Traumatic diaphragmatic hernia: a case report

Diaphragmatic injury is a rare entity and clinically difficult to be diagnosed as symptoms are often masked due to associated injury in a poly trauma case. There are no specific signs and symptoms for diagnosing diaphragmatic rupture. High degree of clinical suspicion is needed in all cases of thoraco-abdominal injury to diagnose a case of diaphragmatic rupture. Computed Tomography (CT) chest and abdomen is very useful in diagnosis. When in doubt a diagnostic laparoscopy should be undertaken to establish a diagnosis to reduce mortality and morbidity.

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Tuberculosis of the Parotid Gland

Case Reports in Radiology ◽

10.1155/2012/278793 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 6

Author(s):

Vivek Gupta ◽

Kiran Patankar ◽

Archana Shinde ◽

Charu Bhosale ◽

Ajitey Tamhane

Keyword(s):

Parotid Gland ◽

Clinical Presentation ◽

Clinical Suspicion ◽

Rare Entity ◽

Imaging Findings ◽

High Degree ◽

Slow Growing ◽

Growing Mass

Parotid gland involvement is extremely rare, even in countries in which tuberculosis is endemic. Clinically, it usually presents as a slow-growing mass indistinguishable from a malignancy. On imaging too, tuberculosis of the parotid may mimic neoplasm. The diagnosis of parotid tuberculosis needs a high degree of clinical suspicion. This paper highlights the clinical presentation, imaging findings, and importance of FNAC in diagnosis of this rare entity.

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Onodi Cell Mucocele: Case Report and Review of the Literature

Ear Nose & Throat Journal ◽

10.1177/014556131609500905 ◽

2016 ◽

Vol 95 (9) ◽

pp. E4-E8 ◽

Cited By ~ 3

Author(s):

John M. Lee ◽

Michael Au

Keyword(s):

Primary Care Physicians ◽

Multidisciplinary Approach ◽

Signs And Symptoms ◽

Surgical Decompression ◽

Clinical Suspicion ◽

Review Of The Literature ◽

Ocular Complications ◽

Wide Range ◽

Onodi Cell ◽

High Degree

Onodi cell mucoceles are rare entities that can cause devastating ocular complications if not treated promptly. Delays in the diagnosis are possible because of the wide range of differential diagnoses of unilateral retrobulbar optic neuropathy. We describe a new case of Onodi cell mucocele in a 39-year-old woman, and we present a comprehensive review of the literature on this entity. To the best of our knowledge, no review of Onodi cell mucoceles has been previously published. Our review found that 69% of patients with an Onodi cell mucocele experienced an improvement in vision after surgical decompression. The vast majority of these patients underwent endoscopic decompression; the timing of surgical decompression did not appear to affect outcomes in terms of vision. Onodi cell mucocele requires a high degree of clinical suspicion for diagnosis and a multidisciplinary approach to management that involves primary care physicians, ophthalmologists, and otolaryngologists. Early surgical treatment via an endoscopic approach is recommended for most patients, regardless of the duration of their ophthalmologic signs and symptoms.

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Malignant Melanoma of the Breast: A Case Report and Review of the Literature

Tumori Journal ◽

10.1177/030089161309900125 ◽

2013 ◽

Vol 99 (1) ◽

pp. e11-e13 ◽

Cited By ~ 3

Author(s):

Marcus Tan ◽

Allison Howard ◽

Amy E Cyr

Keyword(s):

Breast Cancer ◽

Case Report ◽

Malignant Melanoma ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Clinical Suspicion ◽

Rare Entity ◽

Review Of The Literature ◽

High Degree

Primary breast melanoma is a rare entity that on routine histology may be mistaken for triple-negative breast cancer. A high degree of clinical suspicion is necessary to make this diagnosis. This case report describes the presentation and treatment of primary breast melanoma.

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Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

Case Reports in Emergency Medicine ◽

10.1155/2012/395653 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Leonidas Laskaridis ◽

Spyridon Kampantais ◽

Chrysovalantis Toutziaris ◽

Basileios Chachopoulos ◽

Ioannis Perdikis ◽

...

