scholarly journals Persistent hiccups as the presenting symptom of a pulmonary embolism

2012 ◽  
Vol 2 (1) ◽  
pp. 2
Author(s):  
Steven Durning ◽  
David J. Shaw ◽  
Anthony J. Oliva ◽  
Michael J. Morris
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
Pulmonary Embolus ◽  
Lower Lobe ◽  
Initial Evaluation ◽  
Unique Case ◽  
Case Presentation ◽  
History Of ◽  
Symptomatic Bradycardia

An 81-year-old male with a history of symptomatic bradycardia controlled by a pacemaker presented to our institution with three days of persistent hiccups. He denied any pulmonary symptoms and his initial evaluation showed no evidence of tachypnea, tachycardia, or hypoxia. Pacemaker malfunction or migration of the pacer leads was ruled out as an etiology and no intracranial pathology was present. Admission chest radiograph was normal but a computed tomography of the chest demonstrated a left lower lobe pulmonary embolus. After treatment with anticoagulation was initiated, the hiccups resolved within the next week. This is a unique case presentation of hiccups as the only presenting symptom of an otherwise asymptomatic pulmonary embolism.

scholarly journals Polymethylmethacrylate Pulmonary Embolism Following Kyphoplasty

2019 ◽  
Vol 3 (3) ◽  
pp. 226-228
Author(s):  
Oliver Morris ◽  
Josephin Mathai ◽  
Karl Weller
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Chest Radiograph ◽  
History Of

We report a case of polymethylmethacrylate cement pulmonary embolism (PE) that occurred two days following a minimally invasive kyphoplasty procedure. Our patient developed non-specific rib pain postoperatively followed by dyspnea, prompting presentation to the emergency department. The polymethylmetacrylate cement was visualized on initial chest radiograph and further characterized using computed tomography. The patient was admitted and anticoagulation started, later having an uncomplicated hospital course. The polymethylmethacrylate cement has a well-documented history of leakage and other postoperative complications. Cement PE, while rare, can present similarly to a thrombotic PE and requires adequate long-term anticoagulation with close follow-up.

scholarly journals Asymptomatic Post-Traumatic Rupture of the Right Diaphragm Dome

2018 ◽  
Vol 28 (4) ◽  
pp. 102-109
Author(s):  
E. A. Losik ◽  
M. V. Fadeeva ◽  
V. V. Shchegelsky ◽  
R. T. Rzaev ◽  
A. V. Stepanov ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Radiograph ◽  
Vena Cava ◽  
Lower Lobe ◽  
Expectant Management ◽  
Traumatic Rupture ◽  
Thoracic Cavity ◽  
High Position ◽  
History Of ◽  
The Right

Aim.  This paper is aimed at presenting the materials of clinical observations associated with diagnosing rare-occurring ruptures of the right dome of the diaphragm that have been overlooked for a long period.Results.  A 61-year-old man was admitted to hospital with a diagnosis of chronic heart failure. Chest radiograph revealed a high position of the right dome of the diaphragm. Computed tomography revealed a defect in the central parts of the diaphragm on the right, the liver was rotated outward with its visceral surface deployed anteriorly and upward. In the right thoracic cavity, anterior to the liver, were the loops of the intestine and the outlet of the stomach.More than 30 years before, the patient had experienced an explosive trauma, which might have caused a rupture in the right dome of the diaphragm. A 70-year-old man, a smoker with a ten-year history of hypertension, was hospitalized with an increase in dyspnea, a cough with the discharge of purulent sputum, the feeling of heaviness behind the sternum. Chest radiograph revealed a high standing of the right dome of the diaphragm at the level of 3rd rib with a decrease in the volume of the right lung, and an increase in cardiac silhouette (cardiothoracic index 0.64). Computed tomography revealed a high standing of the right dome of the diaphragm as well as the compression of the middle and lower lobe of the right lung with the presence of compression atelectasis. The liver was rotated, displaced into the right thoracic cavity, the deformation of the inferior vena cava to the right was visualized due to the displacement and rotation of the liver. The consolidated fractures of 10th–12th ribs on the right were visualized. The patient had had a chest injury resulting from a traffic accident about 15 years before, with no X-ray examination having been conducted at that time.Conclusion.  In the case of left-sided diaphragm ruptures, which are much more frequent than the right-sided ones, the stomach, large and small intestines as well as spleen are displaced into the thoracic cavity. In the case of rightsided diaphragm ruptures, the liver and gallbladder are displaced into the thoracic cavity. Right-sided posttraumatic diaphragmatic hernias that are not diagnosed at the time of injury or trauma and continue to be asymptomatic for a number of years are very rare. The sensitivity and specificity of computed tomography for the diagnosis of diaphragm ruptures is 61–87 % and 72–100 %, respectively. In an acute period, the treatment of diaphragm ruptures is surgical. However, in long-term asymptomatic ruptures, expectant management is possible, particularly if the risk of surgical treatment is high. 

