review

How to Write and Present a Performance Review

The performance review, as a crucial part of performance management, is one of the dreaded exercises of both managers and team members. However, it doesn’t have to be an intimidating, negative situation. In fact, a manager performance review tip by Harvard Business Review is to pointedly keep the conversation positive. By focusing on successes and opportunities for growth, managers can turn the employee performance review into a constructive experience that benefits everyone in the end.

What is Performance Management

Before we approach performance review examples, it’s necessary to establish some definitions to make sure we’re on the same page.

According to UC Berkeley’s Guide to Managing Human Resources, “Performance management is an ongoing process of communication between a supervisor and an employee that occurs throughout the year, in support of accomplishing the strategic objectives of the organization.”

Notice that performance management is more than a performance annual review. The performance evaluation is one component found in many performance management frameworks. In fact, UC Berkeley goes on to specify that the process “includes clarifying expectations, setting objectives, identifying goals, providing feedback, and reviewing results.”

By the time managers sit down for the performance review process, they will ideally have already been participating in this ongoing communication method. It will lead to much more valuable results than only engaging in the feedback part of the process.

Types of Performance Management Frameworks

Following are three examples of common performance management frameworks.

The Arm­strong Per­for­mance Man­age­ment Cycle

Michael Armstrong , former Chief Examiner of the Chartered Institute of Personnel and Development, established a performance management framework that many human resources professionals abide by. The Armstrong Performance Management Cycle is a continuous process of improving performance. This is achieved by establishing individual and team goals, working towards the goals, evaluating progress, and developing skills. As seen in the name of this management framework, this process repeats constantly throughout a team or individual’s career at the organization.

Agile Con­tin­u­ous Per­for­mance Management

Another performance management framework example is the agile continuous performance management. What makes the agile performance management system valuable is it’s focus on being continual and holistic. Feedback, which is called “check-ins” under this framework, is given frequently, making it feel more natural for all involved. With ongoing, positive performance management, managers and employees can develop authentic workplace relationships based on the performance improvement and transparency.

International Labor Organization’s Revised Performance Management Framework

The International Labor Organization’s system for managing performance aims to be a flexible process that can be applied to individuals or teams in many different fields and industries. It is also a continuous, comprehensive performance management framework. This cycle is divided into four parts, each focusing on dialogue and constructive feedback. One of the unique features of this management system is the inclusion of feedback from employee to leader.

What is a Performance Review?

The component featured in essentially all performance management frameworks is the giving of feedback. This usually presents itself in the form of a performance review. Other names for the performance review are performance evaluation or performance assessment. As opposed to informal or casual feedback, the performance review is a formal appraisal of an employee and their work during an established time period.

While there are dozens of employee review templates out there, most evaluate overall performance, an employee’s strengths and weaknesses, and opportunities for improvement. Many managers and HR professionals use this regularly scheduled evaluation to set goals, as well.

Performance review templates will vary based on who is assessing whom. Common types of performance reviews include the traditional assessment where a manager evaluates an employee’s performance, the self assessment, team assessment, and leader assessment. Different performance management frameworks will involve a combination of these four.

Employee Assessment

This top-down performance review is usually performed by a direct manager or HR manager. This evaluation is useful for establishing the value of an employee with examples of their performance to back it up. Often the employee assessment is conducted together with a self assessment.

Self Assessment

The self assessment component of a performance review is a helpful opportunity for individuals to reflect upon themselves with regards to their strengths and weaknesses. In order to turn the self assessment into a productive introspection, employees should also consider what they think they can do to improve and grow.

When conducted alongside an employee assessment, answers can be compared to see if managers and employees are on the same page. Any discrepancies can be analyzed and addressed, in order to strengthen the working relationship and understanding of the situation.

Team Assessment

A team assessment differs from an individual employee assessment in that it’s an opportunity to make sure team members are aligned and working well together, as well as progressing towards the team goals.

Leader Assessment

As mentioned in the International Labor Organization’s performance management framework, leader assessments can provide valuable feedback as well. During this assessment team members and employees evaluate their own managers, as well as potentially their manager’s superiors. This is often conducted anonymously, to ensure employees can be honest with their feedback without fear of retaliation.

Key Elements of a Performance Review

Depending on the performance management framework, reviews will have different key elements, but there are elements that all methods share, according to Harvard Business Review and Hubspot .

• Evaluate if job requirements are being met
• Compare strengths and weaknesses
• Highlight areas of improvement
• Evaluate if previously defined goals were met
• Recommend actionable goals
• Welcome employee input

How to Write a Performance Review

We recommend managers use a performance review template to help guide them through each step. Evaluation templates help managers know what to say in a performance review. They provide structure to the review, which makes the process consistent. Employee performance templates also make the review process scalable throughout the team or organization.

Prior to Writing the Performance Review

Harvard Business Review recommends reviewers set expectations early, prior to the official feedback. This involves informing the employee that they will be reviewing them soon, asking the employee for their self assessment, and evaluating employee career aspirations.

When Writing the Performance Review

When sitting down to write the performance review, managers should have supporting documentation to help them direct their evaluation. For example, comparing employee performance and characteristics to the organization’s specified values can help guide the evaluation. Additionally, managers can compare employee performance to the actual description of requirements for their role. This helps keep evaluations realistic and on-track. Finally, it’s a good idea to compare current performance to that of previous employee performance reviews. This gives the manager a bigger picture into employee growth, as well as what achievable goals are.

When writing a performance review, managers can also consult with others, including coworkers, other managers, and subordinates of the employee under review. This is called 360-degree feedback and can help give a manager ideas of what to write.

As far as the career aspirations we recommend requesting from the employee prior to the evaluation, this is useful for framing the review. Not every employee has very high aspirations. The evaluation should align both the organization’s expectations of the employee and their own aspirations.

Delivering the Performance Review

HBR also recommends presenting the performance review to the individual about an hour before their meeting to discuss it. This lets the employee move past any potential emotional responses and prepare rational responses. This will lead to a much more constructive discussion and allow for a more positive plan forward.

Whenever possible, hold the performance review presentation face-to-face to avoid misunderstandings. While a performance review PPT or pdf is beneficial for organizing and visualizing the evaluation, presenting them in person will lead to a richer discussion and more realistic action plans.

For high-performing employees, HR experts recommend focusing on the things they are doing well. After discussing examples of achievements and strengths, the manager can ask the employee their feelings about how things are going. This naturally leads into a conversation about opportunities for growth and improvement.

When delivering feedback to marginal employees, they shouldn’t sugar-coat criticisms or provide meaningless compliments. Instead, reviewers should be straightforward and clear with their message. Discuss what isn’t working, what is working, and what actions need to be adopted to improve. When giving advice for improving, managers should be as specific as possible and provide examples.

How to Present a Performance Review

Here are the most important slides to include in a performance review presentation. Following this performance review example structure will help managers lessen the discomfort of presenting a performance review, by following a clear presentation guide.

Slide 1: Cover Slide

Establish who is reviewing, who is being reviewed, and the date of the performance review. Note that this information is also important since the performance review presentation will probably become part of an ongoing performance documentation.

Slide 2: Table of Contents

Part of the discomfort of performance reviews is the concept of the unknown. For an employee, it’s speculating on what their manager is going to say in the performance review. A clear table of contents will hopefully help ground the employee by showing them clearly what they can expect from the presentation, and in what order.

Slide 3: Evaluate if job requirements are being met

In this PPT slide, the reviewer should compare, side-by-side the job requirements and the actual job performance of their subordinate. This requirement versus performance comparison helps the evaluation stay objective. Provide examples of when the requirements are or are not being successfully met, whenever possible.

Slide 4: Strengths

When presenting employee strengths, be as specific as possible. Explain why this strength matters, an example of when this strength was evident, and what impacts this strength has had. In the presentation, add a list of strengths with or without a short description and/or example, in case the performance review is presented without the accompanying meeting.

If the manager previously asked for a self assessment, add a comparison here between the reviewer’s opinion of the employee strengths and their employee’s opinion.

Slide 5: Achievements

List any specific achievements the employee has made during the performance period.

Slide 6: Highlight areas of improvement

This is another way to frame weaknesses. When presenting areas of improvement, consider what the employee needs to improve, why these areas are necessary to address, how the manager can help the employee improve, and what specific steps are needed to improve. Be specific and provide examples whenever possible.