Keyword(s):

Respiratory Symptoms ◽

Pleural Cavity ◽

Obstructive Uropathy ◽

Pleural Space ◽

Clinical Suspicion ◽

Acute Dyspnea ◽

Rare Entity ◽

Urinary Tract Disorders ◽

Bilateral Case ◽

High Degree

Urinothorax (UT) is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine accumulation, known as urinoma, into the pleural space. UT usually is a transudative pleural effusion that presents in patients with obstructive uropathy and it may occur following surgical procedures in the ureter or kidney such as ESWL, PCNL, and URS. Its diagnosis requires a high degree of clinical suspicion since the respiratory symptoms tend to be absent or mild and the urological signs tend to dominate. However, UT may rarely present with severe and acute dyspnea as well. The objectives of this study are to describe two new cases of this rare entity, a bilateral case and an ipsilateral case focusing on the side that occurs according to the affected renal insult, and to alert the physicians to include UT in their differential diagnosis of pleural effusions especially in patients with recent urinary tract disorders.

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Bilateral sacroiliitis: a rare cause for a common presentation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184918 ◽

2018 ◽

Vol 6 (12) ◽

pp. 4119

Author(s):

Subodh Kumar Mahto ◽

Praveen Kumar Singh ◽

Ankita Sheoran ◽

Afroz Jamal ◽

Nagina Agarwal

Keyword(s):

Infectious Disease ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Axial Skeleton ◽

Clinical Suspicion ◽

Musculoskeletal Complaints ◽

Common Presentation ◽

Lethal Complications ◽

High Degree ◽

Bone Sarcoidosis

Fever and osteoarticular involvement of axial skeleton are hallmark clinical manifestations of brucellosis but other diseases like ankylosing spondylitis, tuberculosis, Paget’s disease of bone, sarcoidosis should also be considered as differential diagnosis. Brucellosis is an uncommon infectious disease in India. Signs and symptoms of the disease are highly variable, with musculoskeletal complaints occurring frequently. Authors hereby reported a case of brucellosis presenting with fever, polyathralgia, bilateral sacroiliitis and enthesitis. Knowledge of geographical distribution, evidence of exposure to the cattle and a high degree of clinical suspicion of brucellosis are very important for early differentiation from other diseases to prevent lethal complications and institute early treatment and a prompt recovery.

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Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis

Clinics and Practice ◽

10.3390/clinpract11020031 ◽

2021 ◽

Vol 11 (2) ◽

pp. 216-218

Author(s):

Marta Brandão Calçada ◽

Luís Fernandes ◽

Rita Soares Costa ◽

Sara Montezinho ◽

Filipa Martins Duarte ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Ketoacidosis ◽

Drug Class ◽

Clinical Suspicion ◽

Laboratory Findings ◽

Sodium Glucose Cotransporter ◽

History Of ◽

High Degree ◽

Euglycemic Diabetic Ketoacidosis

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

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Type 4 appendiceal diverticulum within a de Garengeot hernia

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0185 ◽

2016 ◽

Vol 98 (7) ◽

pp. e141-e142 ◽

Cited By ~ 1

Author(s):

SH Rossi ◽

E Coveney

Keyword(s):

Femoral Hernia ◽

Cystic Lesion ◽

Vermiform Appendix ◽

Clinical Suspicion ◽

Intraluminal Pressure ◽

Rare Entity ◽

History Of ◽

The Right ◽

De Garengeot Hernia ◽

Learning Points

A de Garengeot hernia is defined as an incarcerated femoral hernia containing the vermiform appendix. We describe the case of a patient with a type 4 appendiceal diverticulum within a de Garengeot hernia and delineate valuable learning points.A 76-year-old woman presented with a 2-week history of a non-reducible painless femoral mass. Outpatient ultrasonography demonstrated a 36mm × 20mm smooth walled, multiloculated, partially cystic lesion anterior to the right inguinal ligament in keeping with an incarcerated femoral hernia. Intraoperatively, the appendix was found to be incarcerated in the sac of the femoral hernia and appendicectomy was performed. Histopathology demonstrated no evidence of inflammation in the appendix. However, an incidental appendiceal diverticulum was identified.It is widely recognised that a de Garengeot hernia may present with concomitant appendicitis, secondary to raised intraluminal pressure in the incarcerated appendix. Appendiceal diverticulosis is also believed to develop in response to raised pressure in the appendix and may therefore develop secondary to incarceration in a de Garengeot hernia. To our knowledge, only one such case has been described in the literature. A de Garengeot hernia is a rare entity, which poses significant diagnostic challenges. A high index of clinical suspicion is necessary as these hernias are at particularly high risk of perforation and so prompt surgical management is paramount.

