scholarly journals THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Toh Leong Tan ◽  
Chuan Hun Ding
Keyword(s):  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray ◽  
Hypertensive Crises ◽  
The Right

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation.

scholarly journals THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Toh Leong Tan ◽  
Chuan Hun Ding
Keyword(s):  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray ◽  
Hypertensive Crises ◽  
The Right

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation.

scholarly journals A dangerous pleural effusion

2010 ◽  
Vol 92 (5) ◽  
pp. e53-e54 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay K Shukla
Keyword(s):  
Rare Complication ◽  
Sudden Onset ◽  
Biliary Surgery ◽  
Biliary Leak ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
Chest X Ray

Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be life-threatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.

Peran Computed Tomography (CT) Toraks dalam Diagnosis Abses yang Menyerupai Massa Mediastinum

2016 ◽  
Vol 1 (3) ◽  
pp. 178-184
Author(s):  
Krishna P. Wicaksono ◽  
Aziza G. Icksan
Keyword(s):  
Clinical History ◽  
Chest Ct ◽  
X Ray ◽  
Precise Diagnosis ◽  
Life Threatening ◽  
History Of ◽  
Facial Edema ◽  
Chest X Ray ◽  
The Right ◽  
Peripheral Enhancement

Mediastnal abscess is rare, yet it could be a life threatening infecton. A precise diagnosis followed by adequate treatments need to be quickly established. Clinical informaton is usually not diagnostc. Therefore, radiological examinatons have important role.We report a ffy-one years old female with clinical history of sore throat, cough and neck-facial edema since fve days before admission. Laboratory examinatons revealed leukocytosis and ESR elevaton. Chest x-ray depicted a homogenous consolidaton in the right paratracheal region which deviated trachea to the lef. On enhanced chest CT examinaton, we found a cystc mass in the right paratracheal region, extending to the right supero-anterior mediastnum, with peripheral enhancement, air-?uid level and minimal right pleural e?usion, suggestve for mediastnal abscess. Bronchoscopy found no abnormality.Several days later, mediastnal abscess was confrmed surgically and drained through thoracotomy. Although culture of pus failed to grow any bacteria, histopathological examinaton confrmed a non-specifc chronic in?ammaton with no sign of malignancy. The main purpose of this report is to emphasize the importance of enhanced chest CT in evaluatng patent with tumor mimicking mediastnal abscess.

scholarly journals Meningioma With Tyrosine-Rich Crystalloids: A Case Report and Review of the Literature

2017 ◽  
Vol 26 (2) ◽  
pp. 157-160
Author(s):  
Erik Reinertsen ◽  
Stewart G. Neill ◽  
Kambiz Nael ◽  
Daniel J. Brat ◽  
Costas G. Hadjipanayis
Keyword(s):  
Review Of The Literature ◽  
Midline Shift ◽  
The Third ◽  
Orbital Roof ◽  
Aged Woman ◽  
Axial Mass ◽  
Middle Aged Woman ◽  
History Of ◽  
Blurry Vision ◽  
The Right

We report a case of fibrous meningioma with tyrosine-rich crystalloid in the frontal lobe of a middle-aged woman. The patient presented with a history of several years of worsening headaches and blurry vision, which progressed to include syncopal episodes and right-sided weakness. Imaging demonstrated a dural-based extra-axial mass arising from the right orbital roof and extending superiorly along the right frontal convexity causing right-to-left midline shift. The patient underwent a craniotomy and operative resection. Tumor architecture and cytology was similar to that of a Schwannian neoplasm, with spindled cells arranged in a fascicular architecture and displaying focal nuclear palisading. Immunohistochemical stains confirmed a diagnosis of fibrous meningioma. Light microscopy demonstrated extracellular deposits of eosinophilic crystalline material parallel to the spindled tumor cells, reminiscent of “tyrosine-rich” crystals described in salivary gland neoplasms. This is the third meningioma featuring tyrosine-rich crystalloid reported in the literature; we also summarize the previous 2 reports.

scholarly journals Unexpected Tension Pneumothorax-Hemothorax during Induction of General Anaesthesia

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Ekaterini Amaniti ◽  
Chrysoula Provitsaki ◽  
Panagiota Papakonstantinou ◽  
George Tagarakis ◽  
Konstantinos Sapalidis ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Systemic Disease ◽  
Good Condition ◽  
Tension Pneumothorax ◽  
Positive Pressure ◽  
Aged Woman ◽  
Breath Sounds ◽  
Middle Aged Woman ◽  
Chest X Ray ◽  
The Right

Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. After intubation, the patient experienced marked hypoxemia (SpO2=75%), hypotension, and tachycardia. Manual positive pressure ventilation seemed to worsen hypoxemia and tachycardia, while apnoeic oxygenation through circle system with valve open slightly improved cardiorespiratory collapse. The effect of positive ventilation, along with the absence of breath sounds in the right hemithorax and cardiorespiratory collapse, established the diagnosis of tension pneumothorax, managed immediately with emergency thoracentesis and placement of a thoracostomy tube. The patient was improved and pneumothorax was confirmed with chest X-ray and CT. The latter also confirmed the presence of bilateral multiple bullae. The operation was postponed and the patient was extubated a few hours later, in good condition. After thorough evaluation for any systemic disease, which was negative, the patient underwent two-stage thoracotomy for bullectomy.

scholarly journals P.005 Lisdexamfetamine precipitated pathological gambling

2018 ◽  
Vol 45 (s2) ◽  
pp. S17-S17 ◽  
Author(s):  
F Chaudhary ◽  
A Hirsch ◽  
W MacPherson ◽  
J Nayati
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Nucleus Accumbens ◽  
Pathological Gambling ◽  
Risk Taking ◽  
Gambling Behavior ◽  
Hyperactivity Disorder ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
History Of ◽  
Mental Status Examination

Background: Lisdexamfetamine has not heretofore been reported to cause pathological gambling. Such a case is presented. Methods: A middle-aged woman, without past interest in gambling, gaming, or risk taking behavior, with childhood history of attention deficit hyperactivity disorder presented with difficulty focusing and concentrating. Lisdexamfetamine was started at 20 mg daily and gradually escalated due to lack of efficacy. At 70 mg daily, she began binging on sweets and gambling all day, every day at nearby riverboats, which she had never frequented previously. Upon reduction to 60 mg daily, the gambling resolved. Ritalin 20 mg every morning and 50 mg every afternoon was used without gambling reoccurrence. Results: Mental Status Examination: Alert, cooperative and oriented x 3 with good eye contact. Euthymic, without mania, thoughts logical and goal directed. Conclusions: Enhanced dopamine in the nucleus accumbens may induce hedonic activities including gambling, binging on sweets, or sexual activity (Moore et al. 2014). Lisdexamfetamine has been described to induce mania, and pathological gambling may have been an isolated manifestation of early mania. In those who have recently begun lisdexamfetamine, query should be made regarding change in gambling behavior and in those who are pathologically gambling, investigation should be entertained as to whether they are taking lisdexamfetamine.

scholarly journals Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case

2018 ◽  
Vol 12 (1) ◽  
pp. 137-142 ◽  
Author(s):  
Sebastian Klein ◽  
Denise Buchner ◽  
De-hua Chang ◽  
Reinhard Büttner ◽  
Uta Drebber ◽  
...  
Keyword(s):  
Wall Thickening ◽  
Caucasian Woman ◽  
Ischemic Necrosis ◽  
Colonic Wall ◽  
Asian Patients ◽  
Life Threatening ◽  
History Of ◽  
Mesenteric Vessels ◽  
The Right ◽  
European Woman

Phlebosclerotic colitis (PC) is a rare, potentially life-threatening disease of unclear pathogenesis almost exclusively reported in Asian patients of both genders. A fibrous degeneration of venous walls leads to threadlike calcifications along mesenteric vessels and colonic wall thickening, detectable by CT. This causes disturbed blood drainage and hemorrhagic infarction of the right-sided colonic wall. This is a report of PC in a Caucasian woman in Europe without Asian background and no history of herbal medications, a suspected cause in Asian patients. CT revealed no calcification of the mesenteric vein or its tributaries. Instead, submucosal veins of the left-sided colonic wall were calcified, leading to subsequent transmural necrosis. Clinically, the patient developed a paralytic ileus and sigmoidal perforation during a 2-week hospitalization due to a bleeding cerebral vascular aneurysm. This case of a European woman with PC is unique in its course as well as its radiologic, clinical, and pathologic presentation.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

scholarly journals Hypertensive Crisis in the Elderly Patients

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 128-135
Author(s):  
O. N. Tkacheva ◽  
Yu. V. Kotovskaya ◽  
K. A. Eruslanova
Keyword(s):  
Elderly Patients ◽  
Clinical Symptoms ◽  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
The Elderly ◽  
Organ Damage ◽  
Target Organ ◽  
Sudden Increase ◽  
Chronic Therapy ◽  
High Level

A hypertensive crisis is a sudden increase in blood pressure (BP) to an individually high level associated with clinical symptoms and target organ damage, in which BP must be reduced immediately. Since 2018 in Europe and since 2020 in Russia, an uncomplicated hypertensive crisis is recommended to be considered as a part of malignant (uncontrolled) arterial hypertension. The clinical picture of increased BP in elderly patients is characterized by nonspecific symptoms even in target organ damage. Management of this group of patients requires a physician to know the patient’s comorbidities and the drugs taken on a regular basis to minimize development of side effects of the administered drugs and their undesirable interaction with the chronic therapy.

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