scholarly journals Uncommon cause of chest pain in a postoperative spinal patient

2018 ◽  
pp. bcr-2018-225293
Author(s):  
Rajesh Dwivedi
Keyword(s):  
Chest Pain ◽  
Spinal Surgery ◽  
Anterior Chest Wall ◽  
Sternal Fracture ◽  
Pulmonary Angiogram ◽  
Chest Wall Trauma ◽  
History Of ◽  
Ct Pulmonary Angiogram ◽  
Chest X Ray ◽  
Sternal Fractures

An 84-year-old woman with previous spinal operations including vertebroplasty and lumbar decompressions was admitted electively under the spinal team for right-sided L4/5 decompression for worsening back pain which she undergoes using a posterior approach. Postoperatively, she develops stabbing upper central chest pain and given unremarkable chest X-ray, ECG and cardiac troponin, she undergoes a CT pulmonary angiogram which shows a fracture of the upper part of sternum but no pulmonary embolism. There is no history of recent trauma and this is deemed to be secondary to prolonged spinal surgery in the prone position in a patient with osteopenic bones. To date, we have not come across a case of spontaneous sternal fracture as a complication of spinal surgery at our regional spinal unit. Most cases of sternal fractures are secondary to blunt anterior chest wall trauma with spontaneous fractures and stress fractures being rare.

Twenty-three year-old with pleuritic chest pain

Heart ◽  
2018 ◽  
Vol 105 (6) ◽  
pp. 464-469
Author(s):  
Karina P Gopaul ◽  
Helen M Parry ◽  
Damien Cullington
Keyword(s):  
Chest Pain ◽  
Congenital Heart ◽  
White Cell Count ◽  
Coarctation Of The Aorta ◽  
List Type ◽  
Pleuritic Chest Pain ◽  
Reactive Protein ◽  
Pulmonary Angiogram ◽  
Night Sweats ◽  
Ct Pulmonary Angiogram

Clinical introductionA 23-year-old woman followed at another medical centre for congenital heart disease (CHD) presented to our emergency clinic with 3 weeks of bilateral pleuritic chest pain. She returned from holiday in Greece 6 weeks earlier where a tattoo and nasal piercing had been performed. There was no history of night sweats or fever.Her temperature was 37.5°C, heart rate 120 beats/min, oxygen saturations 94% on room air and blood pressure 110/74. Her chest was clear and there was systolic murmur on auscultation. The chest radiograph showed peripheral bilateral lower zone atelectasis. The ECG demonstrated sinus tachycardia. The haemoglobin was 11.2 g/dL, white cell count 10.18×109/L, C-reactive protein 67 mg/L (normal <5 mg/L) and D dimer=430 ng/mL (normal <230 ng/mL).A pulmonary embolus was suspected and a CT pulmonary angiogram was performed (figure 1).QuestionBased on the CT findings, what is the most likely underlying congenital heart lesion in this patient?Bicuspid aortic valveCoarctation of the aortaFontan circulationParachute mitral valveVentricular septal defectFigure 1CT pulmonary angiogram (coronal views).

Primary pulmonary angiosarcoma

2021 ◽  
Vol 14 (11) ◽  
pp. e244578
Author(s):  
Muhammad Kashif Rana ◽  
Owais Rahman ◽  
Aiden O’Brien
Keyword(s):  
Pulmonary Arteries ◽  
Rare Type ◽  
Pulmonary Artery Sarcoma ◽  
Pulmonary Angiogram ◽  
Primary Pulmonary Artery Sarcoma ◽  
History Of ◽  
Ct Pulmonary Angiogram ◽  
The Right ◽  
Specific Symptoms ◽  
Large Primary

Primary pulmonary angiosarcoma is a rare type of malignant vascular tumour with poor prognosis. Diagnosis is often late due to non-specific symptoms and low clinical suspicion for angiosarcoma. A 72-year-old man presented to hospital with a 6-month history of mild progressive dyspnoea, with associated cough, episodes of presyncope and weight loss. CT pulmonary angiogram (CTPA) was reported as a large saddle pulmonary embolism extending into both the right and left pulmonary arteries. Further Multidisciplinary team meeting (MDM) discussion, and review of CTPA and subsequent investigations revealed a large primary pulmonary artery sarcoma which was later confirmed histology. The patient was referred to the cardiothoracic surgeons and underwent left radical pneumonectomy.