This is another good slide where managers can compare their evaluation of areas of improvement with the answers employees provided in their self assessment. You can combine these slides with other performance improvement plan templates for PowerPoint and Google Slides.

Slide 7: Evaluate if previously defined goals were met

If this isn’t the first performance review a manager has conducted for an individual, then there will be previously defined goals from former evaluations. On this slide, list the previous goals and add a brief evaluation for each. This will help decide what goals should be checked off, maintained, or adjusted for the next evaluation period, which will be presented in the next slide.

Slide 8: Recommend actionable goals

When presenting goals, we recommend using the SMART formula. SMART goals stands for specific, measurable, attainable, relevant, and time-based. This method of creating goals helps ensure the goal will be achieved as expected.

The goals established in this performance review will most likely be evaluated during the next performance review. As such, the “time-based” aspect of the goal should take this into account.

Slide 9: Welcome employee input

Close the performance review presentation by giving the employee space to talk.

By following this performance review template, reviewers can make sure their evaluation is more than just a meaningless task checked off the list. When done well, the performance review sets the mood for the whole next period, giving both managers and employees a clear guide towards moving forward and achieving their goals more successfully. As far as the tendency for employee evaluations to be uncomfortable situations, follow the advice in this article, practice, and you’ll soon find the valuable potential of a well-presented performance review.

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Review: Family drama 'Ezra' stalls despite all-star cast

Perhaps the most well-meaning family drama of the year, “Ezra” does everything quote-unquote right. The film’s call sheet is crammed with the biggest names: Robert de Niro, Whoopi Goldberg, Rose Byrne, Bobby Cannavale, Rainn Wilson, Tony Goldwyn and Vera Farmiga. Boiled down, the story is about redemption, sacrifice and forgiveness. There’s a talented child actor who is not only well-positioned in the role, but utterly screen-stealing, even when sparring with Hollywood legends.

All parts do not equal a whole, however, and “Ezra” is missing that magic pixie dust that pushes a film over the edge from merely cohesive to impactful. In addition to starring, Goldwyn directs this little indie-film-that-could, though the film truly hinges on newcomer William A. Fitzgerald, a neurodivergent teen who nails the title role. Ezra is a child with autism who is having a particularly hard time at school and at home. He’s sensitive to many things, and his frequent outbursts have his divorced parents and school administrators concerned.

Cannavale stars as his father Max, an aspiring stand-up comedian who attempts to make his way up in the industry while also living with his aging father (de Niro). His ex-wife Jenna (Byrne) is frustrated by his blasé attitude towards Ezra’s increasing instability. Their relationship, while cordial, was an obvious casualty of Max’s chaotic career path and his own personality defects. Cannavale and Byrne are together in real life, which does give their on-screen relationship an interesting layer.

When he overhears a threatening, albeit sarcastic, comment made by Jenna’s lawyer boyfriend (Goldwyn), Ezra flees the house, and, on his way to his grandfather’s home, is hit by a car. Concerned for his mental and physical well-being, doctors recommend heavy drugs to control the child, a course of action Max is greatly against.

Eager to protect his son, Max kidnaps Ezra and they embark on a father-son bonding road trip to Los Angelesm where Max is also up for a big break: performing on Jimmy Kimmel. There are pitstops along the way, like his old friend Nick (Wilson), a fellow comedian, and Grace (Farmiga), a childhood friend living in rural Michigan who helps the traveling duo with a replacement car. When an Amber Alert goes out for Ezra, the end of their little cross-country road trip turns ominous. Max, attempting to do the right thing by his son, in turn breeds more havoc, destruction, but also maybe a bit more understanding and grace.

The film harbors a weak thesis for an important story. It seeks to portray and represent the struggles, as well as the beauty, of children like Ezra. Unfortunately, the nuances of living with autism or living with someone diagnosed with autism are overshadowed by an over-wrought leading character. Max, whose journey the audience is forced to endure more so than any other of the film’s characters, is an utterly unlikeable, pitiable, self-centered, faux-altruistic specimen whose incessant war cries of self-sacrifice for his son ring hollow and distract from the many other important aspects of the film’s message.

The story itself is admirable, but its telling is undercooked. “When in doubt, take a road trip” seems to be the motto by which "Ezra," like many other family dramas before it, operates. Unlike previous successful road trip dramedies (“Little Miss Sunshine” naturally comes to mind), and despite the fact that one of the film’s leads is meant to be a comedian by trade, there is very little comedic relief to offer viewers who will be begging for levity by the time the destination is reached.

Max isn’t the only frustrating character. Byrne’s role is a one-trick pony, a hyperbole of the worried mother trope, jumping over fire to find her son, even if he is in the safe hands of his own father. The witch hunt set upon Max is another sore point in the script, a seemingly over-blown development that only further distances viewers from the film’s reality. De Niro, a legend, is also underutilized, and Wilson and Farmiga are hardly more than AI-generated sidekicks. Worst of all, the film’s murky moral is buried by its lackluster plot which hits its stops on the road trip without true purpose or intention.

"Ezra" is in theaters now.

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A peculiar foreign body ingestion in 2-year-old girl complicated by esophageal perforation: case report and review of the literature

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Danah Albarrak, Suliman Alrajhi, Mohammed Naeem, A peculiar foreign body ingestion in 2-year-old girl complicated by esophageal perforation: case report and review of the literature, Oxford Medical Case Reports , Volume 2024, Issue 5, May 2024, omae040, https://doi.org/10.1093/omcr/omae040

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Foreign body ingestion is a common pediatric gastrointestinal emergency, which should be suspected in all patients who present with signs of airway obstruction or upper GI bleeding, especially if it developed after the child was left unwitnessed for a while. The most common foreign bodies identified in the literature are button batteries or coins. Early identification and management of suspected foreign body ingestion is crucial as it can lead to devastating complications including bleeding, fistula formation, perforation, mediastinitis, or abscess. Here we report a case of a peculiar foreign body ingestion resulting in esophageal perforation in a 2-year-old girl.

Foreign body (FB) ingestion is considered a common gastrointestinal (GI) emergency in the pediatric population with the majority of cases occurring in children aged 6 months to 5 years [ 1 , 2 ]. The most common FB identified are coins, however, button batteries, magnets, toys, jewelry, and less commonly sharp objects have been reported in the literature [ 1 , 2 ]. Based on the 2021 Annual American Association of Poison Control Center report, FB ingestion in children less than 5 years accounted for approximately 55 000 cases with higher rates observed among boys [ 3 ]. Clinical presentation varies depending on the type and location of the FB ingested however common symptoms may include drooling, vomiting, dysphagia, throat, or chest pain [ 4 ]. Fortunately, the mortality rate is low and the majority of FBs ingested are spontaneously passed [ 1 ]. However, based on current guidelines endoscopic retrieval is indicated if the FB is impacted in the esophagus within 2hrs in case of battery ingestion with or without symptoms. A coin, magnet, or sharp foreign bodies impacted in the esophagus in an asymptomatic patient can be removed within 24hrs [ 5 ]. Any long foreign (more than 6-cm) in the esophagus should be removed within 24hrs even if the patient is asymptomatic. Only < 1% of patients may require further surgical intervention [ 1 ]. Possible complications of FB ingestion include the development of ulceration, bleeding, fistula formation, perforation, mediastinitis, or abscess [ 1 ]. Here we report a case of esophageal perforation caused by FB ingestion in a 2-year-old girl.

A 2-year-old developmentally normal girl with no significant past medical or surgical history presented to the emergency department (ED) with a three-day history of vomiting large amounts of fresh blood with clots and a single episode of dark stool. The family denied any history of fever, abdominal pain, upper respiratory tract symptoms, bleeding from other sites, easy bruising, or trauma. Two days prior to this presentation the family sought medical attention in another hospital, the patient was found to have a low hemoglobin (Hb) level of 5 g/dl. She was suspected to have foreign body ingestion and was recommended to proceed with an endoscopy. However, the family refused and the patient was discharged against medical advice.

