DOCSLIB.ORG

Medical Student Clinical Vignette

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Medical Student Clinical Vignette New York Chapter ACP Resident and Medical Student Forum Saturday, November 14, 2015 SUNY Upstate Medical University Institute for Human Performance 505 Irving Avenue Syracuse, NY 13202 3 New York Chapter ACP Resident and Medical Student Forum Medical Student Clinical Vignette 1 Medical Student Clinical Vignette Author: Rebecca Abi Nader Author: Brandon Brown Additional Authors: Adewale Olajubelo MD, Avery Additional Authors: Vadim Zarubin, MD; In-suk Seo, Davis( MS III), Omar Guitterez MD MD; Kevin Tsai, MD; Elizabeth Guevera, MD Institution: Kingsbrook Jwish Medical Center Institution: The Brooklyn Hospital Center Title: Unexplained Acute Abdominal Pain- Appendicitis Title: Combined Subcutaneous, Intra-abdominal and Epiploicae Thoracic Splenosis: A Noninvasive Diagnosis in the Age of Nuclear Medicine Acute abdominal pain lends itself to various etiologies depending on the location, character, and consistency of the pain. Splenosis is a benign entity whereby splenic tissue Appendicitis epiploicae is an uncommon cause and can present with symptoms mimicking ovarian cyst, appendicitis, diverticulitis autotransplants, generally in the abdominal or or ectopic pregnancy especially in a young woman of child peritoneal cavity, following spleen rupture or bearing age. splenectomy. Ectopic splenic implants in the thoracic A 26 year old female presents to the ED with complaints of acute cavity and subcutaneous tissue are comparatively rare. abdominal pain for 4 days. Pain was located in the upper In the majority of cases, splenosis remains quadrant and radiates to the left lower quadrant and flank. The asymptomatic and is diagnosed incidentally. Previously pain was sharp and 8/10 in severity. Pain is alleviated by lying down and exacerbated by movement. Associated symptoms reported cases often are limited to a single include nausea, loss of appetite and constipation. Her past compartment, abdominal or thoracic. Moreover, a medical history was significant for mild asthma which is majority of those involving intra-thoracic or controlled with albuterol. She has no pertinent surgical history or subcutaneous splenosis are histopathologic diagnoses family history. She takes no medications. She is allergic to after invasive biopsy. We describe a case of combined penicillin and has anaphylactic reaction if used. intra-abdominal, thoracic and subcutaneous splenosis She is G0P0, not sexually active and has no history of STDs. Her LMP was on 06/14/15 with regular cycle lasting 3 to 4 days. in a 42-year-old male resultant to a gunshot wound Review of systems was significant for fatigue, and decrease requiring splenectomy 26 years prior diagnosed on frequency of urination. At the time of presentation, she was in nuclear imaging. This case uniquely features vast mild distress but alert, awake, oriented to place, time and person. anatomic disbursement and is only the second such Vital signs were within normal limits. Physical exam shows case to be reported. In this report and literature review, hypoactive bowel sounds with positive rebound tenderness and guarding of the left upper quadrant. Laboratory studies reveals we emphasize the need for a high index of suspicion for negative beta HCG, low: MCV (75.3), MCH (23.2) MCHC (30.8), splenosis in the setting of relevant imaging findings with and platelets (115). RDW was high at (15.1). These values were history of splenic rupture or splenectomy. As the not specific enough to rule in any particular cause of these ectopic implants often resemble malignancy on patient’s symptoms. Urinalysis was significant for WBC >20 with imaging, patients may undergo undue testing including positive cocci. A radiologic study was done to rule out other invasive procedures while splenosis may be easily possible etiologies. CT of the abdomen without contrast reveals the following: diagnosed on radionuclide scanning - An isodense soft tissue nodule anterior to the spleen measuring 1.6 cm typical for accessory spleen - Bowel shows small foci of infiltration adjacent to distal descending colon with small amount of fluid in paracolic gutter. The right quadrant inferior to the cecum has a second pocket of infiltrative fluid. Appendix was unremarkable, terminal ileum is intact and no bowel dilatation. - Fluid density structure and dilated fallopian tube typical for hydrosalpinx Radiological studies confirmed a diagnosis of Appendicitis epiploicae. She was managed with normal saline, Ketorolac 30mg for pain and 4mg of zofran for nausea.She was discharged home with TMP/SMX, Percocet and Ibuprofen with instructions to follow up at the clinic in 1 week Appendicitis epilploicae presentation is based on where the epiploic tissue is inflamed usually by the sigmoid colon. Initial management is often conservative through symptomatic management; therefore it should not be confused with other causes of acute abdomen thereby preventing unnecessary intervention. 