The Role of Cardiac Magnetic Resonance in Myocardial Infarction and Non-obstructive Coronary Arteries

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) accounts for 5–15% of all presentations of acute myocardial infarction. The absence of obstructive coronary disease may present a diagnostic dilemma and identifying the underlying etiology ensures appropriate management improving clinical outcomes. Cardiac magnetic resonance (CMR) imaging is a valuable, non-invasive diagnostic tool that can aide clinicians to build a differential diagnosis in patients with MINOCA, as well as identifying non-ischemic etiologies of myocardial injury (acute myocarditis, Takotsubo Syndrome, and other conditions). The role of CMR in suspected MINOCA is increasingly recognized as emphasized in both European and American clinical guidelines. In this paper we review the indications for CMR, the clinical value in the differential diagnosis of patients with suspected MINOCA, as well as its current limitations and future perspectives.

Angiomyomatous hamartoma of subglottic tracheal wall in a 12-year-old adolescent: a case report

Background Allergic rhinitis is the most common allergic disease encountered in a primary care setting. Diagnosis is often made clinically based on response to empiric therapy. However, with long-term treatment failure and/or atypical disease presentation, a differential diagnosis should be considered. The following is a report of an unusual and rare presentation of a subglottic tracheal angiomyomatous hamartoma in an adolescent, treated for many years as allergic rhinoconjunctivitis and asthma. Case presentation A 12-year-old Caucasian was referred to the allergy clinic with a lifetime history of bronchospasms and rhinoconjunctivitis symptoms, treated for many years for asthma and environmental allergies. Cough, posterior nasal drainage, self-described “choking on phlegm,” and a sensation of “a flap in the throat,”, worsened 5 months prior to the initial evaluation. Puncture skin testing for common environmental allergens was negative. Spirometry, performed due to history of chronic cough, showed blunting of the forced expiratory phase. A chest X-ray, immediately ordered to rule out possible extrapulmonary obstruction, showed bilateral bibasilar infiltrates. A noncontrast computerized tomographic scan of the chest, ordered to further elucidate X-ray findings, revealed a subglottic tracheal mass. Following a subsequent transfer and admission to a tertiary hospital center, microlaryngoscopy, bronchoscopy, and microsuspension laryngoscopy were performed to remove the tracheal mass. Pathology confirmed squamous mucosa with polypoid angiomyomatous changes and chronic inflammatory features consistent with angiomyomatous hamartoma. Surgical intervention was successful, and follow-up 1 year postoperatively revealed a healthy, asymptomatic adolescent child with normal lung function. Conclusions Although posterior nasal drainage and cough are typical presenting symptoms in the general patient population, they may be clinically impactful as they could disguise more serious medical conditions. A detailed history and careful physical examination may provide a high index of suspicion of disease, and can help work the differential diagnosis. This case presentation is the first documentation of subglottic hamartoma reported in the pediatric literature with clinical manifestation of environmental allergy and asthma symptoms.

Management of large multiple oral papillary lesions suspected Acanthosis Nigricans: a case report

Background Papillary oral pathologies are a heterogenous group. Both virus-associated and non-virus-associated, malignant and benign entities may enter the differential diagnosis. In some cases, oral papillary lesions are part of a variety of skin or systemic disorders and syndromes. It is a challenge for clinicians to identify and treat the various etiology of oral papillary lesions. Case presentation This case report describes the successful management of large multiple oral papillary lesions in a 65-year-old female. Combined the clinical features, pathological findings and medical history, the patient was tended to be the diagnosis of Acanthosis Nigricans and was successfully managed. The neuro-endocrine-immune network and mechanical factors in the pathogenesis of oral papillary lesions of Acanthosis Nigricans were discussed. Common questions regarding differential diagnosis, the management of oral papillary lesions of Acanthosis Nigricans patients and follow-up visits are addressed. Conclusions The neuro-endocrine-immune network and mechanical factors play important roles in the pathogenesis of oral papillary lesions with Acanthosis Nigricans. Removing traumatic factors of oral mucosa and the treatment of underlying systemic diseases is necessary for Acanthosis Nigricans patients with oral papillary lesions. The clinical management plan should comprise both the local treatments of oral papillary lesions and the systemic treatment of underlying diseases. Multidisciplinary correlation is helpful and the patient’s collaboration is necessary to arrive at the correct diagnosis and successful long-term treatment effect. From the clinician’s perspective, recognizing various causes and clinical presentations of oral papillary lesions will help guide management.

Clinical Observation of Peripartum Cardiomyopathy

Research relevance: the article presents the results after clinical observation of peripartum cardiomyopathy in a patient aged 30 years. Purpose of the study: to analyze the results of a clinical study conducted in the cardiology department of the Osh Medical United Clinical Hospital. Research methods: a differential diagnosis of acute myocarditis, idiopathic dilated cardiomyopathy and peripartum cardiomyopathy was carried out. Research results: taking into account the life history, laboratory and instrumental examination data, the diagnosis was peripartum cardiomyopathy. Conclusion: the treatment carried out gave a satisfactory clinical effect.

Thoracic Splenosis - A necessary differential diagnosis for pleural based nodules with history of thoracoabdominal trauma

Thoracic Splenosis (TS) is a rare medical condition, where there is auto-transplantation of the splenic tissue in the thoracic cavity, often leading to pleural based nodules. Our patient is the first ever case of this condition in Pakistan, and underwent extensive diagnostic procedures as well as medical treatments, before receiving the diagnosis of TS. He underwent HRCT for chronic cough that revealed pleural and mediastinal nodules. This coupled with a vague mass in the testes led to the provisional diagnosis of metastasized testicular tumour, and later a diagnosis of pulmonary tuberculosis was made. However, eventually a 99mTc denatured red blood cell scan confirmed the diagnosis of TS. TS is a benign condition, whereas other causes of pleural nodules are relatively malignant, hence its diagnosis is essential in ruling out malignancies. Among the multiple invasive and non-invasive diagnostic modalities, the gold standard remains 99mTc denatured red blood cell scan, which is a sensitive test that provides an accurate diagnosis and bars the need of multiple invasive procedures. doi: https://doi.org/10.12669/pjms.38.3.4563 How to cite this:Mehmood F, Murtaza MM, Ali S, Ashraf A. Thoracic Splenosis - A necessary differential diagnosis for pleural based nodules with history of thoracoabdominal trauma. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4563 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.