scholarly journals Faecopneumothorax due to missing diaphragmatic hernia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Resul Nusretoğlu ◽  
Yunus Dönder
Keyword(s):  
Computed Tomography ◽  
Diaphragmatic Hernia ◽  
Colon Resection ◽  
Emergency Laparotomy ◽  
Hernia Sac ◽  
Case Presentation ◽  
Abdominal Tenderness ◽  
History Of ◽  
Diaphragmatic Hernias ◽  
Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

scholarly journals Lobectomy for lung cancer with a displaced left B1 + 2 and an anomalous pulmonary vein: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shinichi Sakamoto ◽  
Hiromitsu Takizawa ◽  
Naoya Kawakita ◽  
Akira Tangoku
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Pulmonary Vein ◽  
Three Dimensional ◽  
Lower Lobe ◽  
Rare Condition ◽  
3D Ct ◽  
Anatomical Structures ◽  
Case Presentation ◽  
Anomalous Pulmonary Vein

Abstract Background A displaced left B1 + 2 accompanied by an anomalous pulmonary vein is a rare condition involving complex structures. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer. Case presentation A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B1 + 2 and hyperlobulation between S1 + 2 and S3, while the interlobar fissure between S1 + 2 and S6 was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V1 + 2 joining the left inferior pulmonary vein and a branch of the V1 + 2 running between S1 + 2 and S6. We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V1 + 2 and confirm the locations of B1 + 2 and B6 when dividing the fissure. Conclusion The aim of the surgical procedure performed in this case was to divide the fissure between S1 + 2 and the inferior lobe to reduce the risk of an unexpected bronchial injury. 3D-CT helps surgeons to understand the stereoscopic positional relationships among anatomical structures.

scholarly journals A case-report of widespread pulmonary embolism in a middle-aged male seven weeks after asymptomatic suspected COVID 19 infection

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mats Beckman ◽  
Sven Nyrén ◽  
Anna Kistner
Keyword(s):  
Pulmonary Embolism ◽  
High Frequency ◽  
Laboratory Testing ◽  
Troponin T ◽  
Case Presentation ◽  
Contrast Angiography ◽  
History Of ◽  
Exercise Induced ◽  
Significant Disease

Abstract Background Pulmonary embolism (PE) is seen in high frequency in hospital-treated patients with Covid-19. We present a case of suspected Covid-19 with long-term dyspnea and widespread PE. Case presentation A 51- year old male, with no prior medical history, no medication, and non-smoker arrived at the emergency department with exercise induced dyspnea during 4–5 weeks and for the last 48 h dyspnea at rest. Seven weeks before hospitalization, he felt difficulties taking deep breaths for some days but no other symptoms. Oxygen saturation at rest was 93%. Troponin T was 1200 mg/L (ref < 15 mg/L). CT angiography revealed widespread bilateral segmental pulmonary embolism. Additional findings were ground glass opacities that could match Covid-19. The patient tested negative for SARS -CoV-2. Full dose tinzaparin was given for 2 days in hospital, followed by apixaban for 6 months. Recovery has been uneventful so far. Conclusions Long-term breathing difficulties might be relatively common after non-hospitalized symptomatic Covid-19. The frequency of PE in this group is unknown. We report a case of suspected covid-19 with widespread PE and a long history of dyspnea but no other symptoms. In our case slight hypoxia and laboratory testing indicated significant disease, which was proven with contrast angiography. This case shows that PE is a differential diagnosis in non-hospitalized symptomatic Covid-19 with persisting breathing problems.

scholarly journals Fatal deep venous thrombosis and pulmonary embolism secondary to melioidosis in China: case report and literature review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hua Wu ◽  
Dongliang Huang ◽  
Biao Wu ◽  
Mengjie Pan ◽  
Binghuai Lu
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Fatal Case ◽  
Therapeutic Interventions ◽  
Case Presentation ◽  
Reduce Mortality Rate ◽  
Left Lower Extremity ◽  
Appropriate Treatment ◽  
History Of