2 Medical Student Clinical Vignette Author: Daniel Jipescu Author: Daniel Jipescu Additional Authors: Barie Salmon MD, Allison Hoyle DO, Additional Authors: Bankim Shah MD, Karthik Donuur Tracy Salmon MD, Abdul A. Ameen MD, David Flores MD, Hassan Qureshi DO, Abdul A. Ameen MD, Amer MD, Amer Syed MD FACP Syed MD FACP Institution: Barnabas Health, Jersey City Medical Center Institution: Barnabas Health, Jersey City Medical Center Title: THE UNIQUE CASE OF A LARGE DEBILITATING STROKE IN A YOUNG PATIENT WITH CORONARY Title: ANOMALOUS LEFT CORONARY ARTERY - DID THE ARTERY ECTASIA PATIENT TAKE AN ANOMALOUS DECISION? 29 yo African American male with PMH of CVA, HTN, CHF, 68 YO female with PMH significant for hypertension, IDDM, DVT, dilated cardiomyopathy, hypertensive nephropathy and TIA, gastritis, dyslipidemia, paroxysmal A-Fib, and vitiligo was obstructive sleep apnea was brought to emergency sent to ED by her primary physician because of an abnormal department with altered mental status for 4 hours. His co- finding on abdominal CT. This showed a possible thrombus in workers called 911 after they noticed that the patient was not the left ventricle. Patient had been complaining of epigastric verbally responsive and was staring off into space for a long pain and exertional dyspnea for a month. V/S: T 97.8, HR 63, period of time. They reported that the patient was able to BP 158/59, RR 18, O2 Sat 100% RA. Allergies: percocet and speak for a very short period of time prior to EMT arrival. The codeine. Family history: stroke and diabetes mellitus in her EMT personnel however found the patient to be non-verbal. mother. ROS: noncontributory, except epigastric pain of In emergency department, the patient was noted to have variable intensity, that occasionally was increased by walking. memory loss and complained of mild generalized headache. PE: HEENT: NC/AT, PERRLA, EOMI; Neck: supple, no JVD; CV: He denied photophobia, blurry vision, dizziness, or seizure. He S1, S2, RRR, no M/R/G; Abd: soft, NT/ND, obese. Troponin I: also denied chest pain or abdominal pain. Family history was 0.02/0.03/0.02. EKG showed inferior and anterior myocardial significant for early-onset heart disease in his mother and two infarct. Nuclear stress test showed fixed perfusion defect of her sisters. PE: V/S: R arm BP: 171/121, L arm B/P 161/121, throughout the apex and hypoperfusion of the distal anterior HR: 116, O2sat: 96% RA. RR: 16-35, AAOx3 - with intermittent wall region, compatible with prior myocardial infarction; a confusion; HEENT: NC/AT, PERRLA, EOMI. CV: Soft S1, S2, RRR, fixed perfusion of the mid to distal inferolateral segment and tachycardic, grade 2 apical and left lower sternal systolic distal lateral wall, compatible with prior infarction. 2D murmur and a grade 2 systolic murmur in the second IC space Echocardiography presented: Apical wall motion abnormality, on the right. Troponin I: 0.21 / 0.2 / 0.14. CT head showed EF of 72%, and intraluminal thrombus. Cardiac catheterization mild diffuse atrophy slightly greater than expected for the showed anomalous left coronary artery origin. A single right patient’s age. MRI of head showed acute infarction in the coronary artery originated from the right coronary cusp; the right middle cerebral artery distribution involving the majority left circumflex (LCX) originated from the same cusp but a of the right temporal lobe. 2D Echocardiogram revealed separate ostium; what appeared to be the left anterior severe dilatation of all cardiac chambers and severe descending artery (LAD) originated from the proximal right biventricular dysfunction with EF of 10%. Hospitalization coronary artery (RCA). The posterior descending artery was records from a different hospital were obtained. A diagnosis noted to have a subtotal occlusion. What was considered to of Coronary Artery Ectasia (CAE) was noted. The CCU team be the LAD was noted to have 90% stenosis. Obstructive discussed the benefits of an S-ICD with the patient and his disease was noted in the proximal sections of multiple family. After the S-ICD placement and comprehensive medical medium size coronary arteries. After thorough consultation treatment, the patient recovered well. with the cardiothoracic team, the patient was recommended This is a unique case of a young patient with extensive for coronary artery bypass graft surgery. The patient cardiovascular pathology that presented with a large discussed with her family and requested comprehensive debilitating stroke. CAE is dilatation of a coronary artery meetings with the medical and surgical team. In the end the segment to a diameter at least 1.5 times that of the adjacent patient decided to choose only medical management of her normal coronary artery. It has an incidence of 1-5% in patients condition. According to the patient’s wishes, she was undergoing coronary angiography. More than half of CAE are managed medically and discharged in a well and stable due to coronary atherosclerosis, but occasionally they are condition. related to other pathological entities. As the first report of The incidence of coronary anomalies in patients undergoing coronary dilatation in a patient with syphilitic aortitis, CAE has coronary angiography varies from 0.64% to 1.3%.
