Cardiac Tamponade: atypical presentations after cardiac surgery Ravikirti & R Karadi

2012 ◽  
Vol 11 (2) ◽  
pp. 93-96
Author(s):  
◽  
Rangaprasad Karadi ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Tamponade ◽  
High Index ◽  
Atypical Presentation ◽  
Diagnosis And Management ◽  
Early Access ◽  
Life Threatening ◽  
Atypical Presentations ◽  
High Index Of Suspicion

We present two cases of cardiac tamponade presenting in the aftermath of cardiac surgery. We have briefly discussed the aetiology, presentation, diagnosis and management of the condition with emphasis on its atypical presentation in postoperative patients. A high index of suspicion and early access to echocardiography is necessary for prompt recognition and treatment of this life threatening emergency.

Cardiac Tamponade

2020 ◽  
pp. 275-282
Author(s):  
Christopher Read ◽  
Emer Curran
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Tamponade ◽  
Clinical Signs ◽  
Surgical Decompression ◽  
Life Threatening ◽  
Deteriorating Patient ◽  
Postoperative Setting ◽  
High Index Of Suspicion ◽  
And Training ◽  
Surgery Management

The incidence of cardiac tamponade following cardiothoracic surgery can reach 6% and can be a life-threatening emergency. The diagnosis of cardiac tamponade in the postoperative setting can be challenging for several reasons, which include the variety of etiologies of shock after cardiac surgery, that the historical clinical signs are seldom seen, and because investigative aids, such as echocardiography, have their limitations. A high index of suspicion of cardiac tamponade is therefore always warranted when assessing a deteriorating patient following cardiac surgery along with an up-to-date knowledge of cardiac arrest after cardiac surgery management. Surgical decompression of the mediastinum by emergency resternotomy is required for 20%–50% of cardiac arrests after cardiac surgery and may need to take place in the critical care environment, so awareness of and training in this procedure are imperative.

scholarly journals An atypical case of necrotizing fasciitis secondary to perforated cecal cancer

2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
Laura S Heidelberg ◽  
Erica N Pettke ◽  
Teresa Wagner ◽  
Lauren Angotti
Keyword(s):  
Colon Cancer ◽  
Necrotizing Fasciitis ◽  
Unknown Origin ◽  
High Index ◽  
Atypical Presentation ◽  
Atypical Case ◽  
Life Threatening ◽  
Operative Debridement ◽  
High Index Of Suspicion ◽  
Cecal Cancer

Abstract Necrotizing fasciitis is an aggressive, life threatening soft tissue infection that requires high index of suspicion for diagnosis. Diagnosis is clinical with management including broad spectrum antibiotics and emergent operative debridement. The majority of cases are secondary to underlying medical processes, local tissue damage, abscess, or inciting procedure, with a paucity of data correlating causation with colon cancer. We describe the case of an 84-year-old man presenting with sepsis of unknown origin who was diagnosed with an atypical presentation of necrotizing fasciitis secondary to a perforated cecal malignancy. His case is unique in that a less virulent polymicrobial infection was likely involved as he initially improved with conservative management alone. He ultimately declined and expired secondary to overwhelming sepsis from his infection. This case highlights the importance of maintaining a high index of suspicion for necrotizing infection and considerations for alternative etiologies of infection including perforated malignancies.

Benign ano-rectal disorders

2017 ◽  
Vol 10 (5) ◽  
pp. 253-261
Author(s):  
James Kynaston
Keyword(s):  
Primary Care ◽  
High Index ◽  
Diagnosis And Management ◽  
High Index Of Suspicion ◽  
Adult Presentation ◽  
Surgical Referral

Benign ano-rectal disorders are a common adult presentation to primary care; they also generate a significant number of secondary referrals. The exact prevalence of these conditions is difficult to determine, due to under-reporting of symptoms, which patients can find embarrassing and difficult to disclose. It can be challenging to distinguish between different ano-rectal disorders which present with similar symptoms. A high index of suspicion is required to detect serious malignant pathology. The aim of this article is to outline the epidemiology, pathophysiology, diagnosis and management of common benign ano-rectal disorders in primary care. The indications for surgical referral and important cancer referral guidelines are included.

scholarly journals Challenges in the Diagnosis of Giant Cell Arteritis Before Visual Loss

2020 ◽  
pp. 1-5
Author(s):  
Purnima Mehta ◽  
Faaiq Hassan ◽  
Muhammed Omar Qadir ◽  
Shirish Dubey ◽  
Sergio Pagliarini ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Visual Loss ◽  
Systemic Vasculitis ◽  
The Elderly ◽  
Common Type ◽  
Atypical Presentation ◽  
Delay In Diagnosis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Background: Giant cell arteritis (GCA) is the most common type of systemic vasculitis affecting the elderly. Ophthalmic presentations of GCA in particular can be difficult to identify prior to permanent visual loss occurring. Methods: Here, we present 3 challenging cases as a retrospective series to highlight the variable presentations of GCA with ophthalmic involvement, but GCA was not suspected due to atypical presentation. Results: Unfortunately, all 3 cases went on to develop visual loss in the affected eye due to a delay in diagnosis or treatment. The authors wish to highlight the challenges posed to the referring clinicians, when patients had systemic/ocular co-morbidities, which delayed the suspicion of GCA Conclusion with a Practical Point: Our cases highlight the variable presentations of this condition as well as the devastating ophthalmic implications that GCA can have. A high index of suspicion must be maintained; particularly in elderly patients with atypical presentations.

scholarly journals Incidence of mortality due to malaria with typical and atypical presentation