Upon physical examination, vital signs were as follows HR 127 beats/minute, BP 84/39 mmHg, RR 26 breaths/minute, afebrile, and oxygen saturation 98% on room air. The patient was alert and active, with intact pulses, and warm extremities with no bleeding, bruises, or skin changes; the rest of the physical examination was unremarkable. The repeated Hb level was 4 g/dl, thus the patient received 10 ml/kg (-O) packed red blood cells (PRBC) transfusion. Initial chest x-ray (CXR) revealed a round radiolucent object seen lateral to the trachea on the left side with mild widening of the mediastinum, and lung fields were clear ( Fig. 1 ). The patient was anticipated to have a difficult airway and therefore was intubated to proceed with imaging safely, CXR was repeated revealing an opacity in the right upper lung likely due to aspiration ( Fig. 1 ). Computed tomography (CT) showed a hyperdense object measuring 18.1 mm, seen in the posterior mediastinum, consolidation in the right upper lobe due to aspiration and mediastinal hematoma ( Fig. 2 ).

( A ) initial CXR in the ED: reveals a round radiolucent object seen lateral to the trachea on the left side with mild widening of the mediastinum and clear lung fields. ( B ) Repeated CXR 4hrs after, an endotracheal tube is observed and there is an opacity in the right upper lung likely due to aspiration.

Findings of chest CT on the day of patient presentation (red arrows). ( A ) axial view: shows hyperdense object seen in the posterior mediastinum likely within the esophagus. ( B ) Axial and lung window view: hyperdense subject seen in the posterior mediastinum and there is consolidation in the right upper lobe (aspiration). ( C ) Coronal view: hyperdense object (FB) seen in the posterior mediastinum. ( D ) Sagittal view: hyperdense FB seen in the posterior mediastinum. Maximum intensity projection (MIP) imaging revealed a round hyperdense FB measure it 18.1 mm seen in the posterior mediastinum in multiple views, ( E ) Coronal view, ( F ) sagittal view.

The patient was rushed for exploratory thoracotomy and FB retrieval with concurrent esophagogastroduodenoscopy (EGD). Initially, rigid endoscopy was performed and revealed pooling of blood inside the esophageal lumen with bulging of the mucosa, there was no active bleeding. Left thoracotomy revealed multiple perforated feeding vessels to the pleura, which were ligated using a clip. There was no evidence of fistula, active bleeding, or inflammatory process in that area. The esophagus was skeletonized and showed no pus collection, hematoma, or cyst. However, it couldn’t be skeletonized more proximally as the arch of the aorta was intervening. The area was reexamined using rigid endoscopy and there was no evidence of perforation or active bleeding: therefore; proceeded with a fluoroscopic esophagogram which showed an esophageal pouch at the left second rib, suspicious of esophageal duplication cyst. The gastrology department was consulted to perform flexible endoscopy, which revealed a cystic-like lesion in the esophagus at almost 15 cm from the mouth with no evidence of perforation, guidewire was inserted in the cyst for the surgeon to continue.

Left thoracotomy was closed and converted to right thoracotomy which revealed a cystic-like structure, esophageal pouch, which was flimsy and macerated. An enterotomy was performed in the anterior esophageal wall almost 3 cm in length. The esophageal lumen was examined from the inside, and old digested blood coming from the esophageal lumen was noted: however; there was no active bleeding. Additionally, the cyst was followed to its origin and proximal to the enterotomy made, upon closer inspection and dissection the FB was found eroding the esophagus coming from the esophageal mucosa which was easily retrieved ( Fig. 3 ). The operation was concluded by a primary repair of the esophageal side perforation and repair of the esophageal enterotomy.

Picture of the foreign body after retrieval.

Following the surgery, the patient was admitted to PICU for close monitoring. Initially, the patient was doing well: however; on the third day she suddenly developed emesis and epistaxis and had systolic hypotension, tachycardia, and tachypnea. She improved after being managed with 20 ml/kg stat bolus, PRPCs, and platelet transfusion. Additionally, she developed left followed by right-sided pneumothorax which improved the next day. Moreover, the patient’s blood culture came back positive for gram cocci in chains (anginosus group), infectious disease department was consulted and recommended treatment with tazocin. Fluoroscopy was performed seven days postop revealing a narrowing of the upper esophagus with passing contrast to the lower esophagus and stomach ( Fig. 4 ). On day 12, the patient improved clinically and was discharged.

Fluoroscopy on day 7 post-op: revealed a narrowing of the upper esophagus (white arrows) with passing contrast to the lower esophagus and stomach.

FB ingestion is frequently encountered in pediatric emergencies, patients might present with a wide array of symptoms including drooling, dysphagia, vomiting, or emesis [ 4 ]. Timely identification of FB and management is essential to avoid possible complications which can include but are not limited to esophageal ulceration, bleeding, fistula formation, and perforation [ 1 ].

Based on the review of the literature 12 cases reported esophageal perforation secondary to FB ingestion in children aged 24 months or less ( Table 1 ). The most common FBs were button batteries and metal objects, none of the FBs identified was similar to the one retrieved from our patient. Delayed presentation and prolonged duration of impaction, especially > 1 week resulted in the development of multiple complications. Most patients were alive and well on follow-up with no complications, 2 lost follow-up, and 2 developed complications including vocal cord paralysis and intermittent croup [ 6–11 ].

Literature review of esophageal perforation secondary to FB ingestion in children aged 24 months or less

In our case, the patient had delayed presentation of FB ingestion as she started to develop signs of Upper GI bleeding 3 days prior. CT confirmed the presence of a round hyperdense FB in the posterior mediastinum. Flexible endoscopy was only able to identify a spot in the esophagus that looked cystic-like lesion. An emergency thoracotomy retrieved the FB that had eroded the esophagus. This foreign body was found to be a cork that is widely used in the caps of disposable bottles. Postoperatively the patient was admitted to the PICU for close monitoring and later discharged once she was clinically stable.

FB ingestion should be suspected in all pediatric patients who present with signs of airway obstruction or upper GI bleeding, especially if it developed after the child was left unwitnessed for a while. Parental education regarding prevention, signs and symptoms of FB ingestion is imminent in order to prevent delayed presentation and the development of devastating complications.

Primary care and emergency healthcare workers should consider FB ingestion as a differential diagnosis in any pediatric patient presenting with symptoms of airway compromise or GI bleeding, especially if there is a history of leaving the child unchaperoned. Additionally, community education on the topic is recommended to allow early recognition, and treatment and to avoid the development of any complications.

Not applicable.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

The patient provided informed consent for publication of the case report.

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• Case report
• Open access
• Published: 27 May 2024

A rare incidence of severe dermatological toxicities triggered by concomitant administration of all-trans retinoic acid and triazole antifungal in patients with acute promyelocytic leukemia: a case series and review of the literature

• Aisha Jamal   ORCID: orcid.org/0000-0001-5022-7498 1 , 3 ,
• Rafia Hassam 1 ,
• Qurratulain Rizvi 1 ,
• Ali Saleem 1 ,
• Anum Khalid 2 &
• Nida Anwar 1  

Journal of Medical Case Reports volume  18 , Article number:  261 ( 2024 ) Cite this article

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All-trans retinoic acid (ATRA) is an indispensable part of the treatment of acute promyelocytic leukemia (APL). Although, mild cutaneous toxicities like mucocutaneous xerosis, rash, and pruritus are well reported, ATRA associated severe dermatological toxicities are extremely rare. ATRA is primary metabolized by cytochrome P450 (CYP450) enzyme system, and triazole antifungals are notorious for their strong inhibitory effect on CYP450.

Case presentation

Three Asian APL patients experienced rare ATRA-induced severe dermatological toxicities: exfoliative dermatitis (ED) in cases 1 and 2, and necrotic scrotal ulceration in case 3. Both case 1 (33-year-old female), and case 2 (28-year-old male) landed in emergency department with dehydration, generalized skin erythema and xerosis during their induction chemotherapy. Both of these patients also developed invasive aspergillosis and required concomitant triazole antifungals during their chemotherapy. For ED, intravenous fluids and broad-spectrum antibiotics were started along with application of local emollients to prevent transdermal water loss. Although their general condition improved but skin exfoliation continued with complete desquamation of palms and soles. Dermatology was consulted, and clinical diagnosis of ED was established. Discontinuation of ATRA resulted in complete resolution of ED. Case 3 (15-year-old boy) reported two blackish mildly tender scrotal lesions during induction chemotherapy. He also had mucocutaneous candidiasis at presentation and was kept on triazole antifungal. Local bacterial & fungal cultures, and serological testing for herpes simplex virus were reported negative. Despite adequate local care and optimal antibiotic support, his lesions persisted, and improved only after temporary discontinuation of ATRA. After a thorough literature review and considering the temporal association of cutaneous toxicities with triazole antifungals, we speculate that the concomitant use of triazole antifungals inhibited the hepatic metabolism of ATRA, resulting in higher serum ATRA concentration, and markedly accentuated cutaneous toxicities in our patients.