Load more

Recommended publications
  • Unusual Case of Primary Spontaneous Hemopneumothorax in a Young Man with Atypical Tension Pneumothorax: a Case Report Youwen Chen* and Zhijian Guo
    Chen and Guo Journal of Medical Case Reports (2018) 12:188 https://doi.org/10.1186/s13256-018-1732-x CASE REPORT Open Access Unusual case of primary spontaneous hemopneumothorax in a young man with atypical tension pneumothorax: a case report Youwen Chen* and Zhijian Guo Abstract Background: Spontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5–11.6% of patients with primary spontaneous pneumothorax. Spontaneous pneumothorax is a well-documented disorder with a classic clinical presentation of acute onset chest pain and shortness of breath. This disorder might be complicated by the development of hemopneumothorax or tension pneumothorax. Case presentation: A 23-year-old Asian man was referred to the emergency room of Xiamen Chang Gung Memorial Hospital with a 1-day history of right-sided chest pain that had been aggravated for 1 hour. A physical examination revealed a young man who was awake and alert but in mild to moderate painful distress. His vital parameters were relatively stable at first. The examining physician noted slight tenderness along the right posterolateral chest wall along the eighth and tenth ribs. Primary spontaneous pneumothorax was considered, and a standing chest X-ray confirmed the diagnosis. A right thoracostomy tube was immediately placed under sterile conditions, and he was referred to the respiratory service. While in the respiratory department, approximately 420 mL of blood was drained from the thoracostomy tube over 15 minutes. Our patient developed obvious hemodynamic instability with hypovolemic shock and was subsequently admitted to the cardiothoracic surgical ward after fluid resuscitation.
    [Show full text]
  • Complications of Splenectomy 2020; 4(2): 218-222 Received: 08-02-2020 Dr
    International Journal of Surgery Science 2020; 4(2): 218-222 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science Complications of splenectomy www.surgeryscience.com 2020; 4(2): 218-222 Received: 08-02-2020 Dr. Ketan Vagholkar Accepted: 10-03-2020 Dr. Ketan Vagholkar DOI: https://doi.org/10.33545/surgery.2020.v4.i2d.420 Professor, Department of Surgery. DY Patil University School of Abstract Medicine Navi Mumbai, Spleen is an important organ of the reticuloendothelial system. It plays a crucial role in the immunological Maharashtra, India system of the body. Understanding the consequences and diagnosis of hyposlenic and asplenic states is essential. Splenectomy is performed for a variety of indications ranging from haematological conditions to trauma. Complications of splenectomy include surgical as well as immunological. Overwhelming post splenectomy infection is one of the most dreaded complication with high mortality. The physiological basis of immunological function of the spleen, hyposplenism and complications of splenectomy are presented in this paper. Keywords: Post splenectomy, complications, hyposplenia, OPSI Introduction Spleen is a very important constituent organ of the reticuloendothelial system. The organ is crucial in regulating immune homeostasis through its ability to link innate and adoptive immunity in the process of protecting against infection. Hyposplenism is impairment of splenic function. It is usually acquired and caused by severe haematological and immunological disorders. Asplenia refers to the absence of the spleen which is rarely congenital but predominantly post-surgical (splenectomy). The most important complication of asplenic state is infectious complications [1]. These infections have high mortality. In addition to infectious complications, splenectomy can lead to a series of other complications.