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Chronic Constrictive Pericarditis

Case Reports in Cardiology ◽

10.1155/2013/957497 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Hossein Doustkami ◽

Afshin Hooshyar ◽

Nasrollah Maleki ◽

Zahra Tavosi ◽

Iraj Feizi

Keyword(s):

Cardiac Catheterization ◽

Constrictive Pericarditis ◽

Gold Standard ◽

Elevated Serum ◽

Disease Process ◽

Clinical Suspicion ◽

Rare Clinical Entity ◽

Good Recovery ◽

Prompt Treatment ◽

High Degree

Constrictive pericarditis (CP) is a rare clinical entity that can pose diagnostic problems. The diagnosis of CP requires a high degree of clinical suspicion. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. We present a patient with unexplained dyspnea, recurrent right-side pleural effusion, and ascites. Analysis of the ascitic fluid revealed a high protein content and an elevated serum-ascites gradient. Echocardiography, computed tomography, and cardiac catheterization revealed the diagnosis of CP. He underwent complete pericardiectomy and to date has made a good recovery. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. This case exemplifies the difficulty in diagnosing this condition, as well as the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.

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Assessment Framework for Recognizing Clinical Deterioration in Patients With ACS Undergoing PCI

Critical Care Nurse ◽

10.4037/ccn2021904 ◽

2021 ◽

Vol 41 (4) ◽

pp. 18-28

Author(s):

Kevin White ◽

Judy Currey ◽

Julie Considine

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Signs And Symptoms ◽

Coronary Artery Occlusion ◽

Coronary Intervention ◽

Clinical Deterioration ◽

Access Site ◽

Mortality And Morbidity ◽

Coronary Syndrome ◽

Percutaneous Coronary

Topic Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment. Clinical Relevance Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration. Purpose of Paper To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome. Content Covered Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention.

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Clinical Trial of Efficacy and Toxicity of Disoproxil Tenofovir Fumarate and Emtricitabine for Mild to Moderate SARS-CoV-2 Infections

10.1101/2021.09.28.21264242 ◽

2021 ◽

Author(s):

Aldo A M Lima ◽

Erico A G Arruda ◽

Roberto J Pires-Neto ◽

Melissa S Medeiros ◽

J Quirino-Filho ◽

...

Keyword(s):

Clinical Trial ◽

Vitamin C ◽

Respiratory Infection ◽

Clinical Symptoms ◽

Clinical Signs ◽

Signs And Symptoms ◽

Clinical Suspicion ◽

Pharmacological Intervention ◽

Controlled Clinical Trial ◽

Double Blind

This study aimed to evaluate the efficacy and toxicity of tenofovir (TDF) and TDF combined with emtricitabine (TDF/FTC) in patients with mild to moderate COVID-19 infections. We conducted a randomized, double-blind, placebo-controlled clinical trial in patients with clinical suspicion of mild to moderate respiratory infection caused by SARS-CoV-2 who were treated at an outpatient clinic. Patients were randomly recruited to take 10 days of TDF (300 mg/day), TDF (300 mg/day) combined with FTC (200 mg/day) or placebo Vitamin C (500 mg/day). The primary parameter was the score of symptoms and predictive signs of COVID-19, assessed on the seventh day of patient follow-up. From a total of 309 patients with clinical suspicion of SARS-CoV-2, 227 met the inclusion criteria and were randomly distributed into the following groups: (a) 75 (one did not initiate treatment) in the TDF group; (b) 74 in the TDF combined with FTC group; and (c) 77 in the Vitamin C group (placebo). Of the 226 patients, 139 (62%) were positive for SARS-CoV-2. Fever (37.8oC), ageusia or dysgeusia, anosmia or dysosmia, and two or more clinical symptoms or signs were significantly associated with SARS-CoV-2 infection. There was no significant change in clinical score based on clinical symptoms and signs between treatment groups. Patients with mild to moderate infection by SARS-CoV-2 had higher concentrations of G-CSF, IL-1β, IL-6 and TNF-α compared to patients without infection. Patients with mild to moderate respiratory infection, with fever (37.8oC), loss of smell, loss of taste and two or more symptoms, have a better prediction for the diagnosis of COVID-19. Patients with SARS-CoV-2 showed higher and more persistent proinflammatory cytokines profile compared to patients not infected with SARS-CoV-2. Pharmacological intervention with TDF or TDF combined with FTC did not change the clinical signs and symptoms score in mild to moderate respiratory infection in patients with SARS-CoV-2 compared to the Vitamin C group (placebo).

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