RESUMO
Primary cardiac angiosarcoma is a rare disease with a dismal prognosis. We report a case of a 50-year-old man who presented with haemoptysis, cough and worsening dyspnoea. An intracardiac mass was visualised on echocardiogram. He was treated for diffuse alveolar haemorrhage and acute respiratory distress syndrome but died from refractory hypoxaemic respiratory failure leading to cardiac arrest. The diagnosis of primary cardiac angiosarcoma with haemorrhagic pulmonary metastases leading to diffuse alveolar damage was confirmed on autopsy.
Assuntos
Neoplasias Cardíacas/complicações , Hemangiossarcoma/complicações , Hemorragia/etiologia , Pneumopatias/etiologia , Síndrome do Desconforto Respiratório/etiologia , Tosse/etiologia , Dispneia/etiologia , Ecocardiografia , Evolução Fatal , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Hemoptise/etiologia , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Pneumopatias/diagnóstico por imagem , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Alvéolos Pulmonares , Radiografia Torácica , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios XRESUMO
A young man with a history of smoking presented with acute-onset chest pain after lifting weights. He also noticed a change in his voice, tightness in his neck and difficulty breathing. A chest radiograph showed soft tissue emphysema in the neck. A CT scan of the chest revealed moderate amount of pneumomediastinum tracking into the neck and down to the diaphragm. He was haemodynamically stable and had no hypoxia or dysphagia. He was monitored for 48 hours and discharged home after resolution of his symptoms. A chest radiograph repeated after 6 weeks was normal.
Assuntos
Dor no Peito/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Radiografia Torácica , Enfisema Subcutâneo/diagnóstico por imagem , Levantamento de Peso , Dor no Peito/etiologia , Humanos , Masculino , Enfisema Mediastínico/fisiopatologia , Pescoço/patologia , Enfisema Subcutâneo/fisiopatologia , Resultado do Tratamento , Levantamento de Peso/fisiologia , Adulto JovemRESUMO
A 47-year-old man presented with symptoms of fever and productive cough secondary to a left upper lobe pneumonia. He had received more than three courses of antibiotics over a 2-year period. Review of serial radiographic exams including chest x-ray and CT scans revealed consolidation of the left upper lobe. Lack of response to antibiotics prompted invasive testing with bronchoscopy which revealed a growth in the left main bronchus. Histopathology revealed squamous cell carcinoma.
Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias de Células Escamosas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Antibacterianos/uso terapêutico , Broncoscopia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias de Células Escamosas/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Tomografia Computadorizada por Raios X , Falha de TratamentoRESUMO
We report a case of young woman who presented with acute cardiogenic pulmonary oedema and respiratory failure. She underwent emergent endotracheal intubation and was transferred to the intensive care unit. She responded to intravenous diuretics and positive pressure ventilation. Subsequent workup revealed that she had Graves' disease and was in thyrotoxic crisis. Therapy with propranolol and propylthiouracil was instituted to which she showed remarkable improvement.
Assuntos
Insuficiência Cardíaca/complicações , Edema Pulmonar/etiologia , Crise Tireóidea/complicações , Adulto , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Respiração com Pressão Positiva , Edema Pulmonar/diagnóstico , Edema Pulmonar/terapia , Radiografia Torácica , Crise Tireóidea/diagnóstico , Crise Tireóidea/terapiaRESUMO
A 14-year-old male, diagnosed case of type 1 diabetes mellitus since 1 year, presented with uncontrolled blood glucose levels, non-compliance with insulin therapy and recurrent admissions with diabetic ketoacidosis. His blood glucose levels were difficult to control with wide fluctuations in insulin requirement. He had absent secondary sexual characteristics and hepatomegaly. Liver biopsy showed macrovesicularsteatosis without fibrosis or inflammation. Many glycogenated nuclei were present. He was started on intensive insulin therapy, whereby he showed subsequent regression of hepatomegaly and onset of pubertal spurt.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Nanismo/etiologia , Fígado Gorduroso/etiologia , Adolescente , Diabetes Mellitus Tipo 1/tratamento farmacológico , Nanismo/tratamento farmacológico , Fígado Gorduroso/tratamento farmacológico , Humanos , Masculino , Indução de Remissão , SíndromeRESUMO
A 40-year-old female, presented with prerenal acute kidney injury secondary to diarrhoea. With appropriate hydration, she went into diuretic phase and subsequently developed hypokalemic quadriparesis with hypocalcaemic tetany due to hypomagnesemia and subclinical vitamin D deficiency. The patient improved with oral potassium, magnesium, calcium and vitamin D supplementation.
Assuntos
Injúria Renal Aguda/complicações , Hipercalciúria/complicações , Hipocalcemia/complicações , Hipopotassemia/complicações , Nefrocalcinose/complicações , Quadriplegia/etiologia , Erros Inatos do Transporte Tubular Renal/complicações , Tetania/etiologia , Desequilíbrio Hidroeletrolítico/complicações , Adulto , Feminino , HumanosRESUMO
Two sisters presented with lower limb deformity and difficulty in walking without support. Both had short stature; however, neurodevelopment and secondary sexual characters were normal. Abdominal examination revealed splenomegaly and ophthalmic examination showed presence of Kayser-Fleischer (K-F) rings. Diagnosis of Wilson's disease was confirmed with low serum copper and ceruloplasmin levels. Further investigations revealed urinary acidification defect with hypercalciuria pointing towards distal renal tubular acidosis. Both patients were started on copper chelation therapy and showed gradual radiographic improvement in osteopaenia.
Assuntos
Acidose Tubular Renal/etiologia , Degeneração Hepatolenticular/complicações , Acidose Tubular Renal/diagnóstico , Acidose Tubular Renal/metabolismo , Adolescente , Ceruloplasmina/metabolismo , Terapia por Quelação , Consanguinidade , Cobre/metabolismo , Diagnóstico Diferencial , Feminino , Degeneração Hepatolenticular/diagnóstico , Degeneração Hepatolenticular/metabolismo , Humanos , IrmãosRESUMO
Hydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration/inhalation of volatile hydrocarbon compounds with low viscosity and surface tension. The authors describe the case of a 24-year-old male who aspirated diesel while siphoning it from heavy duty crane, developed bilateral pneumonitis and responded to 2-day therapy with non-invasive continuous positive airway pressure ventilation.