    [Show full text]
  • Clinical Study Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation
    Hindawi Publishing Corporation Emergency Medicine International Volume 2015, Article ID 859130, 6 pages http://dx.doi.org/10.1155/2015/859130 Clinical Study Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation Ismail Mahmood,1 Zainab Tawfeek,2 Ayman El-Menyar,3,4,5 Ahmad Zarour,1 Ibrahim Afifi,1 Suresh Kumar,1 Ruben Peralta,1 Rifat Latifi,1 and Hassan Al-Thani1 1 Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar 2Department of Emergency, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar 3Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar 4ClinicalMedicine,WeillCornellMedicalSchool,P.O.Box24144,Doha,Qatar 5Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt Correspondence should be addressed to Ismail Mahmood; [email protected] Received 26 October 2014; Accepted 3 February 2015 Academic Editor: Seiji Morita Copyright © 2015 Ismail Mahmood et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results.Atotalof56chesttraumapatientswithoccult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years.
    [Show full text]
  • Well-Differentiated Angiosarcoma of Spleen: a Teaching Case Mimicking
    Xu et al. World Journal of Surgical Oncology (2015) 13:300 DOI 10.1186/s12957-015-0716-1 WORLD JOURNAL OF SURGICAL ONCOLOGY CASE REPORT Open Access Well-differentiated angiosarcoma of spleen: a teaching case mimicking hemagioma and cytogenetic analysis with array comparative genomic hybridization Lichen Xu1†, Yimin Zhang1†, Hong Zhao1, Qingxiao Chen2, Weihang Ma1,3* and Lanjuan Li1 Abstract Primary splenic angiosarcoma is extremely rare but aggressive malignant vascular neoplasm. Here, we report a case of vascular tumor in spleen that was initially misinterpreted as hemangioma. Two years after splenectomy, the patient admitted again with aggravated abdomen pain and severe anemia. The magnetic resonance imaging (MRI) scan showed widely metastases. The ensuing biopsy for lesion both in liver and in bone marrow showed the similar pathological findings as that in spleen, which supported the final diagnosis of well-differentiated splenic angiosarcoma with extensive metastases. The patient was dead in 3 months after discharge without chemotherapy. The copy number changes for spleen lesion detected by array comparative genome hybridization showed copy number gain at 11q23.2, 11q24.3, 12q24.33, 13q34, copy number loss at 1q24.2-q31.3, 1q41-q42.2, 1 q42.3-q43, 2q36.3-q37.3, 2q37.7, 3q13.33-q26.2, 3q28 - q29, 9p11.2, 13q11, 15q11, homozygous copy loss at 8p11.22, 22q11.23. Less than 200 cases of splenic angiosarcoma have been published in literature of English. To the best of our knowledge, this is the first time analyzed cytogenetic alteration in a well-differentiated primary splenic angiosarcoma. Keywords: Angiosarcoma, Well-differentiation, Splenectomy, Array comparative genomic hybridization, Copy number change Background cytogenetic changes to this subgroup of angiosarcoma Primary splenic angiosarcoma (PSA) is a rare malignant has been published.
    [Show full text]
  • Presumptive Antibiotics in Tube Thoracostomy for Traumatic
    Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2019-000356 on 4 November 2019. Downloaded from Open access Plenary paper Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, Multicenter American Association for the Surgery of Trauma Study Alan Cook ,1 Chengcheng Hu,2 Jeanette Ward,3 Susan Schultz,4 Forrest O’Dell Moore III,5 Geoffrey Funk,6 Jeremy Juern,7 David Turay,8 Salman Ahmad,9 Paola Pieri,10 Steven Allen,11 John Berne,12 for the AAST Antibiotics in Tube Thoracostomy Study Group For numbered affiliations see ABSTRact a hemothorax, pneumothorax, or hemopneu- end of article. Background Thoracic injuries are common in trauma. mothorax (HPTX).1–4 Although no statistics are Approximately one- third will develop a pneumothorax, available for the number of post- traumatic tube Correspondence to hemothorax, or hemopneumothorax (HPTX), usually with thoracostomies (TT) performed in the USA annu- Dr Forrest O’Dell Moore III, John Peter Smith Healthcare Network, concomitant rib fractures. Tube thoracostomy (TT) is the ally, this commonly performed procedure remains Fort Worth, TX 76104, USA; standard of care for these conditions, though TTs expose the first- line treatment for drainage of the pleural fmoore@ jpshealth. org the patient to the risk of infectious complications. The cavity. controversy regarding antibiotic prophylaxis at the time It is well documented that TTs placed in the Presented at the American trauma setting are associated with increased Association for the Surgery of of TT placement remains unresolved. This multicenter 5 6 Trauma 77th Annual Meeting, study sought to reconcile divergent evidence regarding hospital length of stay (LOS), morbidity, and cost.