Suspecting a fatal condition on a plain chest radiograph; Boerhaave syndrome

2020 ◽  
pp. 003693302096118
Author(s):  
Muhammad Adeel Rizwan Hashmi ◽  
Moustafa El-Badawy ◽  
Adnan Agha
Keyword(s):  
Chest Pain ◽  
Chest Radiograph ◽  
Medical Condition ◽  
Organ Support ◽  
Chest Drain ◽  
Diagnostic Challenge ◽  
Plain Chest Radiograph ◽  
Pulmonary Angiogram ◽  
History Of ◽  
Boerhaave Syndrome

Spontaneous oesophagus rupture, also known as Boerhaave syndrome, is a rare but near-fatal medical condition and despite recent medical advancements, it remains a diagnostic challenge for front-door clinicians. The authors describe a similar presentation in an elderly gentleman who presented to the emergency department with sudden chest pain post vomiting. His initial chest radiograph showed bilateral dense consolidations and pleural effusions, and was treated as sepsis secondary to bilateral pneumonia. He underwent computed tomography pulmonary angiogram to rule out pulmonary embolism because of his chest pain with elevated D-dimer which confirmed the diagnosis of oesophagus rupture. His care was transferred to Surgical and Intensive care colleagues with plans for radiological chest drain insertion to limit contamination of mediastinum, however the patient became hypoxic and hypotensive and despite maximal organ support passed away within 6 hours of admission. Retrospect review of chest radiograph revealed Peri-oesophageal air tracking, a sign of Boerhaave syndrome. The aim of this case is to emphasise the importance of raising the suspicion of Boerhaave syndrome in patients with sudden chest pain, unexplained pleural effusion or pneumothorax with a history of recent vomiting as early diagnosis holds the key to prompt lifesaving management.

Bilateral spontaneous chylothorax presenting as a left-sided neck mass

2021 ◽  
Vol 14 (4) ◽  
pp. e240320
Author(s):  
Sarah Akbar ◽  
Rajeev Advani ◽  
Rohini Aggarwal
Keyword(s):  
Soft Tissues ◽  
Anterior Chest Wall ◽  
Neck Mass ◽  
Ct Scans ◽  
X Ray ◽  
Low Fat Diet ◽  
History Of ◽  
Chest X Ray ◽  
Inflammatory Changes

A previously well 36-year-old woman presented with a 2-day history of a tender left-sided neck mass associated with left-sided otalgia and odynophagia. On examination, there was a diffuse, tender swelling of the left anterior triangle of the neck with extension onto the anterior chest wall. Ultrasound and CT scans of the neck revealed extensive inflammatory changes in the soft tissues of the neck and a chest X-ray showed blunting of both costophrenic angles. A diagnostic pleural aspiration was subsequently performed and yielded chyle. The patient was commenced on total parenteral nutrition and placed on a low-fat diet; symptoms completely resolved within 5 days, and at follow-up at 6 weeks, there were no further episodes or complications. Bilateral spontaneous chylothorax is a rarely reported phenomenon in the literature; it has been reported in females following the possibility of minor physical exercise such as stretching or hyperextension of the neck.

Picture Quiz: A Case of Sudden Severe Chest Pain

2007 ◽  
Vol 6 (1) ◽  
pp. 27-27
Author(s):  
Mustafa Abu Rabia ◽  
◽  
P Sullivan ◽  
Stavros M Stivaros. ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Medical History ◽  
Chest Wall ◽  
Epigastric Pain ◽  
Anterior Chest Wall ◽  
Sudden Onset ◽  
Severe Chest Pain ◽  
History Of ◽  
Previous Medical History

An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

Advanced lung cancer on CT pulmonary angiogram in a patient presenting to an accident and emergency department with chest pain and breathlessness

2018 ◽  
pp. 20-23
Author(s):  
Adam Ainley ◽  
Himender Makker
Keyword(s):  
Lung Cancer ◽  
Emergency Department ◽  
Chest Pain ◽  
Advanced Lung Cancer ◽  
Pulmonary Angiogram ◽  
Accident And Emergency ◽  
Ct Pulmonary Angiogram ◽  
Accident And Emergency Department

This case study looks at Advanced lung cancer on CTPA in a patient presenting to Accident & Emergency department with chest pain and breathlessness, and provides questions with model answers.

scholarly journals The Association between Blunt Cardiac Injury and Isolated Sternal Fracture

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Anahita Dua ◽  
Jason McMaster ◽  
Pathik J. Desai ◽  
Sapan S. Desai ◽  
SreyRam Kuy ◽  
...  
Keyword(s):  
Normal Sinus Rhythm ◽  
Cardiac Injury ◽  
Sternal Fracture ◽  
Normal Sinus ◽  
Chest X Ray ◽  
Level I ◽  
Clinically Significant ◽  
The Uk ◽  
Sternal Fractures

The treatment of isolated sternal fractures (ISF) throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years) with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77) were admitted to hospital with 66% (58) of them discharged within 48 hours. Two (2%) patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63%) patients with only 2 (2%) having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7%) patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER.

