‘Focal’ Cardiac Concussion – An Under-Recognized Problem?

Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.

14 year old male with oliguria and respiratory distress- What is your diagnosis?

@#A 14 year old male from Quezon City Manila was admitted due to oliguria. He presented with 7 days of intermittent fever associated with malaise, photophobia with redness of the eyes. A few hours before admission, he developed repetitive vomiting with decreased urine output. He denied any muscle pain, change in his sensorium or seizure episode. He had a history of wading in flooded waters.

Pinzamiento anterolateral del tobillo: evaluación ecotomográfica / Anterolateral impingement on ankle: echotomographic evaluation

Se realizó una evaluación de la anatomía ultrasonográfica de los ligamentos normales y patológicos de la región lateral del tobillo, con el objeto de determinar su utilidad en pacientes con clínica sugerente de pinzamiento anterolateral. Se estudiaron ambos lados en 15 pacientes sanos y en 14 pacientes referidos por traumatólogo con clínica sugerente. Los ligamentos evaluados fueron los: tibioperoneo anterior (TPA), peroneoastragalino (PA) y peroneocalcáneo. (PC) En pacientes sanos se observan como bandas ecogénicas, rectas, con estructura hipoecoica posterior. En 8 pacientes con sospecha clínia se detectó alteración en 11 ligamentos, observándose aumento de volumen y convexidad de la banda. A cuatro de estos pacientes se les practicó cirugía endoscópica encontrándose una buena correlación con los hallazgos ecotomográficos. En todos se indicó correctamente los ligamentos comprometidos. La ecotomografía de alta resolución puede ser un buen método diagnóstico en el pinzamiento anterolateral del tobillo a nivel de PA y TPA, especialmente si se considera como método alternativo a la RM por su bajo costo y accesibilidad