scholarly journals Chest Pain? An Unusual Presentation of Vertebral Osteomyelitis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Cristian Landa ◽  
Stanley Giddings ◽  
Pramod Reddy
Keyword(s):  
Tissue Culture ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Vertebral Osteomyelitis ◽  
Cord Compression ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Rule Out

We present a case of vertebral osteomyelitis presenting as chest pain. The patient initially underwent a CT chest angiogram to rule out a pulmonary embolism, which incidentally showed a soft tissue vertebral mass at T3-T4 disk space. Subsequent thoracic vertebral MRI was consistent with osteomyelitis with cord compression. Tissue culture from a CT-guided biopsy grew MRSA. The patient was successfully treated with Vancomycin. This is a rare presentation of vertebral osteomyelitis which poses an interesting diagnostic challenge.

Cryptogenic organising pneumonia: an unusual cause of pleuritic chest pain

2021 ◽  
Vol 14 (1) ◽  
pp. e238514
Author(s):  
Rebecca Ceci Bonello ◽  
Etienne Ceci Bonello ◽  
Christian Vassallo ◽  
Edward Giles Bellia
Keyword(s):  
Chest Pain ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Clinical Status ◽  
Lower Lobe ◽  
Pleuritic Chest Pain ◽  
Ct Guided ◽  
Atypical Pathogens ◽  
Ct Guided Biopsy ◽  
The Right

A 76-year-old woman presented with a 2-hour history of pleuritic chest pain with no other associated symptoms. Blood investigations revealed raised inflammatory markers and an elevated white cell count. On chest radiograph, an airspace shadow indicative of a consolidation was prominent. This was followed by a CT scan of her thorax which showed a spiculated lesion in the right upper lobe, a lesion in the posterior segment of the left lower lobe and mildly enlarged right hilar lymph nodes. She was started on dual antibiotic therapy; however, the patient’s clinical status and inflammatory markers did not improve. A bronchoscopy was performed which excluded malignancy and atypical pathogens. CT-guided biopsy confirmed the presence of cryptogenic organising pneumonia. Prednisolone 50 mg daily was prescribed with quick resolution of symptoms.

scholarly journals A Rare Case of Cyclical Hemothorax: Thoracic Endometriosis Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Shabbir Rawala ◽  
Muhammad Farhan Khaliq ◽  
Muhammad Asif Iqbal ◽  
S. Tahira Shah Naqvi ◽  
Kinaan Farhan ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pleural Effusion ◽  
Reproductive Age ◽  
Common Disease ◽  
Pleuritic Chest Pain ◽  
Rare Presentation ◽  
Ct Guided ◽  
Endometrial Cells ◽  
Wide Range ◽  
Thoracic Endometriosis

Endometriosis is a common condition in which endometrial cells and stroma are deposited in extrauterine sites. Its prevalence has been estimated to be 10% of reproductive age females. It is commonly found in the pelvis; however, it may be found in the abdomen, thorax, brain, or skin. Thoracic involvement is a relatively rare presentation of this common disease. Thoracic endometriosis commonly presents as pneumothorax in 73% of patients. A rarer presentation of thoracic endometriosis is hemothorax (<14%) or hemoptysis (7%). Thoracic endometriosis is an uncommon cause of a pleural effusion. We present a case of 28-year-old African American female with no other medical conditions. She presented to the hospital with worsening right-sided pleuritic chest pain, dyspnea, and menorrhagia. She had been complaining of pleuritic chest pain for 5 years, the onset of which corresponds to the start of her menstrual cycle and is relieved with cessation of menses. Initial laboratory studies revealed a severe microcytic anemia with normal coagulation profile. Chest X-ray showed small right pleural effusion and suspicious for airspace disease. A computed tomography (CT) of chest was ordered for further clarification and identified large right pleural effusion. CT-guided thoracentesis removed 500 ml of serosanguinous fluid consisting of blood elements. There can be multiple sites involved with endometriosis and can present with wide range of symptoms that occur periodically with menses in young woman. The history and pleural fluid findings of this case are suggestive of Thoracic Endometriosis Syndrome. The diagnosis of this is often missed or delayed by clinicians, which can result in recurrent hospitalization and other complications. As internists we should be suspicious of atypical presentations of endometriosis and treat them early before complications develop. This case also highlights the importance of suspecting atypical etiologies for pleural effusion.

scholarly journals Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review

2019 ◽  
Vol 12 (12) ◽  
pp. e231508 ◽  
Author(s):  
Sanchit Turaga ◽  
Michael Thomas ◽  
Lloyd Savy ◽  
Benjamin E Schreiber
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Calcium Pyrophosphate ◽  
Rare Presentation ◽  
Ct Guided ◽  
Calcium Pyrophosphate Deposition Disease ◽  
Signal Abnormality ◽  
Birefringent Crystals ◽  
Ct Guided Biopsy ◽  
Spindle Cell Tumour