By highlighting this crucial pharmacokinetic interaction, we want to caution the fellow oncologists to be mindful of the inhibitory effect of triazole antifungals on CYP450. We propose using a non-myelosuppressive combination of ATRA and arsenic trioxide for management of APL hence, obliterating the need of prophylactic antifungals. However, in the event of invasive fungal infection (IFI), we suggest using alternative class of antifungals.

Peer Review reports

Acute promyelocytic leukemia (APL) is a rare and potentially curable subtype of acute myeloid leukemia (AML), accounting for 5–8% of AML cases [ 1 ]. Genetically, APL is characterized by reciprocal translocation t(15:17) (q22;q11–12), with consequent fusion of promyelocytic (PML) gene on chromosome 15q22 to retinoic acid receptor-alpha (RAR-alpha) gene on chromosome 17q21. The resultant fusion oncoprotein, PML-RARA, induces transcriptional repression, chromatin condensation, maturation arrest, and accumulation of abnormal promyelocytes [ 2 ]. Advent of all-trans retinoic acid (ATRA) has revolutionized the treatment landscape of APL, and along with the backbone of anthracycline based chemotherapy, it is considered to be the standard of care for APL patients. Combination treatment with ATRA plus anthracycline based chemotherapy achieves an overall complete remission and cure rate of 95% and 80% respectively, rendering ATRA indispensable in the management of APL [ 3 ].

ATRA, an active metabolite of vitamin A, belongs to a class of retinoids. Although retinoids are well known for their dermatological side effects like xerosis, xerostomia, erythema, pruritis, and exfoliation; severe dermatological side effects of ATRA, especially in the dosage pertinent to APL (45 mg/m 2 ), are rare. So far, only a single case of exfoliative dermatitis (ED) and a few cases of scrotal ulceration have been reported in literature [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. We, here in, report a case series of three patients with serious and rare ATRA associated dermatological complications. We have also discussed upon the potentially precipitating pharmacokinetic interactions, as well as the detailed clinical course and management of our patients as simply withholding ATRA can jeopardize the outcome of this potentially curable malignant disorder.

In all three patients, ATRA was started as soon as abnormal promyelocytes were documented on peripheral smear/bone marrow aspirate examination (Figs.  1 , 2 , 3 ). Diagnosis was further confirmed through cytogenetic analysis as well as PML-RARA detection by polymerase chain reaction. Additionally, in all three patients, chemotherapeutic treatment was instituted according to European APL protocol, based on their risk-group classification.

Exfoliative dermatitis &Onychomadesis (CASE 1). a Peripheral smear. b Bone marrow aspirate. c Desquamation of soles. d Desquamation of palms. e Dry exfoliation of feet and shins. f Onychomadesis

Exfoliative dermatitis (CASE 2). a Peripheral smear. b Bone marrow aspirate. c and d Erythema and scaling of hands. e Cutaneous desquamation of soles

Scrotal lesions (CASE 3). a Peripheral smear. b Bone marrow aspirate. c and d Necrotic scrotal lesions with black eschar

Case 1: A 33-year-old Asian female presented in ER with history of fever, heavy menstrual bleeding and rash all over body. Induction chemotherapy and steroid prophylaxis was promptly started to prevent differentiation syndrome (DS). On Day-10 of induction chemotherapy, she developed high grade fever, cough and shortness of breath. High-resolution computerized tomography (HRCT) showed randomly scattered discrete nodular opacities with surrounding ground glass haze in both lung fields, suggestive of invasive fungal infection (IFI). Voriconazole was immediately started along with broad-spectrum antibiotics. She improved over the following 72 hour, and was discharged from hospital on Day-17. Subsequently, she landed in emergency department on Day-23 with severe dehydration, shivering, tachycardia, generalized skin erythema and discoloration of nail beds. Intravenous fluids and broad-spectrum antibiotics were started along with application of local emollients to prevent transdermal water loss. Over the next 24-36 hour, her general condition was stabilized however; skin exfoliation continued with complete desquamation of palms and soles (Fig.  1 ). Dermatology was consulted, and a clinical diagnosis of onychomadesis and exfoliative dermatitis (ED) was made. A review of her clinical case demonstrated no apparent cause for ED except for a rare association with ATRA. However, considering the curative potential of ATRA, it was continued till Day-28 as per protocol. Her skin condition gradually resolved over next 10–14 days after discontinuation of ATRA. She had recurrence of similar skin condition upon re-exposure to ATRA in her consolidation chemotherapeutic cycles, however, the exfoliation was mild and patchy that responded well to good oral hydration and local skin emollients.

Case 2: A 28-year-old Asian male presented in the out-patient clinic with the history of generalized weakness, high-grade-fever, productive cough and bruises over body. On examination, he had multiple ecchymosis and petechiae with coarse crepitations involving right-middle and left-lower lung fields. He was promptly started on broad-spectrum antibiotics. Additionally, as per protocol, induction chemotherapy and dexamethasone prophylaxis was also instituted. His fever and cough remained unresponsive despite broad-spectrum antibiotics. Voriconazole was instituted upon the identification of IFI on HRCT findings. By day-10, coagulopathy was normalized, and clearance of abnormal promyelocytes was documented by Day-18. On Day-20, he complained of skin dryness, itching and scaling; physical examination revealed generalized xerosis and erythema (Fig.  2 ). Despite aggressive skin care, generalized skin exfoliation, most pronounced on palms and soles, ensued. Clinical diagnosis of ED was established after obtaining dermatological consultation. However, in view of his clinical stability, ATRA was continued. Bone marrow aspirate on Day-28 showed morphological remission. Recurrence of erythema and exfoliation was documented during consolidation phase of chemotherapy, but the condition was responsive to local emollients and oral hydration.

Case 3: A 15-year-old Asian male presented in the out-patient clinic with complains of high-grade-fever, muco-cutaneous bleeding and pancytopenia. On presentation, patient was febrile and had oral thrush. After sending his baseline tests he was taken on broad-spectrum antibiotics and triazole antifungal (itraconazole). After completion of induction chemotherapy, patient was discharged with bi-weekly follow-ups.On Day15, he reported two blackish, mildly tender scrotal lesions with minimal serous discharge (Fig.  3 ). Antibiotic cover for soft tissue infection was commenced along with local wound care with topical steroids and antibiotics. He had no sign of systemic infection/sepsis. Local bacterial & fungal cultures and serological testing for herpes simplex virus were reported negative. Despite adequate local care and optimal antibiotic support, his lesions showed no sign of healing, and two new lesions were developed. Lesion biopsy for histopathological evaluation was declined by the patient. Keeping the rare but reported occurrence of ATRA-induced scrotal ulceration and fournier's gangrene; ATRA was transiently withheld for ten days and the lesions started to regress. However, considering the indispensable role of ATRA in APL, it was reinstituted. Scrotal lesions persisted without any worsening. ATRA was stopped after completion of protocol. Complete resolution of scrotal lesions was documented over the following two weeks. Afterwards, he received two cycles of consolidation chemotherapy, but no recurrence was reported.

Discussion and conclusion

The antineoplastic role of ATRA remains indispensable in the curative management of APL. It is considered a relatively safe drug with a well-known toxicity profile. Commonly reported adverse events include DS, pseudotumor-cerebri, hypertriglyceridemia, transaminitis, and headache. Although, mild cutaneous toxicities like muco-cutaneous xerosis, photosensitivity, rash, pruritus and sweet’s syndrome are well reported, severe dermatological toxicities are rarely reported in literature [ 18 , 19 ]. In this case series, we have discussed three cases of ATRA-induced rare dermatological complications in APL.

Case 1 and 2 developed ED during remission induction phase of chemotherapy. Literature review revealed only a single reported occurrence of ATRA-induced ED in APL by YonelIpek et al. [ 4 ]. ED is a potentially life-threatening cutaneous manifestation that is characterized by diffuse skin erythema and scaling. Various underlying disorders can trigger its onset through a complex interplay of inflammatory cytokines and phagocytes. In contrast to our cases, the case reported by Yonel Ipek et al. developed xerosis in consolidation phase, which akin to our cases started after two weeks of ATRA exposure and rapidly deteriorated to generalized erythroderma and scaling. In both cases, discontinuation of ATRA resulted in complete resolution of ED.

