- Massive Spontaneous Hemothorax as a Complication of Apixaban Treatment. [Journal Article]
- CRCase Rep Pulmonol 2018; 2018:8735036
- CONCLUSIONS: Spontaneous hemothorax is a rare complication of anticoagulant therapy and might not exhibit the usual radiological signs of traumatic hemothorax. Health care providers should have high index of suspicion for spontaneous hemothorax when evaluating new pleural effusion in patients receiving DOACs therapy. Drainage by small bore pigtail catheter might be as effective as larger chest tubes.
- Traumatic Pneumothorax Secondary to Acupuncture Needling. [Journal Article]
- CCureus 2018 Aug 23; 10(8):e3194
- Acupuncture is a common form of therapy involving insertion of fine needles to alleviate nausea and various forms of pain. We describe a case of pneumothorax secondary to acupuncture. A 50-year-old w...
Acupuncture is a common form of therapy involving insertion of fine needles to alleviate nausea and various forms of pain. We describe a case of pneumothorax secondary to acupuncture. A 50-year-old woman presented to the emergency department with right-sided pleuritic chest pain. This was following a history of acupuncture and cupping treatment an hour earlier at a traditional practitioner for long-standing neck pain. On physical examination, the respiratory rate was 22 breaths per minute and her oxygen saturation was 100% on room air. Breath sounds were decreased on the right hemithorax with hyper resonance to percussion. Inspection of her back revealed multiple needling and cupping marks. A chest radiograph revealed a right-sided pneumothorax with an apex-cupola distance of 3.6 cm. She was put on high flow oxygen and a chest tube was inserted into the right chest wall. The patient was admitted. She had radiographic resolution of the pneumothorax four days later and was discharged uneventfully. Follow-up one week later in the clinic showed no radiographic recurrence of the pneumothorax.
- Pulmonary Tuberculosis Reactivation: Triggered by the Descent in Altitude? [Case Reports]
- AMActa Med Port 2018 Oct 31; 31(10):589-592
- High altitudes are linked to decreased rates of pulmonary tuberculosis infection, disease and mortality. However, its relevance as a trigger for pulmonary tuberculosis reactivation in immunocompetent...
High altitudes are linked to decreased rates of pulmonary tuberculosis infection, disease and mortality. However, its relevance as a trigger for pulmonary tuberculosis reactivation in immunocompetent patients is not documented. A 28-year-old healthy Nepalese female was admitted in the emergency department with sudden left pleuritic back pain with shortness of breath, two weeks after arriving in Lisbon, having arrived from Kathmandu and undergone a change in altitude of 1400 metres. She also had evening low-grade fever and fatigue since she arrived. Her mother-in-law had died of tuberculosis two years before. Chest radiography and computed tomography scan showed a left upper lobe consolidation. Laboratory analyses were 79 mm/sec. Human immunodeficiency virus serology, blood cultures and urinary antigen testing were negative. Bronchial secretions' cultures became positive for Mycobacterium tuberculosis complex. The patient was started on anti-tuberculous treatment and made a steady recovery. This case reports a probable reactivation of pulmonary tuberculosis infection that could have been triggered by altitude differences.
- Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting. [Journal Article]
- BCBMJ Case Rep 2018 Oct 27; 2018
- We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initi...
We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initial investigations showed a right-sided pleural effusion and pleural thickening suggestive of malignancy, which would have been in keeping with the clinical presentation. Initial pleural biopsy showed features suggestive of possible TB infection, though no growth on cultures. A repeat biopsy was negative on initial microscopy, but was culture positive for Mycobacterium tuberculosis, also identifying isoniazid resistance. This case highlights that TB remains an important differential even in the absence of classical risk factors, and illustrates the diagnostic challenges it poses. It also highlights the value of culture positivity in identification of drug resistance and facilitation of appropriate treatment.
- Chest pain following permanent pacemaker insertion… a case of pneumopericardium due to atrial lead perforation. [Journal Article]
- BCBMJ Case Rep 2018 Oct 25; 2018
- Permanent pacemaker (PPM) implantation is an increasingly common procedure with complication rate estimated between 3% and 6%. Cardiac perforation by pacemaker lead(s) is rare, but a previous study h...
Permanent pacemaker (PPM) implantation is an increasingly common procedure with complication rate estimated between 3% and 6%. Cardiac perforation by pacemaker lead(s) is rare, but a previous study has shown that it is probably an underdiagnosed complication. We are presenting a case of a patient who presented 5 days after PPM insertion with new-onset pleuritic chest pain. She had a normal chest X-ray (CXR), and acceptable pacing checks. However, a CT scan of the chest showed pneumopericardium and pneumothorax secondary to atrial lead perforation. The pain only settled by replacing the atrial lead. A repeat chest CT scan a few months later showed complete resolution of the pneumopericardium and pneumothorax. We believe that cardiac perforation can be easily missed if associated with normal CXR and acceptable pacing parameters. Unexplained chest pain following PPM insertion might be the only clue for such complication, although it might not always be present.
- Pulmonary embolism, frostbite and high-altitude retinopathy - a combination of life- and sight-threatening vascular complications at high altitude. [Journal Article]
- SMScott Med J 2018 Oct 25; :36933018807343
- The effects of high altitude on the human vascular system are well described. This case demonstrates an interesting combination of vascular complications at high altitude which were both life- and si...