Abstract Background Burkholderia pseudomallei is a gram-negative bacterium and the causative pathogen of melioidosis, which manifests a variety ranges of infection symptoms. However, deep venous thrombosis (DVT) and pulmonary embolism (PE) secondary to bacteremic melioidosis are rarely documented in the literature. Herein, we reported a fatal case of melioidosis combined with DVT and PE. Case presentation A 54-year-old male construction worker and farmer with a history of diabetes was febrile, painful in left thigh, swelling in left lower limb, with chest tightness and shortness of breath for 4 days. He was later diagnosed as DVT of left lower extremity and PE. The culture of his blood, sputum and bone marrow samples grew B. pseudomallei. The subject was administrated with antibiotics (levofloxacin, cefoperazone/tazobactam, and imipenem) according to antimicrobial susceptibility testing and low molecular heparin for venous thrombosis. However, even after appropriate treatment, the patient deteriorated rapidly, and died 2 weeks after admission. Conclusions This study enhanced awareness of the risk of B. pseudomallei bloodstream infection in those with diabetes. If a patient has predisposing factors of melioidosis, when DVT is suspected, active investigation and multiple therapeutic interventions should be implemented immediately to reduce mortality rate.

scholarly journals Septic Pulmonary Embolism Secondary to Klebsiella pneumoniae Epididymitis: Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Juan Sebastián Alonso Ojeda Gómez ◽  
Jorge Alberto Carrillo Bayona ◽  
Laura Cristina Morales Cifuentes
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Circulation ◽  
Respiratory Symptoms ◽  
Unusual Complication ◽  
Chest Imaging ◽  
Case Presentation ◽  
History Of ◽  
Septic Pulmonary Embolism ◽  
Uncommon Condition ◽  
Acute Epididymitis

Background. Septic pulmonary embolism (SPE) is defined as the occurrence of septic thrombi in the pulmonary circulation. We report a case of SPE secondary to K. pneumoniae epididymitis. Case Presentation. A 74-year-old male with a history of diabetes mellitus experienced SPE secondary to epididymitis, with isolation of K. pneumoniae in blood and presence of lung nodules, with a chest computed tomography showing the halo and reversed halo signs. Discussion. SPE is characterized by the presence of septic thrombi in the pulmonary circulation coming from an extrapulmonary infective focus. SPE secondary to K. pneumoniae epididymitis is an uncommon condition that is characterized by the presence of multiple bilateral nodules of peripheral distribution. Conclusion. SPE is an unusual complication of acute epididymitis. Suspicion of SPE should be considered in patients with a diagnosis of epididymitis, respiratory symptoms, and multiple nodules in chest imaging assessments.

scholarly journals A successfully treated primary tracheal synovial sarcoma

2020 ◽  
pp. 201010582094853
Author(s):  
Mohamed Faisal Abdul Hamid ◽  
Sopian Wahab ◽  
Nik Nuratiqah Nik Abeed ◽  
Ng Boon Hau ◽  
Andrea Ban Yu-Lin
Keyword(s):  
Computed Tomography ◽  
Airway Obstruction ◽  
Synovial Sarcoma ◽  
Successful Treatment ◽  
Initial Evaluation ◽  
Computed Tomography Scan ◽  
History Of ◽  
Rare Malignancy ◽  
Tomography Scan

Primary tracheal synovial sarcoma is a rare malignancy and is usually found incidentally. Tumours can present with cough, dyspnoea, stridor and intermittent haemoptysis. The diagnosis is challenging because it is rare, and the symptoms may mimic other diseases of airway obstruction. A previously well 53-year-old man presented with an eight-month history of cough. He had a history of minimal haemoptysis a few months prior to presentation. Spirometry showed an obstructive pattern, and a computed tomography scan of the thorax revealed an intraluminal tracheal mass. This case highlights that a thorough initial evaluation, including spirometry, leads to an earlier diagnosis and successful treatment of this rare sarcoma.

scholarly journals An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ha Son Nguyen ◽  
Harvey Woehlck ◽  
Peter Pahapill
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Unusual Case ◽  
Case Presentation ◽  
Volume State ◽  
Lead Placement ◽  
History Of ◽  
Symptomatic Bradycardia ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery.Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully.Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.

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