ABSTRACT
The diagnosis of the Marfan syndrome rests on the four criteria of characteristic musculoskeletal, cardiovascular, ocular, and familial features. Biliary tract manifestations have not been described. A case of Marfan syndrome with recurrent biliary obstruction is presented. Endoscopic retrograde cholangiograms presented a grossly ectatic biliary system which is postulated to be an unrecognized manifestation of this syndrome. In addition, the patient developed choledocholithiasis, which may have resulted from biliary stasis secondary to bile duct ectasia. Biliary obstruction developed in the presence and absence of choledocholithiasis, the latter apparently through kinking of the ectatic common bile duct. Obstruction was clinically relieved by biliary endoprosthesis. The presence of a Zenker's diverticulum in this patient, also unreported in the Marfan syndrome, is of incidental interest.
Subject(s)
Cholestasis/physiopathology , Common Bile Duct Diseases/physiopathology , Marfan Syndrome/physiopathology , Aged , Female , Gallstones/physiopathology , Humans , Marfan Syndrome/diagnosisABSTRACT
A patient with laryngeal and pulmonary tuberculosis is described. The similarity between the clinical presentation and gross appearance of laryngeal carcinoma and tuberculosis in this patient and others reported in the literature is emphasized. Laryngeal biopsy is necessary to establish the correct diagnosis, but this must be done only after the proper precautions are taken to reduce the risk of infection to the physician performing the biopsy. Examination of the chest x-ray and acid-fast stain of the sputum are rapid and highly reliable screening tests for laryngeal tuberculosis.
