Acute obstruction of a mechanical aortic valve in a young woman: case report and review of the literature

SummaryAcute aortic valve obstruction is a medical and surgical emergency necessitating intensive care unit admission. The differential diagnosis includes thrombosis, pannus formation or vegetations. The diagnosis should be obtained as soon as possible, with possible orientation towards the cause. Different diagnostic modalities exist nowadays. Notably, the transesophageal echocardiography (TEE) offers a diagnosis and a guide for management. Surgical treatment remains of choice despite growing evidence about a benefit of combined thrombolytic and anticoagulation line of management.Learning pointsAcute management and resuscitation of acute valvular obstruction.Differential diagnosis and role of echo in the diagnosis.Management options.

Download Full-text

Accidental transdermal methanol poisoning presenting to a regional emergency department

CJEM ◽

10.1017/cem.2018.499 ◽

2019 ◽

Vol 21 (3) ◽

pp. 435-437

Author(s):

Chelsea R. Beaton ◽

Clinton Meyer

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Metabolic Acidosis ◽

Laboratory Testing ◽

Clinical Findings ◽

Anion Gap ◽

List Type ◽

Emergency Physicians ◽

Clinical Presentations ◽

Learning Points

Learning Points:•Know and identify clinical presentations of toxic alcohols.•Understand the differential diagnosis of high anion gap metabolic acidosis.•Appreciate the importance of history and clinical findings in establishing methanol toxicity diagnoses, especially in centres where laboratory testing is unavailable.•Recognize the value of provincial poison centres in supporting emergency physicians in the diagnosis and management of poisonings and overdoses.

Download Full-text

Macroprolactinoma appearing after resolution of hydrocephalus

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-16-0157 ◽

2017 ◽

Vol 2017 ◽

Author(s):

Oscar D Bruno ◽

Ricardo Fernández Pisani ◽

Gabriel Isaac ◽

Armando Basso

Keyword(s):

Pituitary Adenoma ◽

Pituitary Tumour ◽

Empty Sella ◽

List Type ◽

Liquid Pressure ◽

Final Size ◽

Mechanical Factors ◽

Pressure Resistance ◽

Learning Points

Summary The role of mechanical forces influencing the growth of a pituitary adenoma is poorly understood. In this paper we report the case of a young man with hyperprolactinaemia and an empty sella secondary to hydrocephalia, who developed a macroprolactinoma following the relief of high intraventricular pressure. Learning points: The volume of a pituitary tumour may be influenced not only by molecular but also by local mechanical factors. Intratumoural pressure, resistance of the sellar diaphragm and intracranial liquid pressure may play a role in the final size of a pituitary adenoma. The presence of hydrocephalus may hide a pituitary macroadenoma.

Download Full-text

Plasma exchange in the treatment of thyroid storm secondary to type II amiodarone-induced thyrotoxicosis

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-16-0039 ◽

2016 ◽

Vol 2016 ◽

Cited By ~ 3

Author(s):

Ling Zhu ◽

Sueziani Binte Zainudin ◽

Manish Kaushik ◽

Li Yan Khor ◽

Chiaw Ling Chng

Keyword(s):

