Primary Aortoesophageal Fistula: Is a High Level of Suspicion Enough?

Aortoenteric fistula (AEF) is a rare condition with a high mortality rate. AEFs are classified according to their primary and secondary causes, the former being less frequent. Primary AEFs occur in a native aorta and their causes include aneurysms, foreign bodies, tumours, radiotherapy and infection. The classic triad of aortoesophageal fistulas, a subtype of AEFs, are mid-thoracic pain and sentinel haemorrhage, followed by massive bleeding after a symptom-free interval. We present the case of a 41-year-old male patient who presented in the emergency room after successive episodes of abundant haematemesis. He was hypovolemic, hypothermic and acidotic at presentation. His medical history included an emergency room visit the week before with chest pain but no relevant anomalies on work-up, active intravenous drug use and chronic hepatitis. Esophagogastroduodenoscopy (EGD) showed a bulging ulcerated lesion suspicious for aortoesophageal fistula, confirmed by computed tomography (CT) angiography, which revealed a saccular aortic aneurysm with a bleeding aortoesophageal fistula. The patient underwent urgent thoracic endovascular aortic repair. The sentinel chest pain, leucocytosis and CT findings hinted at the presence of a mycotic aneurysm, despite the negative blood cultures. It was most likely caused by a septic embolus due to the patient’s risk factors. While a high level of suspicion for aortoesophageal fistula is needed to prompt a fast diagnosis, EGD and CT findings were crucial to establish it and allow a life-saving intervention. We conclude that chest pain cannot be disregarded in a patient aged 41 years with multiple comorbidities, despite normal work-up, to prevent a fatal outcome.

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Boerhaave syndrome: A rare cause of retrosternal pain

PONS - medicinski casopis ◽

10.5937/pomc17-28156 ◽

2020 ◽

Vol 17 (2) ◽

pp. 83-88

Author(s):

Adna Kafedžić ◽

Nedim Katica

Keyword(s):

Chest Pain ◽

Case Reports ◽

Treatment Options ◽

Acute Chest Pain ◽

Rare Condition ◽

Individual Case ◽

Retrosternal Pain ◽

Specialist Treatment ◽

Boerhaave Syndrome ◽

High Level

Acute chest pain is one of the biggest challenges in diagnostic and therapeutic terms due to a number of differential diagnostic options. Boerhaave syndrome is a rare condition, but at the same time one of the most lethal diseases of the gastrointestinal tract. For this reason, a high level of suspicion is required in patients with presenting retrosternal pain. Classic symptoms such as vomiting, chest pain, and subcutaneous emphysema may not always be present. The approach to the patient with Boerhaave syndrome is multidisciplinary. The patient needs urgent rehydration, antibiotic treatment and consultation with a surgery specialist. Treatment is based on the clinical picture of the patient, the location and size of the perforation, but the most important prognostic factor is the time of diagnosis. There are still no official guidelines for the treatment of this condition, and knowledge of treatment options is based on individual case reports from the literature.

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Eletrocardiogram gate time in patients with thoracic pain in the emergency

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v12i4a231123p1027-1036-2018 ◽

2018 ◽

Vol 12 (4) ◽

pp. 1027

Author(s):

David Bernar Oliveira Guimarães ◽

Tatyanne Silva Rodriguês ◽

Sarah Carolline Mazza Oliveira ◽

Fernanda Valéria Silva Dantas Avelino

Keyword(s):