In case 3, we have reported ATRA-induced necrotic scrotal ulceration. Literature review revealed that over the last two decades, a total of twenty cases of ATRA-induced scrotal ulceration have been reported. Histopathological evaluation of these lesions revealed atypical granulocytic infiltration, pointing towards the possible etiological role of differentiated APL cells in the pathogenesis. Most of these cases, including ours, developed genital-lesions almost after two weeks of ATRA exposure and remained unresponsive to local and systemic antibiotics. ATRA had to be halted in most of the cases to prevent progression to fournier’s gangrene [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].

Scattered over the span of three years and considered in isolation, it was not initially apparent to us that all three cases had one striking similarity: concomitant use of ATRA and triazole antifungals. ATRA is primary metabolized by cytochrome P450 enzyme system. Triazole antifungals are notorious for their strong inhibitory effect on CYP450 enzyme system, resulting in supra-therapeutic drug levels and toxicity [ 20 , 21 , 22 ].

Potentiation of serum ATRA levels by inhibition of CYP450 system was first explored by Rigas et al. [ 23 ]. This study reported 1.8 times higher serum concentration of ATRA with concomitant use of ketoconazole. Since then a number of cases have reported the augmentation of ATRA-induced toxicities due to this pharmacokinetic interaction. Concomitant use of ATRA and triazole antifungals that is voriconazole and posaconazole has been implicated to cause severe hypercalcemia [ 24 , 25 , 26 , 27 ]. Similarly, combination with fluconazole has been reported to cause severe neurotoxicity and nephrotoxicity [ 28 , 29 ].

Considering the temporal association of dermatological complications with triazole antifungals in our patients, we speculate that the concomitant use of triazole antifungals inhibited the metabolism of ATRA, resulting in higher serum concentrations and markedly accentuated cutaneous toxicities. A study further strengthening our hypothesis was conducted by Kurzrock et al. to evaluate the maximum tolerable dose of ATRA in myelodysplastic syndrome. The study reported severe dose-limiting cutaneous toxicities, such as generalized desquamation and genital ulceration, at doses > 150 mg/m 2 /day, compared to mild xerosis and erythema in the dose range of 45–100 mg/m 2 /day. Akin to our cases, the study reported complete resolution of cutaneous toxicities within 1–2 weeks of ATRA discontinuation [ 30 ].

Another important point is the recurrence of ED in both case 1 and 2 during their consolidation chemotherapy cycles, whereas recurrent scrotal ulceration was not documented in case 3. The most likely explanation is the continuation of voriconazole as secondary prophylaxis in patients with invasive fungal infections (IFI) (case 1 and 2), whereas itraconazole was discontinued after remission induction in case 3. This once again underscores the pharmacokinetic potentiation of ATRA-induced cutaneous toxicities by triazole antifungals. An important limitation of our study is that, due to the unavailability of serum voriconazole testing, we couldn’t document serum voriconazole levels, something that could provide valuable insights into the effect of serum azole levels on the severity of cutaneous manifestations.

By highlighting this crucial pharmacokinetic interaction and its potentially severe implications, we urge our fellow oncologists to remain vigilant regarding the inhibitory effects of triazole antifungals on the metabolism of ATRA. We propose the use of a non-myelosuppressive combination of ATRA and arsenic trioxide for APL, thereby eliminating the need for prophylactic antifungals. In the case of invasive fungal infections (IFI), we recommend considering alternative classes of antifungals. However, if triazole antifungals are deemed unavoidable, we suggest close monitoring for potential side effects and implementing prophylactic measures as clinically necessary.

Availability of data and materials

Data sharing is not applicable to this manuscript as no datasets were generated or analyzed during the current study.

Abbreviations

Acute promyelocytic leukemia

All-trans retinoic acid

Cytochrome P450

Differentiation syndrome

• Exfoliative dermatitis

High-resolution computerized tomography

Invasive fungal infections

Promyelocytic leukemia-retinoic acid receptor alpha

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Aisha Jamal, Rafia Hassam, Qurratulain Rizvi, Ali Saleem & Nida Anwar

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Anum Khalid

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Aisha Jamal: Conceptualization, writing-original draft, writing-review & editing. Rafia Hassam: Conceptualization, writing-original draft. Qurratulain Rizvi: Writing-review & editing. Ali Saleem: Data curation, writing—review & editing. Anum Khalid: Writing—review &editing. Nida Anwar: Writing—review & editing.

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Jamal, A., Hassam, R., Rizvi, Q. et al. A rare incidence of severe dermatological toxicities triggered by concomitant administration of all-trans retinoic acid and triazole antifungal in patients with acute promyelocytic leukemia: a case series and review of the literature. J Med Case Reports 18 , 261 (2024). https://doi.org/10.1186/s13256-024-04577-1

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“ The bartender, Billy was absolutely friendly and had great suggestions and very knowledgeable when it comes to the drinks. ” in 3 reviews

“ The jazz music creates a chill relaxing vibe, and the awesome tiki decor everywhere . ” in 2 reviews

“ With over 500 different varieties to choose from, it's a haven for rum enthusiasts. ” in 3 reviews

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1600 NE 1st Ave

Miami, FL 33132

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Hawaiian fried rice is delicious. Enjoyed the bao buns. Thanks for the night, and all the memories!

A great hidden tiki bar. Didn't try the food, but it looked really good ! The drinks are so good. They are tasty, strong, and I love a good presentation with my drink. The service is amazing. Was greeted with so many smiles & the hospitality was outstanding. The ambiance is everything you'd want in a tiki bar. The jazz music creates a chill relaxing vibe, and the awesome tiki decor everywhere . This place offers 500 different types of rum, which is a great opportunity to try different rums that you haven't been able to. (They have a whole rum flight selection on the menu). Stop by this place, it's a must if you're a tiki enthusiast!

I loved the kaona room so much that we went twice on our visit to Miami (first and last night!) The whole bar was so beautiful and immersive. You could tell that no expense was spared to create the perfect environment. The bartender was so friendly and the drinks were all very photogenic. Couldn't recommend this place enough. Bonus: the drinks came with a dry ice show!

The Kaona Room is not your average tiki bar and speakeasy; it's an escape to another realm altogether. From the moment you step through its doors, you're transported to a tropical paradise, enveloped in an ambiance that exudes relaxation and adventure simultaneously. The decor of the Kaona Room is a testament to meticulous attention to detail. Every corner is adorned with artifacts, trinkets, and lush greenery that evoke the essence of a faraway island. The atmosphere is immersive, and you can't help but feel like you've embarked on a journey to some exotic locale. But what truly sets the Kaona Room apart is its staggering selection of rum. With over 500 different varieties to choose from, it's a haven for rum enthusiasts. Whether you're a seasoned connoisseur or just beginning your rum odyssey, there's something here to tantalize your taste buds. While the menu does feature an array of specialty cocktails, ranging from $15 to upwards of $200, the real joy lies in exploring the extensive rum collection. However, it's worth noting that our drinks took a bit longer than expected to arrive. Yet, the friendly service staff more than made up for it, treating us to a complimentary shot of Jamaican rum as a gesture of apology. The Kaona Room is an ideal destination for a night out with friends or a romantic rendezvous. Its intimate setting lends itself well to small groups, fostering an atmosphere of conviviality and camaraderie. Whether you're seeking an adventurous evening or simply looking to unwind in style, the Kaona Room promises a truly unforgettable experience.

See all photos from Tony N. for Kaona Room

I can't say enough good things about my favorite bar in Miami. My boyfriend and I are tiki bar enthusiasts and Kaona Room is just the BEST. The drinks are all delicious and strong. My personal favorite is the Martini Colada. It's such a smooth cocktail and I've never had anything like it. My boyfriend's favorite is the Navy Grog. The presentation for each drink is always amazing. If you order a tiki bowl, you get a show with flames. The servers are very friendly and shout out to Billy! He always makes us feel so welcome when we're there. We started going to Esotico in 2019 and although we're sad it's not there anymore, at least we have Kaona Room. We will DEFINITELY be back again and again. Oh and if you're going on a Friday or Saturday night, I would recommend making a reservation beforehand or you may have to wait a little bit.

