Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal
Keyword(s):  
Early Diagnosis ◽  
Nasogastric Tube ◽  
Common Type ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Tube Position ◽  
Esophageal Pouch ◽  
High Index Of Suspicion ◽  
Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

scholarly journals Challenges in the Diagnosis of Giant Cell Arteritis Before Visual Loss

2020 ◽  
pp. 1-5
Author(s):  
Purnima Mehta ◽  
Faaiq Hassan ◽  
Muhammed Omar Qadir ◽  
Shirish Dubey ◽  
Sergio Pagliarini ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Visual Loss ◽  
Systemic Vasculitis ◽  
The Elderly ◽  
Common Type ◽  
Atypical Presentation ◽  
Delay In Diagnosis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Background: Giant cell arteritis (GCA) is the most common type of systemic vasculitis affecting the elderly. Ophthalmic presentations of GCA in particular can be difficult to identify prior to permanent visual loss occurring. Methods: Here, we present 3 challenging cases as a retrospective series to highlight the variable presentations of GCA with ophthalmic involvement, but GCA was not suspected due to atypical presentation. Results: Unfortunately, all 3 cases went on to develop visual loss in the affected eye due to a delay in diagnosis or treatment. The authors wish to highlight the challenges posed to the referring clinicians, when patients had systemic/ocular co-morbidities, which delayed the suspicion of GCA Conclusion with a Practical Point: Our cases highlight the variable presentations of this condition as well as the devastating ophthalmic implications that GCA can have. A high index of suspicion must be maintained; particularly in elderly patients with atypical presentations.

scholarly journals Confirming nasogastric tube position with electromagnetic tracking versus pH or X-ray and tube radio-opacity

2014 ◽  
Vol 23 (7) ◽  
pp. 352-358 ◽  
Author(s):  
Stephen Taylor ◽  
Kaylee Allan ◽  
Helen McWilliam ◽  
Alex Manara ◽  
Jules Brown ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Electromagnetic Tracking ◽  
X Ray ◽  
Tube Position

scholarly journals Biologically transparent illumination is a safe, fast, and simple technique for detecting the correct position of the nasogastric tube in surgical patients under general anesthesia

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250258
Author(s):  
Hirofumi Hirano ◽  
Hanayo Masaki ◽  
Teppei Kamada ◽  
Yoshie Taniguchi ◽  
Eiji Masaki
Keyword(s):  
General Anesthesia ◽  
Nasogastric Tube ◽  
Prospective Observational Study ◽  
The Other ◽  
Surgical Patients ◽  
Correct Position ◽  
X Ray ◽  
Tube Position ◽  
Safe Technique ◽  
Finger Pressure

The aim of this study was to evaluate the effectiveness of using biologically transparent illumination to detect the correct position of the nasogastric tube in surgical patients. This prospective observational study enrolled 102 patients undergoing general surgeries. In all cases, a nasogastric tube equipped with a biologically transparent illumination catheter was inserted after general anesthesia. The identification of biologically transparent light in the epigastric area either with or without finger pressure indicated that the tube had been successfully inserted into the stomach. X-ray examination was performed to ascertain the tube position and was compared with the findings of the biologically transparent illumination technique. Biologically transparent light was detected in 72 of the 102 patients. In all of these 72 patients, the position of the nasogastric tube in the stomach was confirmed by X-ray examination. The light was not detected in the other 30 patients; X-ray examination showed that the nasogastric tube was positioned in the stomach in 21 of these 30 patients but not in the other 9. The sensitivity and specificity of the illumination were 77.4% and 100%, respectively. The results suggest that biologically transparent illumination is a useful and safe technique for detecting the correct position of the nasogastric tube in surgical patients under general anesthesia. When the BT light cannot be identified, X-ray examination is mandatory to confirm the position of the nasogastric tube.

Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment

2008 ◽  
Vol 2 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Yukihiko Sonoda ◽  
Toshihiro Kumabe ◽  
Shin-Ichiro Sugiyama ◽  
Masayuki Kanamori ◽  
Yoji Yamashita ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Early Diagnosis ◽  
Germ Cell ◽  
Precocious Puberty ◽  
Germ Cell Tumors ◽  
Young Patients ◽  
Early Recurrence ◽  
Initial Therapy ◽  
Motor Weakness ◽  
Delay In Diagnosis

Object Intracranial germ cell tumors (GCTs) originating in the basal ganglia are rare. The authors investigated factors related to the diagnosis of these lesions as well as outcome in order to help decrease the time to diagnosis and improve treatment efficacy. Methods The authors reviewed the clinical features of 142 cases of intracranial GCT in their institute. Fourteen cases of basal ganglia GCT were identified. The symptoms, neuroimaging findings, delay between symptom onset and diagnosis or treatment, initial and further treatment, and outcome were investigated. Results Major symptoms were motor weakness and precocious puberty. Gadolinium-enhanced T1-weighted MR images showed enhancement in 8 of 11 patients examined, but only slight hyperintensity without enhancement in 2 patients. Ipsilateral peduncle and hemispheric atrophy were found in 3 and 4 patients, respectively. Cases of basal ganglia GCT were characterized by a longer delay from the initial neuroimaging examination to diagnosis compared with GCT in other regions. Five patients had aggravated hemiparesis in the extremities due to the delay in diagnosis. Despite good response to the initial therapy, 5 patients experienced recurrence; 2 of these 5 had malignant GCTs, and 3 had been treated only with chemotherapy or radiochemotherapy with insufficient radiation dose and field. Finally, the 2 patients with malignant GCTs died of the disease, and 1 died of aspiration pneumonia due to dissemination around the brainstem. Conclusions Early diagnosis requires MR imaging with administration of contrast medium in young patients presenting with motor weakness and/or precocious puberty. Serial neuroimaging studies should be performed if any tiny lesion is detected in the basal ganglia. Since insufficient treatment resulted in early recurrence, radiation therapy with adequate dose and field is essential.

scholarly journals An Integrated Framework with Machine Learning and Radiomics for Accurate and Rapid Early Diagnosis of COVID-19 from Chest X-ray

2021 ◽  
pp. 115152
Author(s):  
Mahbubunnabi Tamal ◽  
Maha Alshammari ◽  
Meernah Alabdullah ◽  
Rana Hourani ◽  
Hossain Abu Alola ◽  
...  
Keyword(s):  
Machine Learning ◽  
Early Diagnosis ◽  
X Ray ◽  
Integrated Framework ◽  
Chest X Ray

scholarly journals Diagnosing gastric volvulus in chest X-ray: report of three cases

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Narendra Pandit ◽  
Abhijeet Kumar ◽  
Tek Narayan Yadav ◽  
Qamar Alam Irfan ◽  
Sujan Gautam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Abdomen ◽  
Gastric Volvulus ◽  
X Ray ◽  
Pain Abdomen ◽  
Life Threatening ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Specific Symptoms ◽  
Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

Wegener’s granulomatosis: diagnostic dilemma

2001 ◽  
Vol 115 (1) ◽  
pp. 46-47 ◽  
Author(s):  
A. Banerjee ◽  
J. M. Armas ◽  
J. H. Dempster
Keyword(s):  
Early Diagnosis ◽  
Wegener’S Granulomatosis ◽  
Systemic Disease ◽  
Wegener's Granulomatosis ◽  
The Body ◽  
Facial Nerve Paralysis ◽  
Diagnostic Dilemma ◽  
Nerve Paralysis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Wegener’s granulomatosis is a systemic disease characterized by a granulomatous lesion that can affect any organ throughout the body.This case-report illustrates the problem posed by a patient presenting with bilateral serous otitis media with marked sensorineural hearing loss, facial nerve paralysis and an atypical serological picture. The importance of early diagnosis and the protocol for the management of a patient with an uncertain diagnosis is discussed. Due to atypical presentations, only a high index of suspicion will ensure an early diagnosis.

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