Calcium pyrophosphate deposition (CPPD) disease is a crystal arthropathy primarily affecting peripheral joints, most commonly the wrist and the knees. However, CPPD in the cervical spine is a rare entity. This report describes a case of CPPD of the cervical spine which presents with symptoms of neck pain and brachalgia. A 62-year-old woman presented with left-sided upper limb and neck pain. MRI scanning revealed a low signal abnormality within the C6 and C7 vertebrae, and the possibility of lymphoma was raised. The patient was recalled for gadolinium-enhanced scans which showed perivertebral and marrow enhancement. Fine-needle aspirate histology initially suggested a spindle cell tumour or lymphoma. However, CT-guided biopsy showed positively birefringent crystals, confirming CPPD. CPPD of the spine is a rare differential of nerve impingement in the cervical spine when MRI scanning perivertebral signal enhancement. Furthermore, CPPD of the spine can mimic malignancy.

scholarly journals Pulmonary embolism in the COVID-19 pandemic era: Importance of bedside electrocardiography, echocardiography and use of Tenecteplase.

2021 ◽  
Vol 10 (1) ◽  
pp. 9-15
Author(s):  
O.F. Nwako ◽  
C.A. Nwako ◽  
C.N. Nwako ◽  
A.B. Nwako
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Pulmonary Arteries ◽  
Sudden Onset ◽  
Daily Activities ◽  
Productive Cough ◽  
Diagnostic Challenge ◽  
Antithrombotic Agent ◽  
The Third

Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs. Globally, it is the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke. This is a 43-yearold Nigerian diabetic man who had liposuction three weeks before presenting with sudden onset breathlessness, productive cough, chest pain, fever, inability to complete a sentence and inability to carry out his normal daily activities during this coronavirus 2019 (COVID-19) pandemic. He was tachypneic, tachycardic, hypotensive with rapidly dropping oxygen saturation (84%-86%, 80%-84%). This presented a diagnostic challenge which was rapidly resolved with bedside electrocardiography and echocardiography. A diagnosis of pulmonary embolism was sustained. Subsequent SARS-COV-2 PCRbased test was negative. He was successfully managed with an antithrombotic agent, tenecteplase, without any adverse events. Keywords: COVID-19, pulmonary embolism, tenecteplase, electrocardiography, echocardiography

Diagnostic strategy using a modified clinical decision rule and D-dimer test to rule out pulmonary embolism in elderly in- and outpatients

2005 ◽  
Vol 94 (07) ◽  
pp. 206-210 ◽  
Author(s):  
Pieter W. Kamphuisen ◽  
Patricia J. W. B. van Mierlo ◽  
Harry R. Büller ◽  
Maaike Söhne
Keyword(s):  
Pulmonary Embolism ◽  
Elderly Patients ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Strategy ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Challenge ◽  
Co Morbidity ◽  
D Dimer ◽  
Rule Out

SummaryExcluding or confirming pulmonary embolism remains a diagnostic challenge. In elderly patients pulmonary embolism is associated with substantial co-morbidity and mortality, and many elderly patients with suspected pulmonary embolism are inpatients. The safety and efficacy of the combination of a clinical probability (CDR) and d-dimer test in excluding pulmonary embolism in this group is unclear. We retrospectively analysed data of two prospective studies of consecutive in-and outpatients with suspected pulmonary embolism. The patients were categorized into three age groups: <65 years, 65–75 years and >75 years. The sensitivity, negative predictive value and the proportion of patients with the combination of a non-high CDR score according to Wells (≤ 4) and a normal d-dimer result were calculated for each group. In 747 consecutive patients with suspected pulmonary embolism, sensitivity and negative predictive value of a non-high CDR and a normal d-dimer result in outpatients (n=538) of all age categories (<65 years, 65–75 years and >75 years) were both 100%.These tests were, however, less reliable for inpatients(n=209), irrespective of their age (sensitivity 91% [ CI: 79–98%], negative predictive value 88 % [CI: 74–96%].The proportion of both in-and outpatients >75 years with a non-high CDR and a normal d-dimer concentration was only 14%,whereas this was 22% in patients 65–75 years and 41% among in-and outpatients <65 years, respectively. In elderly outpatients the combination of a non-high CDR and a normal d-dimer result is a safe strategy to rule out pulmonary embolism. However, in inpatients this algorithm is not reliable to safely exclude pulmonary embolism. In addition, the proportion of patients >65 years in which this strategy excludes pulmonary embolism is markedly lower compared to younger patients.

scholarly journals Patients with Mild COVID-19 Symptoms and Coincident Pulmonary Embolism: A Case Series

2020 ◽  
Vol 4 (3) ◽  
pp. 295-298
Author(s):  
Joshua Joseph ◽  
Jonathan Roberts ◽  
Cheri Weaver ◽  
Jonathan Anderson ◽  
Matthew Wong
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Case Series ◽  
Elevated Risk ◽  
Pulmonary Emboli ◽  
Mild Disease ◽  
Thrombotic Complications ◽  
Common Risk Factors ◽  
Unknown Case ◽  
Rule Out