2018 ◽  
Vol 5 (4) ◽  
pp. 818
Author(s):  
Shital N. Rathod ◽  
Arvind Chavan ◽  
Shilpa Sharma ◽  
Tushar Rathod ◽  
Koustubh Bavdhankar
Keyword(s):  
Mortality Rate ◽  
Falciparum Malaria ◽  
Age Groups ◽  
Clinical Suspicion ◽  
Study Group ◽  
Atypical Presentation ◽  
Peripheral Smear ◽  
Atypical Presentations ◽  
High Index Of Suspicion ◽  
Mixed Infestation

Background: Malaria, despite intensive efforts to control, remains a leading cause of morbidity and mortality in humans. India contributes to 61 per cent of malaria cases and 41 per cent of malaria deaths in SEAR countries. The objective of the present study was to find out an incidence of mortality due to malaria with typical and atypical presentation.Methods: The present was conducted over a period of three years. During the study period 630 patients with clinical suspicion of malaria were tested for malaria using peripheral smear, QBC and RDT.Results: The mortality rate in this study group 161 (25.55%) out of which maximum mortality observed in patients with falciparum malaria either singly or with mixed infestation. There is no significant correlation between the typical and atypical presentations in the different age groups with mortality.Conclusions: For timely diagnosis and treatment a high index of suspicion for the disease should be maintained by treating physicians, especially in endemic areas. They should be aware of the varied manifestations to minimize the mortality due to malaria.

Life-threatening cardiac hypertrophy associated with dexamethasone treatment of bronchopulmonary dysplasia

1996 ◽  
Vol 6 (4) ◽  
pp. 337-340
Author(s):  
Keith J. Gallaher ◽  
Braxton Strickland ◽  
Kimberly Pickett ◽  
Jan M. Carter
Keyword(s):  
Cardiac Hypertrophy ◽  
Bronchopulmonary Dysplasia ◽  
Steroid Therapy ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Causal Link ◽  
High Index ◽  
Dexamethasone Treatment ◽  
Life Threatening ◽  
High Index Of Suspicion

SummaryWe report the case of an infant who developed severe cardiac compromise due to hypertrophic obstructive cardiomyopathy that developed while he was being treated with dexamethasone for bronchopulmonary dysplasia. This case is illustrative, as previous reports have described steroid-induced hypertrophic obstructive cardiomyopathy as being transient and benign. In this infant, the hypertrophic obstructive cardiomyopathy, waxed, waned, waxed, and waned again during two courses of dexamethasone, thus strengthening a causal link with steroid therapy. A high index of suspicion of hypertrophic obstructive cardiomyopathy as the etiology of hypoperfusion in steroid-treated infants with bronchopulmonary dysplasia is important. Serial echocardiographic monitoring of these infants is helpful in identifying cardiac compromise.

Pharyngeal trauma in children – accidental and otherwise

1995 ◽  
Vol 109 (12) ◽  
pp. 1168-1175 ◽  
Author(s):  
P. M. J. Tostevin ◽  
L. J. Hollis ◽  
C. M. Bailey
Keyword(s):  
Parapharyngeal Space ◽  
Accurate Diagnosis ◽  
High Index ◽  
Accidental Injury ◽  
Pharyngeal Wall ◽  
Penetrating Wounds ◽  
Pharyngeal Perforation ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Non Accidental Injury

AbstractPharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management.We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non- accidental injury of the child must be seriously considered in all cases.

Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass

2017 ◽  
Vol 22 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Stephen Hall Sams ◽  
Stephen Revilla ◽  
David Lawrence Stahl
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Malignant Hyperthermia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Life Threatening ◽  
Cardiac Intensive Care ◽  
High Index Of Suspicion ◽  
Post Cardiac Surgery

Malignant hyperthermia (MH) is a rare but potentially life-threatening disorder encountered during general anesthesia. The use of cardiopulmonary bypass during cardiac surgery can obscure many of the cardinal signs and symptoms of MH. The development of postoperative MH following cardiac surgery is rare, but anesthesiologists and intensivists must maintain a high index of suspicion in order to make a prompt diagnosis. Initiation and tailored maintenance of MH therapy must also consider the complex physiologic changes of patients in the immediate post–cardiac surgery period. In this article, we present a case of the development of postoperative MH in the cardiac intensive care unit after elective open heart surgery with cardiopulmonary bypass.

scholarly journals Atypical Presentation of Systemic Arthritis in a Toddler with Down Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Emily Worley ◽  
Weijie Li ◽  
Jordan T. Jones
Keyword(s):  
Down Syndrome ◽  
Case Report ◽  
Broad Spectrum ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Chronic Inflammatory Disease ◽  
Atypical Presentation ◽  
Increased Risk ◽  
Macular Rash ◽  
Life Threatening ◽  
Atypical Presentations

Systemic juvenile idiopathic arthritis (sJIA) is a chronic, inflammatory disease of childhood, which is characterized by the combination of arthritis, serositis, daily, high-spiking fevers, and evanescent macular rash and can present with the life-threatening complication of macrophage activation syndrome (MAS). Children with Down syndrome (DS) have complex medical challenges related to abnormalities in their immune system, which can cause a broad spectrum of disease manifestations, which can occur atypically. Children with DS are at increased risk for arthritis and interstitial lung disease (ILD) associated with sJIA that has high mortality. This case report outlines an atypical presentation of sJIA in a 21-month-old male with DS in which fever was not part of the initial presentation of sJIA and then later developed MAS and ILD. Due to broad spectrum of disease and atypical presentation in children with DS, this case report was created to increase awareness of atypical presentations of rheumatic disease in children with DS.

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