Plasma Exchange ◽

Thyroid Storm ◽

List Type ◽

Type Ii ◽

Free Triiodothyronine ◽

Bridging Therapy ◽

Session Type ◽

Learning Points ◽

Prompt Diagnosis

Summary Type II amiodarone-induced thyrotoxicosis (AIT) is an uncommon cause of thyroid storm. Due to the rarity of the condition, little is known about the role of plasma exchange in the treatment of severe AIT. A 56-year-old male presented with thyroid storm 2months following cessation of amiodarone. Despite conventional treatment, his condition deteriorated. He underwent two cycles of plasma exchange, which successfully controlled the severe hyperthyroidism. The thyroid hormone levels continued to fall up to 10h following plasma exchange. He subsequently underwent emergency total thyroidectomy and the histology of thyroid gland confirmed type II AIT. Management of thyroid storm secondary to type II AIT can be challenging as patients may not respond to conventional treatments, and thyroid storm may be more harmful in AIT patients owing to the underlying cardiac disease. If used appropriately, plasma exchange can effectively reduce circulating hormones, to allow stabilisation of patients in preparation for emergency thyroidectomy. Learning points Type II AIT is an uncommon cause of thyroid storm and may not respond well to conventional thyroid storm treatment. Prompt diagnosis and therapy are important, as patients may deteriorate rapidly. Plasma exchange can be used as an effective bridging therapy to emergency thyroidectomy. This case shows that in type II AIT, each cycle of plasma exchange can potentially lower free triiodothyronine levels for 10h. Important factors to consider when planning plasma exchange as a treatment for thyroid storm include timing of each session, type of exchange fluid to be used and timing of surgery.

Download Full-text

Diagnosis and differential diagnosis of acute transverse myelopathy. The role of neuroradiological investigations and review of the literature

Neurological Sciences ◽

10.1007/s100720100038 ◽

2001 ◽

Vol 22 (8) ◽

pp. S69-S73 ◽

Cited By ~ 46

Author(s):

G. Scotti ◽

S. Gerevini

Keyword(s):

Differential Diagnosis ◽

Review Of The Literature ◽

Transverse Myelopathy

Download Full-text

A Rare Twist of the Forgotten Disease: A Case of Fusobacterium necrophorum Sepsis with Portomesenteric Thrombosis and a Review of the Literature

Case Reports in Gastrointestinal Medicine ◽

10.1155/2021/6699867 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Nicholas Lazar ◽

Kamil Sardarli ◽

Zaid Imam ◽

Majd Khasawneh ◽

Ismail Hader

Keyword(s):

Literature Review ◽

Bacterial Translocation ◽

Fusobacterium Necrophorum ◽

Favorable Outcome ◽

Review Of The Literature ◽

Fatal Complication ◽

Lemierre’S Syndrome ◽

Management Options ◽

Prompt Treatment

Abdominal variants of Lemierre’s syndrome presenting with pylephlebitis are rare, and the role of anticoagulation in treatment is controversial. We hereby report a case of pylephlebitis secondary to F. necrophorum bacteremia in a 57-year-old female originating from bacterial translocation secondary to colitis, who developed a favorable outcome with prompt treatment with antibiotics and anticoagulation. We also perform a literature review on similar cases in the literature and discuss management options of this rare but potentially fatal complication.

Download Full-text

Intermittent Diplopia

Neuro-Ophthalmology ◽

10.1093/med/9780190603953.003.0021 ◽

2019 ◽

pp. 115-120

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak

Keyword(s):

Differential Diagnosis ◽

Neuromuscular Junction ◽

Crucial Role ◽

Cranial Nerve ◽

Extraocular Muscle ◽

Diagnostic Evaluation ◽

Management Options ◽

Binocular Diplopia ◽

Superior Oblique

Intermittent diplopia is a common complaint that has a broad differential diagnosis. In this chapter, we begin by discussing the crucial role of the history in the evaluation of intermittent diplopia. We next review the differential diagnosis for intermittent diplopia, which includes conditions involving the eye, extraocular muscle, neuromuscular junction, cranial nerve, brainstem, and cerebellum. We emphasize the importance of distinguishing monocular diplopia from binocular diplopia when determining the appropriate diagnostic approach. We then review the symptoms, signs, pathogenesis, and diagnostic evaluation of superior oblique myokymia. We discuss practical strategies for detecting the ocular oscillations of superior oblique myokymia. Lastly, we review the medical and surgical management options for superior oblique myokymia.