Chest Pain ◽

Angina Pectoris ◽

Emergency Room ◽

Web Of Science ◽

Prehospital Care ◽

Developed Countries ◽

Thoracic Pain ◽

De Se ◽

Gate Time ◽

Cardiac Disorders

ABSTRACT Objective: to identify electrocardiogram gate time in patients with chest pain in the emergency room. Method: integrative review, using PVO technique, carried out in February 2017, in the VHL Portal and Medline, Web of Science, ScieLO and CIHNAL sites, using the descriptors Chest Pain, Electrocardiography, Emergencies, identified in the MeSH, in the title CINAHL , coinciding with the DeCS, using the Boolean operator AND in all associations. Results: according to the search strategies, ten articles with origin in developed countries and only one Brazilian were identified. Conclusion: the literature defines that the electrocardiogram for patients with chest pain in the emergency room should be done within ten minutes. There is a need to develop further studies on the performance of the ECG in prehospital care in order to carry out conducts directed to cardiac disorders. Descritores: Angina Pectoris; Emergencies; Electrocardiography; Nursing Care; Emergency Nursing; ST Elevation Myocardial Infarction.RESUMOObjetivo: identificar o tempo porta eletrocardiograma em pacientes com dor torácica na emergência. Método: revisão integrativa, utilizando técnica PVO, realizada em fevereiro de 2017, no Portal da BVS e nos sites Medline, Web of Science, ScieLo e CIHNAL, com o uso dos descritores dor no peito, eletrocardiografia, emergências, identificados no MeSH, no título CINAHL, coincidindo com os DeCS, utilizando o operador booleano AND em todas as associações. Resultados: segundo as estratégias de busca, identificaram-se dez artigos de origem em países desenvolvidos e somente um brasileiro. Conclusão: a literatura define que a realização do eletrocardiograma para pacientes com dor torácica na emergência deve ser feita em até dez minutos. Há a necessidade de se desenvolverem mais estudos sobre a realização do ECG no atendimento pré-hospitalar para se tomarem condutas direcionadas diante a agravos cardiológicos. Descritores: Angina Pectoris; Emergências; Eletrocardiografia; Cuidados de Enfermagem; Enfermagem em Emergência; Infarto do Miocárdio com Supradesnível do Segmento ST. RESUMEN Objetivo: identificar el tiempo puerta-electrocardiograma en pacientes con dolor torácico en la emergencia. Método: revisión integrativa, utilizando técnica PVO, realizada en febrero de 2017 en los servicios, en el Portal de la BVS, y en los sitios, Medline, Web of Science, ScieLo y CIHNAL, con el uso de los descriptores dolor en el pecho, electrocardiografía, emergencias, identificados en el MeSH, en el título CINAHL, coincidiendo con los DeCS, utilizando el operador booleano AND en todas las asociaciones. Resultados: según las estrategias de búsqueda, se identificaron diez artículos, los cuales son de origen en países desarrollados y sólo uno es brasileño. Conclusión: la literatura define que la realización del electrocardiograma para pacientes con dolor torácico en la emergencia debe ser hecha en hasta 10 minutos. Hay la necesidad de desarrollar más estudios sobre la realización del ECG en la atención prehospitalaria para tomar conductas dirigidas ante agravios cardiológicos. Descritores: Angina de Pecho; Urgencias Médicas; Electrocardiografía; Atención en Enfermería; Enfermería de Urgencia; Infarto del Miocardio con Elevación del ST.

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313 Prognostic implications of semi-supine exercise stress echocardiography for the evaluation of chest pain in the emergency room

European Journal of Echocardiography ◽

10.1016/s1525-2167(99)80089-4 ◽

1999 ◽

Vol 1 ◽

pp. S26-S26

Author(s):

P LANCELLOTTI ◽

E HOFFER ◽

H APPELTANS ◽

A GHUYSEN ◽

V DORIO ◽

...

Keyword(s):

Chest Pain ◽

Emergency Room ◽

Stress Echocardiography ◽

Exercise Stress ◽

Exercise Stress Echocardiography ◽

Prognostic Implications

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Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.sc1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 179-185 ◽

Cited By ~ 7

Author(s):

Suvadip Chatterjee ◽

Kofi W. Oppong ◽

John S. Scott ◽

Dave E. Jones ◽

Richard M. Charnley ◽

...

Keyword(s):

Autoimmune Pancreatitis ◽

Rare Condition ◽

Team Approach ◽

Diagnostic Challenge ◽

Multisystem Disorder ◽

North East ◽

The North ◽

Work Up ◽

Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

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