ABSTRACT
A 45-year-old woman presented at the emergency room with acute dyspnoea and slight fever, without coughing. The chest radiography showed a consolidation in the lower left lobe. The CT scan revealed a consolidation in the posterior-basal segment of the lower left lobe without an air bronchogram but with various densities. Based on these findings, the possibility of pulmonary sequestration was considered. A CT scan showed an arterial branch arising from the aorta that supplied the consolidation, confirming pulmonary sequestration. The patient underwent resection of the intralobar sequestrum, after which she recovered and was asymptomatic. Pulmonary sequestration should be considered in any patient with pneumonia or recurrent pneumonia in the lower lobes of the lung, especially in the absence of an air bronchogram or signs of endobronchial obstruction. The treatment ofchoice is surgical resection.
Subject(s)
Bronchopulmonary Sequestration/surgery , Bronchopulmonary Sequestration/diagnosis , Female , Humans , Middle Aged , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We present the case of a 54-year old woman who presented twice at our emergency department with progressive abdominal pain. Over the last few years, multiple short periods of abdominal pain had occurred: the pain always resolved spontaneously after a few hours. She had no past medical history. CT scan revealed a sac-like mass of small bowel loops to the left of the ligament of Treitz, consistent with the diagnosis of a left paraduodenal hernia. On laparotomy, a left paraduodenal hernia with incarceration of small bowel loops was found; the herniated loops were reduced and the hernia orifice closed. The anatomy, treatment and importance of considering this uncommon diagnosis when examining a patient with acute small bowel obstruction are discussed.
Subject(s)
Duodenal Diseases/complications , Hernia/complications , Intestinal Obstruction/etiology , Abdominal Pain/etiology , Female , Humans , Laparotomy , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Subclavian Vein/injuries , Wounds, Nonpenetrating , Adult , Bicycling/injuries , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Endothelium, Vascular/injuries , Endothelium, Vascular/pathology , Humans , Male , Regional Blood Flow , Subclavian Vein/pathology , Tunica Intima/injuries , Tunica Intima/pathology , Wounds, Nonpenetrating/surgeryABSTRACT
The case of a patient with immune thrombocytopenia associated with mycoplasma pneumoniae infection is described. The thrombocytopenia was considered to be provoked by the infection and disappeared gradually after antibiotic treatment.
Subject(s)
Pneumonia, Mycoplasma/complications , Purpura, Thrombocytopenic/etiology , Adolescent , Erythromycin/therapeutic use , Humans , Male , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/drug therapy , Prednisone/therapeutic use , Purpura, Thrombocytopenic/drug therapy , Purpura, Thrombocytopenic/immunologyABSTRACT
We correlated the amount of gastric fluid identified by sonography in 143 fasting patients with the presence of duodenal ulcer disease and gastric-outlet obstruction as seen on barium studies. Unselected consecutive patients who were referred for a barium study of the upper gastrointestinal tract were included in a double-blinded prospective study. Sonograms were obtained in the right lateral decubitus position to allow gastric fluid to accumulate in the antrum, where it was quantified by measuring the maximal cross-sectional area of antral fluid in square centimeters. Sonograms revealed no fluid or a small amount (less than 5 cm2) in 87 (61%) of the patients and a large amount of fluid (greater than or equal to 5 cm2) in 56 patients (39%). Barium examinations showed a duodenal ulcer in 26 (46%) of the 56 patients with sonographic evidence of a large amount of gastric fluid compared with 10 patients (11%) in the group with little or no fluid on sonography (p = .001). Sonographic evidence of a large amount of fluid was found in all five patients who had gastric-outlet obstruction on barium examination (p = .02). The detection of a large amount of fluid in the stomach on sonography appears to be a feature of duodenal ulcer disease and gastric-outlet obstruction.
Subject(s)
Duodenal Ulcer/diagnosis , Fasting , Gastric Juice , Pyloric Stenosis/diagnosis , Ultrasonography , Adolescent , Adult , Aged , Aged, 80 and over , Duodenal Ulcer/physiopathology , Female , Gastric Juice/metabolism , Humans , Male , Middle Aged , Pyloric Stenosis/physiopathologyABSTRACT
Heterotopic gastric mucosa in the duodenal bulb causes a characteristic radiologic abnormality consisting of multiple small, well-defined nodules in the mucosa. This finding was identified in 92 (5%) of 1873 consecutive standard biphasic barium examinations of the upper gastrointestinal tract. Of these 92, only one patient (1%) had an associated duodenal ulcer as compared with the other 1781 patients without heterotopic gastric mucosa of whom 225 (13%) had duodenal ulcers or scars (p = .002). No gastric ulcers or ulcer scars were identified in the patients with heterotopic gastric mucosa, whereas ulcers or scars were identified in 88 patients (5%) without heterotopic gastric mucosa (p = .05). These data raise the possibility that heterotopic gastric mucosa protects against peptic ulceration.
