scholarly journals False-Positive Elevation of CK-MB Levels with Chest Pain in Lung Adenocarcinoma

2020 ◽  
Vol 13 (1) ◽  
pp. 100-104
Author(s):  
Takayo Ota ◽  
Yoshikazu Hasegawa ◽  
Eriko Murata ◽  
Noriko Tanaka ◽  
Masahiro Fukuoka
Keyword(s):  
Chest Pain ◽  
Lung Adenocarcinoma ◽  
Cardiac Injury ◽  
Electrophoretic Analysis ◽  
Computed Tomography Scan ◽  
Laboratory Findings ◽  
Coronary Syndrome ◽  
Visceral Pleural Invasion ◽  
Tomography Scan

The creatinine kinase (CK)-MB assay can be used for the early diagnosis of acute coronary syndrome. We describe the case of an 82-year-old male with lung adenocarcinoma who presented with chest pain. While laboratory findings showed elevated CK-MB levels, there was no cardiac injury. A chest computed tomography scan revealed pleural carcinomatosis. Later, electrophoretic analysis of CK showed a normal CK-MB range but increased CK-BB levels and the presence of macro CK type 2. We determined that the patient’s chest pain originated from the visceral pleural invasion of lung cancer. Because of the methods used to measure the CK-MB isozyme, the CK-MB level appeared elevated.

A Rare Cardiac Neoplasm Presenting as a Chest Pain

2012 ◽  
Vol 8 (3) ◽  
pp. 223
Author(s):  
Hemasri Tokala ◽  
Jagadeesh Kalavakunta ◽  
Heather Laird-Fick ◽  
Sreenivas Kamath ◽  
Vishal Gupta ◽  
...  
Keyword(s):  
Chest Pain ◽  
Sudden Onset ◽  
Adrenergic Blockade ◽  
Computed Tomography Scan ◽  
Acute Pericarditis ◽  
Cardiac Neoplasm ◽  
Cardiac Tumours ◽  
St Elevation ◽  
Jugular Venous Distension ◽  
Tomography Scan

Cardiac paragangliomas are the rarest primary cardiac tumours and account for less than one percent of cases. A 24-year-old man presented with complaints of sudden onset of chest pain. The pain started suddenly when he was skiing halfway down the slope and went into a tuck position. Physical examination was significant for elevated jugular venous distension. His electrocardiogram revealed diffuse ST elevation suggestive of acute pericarditis. The echocardiogram revealed pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis, but the effusion rapidly re-accumulated, requiring a second pericardiocentesis. Computed tomography scan of the chest revealed haemorrhage in the anterior left mediastinum with pericardial extension. The patient underwent emergency cardiac surgery. A 5.0 x 4.5 x 3.2 cm mass, diagnosed histopathologically as paraganglioma, was excised without complication. In all cardiac or extra cardiac tumours we should check pre-operatively for hormonal activity and pre-operative and intra-operative adrenergic blockade must be employed in all secretory paragangliomas.

Are There Two Distinct Mechanistic Pathways That Explain the Varying Clinical Presentations, Laboratory Findings, and Outcomes of Thienopyridine-Associated Thrombotic Thrombocytopenic Purpura (TTP)?.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 860-860
Author(s):  
Benjamin Kim ◽  
Kenneth R. Carson ◽  
Kathryn McCaffrey ◽  
Denise Finley ◽  
Anaadriana Zakarija ◽  
...  
Keyword(s):  
Survival Rates ◽  
Laboratory Data ◽  
High Survival ◽  
Adamts13 Activity ◽  
Laboratory Studies ◽  
Laboratory Findings ◽  
Coronary Syndrome ◽  
Clinical Presentations

