ABSTRACT
Catamenial pneumothorax is a rare disease that is usually diagnosed on clinical grounds. Delay in diagnosis can lead to considerable morbidity. We describe a case in which spiral CT scan and videothoracoscopy led to early objective diagnosis and management.
Subject(s)
Endometriosis/diagnosis , Pneumothorax/etiology , Thoracic Diseases/diagnosis , Thoracoscopy , Tomography, X-Ray Computed , Videotape Recording , Adult , Diagnosis, Differential , Endometriosis/complications , Endometriosis/diagnostic imaging , Female , Humans , Thoracic Diseases/complications , Thoracic Diseases/diagnostic imaging , Thoracoscopy/methods , Tomography, X-Ray Computed/methodsABSTRACT
Intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient taking anticoagulant agents who complains of local or referred spinal pain associated with limb weakness, sensory deficits, or urinary retention. We describe a patient with hematomyelia, review the literature on hematomyelia and other intraspinal hemorrhage syndromes, and summarize intraspinal hemorrhage associated with oral anticoagulant therapy. The patient (a 62-year-old man) resembled previously described patients with hematomyelia in age and sex. However, he was unusual in having cervical rather than thoracic localization. As with intracranial bleeding, the incidence of intraspinal hemorrhage associated with anticoagulant therapy might be minimized by close monitoring and tight control of the intensity of anticoagulation. However, it is noteworthy that many of the reported cases were anticoagulated in the therapeutic range. If intraspinal hemorrhage is suspected, anticoagulation must be reversed immediately. Emergency laminectomy and decompression of the spinal cord appear mandatory if permanent neurologic sequelae are to be minimized. A high index of suspicion, prompt recognition, and immediate intervention are essential to prevent major morbidity and mortality from intraspinal hemorrhage.
Subject(s)
Anticoagulants/adverse effects , Hemorrhage/chemically induced , Spinal Cord Vascular Diseases/chemically induced , Warfarin/adverse effects , Administration, Oral , Anticoagulants/administration & dosage , Diagnosis, Differential , Hematoma, Epidural, Cranial/chemically induced , Hematoma, Epidural, Cranial/diagnosis , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural/chemically induced , Hematoma, Subdural/diagnosis , Hematoma, Subdural/surgery , Hemorrhage/diagnosis , Hemorrhage/surgery , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Middle Aged , Spinal Cord Vascular Diseases/diagnosis , Spinal Cord Vascular Diseases/surgery , Thromboembolism/drug therapy , Warfarin/administration & dosageABSTRACT
The authors report a case of acute myocardial infarction following gemcitabine infusion and electrocardiographic abnormalities suggestive of ischemia on rechallenge of the drug. The possible underlying mechanisms of ischemia and/or infarction and the strategies for prevention are discussed.