Download Full-text

Recurrent primary hyperparathyroidism: a diagnostic and management dilemma

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0136 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Ben Wilkinson ◽

Sharifah Faradila Wan Muhamad Hatta ◽

Andrew Garnham ◽

Harit N Buch

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Surgical Planning ◽

List Type ◽

Viable Option ◽

Surgical Recurrence ◽

Adenomatous Tissue ◽

Diagnostic Modalities ◽

Learning Points

Summary Primary hyperparathyroidism requires a surgical approach to achieve a long-term cure. However, post-surgical recurrence significantly complicates the management of this condition. A number of causes for recurrent disease are well understood and several diagnostic modalities exist to localise the culprit parathyroid adenoma although none of them is efficacious in localisation of the recurrent lesion. In this case report, we highlight a novel causative mechanism and describe a unique diagnostic sequence that enabled curative treatment to be delivered. Learning points In the case described herein, we describe a novel location for a parathyroid adenoma causing recurrent PHPT. The case elucidates well the difficulties presented by such cases in terms of surgical planning and show the utility of PVS in such cases. Based on this case, we make the following recommendations: Meticulous care must be taken to prevent seeding of adenomatous tissue during primary excision. To consider the use of PVS in patients with discordant imaging in the setting of recurrent/persistent PHPT as a method to localise the causative adenoma. Same day PVS and surgery is a viable option for patients who either represent an anaesthetic risk or who are extremely anxious about the prospect of two separate procedures. Disordered calcium homeostasis is an important but forgotten cause of dysphagia which can be extremely debilitating for affected patients.

Download Full-text

Methimazole-induced myositis: a case report and review of the literature

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-13-0008 ◽

2013 ◽

Vol 2013 ◽

Cited By ~ 1

Author(s):

R Bou Khalil ◽

M Abou Salbi ◽

S Sissi ◽

N El Kara ◽

E Azar ◽

...

Keyword(s):

Adverse Reactions ◽

List Type ◽

Musculoskeletal Complaints ◽

Review Of The Literature ◽

Hyperthyroid Patient ◽

Safe Medication ◽

Delayed Onset ◽

Rare Side Effect ◽

Additional Therapy ◽

Learning Points

Summary Methimazole is an anti-thyroid drug commonly used to treat hyperthyroidism and is a relatively safe medication. Several side effects have been reported and usually develop within 3 months of therapy. Well-known adverse reactions include agranulocytosis, hepatitis, skin eruptions, and musculoskeletal complaints such as myalgia, arthralgia, and arthritis. So far, myositis secondary to carbimazole was described in the context of a lupus-like syndrome or other rare cases of anti-neutrophil cytoplasmic antibodies-associated vasculitis. Methimazole-induced myositis occurring independently of such reactions was rarely stated. We report a patient with hyperthyroidism who, early after therapy with methimazole, developed hepatitis, eosinophilia, and fever that resolved completely after stopping the medication as well as a delayed onset of biopsy-proven eosinophilic myositis and fasciitis of gluteal muscles that resolved eventually without any additional therapy. Therefore, we raise the awareness regarding a rare side effect of methimazole: myositis. Learning points Several differential diagnoses arise when managing a hyperthyroid patient with muscle complaints. Both hyperthyroidism and methimazole are associated with myositis. Methimazole-induced myositis is a rare clinical entity. Resolution of symptoms may occur after stopping methimazole.

Download Full-text

Vanishing hypercalciuric kidney stones after treating underlying acromegaly

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-13-0001 ◽

2013 ◽

Vol 2013 ◽

Author(s):

Eline van der Valk ◽

Tom Tobe ◽

Aline Stades ◽

Alex Muller

Keyword(s):

Calcium Oxalate ◽

Kidney Stones ◽

Common Finding ◽

List Type ◽

Primary Role ◽

Short Overview ◽

Learning Points

Summary A 53-year-old male presented with recurrent calcium oxalate kidney stones as a first sign of underlying acromegaly, which vanished when his acromegaly was controlled. The exact mechanism behind hypercalciuria and urolithiasis in acromegaly is not yet clear. By discussing this case, a short overview of the pathophysiology of hypercalciuria in acromegaly and practical insights are given. Learning points Hypercalciuria is a common finding in acromegaly. There are only few reports describing hypercalciuric kidney stones in acromegaly. We assume that in acromegaly there is a primary role of IGF1-mediated, PTH-independent increase in calcitriol synthesis resulting in hypercalciuric kidney stones.

Download Full-text