    [Show full text]
  • Human Autoimmunity and Associated Diseases
    Human Autoimmunity and Associated Diseases Human Autoimmunity and Associated Diseases Edited by Kenan Demir and Selim Görgün Human Autoimmunity and Associated Diseases Edited by Kenan Demir and Selim Görgün This book first published 2021 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2021 by Kenan Demir and Selim Görgün and contributors All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-5275-6910-1 ISBN (13): 978-1-5275-6910-2 TABLE OF CONTENTS Preface ...................................................................................................... viii Chapter One ................................................................................................. 1 Introduction to the Immune System Kemal Bilgin Chapter Two .............................................................................................. 10 Immune System Embryology Rümeysa Göç Chapter Three ............................................................................................. 18 Immune System Histology Filiz Yılmaz Chapter Four .............................................................................................. 36 Tolerance Mechanisms and Autoimmunity
    [Show full text]
  • Accessory Spleen ORIGINAL RESEARCH ARTICLE
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 10 Ver.III (Oct. 2015), PP 01-03 www.iosrjournals.org Accessory spleen ORIGINAL RESEARCH ARTICLE V. Durgesh*1, CH. Roja Rani2 1Associate Professor Department of Anatomy Faculty of Medicine Maharajah Institute of Medical Sciences Nellimarla Vizianagaram district Andhra Pradesh 2.Assistant Professor Mims, Nellimarla Vizianagaram Distrct Andhrapradesh Abstract: Accessory spleen is a congenital failure of fusion of splenicules usually found close to the splenic hilum or in the greater omentum or tail of the pancreas. Though mostly asymptomatic, these could confuse the diagnosis of certain tumors and also be the cause of relapse post splenectomy. The aim of this article is to present a case of accessory spleen found during the dissection and discuss the various diagnostic procedures, clinical implications and focus on splenosis. Key words: accessory spleen, splenosis, dorsal mesogastrium I. Introduction During the fifth week of intrauterine life, mesenchymal condensations called ‘splenicules” start to appear in the left leaf of dorsal mesogastrium which eventually fuse to form the spleen. Any failure of this fusion results in small splenic tissues developing separately and resulting in accessory spleens. They are relatively common, with an autopsy study involving 3000 patients identifying 364 accessory spleens, of which 61 were found in the pancreatic tail. The pancreatic tail and the splenic hilum are the most common sites though accessory spleens can be found anywhere along the line of dorsal mesogastrium and close to the urogenital ridge such as the stomach, jejunum, mesentery as well as the ovaries, spermatic cord,scrotum1and testis.