The effects of high altitude on the human vascular system are well described. This case demonstrates an interesting combination of vascular complications at high altitude which were both life- and sight-threatening. In May 2017, during an attempt on Mount Everest, a 58-year-old man was forced to descend from 8000 m because of adverse weather. He suffered significant frostbite of his right hand, later requiring termination of the distal phalanx of one of the affected digits. He also experienced increasing breathlessness and went on to develop pleuritic chest pain. A CT pulmonary angiogram performed upon return to sea level revealed multiple small sub-segmental pulmonary emboli. He was anticoagulated for three months and made a full recovery. The patient also reported visual loss in the left eye and on ophthalmic examination was found to have multiple retinal haemorrhages including a left macular haemorrhage, consistent with high altitude retinopathy. The retinal haemorrhages settled with conservative management. The vascular complications suffered by this patient demonstrate the potentially fatal changes that can occur at altitude. They also serve to act as a reminder for physicians, even at sea level of the potential complications in patients returning from high altitude.
- F/A-18 Aviator Successfully Returned to Flight After an In-Flight Spontaneous Pneumothorax. [Journal Article]
- AMAerosp Med Hum Perform 2018 Nov 01; 89(11):1008-1012
- BACKGROUND: Spontaneous pneumothorax (PTX) is a diagnostic challenge in aviators given the common occurrence of musculoskeletal pain after flight and notorious underreporting of symptoms of other di...
BACKGROUND: Spontaneous pneumothorax (PTX) is a diagnostic challenge in aviators given the common occurrence of musculoskeletal pain after flight and notorious underreporting of symptoms of other diseases in this group.CASE REPORT: A 24-yr-old active duty F/A-18 Weapon Systems Officer performed an anti-G straining maneuver (AGSM) in response to a 6.5-g warm-up turn during a training flight at 16,000 ft (4876.8 m) above sea level. He immediately developed right-sided thoracic back pain. The flight was terminated, he landed, and the pain improved. Over the next 5 d, he noticed the insidious development of pleuritic chest pain and dyspnea. His symptoms prompted presentation to an aviation medicine clinic where a large right sided PTX was identified. After transfer to a local emergency department, a large bore chest tube was placed. A CT scan showed bilateral apical blebs requiring right and subsequently left video assisted thoracoscopy (VATS) with chemical/mechanical pleurodesis and apical wedge resection. Pulmonary function testing (PFT) showed a mild restriction defect 2-1/2 mo after surgery. The patient also completed cardiopulmonary exercise testing (CPET), performing better than his predicted reference range. After a high resolution CT showed no remaining signs of bleb or cyst disease and another month of healing he was returned to flight.DISCUSSION: PTX should be considered in aviators with perithoracic pain after flight as several aspects of flight in high performance aircraft may increase the risk for PTX. These include positive pressure breathing through a facemask, repeated use of the AGSM, and the possibility of bleb expansion at altitude.DeYoung H, Ahmed Y, Buckley J. F/A-18 aviator successfully returned to flight after an in-flight spontaneous pneumothorax. Aerosp Med Hum Perform. 2018; 89(11):1008-1012.
- Complete heart block in young adult with acute rheumatic fever. [Journal Article]
- MJMed J Malaysia 2018; 73(5):323-325
- Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifesta...
Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifestation. Most cases occurred in children. We reported a 25 year old man who developed complete heart block during an acute episode of ARF. He presented to hospital with five days history of fever, malaise and migrating arthralgia, followed by pleuritic chest pain. One day after admission his electrocardiogram (ECG) revealed complete heart block. Transthoracic echocardiography showed good left ventricular function with thickened, mild mitral regurgitation with minimal pericardial effusion. ASOT titer was positive with elevated white blood count and acute phase reactant. A temporary pacemaker was inserted in view of symptomatic bradycardia. The complete heart block resolved after medical therapy. He was successfully treated with penicillin, steroid and aspirin. He was discharged well with oral penicillin. The rarity of this presentation is highlighted.
- Acute pericarditis following treatment of a metastatic liver tumor with radiofrequency ablation: a case report. [Journal Article]
- BCBMC Cardiovasc Disord 2018 Oct 22; 18(1):200
- CONCLUSIONS: Potential cardiovascular complications are possible after radiofrequency catheter ablation for liver tumors located at segment II. Artificial ascites with normal saline before radiofrequency ablation may separate the liver and diaphragm to prevent cardiac complications. During the procedure, electrocardiographic monitoring and close observation of the patient's symptom are required. Echocardiography can be used to confirm cardiac complications.
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- Shisha smoking as a possible cause of bilateral granulomatous lung lesions. [Journal Article]
- RCRespirol Case Rep 2018; 6(9):e00374
- A 19-year-old male who regularly smoked tobacco shisha pipes presented with pleuritic chest pain, dyspnoea, and cough. He was found to have multiple bilateral lung nodules on computed tomography. A b...
A 19-year-old male who regularly smoked tobacco shisha pipes presented with pleuritic chest pain, dyspnoea, and cough. He was found to have multiple bilateral lung nodules on computed tomography. A biopsy of the lung revealed necrotizing granulomatous inflammation but without evidence of infection, foreign body, vasculitis, or malignancy. There was spontaneous and complete clinical and radiographic resolution over the next 12 weeks following cessation of shisha use.