TRUE RATING: 6/10 Billy was our bartender and he gave us the most phenomenal experience today. Let's start with ambiance. The place is completely decked out with tiki decor. So so amazing. Down to the T everything is detailed and hand-picked. Shrunken heads, cute pineapple heads, aloha figures, lamps, and all kinds of tiki-related. The drinks. We got the Sexy Colada, a Painkiller, and a Zombie. We spent time discussing out options with Billy and he carefully described the ingredients and his process of making certain homemade components of those crafted cocktails. He truly has his heart in what he does and it is all reflected in the final results. His cocktails are incredible. He is also the nicest person ever. Food. We got the peanut butter dumplings and they surprised me. They were to die for. We could have eaten one hundred more. Then, we got the Hawaiian Fried Rice. It really might be the best fried rice I've ever had in my life. The little pieces of corn add unexpected sweetness Along with the onion pieces. Best fried rice o-m-g. Everything was to-die-for. I hope this place lasts because it is so top-tier. I can't sing its praises enough. GET HERE.

See all photos from Renée C. for Kaona Room

What a fun night - our friend is a big tiki fan and has been wanting to come here for awhile to try one of the rare rums they carry. I went to Esotico a few years ago, but didn't realize they opened a hidden tiki room in the back last year! When the hostess walked us to the back, you walk through a set of doors, that look like it would lead to an employee office or something, but open up to a brilliantly decorated tiki room. Every single cocktail was amazing, they each had their own interesting complexities, and they explained us their special process for aging the rum. The menu had fun graphics and tidbits of tiki history. My favorite drink of the night was the Aku Aku Lapu, which I didn't even think to order, had a sip of my friend's, which led to us ordering another. Many of the drinks involve them rolling over a tiki cart and giving a presentation with sound, fog, and fire. Several of the cups were available for purchase if you want to bring some barware home to start your own tiki collection. While the cocktails are the main star, the food should not be overlooked. In fact, you could eat an entire dinner here. Every single thing we had was so delicious - rock n shrimp, king bao, peanut butter dumplings, fried rice. The sushi boat was well priced, we were pleasantly surprised, given the cool presentation. Last but definitely not least, GET THE RUM CAKE, you know you want to end the night with more fire and alcohol, trust me. Service was superb, they have a massive selection of cocktails, the staff answered all our questions and guided us in the right direction all night. The playlist had vibey 60s esque tiki jams, that matched the atmosphere perfectly. 5 stars for a delightful night on the town, we were having fun for hours!.

See all photos from Francesca D. for Kaona Room

Kaona Room is a hidden gem in Miami, the ambiance and drinks are amazing but the best part is the service! Everyone makes you feel like you are part of the tiki family and truly appreciated for being there. As a tourist this is always on the list when we are in Miami and has been excellent and consistent each time we've been. Highly recommend, we'd be here everyday if we could!

Zombie....strong but amazing!

Amazing little tiki bar! The ambiance is great. The moment you walk in, it's very dark with little lighting. There are a lot of cute tiki designed furniture and decor. The bar is fairly small but it wasn't busy when my husband and I were there. The bartender, Billy was absolutely friendly and had great suggestions and very knowledgeable when it comes to the drinks. We had 4 different cocktails and they were sooo good! The cocktails were creative and we enjoyed it all.

It pains me to only give this place two stars because it has so much potential. It's a really cool speakeasy with a great vibe and delicious drinks with amazing presentation. However, I've been here twice and the service is ridiculously poor. The first time I went the drinks took forever and one of my friends never got his food. The second time I went was just this past Saturday and our greeting by the server was a warning that the service was particularly slow - a terrible sign. And he wasn't kidding - our drinks took at least 35 minutes, to the point that they came after our food arrived. And the table behind us was so upset at the slow service that the gentleman complained to the server and we heard everything. It definitely set a weird tone for the whole night when you know other patrons are upset and you're also getting mediocre service. If you're the owner of Kaona Room: please hire more severs and bartenders. You have great potential but you need to improve your service ASAP!

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• Case Report
• Open access
• Published: 29 May 2024

Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature

• Hanxuan Liu 1   na1 ,
• Zhangjie Yu 2   na1 ,
• Ying Xu 1 ,
• Yan Zhou 2 ,
• Juntao Yang 1 ,
• Yinyin Qiu 1 ,
• Yangbo Xing 2 ,
• Fang Peng 2 &
• Weiliang Tang 2  

BMC Cardiovascular Disorders volume  24 , Article number:  281 ( 2024 ) Cite this article

49 Accesses

Metrics details

Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired).

Case presentation

We report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward.

Conclusions

Acute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.

Peer Review reports

Acute coronary syndrome (ACS) is commonly attributable to coronary atherosclerotic plaque rupture, resulting in thrombosis and obstruction in coronary artery. Nevertheless, coronary artery embolism (CAE), as an infrequent nonatherosclerotic cause of ACS, should also be taken into account. It was reported that the incidence of acute myocardial infarction caused by CAE is 2.9% [ 1 ].One systemic review demonstrated that the most commonly documented etiologies of CAE included infective endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart valve thrombosis (16.3%), only one CAE case was caused by an ascending aortic thrombus (0.6%) [ 2 ]. Ascending aortic thrombus is usually associated with aortic pathologies, including aortic aneurysm, severe aortic atherosclerosis, and aortic dissection [ 3 ]. Ascending aortic thrombus in the absence of the lesions above is very uncommon. This report presents a rare case of the ACS secondary to a mural thrombus sited in a normal ascending aorta, ultimately well-treated with anticoagulation and antiplatelet agents.

A 58-year-old male presented to our emergency department with excruciating chest pain lasting for over 30 min. He had a smoking addiction (over 300 packs of cigarettes per year for more than 20 year) and a history of hypertension that was well-controlled with antihypertensive drugs (including nifedipine, telmisartan and hydrochlorothiazide), with no previous history of atrial fibrillation, valvular diseases or thromboembolic events. On admission, his blood pressure was too low to detect, and the oxygen saturation level in atmospheric air dropped to 90.1%. The initial electrocardiogram (ECG) showed persistent ST-segment depression in leads II, III, AVF and V1-V6, indicating ongoing massive myocardial ischemia and acute non-ST elevation myocardial infarction (non-STEMI) (Fig.  1 ). The serum troponin I (TnI) level increased to 2.46 ng/mL. Echocardiography showed left ventricular dyskinesia with an enlarged left atrium and an ejection fraction of 27%, negative for endocarditis, valve abnormalities, or any thrombus in the cardiac chambers (Supplementary File 1 and File 2 ). Based on the latest guideline for the management of ACS [ 4 ], the patient was advised for invasive coronary angiography and emergency percutaneous coronary intervention, which was rejected by the patient’s dependents for the high risk of intraoperative adverse events. Emergency treatments were immediately performed including a loading dose of aspirin and clopidogrel, dopamine boost, norepinephrine and low molecular weight heparin (LMWH).

Emergency room 12-Lead Electrocardiogram presenting ST-segment depression in leads II, III, AVF and V1-V6, indicating acute non-STEMI