    [Show full text]
  • Emergency Department Evaluation and Management of Blunt Chest
    June 2016 Emergency Department Volume 18, Number 6 Authors Evaluation And Management Of Eric J. Morley, MD, MS Associate Professor of Clinical Emergency Medicine, Associate Residency Director, Department of Emergency Medicine, Stony Brook Blunt Chest And Lung Trauma Medicine, Stony Brook, NY Scott Johnson, MD Associate Professor of Clinical Emergency Medicine, Residency Abstract Director, Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY The majority of blunt chest injuries are minor contusions or Evan Leibner, MD, PhD Department of Emergency Medicine, Stony Brook Medicine, Stony abrasions; however, life-threatening injuries, including tension Brook, NY pneumothorax, hemothorax, and aortic rupture can occur and Jawad Shahid, MD must be recognized early. This review focuses on the diagnosis, Department of Emergency Medicine, Stony Brook Medicine, Stony management, and disposition of patients with blunt injuries to Brook, NY the ribs and lung. Utilization of decision rules for chest x-ray and Peer Reviewers computed tomography are discussed, along with the emerging Ram Parekh, MD role of bedside lung ultrasonography. Management controversies Assistant Clinical Professor, Emergency Department, Elmhurst Hospital presented include the limitations of needle thoracostomy us- Center, Icahn School of Medicine at Mount Sinai, New York, NY Christopher R. Tainter, MD, RDMS ing standard needle, chest tube placement, and chest tube size. Assistant Clinical Professor, Department of Emergency Medicine, Finally, a discussion is provided related to airway and ventilation Department of Anesthesiology, Division of Critical Care, University of management to assist in the timing and type of interventions California San Diego, San Diego, CA needed to maintain oxygenation. Prior to beginning this activity, see “Physician CME Information” on the back page.
    [Show full text]
  • Post-Splenectomy Sepsis: a Review of the Literature
    Open Access Review Article DOI: 10.7759/cureus.6898 Post-splenectomy Sepsis: A Review of the Literature Faryal Tahir 1 , Jawad Ahmed 1 , Farheen Malik 2 1. Internal Medicine, Dow University of Health Sciences, Karachi, PAK 2. Pediatrics, Dow University of Health Sciences, Karachi, PAK Corresponding author: Jawad Ahmed, [email protected] Abstract The spleen is an intraperitoneal organ that performs vital hematological and immunological functions. It maintains both innate and adaptive immunity and protects the body from microbial infections. The removal of the spleen as a treatment method was initiated from the early 1500s for traumatic injuries, even before the physiology of spleen was properly understood. Splenectomy has therapeutic effects in many conditions such as sickle cell anemia, thalassemia, idiopathic thrombocytopenic purpura (ITP), Hodgkin’s disease, and lymphoma. However, it increases the risk of infections and, in some cases, can lead to a case of severe sepsis known as overwhelming post-splenectomy infection (OPSI), which has a very high mortality rate. Encapsulated bacteria form a major proportion of the invading organisms, of which the most common is Streptococcus pneumoniae. OPSI is a medical emergency that requires prompt diagnosis (with blood cultures and sensitivity, blood glucose levels, renal function tests, and electrolyte levels) and management with fluid resuscitation along with immediate administration of empirical antimicrobials. OPSI can be prevented by educating patients, vaccination, and antibiotic prophylaxis.
    [Show full text]
  • Diagnosis and Treatment of Primary Spontaneous Pneumothorax
    Luh / J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2010 11(10):735-744 735 Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology) ISSN 1673-1581 (Print); ISSN 1862-1783 (Online) www.zju.edu.cn/jzus; www.springerlink.com E-mail: [email protected] Review: Diagnosis and treatment of primary spontaneous pneumothorax Shi-ping LUH (Department of Surgery, St. Martin de Porres Hospital, Chia-Yi City 60069, Taiwan, China) E-mail: [email protected] Received Apr. 8, 2010; Revision accepted May 16, 2010; Crosschecked Sept. 2, 2010 Abstract: Primary spontaneous pneumothorax (PSP) commonly occurs in tall, thin, adolescent men. Though the pathogenesis of PSP has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Herein, the literature is reviewed concerning mechanisms and personal clinical experience with PSP. The chest computed tomography (CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies. The development of video-assisted thoracoscopic surgery (VATS) has changed the profiles of management strategies of PSP due to its minimal inva- siveness and high effectiveness for patients with these diseases. Key words: Primary spontaneous pneumothorax (PSP), Diagnosis, Treatment doi:10.1631/jzus.B1000131 Document code: A CLC number: R56 1 Pneumothorax definition and classification al., 2001; Chen Y.J. et al., 2008). Secondary spon- taneous pneumothorax (SSP) usually occurs in older Pneumothorax is defined as air or gas accumu- people with underlying pulmonary disease, such as lated in the pleural cavity. A pneumothorax can occur emphysema or asthma, acute or chronic infections, spontaneously or after trauma to the lung or chest wall.