Introduction: Frequent thrombotic complications have been reported in patients with severe coronavirus disease 2019 (COVID-19) infection. The risk in patients with mild disease is unknown. Case Report: We report a case series of three individuals recently diagnosed with COVID-19, who presented to the emergency department with chest pain and were found to have pulmonary emboli. The patients had mild symptoms, no vital sign abnormalities, and were negative according to the pulmonary embolism rule-out criteria. Conclusion: This suggests that patients with active or suspected COVID-19 should be considered at elevated risk for pulmonary embolism when presenting with chest pain, even without common risk factors for pulmonary embolism.

scholarly journals Thoracic spine Langerhans cell histiocytosis in a child with achondroplasia

2019 ◽  
Vol 12 (7) ◽  
pp. e228801
Author(s):  
Zoe Chan ◽  
Lesley Simpson ◽  
Pasquale Gallo
Keyword(s):  
Spinal Cord ◽  
Langerhans Cell Histiocytosis ◽  
Cord Compression ◽  
Langerhans Cell ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Leg Weakness ◽  
Radiological Response ◽  
Posterior Soft Tissue

Multifocal bone Langerhans cell histiocytosis (LCH) is usually treated with prednisolone and vinblastine. We present a case conservatively treated with indomethacin with good clinical and radiological response. A 7-year-old achondroplastic boy presented with worsening thoracic back pain and leg weakness. An admission MRI spine showed a pathological T1 vertebrae fracture with posterior soft tissue extension compressing and distorting the spinal cord. A CT guided biopsy revealed an LCH. Steroids were avoided to reduce osteopenia risk and further vertebral fragility. Considering the risk of a thoracic surgical approach in a child with this background, he was managed conservatively with indomethacin and a Sternal Occipital Mandibular Immobilizer (SOMI) Brace. Pain resolved completely within 6 months and the brace was discontinued. Serial follow-up scans showed progressive resolution of the pathological T1 fracture and complete resolution of the spinal cord compression.

scholarly journals Young male with chest pain and abnormal T-waves

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Amrithanand Velluridathil Thazhathidathil ◽  
Naman Agrawal ◽  
Roshan Mathew
Keyword(s):  
Chest Pain ◽  
Early Recognition ◽  
Young Male ◽  
Artery Occlusion ◽  
Ecg Changes ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Coronary Syndrome ◽  
T Wave ◽  
T Waves

Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But presentation with atypical ECG changes constitute a diagnostic challenge. We here report a case of 23-year-old male who presented with chest pain having atypical ECG changes with hyper-acute T waves called de Winters T wave. This is a rare presentation of patient with acute Left Anterior Descending artery occlusion. Some authors propose that de Winters pattern should be considered as “STEMI Equivalent”.

Performance of Computed Tomography-Guided Spine Biopsy for the Diagnosis of Malignancy and Infection

2021 ◽  
Author(s):  
Lauren Harris ◽  
Devika Rajashekar ◽  
Puneet Sharma ◽  
Karoly M David
Keyword(s):  
Computed Tomography ◽  
Vertebral Osteomyelitis ◽  
Ct Guided ◽  
Exact Test ◽  
Suspected Infection ◽  
Included Patient ◽  
Chi Squared ◽  
Ct Guided Biopsy ◽  
Spinal Biopsy

Abstract BACKGROUND Computed tomography (CT)-guided percutaneous biopsies are used to guide treatment in vertebral osteomyelitis and spinal malignancy, but the efficacy of this study remains unclear. OBJECTIVE To investigate the performance of CT-guided spinal biopsy, and factors that may influence its success. METHODS Retrospective study of all consecutive patients who underwent a CT-guided spine biopsy at a UK teaching hospital between April 2012 and February 2019. Biopsies were performed by 3 consultant neuroradiologists for a lesion suggestive of either malignancy or infection. Data collection included patient factors, biopsy factors, further investigations required, and diagnosis. Data were analyzed using contingency tables, analysis of variance, unpaired t-test, chi-squared test, and Fisher's exact test. RESULTS A total of 124 percutaneous biopsies were performed on 109 patients with a mean follow-up of 34.5 mo (range 4-86 mo) and a mean age of 66 yr (range 27-93). Approximately 32.3% (n = 40) of the biopsies investigated possible infection, and 67.7% investigated malignancy. The sensitivity for infected cases was 37.0%, and for malignancy 72.7%. The diagnostic accuracy was 57.5% and 78.6%, respectively. Complication rate was 1.6%. In our study, neither needle gauge, anatomic level of the biopsy, or bone quality significantly affected the rate of positive biopsy. CONCLUSION Both in our study and in the wider literature, CT-guided biopsy has a vastly superior sensitivity for malignancy compared with suspected infection. These procedures may be painful, poorly tolerated, and are not entirely risk free. As such we advocate judicious use of this modality particularly in cases of suspected infection.

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