The patient was transferred to the department of cardiology after the symptoms were palliated. Laboratory data showed a high D-dimer level (2.25 µg/mL). Blood cell count, tumor markers antinuclear antibody and blood lipid profile were normal. The computed tomography angiography (CTA) of coronary artery demonstrated a completely normal coronary artery, with no obstructions or stenosis (Fig.  3 ). Unexpectedly, the CTA identified a lobulated mass in the proximal part of ascending aorta, located above the left coronary ostium, measuring 1.5 × 1.1 × 0.9 cm, suggestive for a mural thrombus in the ascending aorta (Fig.  4 ). The pursued CTA of aorta obtained the consistent result that the coronary artery showed no obvious abnormality, and that no signs of atherosclerotic deposits, aneurysms or aortic dissection were found in the ascending aorta (Fig.  5 ). The patient had received short-term anticoagulant and antiplatelet therapy before receiving the aortic CTA, which showed that the original thrombus decreased in size and became indistinct at the edges. His Society of Thoracic Surgery score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II were 59.8% and 20.81% respectively, for isolated coronary artery bypass grafting (CABG). Considering the life-threatening risk of interventional therapy and surgery, the patient was determined on conservative treatment. Therefore, dual antiplatelet and anticoagulant therapy (aspirin 100 mg, clopidogrel 75 mg and LMWH) were still administered, which subsequently relieved his chest pain. Echocardiography revealed LVEF of 45%, and left atrial diameter (LAD) 32 mm, left ventricular internal dimension at end-diastole (LVIDd) 50 mm (shown in Supplementary Fig. 1A and Fig.  1 B in the revised manuscript). However, after the 6 days of conservative treatment, the patient was attacked by a recurrence of chest pain and became hemodynamically unstable. Bedside ECG showed ST segment elevation in precordial leads V1 to V5 and limb leads II, III, AVF, indicating extensive anterior and inferior myocardial infarction (Fig.  2 ). Serum troponin I level increased significantly to 36.17ng/mL. CAE originating from the ascending aortic thrombus accounting for the ACS was suspected. In such condition, coronary intervention carries a hazard of catheter-induced thrombus dislodgement resulting in life-threatening thromboembolic events, including but not limited to acute coronary occlusion and cerebral embolism. As the thrombus had been present for several days (over 24 h), it already passed the time window for intravenous thrombolysis. Therefore, intravenous thrombolytic therapy not only has little effect on resolving such a subacute thrombus but also contributes to bleeding tendencies. Even worse, the subsequent dissolution and dislodgement of the thrombus might pose a risk of secondary arterial embolism. In order to properly get rid of the thrombus, the patient was referred to the department of cardiovascular surgery for surgical thrombectomy. However, considering the huge traumatic stress that the surgery brings, as well as the possible risk of the thrombus dislodgement during operation, the patient rejected the surgical thrombectomy in the end. He continued the conservative treatment consisting of Vasodilators, dual antiplatelet and anticoagulant agents for the remaining days of the hospital stay, which fortunately alleviated the chest pain. Afterwards, the serum troponin I turned to normal level and repeat coronary CTA showed complete resolution of the lobulated thrombus without any abnormality in the coronary artery (Fig.  6 ). The patient was discharged with warfarin (2.5 mg) and aspirin(100 mg), followed up biweekly to ensure the international normalized ratio (INR) ranged between 2.0 and 3.0. Repeat echocardiography at 1month indicated his cardiac function was basically recovered (shown in Supplementary Fig.  2 A and Fig.  2 B). Follow-up CTA at 6 months revealed no thrombus in the aortic root or ascending aorta (Fig.  7 ). No thromboembolic events occurred henceforward.

Bedside Electrocardiogram after the reoccurrence of chest pain shows ST-segment elevation in leads II, III, AVF and V1-V5, with Q waves in leads I II, III, AVF, indicating acute ST-segment elevation myocardial infarction in extensive anterior and inferior walls

Coronary CTA images in ( A ) axial and ( B ) sagittal planes showing a lobulated filling defect suggestive of a thrombus, located in the proximal portion of ascending aorta. The thrombus occurs just above the left coronary ostium, closed to the sinotubular junction and the sinus of Valsalva. No abnormality was found in the coronary artery

3D reconstruction based on coronary CTA revealing the presence of a large thrombus in the proximal portion of the ascending aorta, measuring 1.5 × 1.1 × 0.9 cm. Red structure indicates the thrombus

( A ) and ( B ): The pursued CTA of aorta showed patency of coronary artery. The original thrombus decreased in size and became indistinct at the edges after the short-term anticoagulant and dual antiplatelet therapy. ( C ) Three-dimensional reconstruction of the aorta. Yellow arrow indicates the dissolving thrombus

( A ) and ( B ): Repeated coronary CTA before discharge showed no obvious abnormalities

( A ) and ( B ): Follow-up CTA at 6 months demonstrating complete resolution of the previous thrombus

ACS due to an aortic mural thrombus (AMT) sited in the ascending aorta is a distinctive and uncommon cause of acute myocardial infarction. In many cases, AMT is usually associated with aortic pathologies, including severe atherosclerosis, vasculitis, aneurysm and dissection of the aorta. Primary aortic mural thrombosis (PAMT), defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysm disease in the aorta, is a relatively rare entity. Machleder et al. reported an incidence rate of 0.45% for non-aneurysmal AMT based on a consecutive series of 10,671 autopsies, none of which involves ascending aorta [ 5 ]. In addition, the proximal portion of the ascending aorta is an uncommon site for PAMT. Existing literature acknowledged that the descending thoracic aorta was the most common location of the AMT (38%), while the ascending aorta were the least common location (12%) [ 6 ]. Verma et al. documented 19 patients of PAMT manifested as peripheral embolic events, of whom only 2 patients had a thrombus located in the ascending aorta [ 7 ].

The presented case has attracted much interest because of the infrequent manifestation of ACS caused by an ascending aortic thrombus. Most cases of ascending AMT are clinically silent, usually diagnosed after an embolic event or occasionally identified through echocardiography and CTA [ 8 ]. The typical embolic events caused by AMT include ischemic stroke, visceral and distal embolization, while the coronary events are relatively rare [ 6 ]. What’s unexpected, our patient underwent repeated ACS in his hospital stay. As reported in previous cases, both thrombi in the ascending aorta originating from the ostium of coronary artery and an aortic root thrombus extending into the coronary sinus of Valsalva can account for ACS [ 9 , 10 ]. The occurrence of ACS could arise from the distal CAE caused by the detachment of the aortic thrombus. Ascending aortic thrombus occluding the coronary ostium is also a possible condition. The differential diagnosis relying on effective investigation seems rather critical. Though transesophageal echocardiography (TEE) can precisely localize aortic thrombi and atherosclerosis, TEE still has limitations in presenting the ascending aorta and the proximal aortic arch due to the interference of the trachea, making CTA a superior examination to detect ascending aortic thrombus [ 8 ]. Coronary CTA possess high diagnostic value in excluding significant coronary artery disease (CAD) [ 11 ]. As the first-line anatomic test, Coronary CTA could reduce the total costs of diagnosis in stable CAD patients by avoiding invasive coronary angiography and hospitalization [ 12 ]. We ultimately ruled out the cardiogenic thrombus resulting in ACS, for no evidence of atrial fibrillation and left ventricular thrombus was revealed in the CTA. Then thorough investigations about the etiologies of ascending aortic thrombosis were planned on this patient.

Although the pathophysiological mechanism of an ascending aortic mural thrombosis has not been fully explored, the principle of Virchow’s triad for thrombogenesis remains closely related. Virchow’s triad describes the three factors related to thrombosis: hemodynamics (fluid stasis), endothelial injury (associated with foreign materials), and hypercoagulability (abnormal blood chemistry) [ 13 ]. The high-flow environment of the ascending aorta, characterized by the large blood flow, the high blood pressure and high shear stress, theoretically serves as a protective mechanism against stasis and thrombosis, and contributes to the scarcity of mural thrombi at the proximal ascending aorta. Also, the helical blood flow in the ascending aorta protects the aortic wall from atherosclerosis, thrombus formation, and intimal proliferation [ 14 ]. On the other hand, the Valsalva sinuses in the aortic root complex has been reported to alleviate the high sheer stress of the aortic root. The Valsalva sinuses create a space between the aortic valve leaflets and the aortic wall. As the valve leaflets move towards the aortic wall in the early systole, the space make it possible for blood to flow along the sinotubular junction and enters the Valsalva sinuses, facilitating the eddy current development and promoting thrombosis in the ascending aorta [ 15 ]. In our case, the thrombus was located just around the sinotubular junction and the sinus of Valsalva, somehow making sense of the ascending aortic thrombosis in the patient. In addition to hemodynamics, endothelial injury and hypercoagulable states are closely associated with aortic thrombosis. Prior studies indicated that aortic endothelial injury could arise from prosthetic aortic valve implantation, aortic stent implantation, open aortic surgery, aortitis and infective endocarditis, potentially leading to thrombus-related CAE [ 16 , 17 , 18 , 19 , 20 ]. Therefore, actively searching for evidence of hypercoagulative conditions is our clinical strategy to determine the probable causes of ascending aortic thrombosis in a normal aorta. The hypercoagulable states that have been reported to be associated with the pathogenesis of ascending aortic thrombi include active cancer, inherited thrombophilia, thrombocythemia, polycythemia, antiphospholipid syndrome, systemic infectious diseases [ 5 , 21 , 22 , 23 , 24 , 25 , 26 ]. However, in our case, neither associations with aortic endothelial injury and aortic pathologies such as aortic atherosclerosis, aneurysm, or dissection were found through CTA, nor were any signs indicating risk factors for the aforementioned hypercoagulable states observed during post-admission examinations. Predisposing factors for aortic thrombosis include old age, diabetes, hypertension, hyperlipidemia, smoking addiction, trauma, oral contraceptive use, hormone replacement therapy, and use of exogenous steroids [ 7 ]. Our patient unexpectedly has no other marked predisposing factors but only history of hypertension and smoking. Since hypertension was well controlled, the possible explanation is a transient hypercoagulable state induced by smoking. Also, nicotine in tobacco can cause to vascular endothelial injury, increasing the risk of aortic thrombosis. But the exact cause of thrombosis in the ascending aorta remains mysterious. The interaction of Virchow’s triad potentially led to the ascending aortic thrombosis.