    [Show full text]
  • (ACR), Case in Point
    Selected Publications Duran A, Heller G. Tuberculum Sellae Meningioma. American College of Radiology (ACR), Case in ​ ​ Point. July 2020. ​ ​ Gromis J, Moore JA, Van Kouwenberg, Benitez CL. Wrist Extensor Tendon “Floating Fat” Sign: A ​ ​ ​ Strong Indicator to Recognize Occult Fractures in the Distal Radius. Journal of Bone and Joint ​ Surgery Case Connector. Accepted 2020 June, awaiting PMID. ​ ​ ​ Grover H, Grover SB, Goyal P, Hedge R, Gupta S, Malhotra S, Li S, Gupta N. Clinical and imaging ​ features of idiopathic granulomatous mastitis - The diagnostic challenges and a brief review. Clinical Imaging. Accepted 2020 June, awaiting PMID. ​ ​ ​ Doo FX, Kassim G, Lefton D, Patterson S, Pham H, Belani P. Unusual neurological presentations of ​ ​ ​ COVID-19: Leukoencephalopathy and carotid Thrombosis. Clinical Imaging. Accepted June 7 2020, ​ ​ awaiting PMID. ​ Zaman O, Doo FX, Shah S, Pfaff HC, Kamath A, Gastropulmonary fistula. American College of ​ ​ Radiology (ACR), Case in Point. 2020. ​ Chundru K, Roudenko A, Pham H, Benitez CL. Analysis of Different Levels of Structured Reporting ​ ​ ​ in Knee Magnetic Resonance Imaging. Academic Radiology. 2020 February. PMID: 32037259 ​ ​ Doo FX, Khorsandi A, Avanessian B, Bowers M, Somwaru A . Gender Affirmation Surgery: A Primer ​ on Imaging Correlates for the Radiologist. American Journal of Roentgenology. 2019 December. ​ ​ PMID: 31414889. Nguyen B, Doo FX, Hannan P, Hayon R. Chapter 5 - Prevention. The Equal Curriculum: Student and ​ ​ ​ Educator Guide to LGBT Health (1st ed. Springer Press). 2019 October. ISBN 978-3-030-24025-7 ​ (ebook), ISBN 978-3-030-24024-0 (softcover). Gunio D, Vulcano E, Benitez C. Dynamic Stress MR-imaging of Midfoot Injuries: Measurable ​ Morphology and Laxity of the Sprained Lisfranc Ligament during Mechanical Loading: A Case Report.
    [Show full text]
  • Accessory Spleen Mimicking Pancreatic Tumour: Evaluation by 99Mtc-Labelled Colloid SPECT/CT Study
    Folia Morphol. Vol. 74, No. 4, pp. 532–539 DOI: 10.5603/FM.2015.0119 C A S E R E P O R T Copyright © 2015 Via Medica ISSN 0015–5659 www.fm.viamedica.pl Accessory spleen mimicking pancreatic tumour: evaluation by 99mTc-labelled colloid SPECT/CT study. Report of two cases and a review of nuclear medicine methods utility M. Pachowicz1, 2, A. Mocarska3, E. Starosławska3, Ł. Pietrzyk2, 4, B. Chrapko1 1Chair and Department of Nuclear Medicine, Medical University of Lublin, Poland 2Department of Didactics and Medical Simulation, Medical University of Lublin, Poland 3St. John’s Cancer Centre, Lublin, Poland 4General and Minimally Invasive Surgery Department, 1st Clinical Military Hospital, Lublin, Poland [Received 31 August 2014; Accepted 13 January 2015] The accessory spleen is a common congenital anomaly, typically asymptomatic and harmless to the patient. However, in some clinical cases, this anomaly beco- mes significant as it can be mistaken for a tumour or lymph node and be missed during a therapeutic splenectomy. There are nuclear medicine modalities which can be applied in the identification and localisation of an accessory spleen. They include scintigraphy with radiolabelled colloids or heat damaged red blood cells, which are trapped in the splenic tissue. Modern techniques, including hybrid imaging, enable simultaneous structure and tracer distribution evaluations. Additionally, radiation-guided surgery can be used in cases where the accessory spleen, which is usually small (not exceeding 1 cm) and difficult to find among other tissues, has to be removed. In the study, we would like to present 2 cases of patients in which the malignancy had to be excluded for the reason that the multiple accessory spleens were very closely related to the pancreas.
    [Show full text]