Deep vein thrombosis in pregnancy

2021 ◽  
Vol 20 (3) ◽  
pp. 137-142
Author(s):  
Zacharias Fasoulakis ◽  
Aikaterini Mpairami ◽  
George Asimakopoulos ◽  
Konstantinos Tasias ◽  
Michael Sindos ◽  
...  
Keyword(s):  
Developed Countries ◽  
X Ray ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Pulmonary Angiogram ◽  
Compression Ultrasound ◽  
Life Threatening ◽  
History Of ◽  
Ct Pulmonary Angiogram ◽  
Deep Vein

Venous thrombotic events (VTE) prevalence is estimated to be 1-2 for every 10,000 pregnancies, making it one of main causes of maternal mortality in developed countries. VTE’s leading risk factors are history of the condition and hereditary thrombophilia. D-dimer tests conducted during pregnancies have in many cases led to false positive results while a few false negatives have also been found. For pregnant women, it is important for evaluation to begin with compression ultrasound before magnetic resonance imaging, which seeks a negative test and focuses on the pelvis. On the other hand, a chest x-ray should be done for pulmonary embolism, which helps in deciding between a CT pulmonary angiogram and perfusion study for normal and abnormal x-ray, respectively. Generally, treatment is composed of heparin of low molecular weight for at least six weeks after childbirth. Thrombolysis can be significant for life-threatening and serious thrombolysis. For populations at high risk, VTE prophylaxis still faces a lot of uncertainty. In fact, there is still little evidence to support the essence of mechanical prophylaxis for all women who have delivered through cesarean.

scholarly journals Spontaneous Sternal Fracture — A Misnomer

1986 ◽  
Vol 79 (3) ◽  
pp. 175-176 ◽  
Author(s):  
R C Bowyer ◽  
V L R Touquet
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Sudden Onset ◽  
Sternal Fracture ◽  
Uncomplicated Case ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Sternal Fractures

Spontaneous sternal fractures, although rare, may present to the Accident and Emergency Department as a severe central chest pain of sudden onset. These may be confused with myocardial infarction1 or pulmonary embolism2. Treatment in the uncomplicated case may be symptomatic with analgesics, but this fracture may require sternal wiring if paradoxical sternal movement embarrasses respiration. Spontaneous fracture of the sternum appears in the majority of cases to be due either to secondary metastatic infiltration, myelomatosis or extreme osteoporosis3. We report a case which emphasizes the importance of investigating these patients.

scholarly journals Epipericardial Fat Necrosis: A Case Report and a Review of the Literature

2020 ◽  
Vol 13 ◽  
pp. 117954762094076
Author(s):  
Synnøve Gjelsten Mortensen ◽  
Petr Buchmann ◽  
Knut Tore Lappegård
Keyword(s):  
Chest Pain ◽  
Imaging Techniques ◽  
Acute Chest Pain ◽  
Fat Necrosis ◽  
Short History ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Inflammatory Drugs

Epipericardial fat necrosis (EFN), also known as pericardial or mediastinal fat necrosis, has until lately been considered an unusual cause of acute chest pain. Due to increased use of computed tomography (CT) and other imaging techniques, EFN is now believed to be an under-diagnosed cause of acute chest pain. We here present a patient with a short history of acute, left-sided pleuritic chest pain and dyspnoea, with total resolution of symptoms upon few days with nonsteroidal anti-inflammatory drugs (NSAIDs) treatment. Chest X-ray showed a paracardial opacity with ipsilateral pleural effusion, echocardiography revealed features of EFN, and CT scan demonstrated the cardinal lesion of EFN—an ovoid, fat-containing paracardial mass with surrounding inflammatory stranding. There was a near to full radiological resolution in 3 weeks.

Sign in / Sign up

Export Citation Format

Share Document