A systematic review indicates that ACS due to coronary embolism has a worse prognosis than atherosclerotic ACS [ 2 ], for the former type has larger myocardial infarct areas. Early differential diagnosis and coronary revascularization are crucial. One must rule out a thrombus within an aneurysm and aortic atherosclerotic thrombus, for the different therapeutic avenues. Aortic mural thrombi associated with aneurysmal formation are most sited in the abdominal aorta, known as intraluminal thrombus (ILT). ILT adheres firmly to the aortic wall, so it’s rare the ever-growing ILT leads to distal occlusion. Anticoagulation is notoriously difficult to reverse in the event of hemorrhage. Currently, neither antiplatelet nor anticoagulant therapy is clinically used except aspirin recommended as secondary prevention for abdominal aortic aneurysm-induced cardiovascular diseases [ 27 ]. Aortic atherosclerotic thrombosis involves thrombus building up on complex or ulcerated aortic plaques. The present evidence supports that dual antiplatelet therapy or moderate intensity anticoagulation with warfarin as secondary prevention of aortic atheroma could decrease the recurrence of thromboembolic stroke [ 28 ]. There is no consensus or properly evolved guidelines about the management of ascending aortic thrombus because of its scarcity, so the management of AMT rely much on clinical experience. Treatment options reported so far include anticoagulation, antiplatelet therapy, the combination of anticoagulation and antiplatelet agents, thrombolysis, endovascular stent graft placement, and surgical therapy. Individualized treatment is recommended, taking into consideration factors including the size, location, mobility and implantation base of the thrombus, hemodynamic stability of the patient, and the medical standard of the hospital. Surgery is the recommended treatment for AMT in a normal or mildly atherosclerotic aorta and thrombus located in the ascending aorta, with lower incidence of recurrent thrombus, thromboembolic complication, and limb loss [ 6 ]. As for thrombus located in the aortic arch, descending aorta, and abdominal aorta, endovascular treatment or medical treatment are the preferred option [ 29 ]. Aortic mural thrombi are classified as sessile and pedunculated based on the implantation base. For large and pedunculated thrombi bear a higher risk of secondary embolism, surgical treatment may obtain better clinical results [ 30 ]. In contrast, small and sessile thrombi are appropriate for anticoagulation [ 31 ]. Thrombi over 1 cm in diameter were reported with higher risks of embolic events [ 32 ]. Previous studies postulated that anticoagulation may lysing the thin attachment site of the pedunculated thrombus before lysing the thrombus itself, thus triggering the subsequent embolic events [ 31 ]. Laperche et al. reported 23 patients with isolated ascending aortic arch thrombus, among whom 17 patients were treated with anticoagulants, and the aortic arch thrombi in 11 patients (92%) disappeared from 3 days to 6 months after the initial embolic event, indicating the therapeutic potential of anticoagulants in the management of ascending aortic thrombus. Choukron et al. recommended anticoagulation as initial therapy and resorting to surgical thrombectomy only when anticoagulation proves ineffective [ 33 ]. Some cases also reported successful resolution of aortic thrombi under the combination of anticoagulation and antiplatelet therapy, but it brings an increased tendency of bleeding [ 34 ]. Currently, the optimal drug, dose, and duration of anticoagulation therapy for ascending aortic thrombus have not been standardized, and no study has assessed direct oral anticoagulants in aortic thrombus so far [ 28 ]. We referred to the management for left ventricular thrombus and prescribed the patient warfarin with stable INR (within the range of 2.0–3.0) [ 35 ]. Endovascular stent graft is less invasive than surgery, also possibly decreasing the size of residual aortic thrombus with a reduced risk of recurrent embolization in comparison to anticoagulation. But when dealing with ascending aortic thrombus, endovascular treatment may pose the risk of dislodging the thrombus during the stent placement, giving rise to fatal embolism [ 7 ]. Thrombolysis, though infrequently performed in managing aortic thrombus, has also provided successful treatments in some cases [ 36 ]. Conventional surgery can remove the aortic thrombus once for all and avoid recurrent embolism, but as a more invasive choice, it involves sternotomy procedure, cardiopulmonary bypass, deep hypothermia and a subsequent series of post-operative complications, including arrhythmias and even post-thrombectomy mortality [ 37 ]. Pre-operative hemodynamic instability is usually associated with the increased risks of surgical mortality. Considering our patient’s hemodynamic instability and his strong preference for conservative treatment, we determined on a safer management, which consisted of anticoagulant and dual antiplatelet agents. Fortunately, the patient’s symptoms and quality of life were all improved at the six-month follow-up.

ACS due to coronary artery embolism in the setting of a mural thrombus sited in a normal ascending aorta is rather rare. This case report has attempted to elaborate the potential mechanisms of ascending aortic thrombosis from the perspective of the well-known Virchow’s triad. Active hypercoagulable investigations on the patients are essential. Our patient was successfully treated with antiplatelet and anticoagulant therapy, it should be noted that AMT sited in the ascending aorta is a hazardous condition. When surgery therapy was unavailable or inapplicable, antiplatelet and anticoagulant therapy could bring a chance of resolving ascending mural thrombi. However, it also comes with possibilities of secondary embolic events, including CAE as one of the worst conditions.

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All data generated or analysed during this study are included in this article.

Abbreviations

Acute Coronary Syndrome

Coronary Artery Embolism

Electrocardiogram

non-ST elevation myocardial infarction

Low Molecular Weight Heparin

Computed Tomography Angiography

Coronary Artery Bypass Grafting

European System for Cardiac Operative Risk Evaluation

International Normalized Ratio

Aortic Mural Thrombus

Primary Aortic Mural Thrombosis

Transesophageal Echocardiography

Coronary Artery Disease

Intraluminal Thrombus

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Acknowledgements

The authors would like to thank the patient for his participation in this study.

This research was funded by Zhejiang Traditional Chinese Medicine Science and Technology Program (2023ZL184).

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Hanxuan Liu and Zhangjie Yu shared first authorship.

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School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China

Hanxuan Liu, Ying Xu, Juntao Yang & Yinyin Qiu

Department of Cardiology, Shaoxing People’s Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China

Zhangjie Yu, Yan Zhou, Yangbo Xing, Fang Peng & Weiliang Tang

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Hanxuan Liu and Zhangjie Yu equally contributed and authored the manuscript. Concept – Hanxuan Liu, Zhangjie Yu, Weiliang Tang; Design – Hanxuan Liu, Zhangjie Yu, Ying Xu; Supervision – Zhangjie Yu, Weiliang Tang; Funding – Zhejiang Traditional Chinese Medicine Science and Technology Program (2023ZL184); Materials –Zhangjie Yu, Juntao Yang; Data collection and/or processing – Zhangjie Yu, Juntao Yang, Yinyin Qiu; Analysis and/or interpretation – Hanxuan Liu, Ying Xu, Weiliang Tang; Literature review – Hanxuan Liu, Fang Peng, Weiliang Tang; Writer – Hanxuan Liu, Zhangjie Yu; Critical review – Fang Peng, Yan Zhou; Other – None.

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The case report was approved by the Ethics Committee of Shaoxing People’s Hospital (Ethical Determination for Case Report No: 003, Date: 27 − 12 -2023). The study was conducted in accordance with the local legislation and institutional requirements.

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Liu, H., Yu, Z., Xu, Y. et al. Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature. BMC Cardiovasc Disord 24 , 281 (2024). https://doi.org/10.1186/s12872-024-03956-2

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Received : 30 January 2024

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DOI : https://doi.org/10.1186/s12872-024-03956-2

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• Ascending aortic thrombus
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