Abstract Introduction: The antiplatelet agents ticlopidine and clopidogrel are thienopyridine derivatives that are commonly used for secondary prevention of cerebrovascular events, prevention of coronary artery stent thrombosis, and for treatment of acute coronary syndrome. While these chemically related agents are the first and third most common causes of drug-associated TTP respectively, clinical presentations, laboratory findings, and outcomes suggest that there may be two distinct mechanistic pathways. Methods: Clinical and laboratory data for 60 cases of ticlopidine-associated TTP and 35 cases of clopidogrel associated TTP were reviewed. Results: Type 1 thienopyridine-associated TTP, characterized by onset of disease > 5 days after drug initiation, occurred in 98% of the ticlopidine patients versus 63% of the clopidogrel patients. Laboratory studies identified severe deficiency of ADAMTS13 activity and the presence of IgG inhibitors in 7 ticlopidine (Tsai, et al.; Annals of Internal Medicine, 2000) and 2 clopidogrel (Bennett, et al.; NEJM, 2000) patients. Survival was 68% in the ticlopidine patients versus 91% in the clopidogrel patients. Type 2 thienopyridine-associated TTP, consisting of TTP onset within 5 days of drug initiation, occurred in 2% of the ticlopidine patients versus 37% of the clopidogrel patients. Laboratory studies failed to identify deficient ADAMTS13 activity or the presence of IgG inhibitors in 1 clopidogrel patient (Zheng, et al.; Blood, 2004). Survival was 0% in the ticlopidine patients versus 38% in the clopidogrel patients. Conclusion: The proposed type 1 and type 2 thienopyridine-associated TTP may be distinguished on the basis of clinical presentation, ADAMTS13 levels, and outcome. Type 1 thienopyridine-associated TTP—characterized as occurring after > 5 days of thienopyridine treatment, severely deficient ADAMTS13 activity and presence of IgG inhibitors, and high survival rates with plasmapheresis—is more likely to occur in patients receiving ticlopidine. Type 2 thienopyridine-associated TTP—characterized as occurring within 5 days of thienopyridine therapy initiation, normal ADAMTS13 activity and undetectable IgG inhibitors, and poor survival rates despite plasmapheresis—is more likely to occur in patients receiving clopidogrel. Additional confirmatory studies on larger numbers of patients are needed.

scholarly journals Colonic Metastasis of Primary Lung Cancer

2021 ◽  
pp. 901-905
Author(s):  
Salman Idrees Bhutta ◽  
Yasar Ahmed ◽  
Talal Zahid ◽  
Habib ur Rehman ◽  
Mutaz M. Nur ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lung Adenocarcinoma ◽  
Colorectal Adenocarcinoma ◽  
Primary Lung Cancer ◽  
Secondary Site ◽  
Computed Tomography Scan ◽  
Colonic Metastasis ◽  
The Poor ◽  
Tumor Biopsies ◽  
Tomography Scan

The colon is an uncommon secondary site for metastasis of lung adenocarcinoma. Distinguishing primary colonic carcinoma from metastatic spread of lung carcinoma can be difficult. We present a case of a patient with lung adenocarcinoma who, on abdominal computed tomography scan examination, was found to have a sigmoid tumor that was thought to represent a synchronous primary colorectal adenocarcinoma. Histological examination of endoscopic sigmoid tumor biopsies confirmed this to be metastasis from the lung adenocarcinoma. The patient subsequently developed major rectal bleeding and deteriorated significantly. This case also illustrates the poor prognosis association with colorectal metastasis of lung cancer.

scholarly journals An Unexpected Case of Malignant Mesothelioma in a Young Woman

2021 ◽  
Vol 9 ◽  
pp. 232470962199724
Author(s):  
Umaima Dhamrah ◽  
Nadia Solomon ◽  
Olive C. Osuoji
Keyword(s):  
Computed Tomography ◽  
Clinical Investigation ◽  
Past Medical History ◽  
Computed Tomography Scan ◽  
Laboratory Findings ◽  
Pleural Thickening ◽  
Vein Occlusion ◽  
The Right ◽  
Patient Presentation ◽  
Tomography Scan

A 41-year-old female with a past medical history significant only for right retinal vein occlusion presented with chest pain, cough, and shortness of breath. After being found to have a large right-sided pleural effusion and undergoing a nondiagnostic thoracentesis, a noncontrast chest computed tomography scan revealed multiple diffuse nodules in the right lung with irregular paraspinal pleural thickening. An extensive workup followed, with computed tomography–guided biopsy ultimately revealing the diagnosis. The following report describes the patient presentation, laboratory findings, and extensive clinical investigation, and provides a discussion of the epidemiology, imaging findings, prognosis, and differential diagnoses for the illness in question.

scholarly journals Dissection aortique lors de la délivrance par césarienne

2019 ◽  
Vol 6 (1) ◽  
pp. 51-53
Author(s):  
Baya AZIZA ◽  
◽  
Samiha CHERIF ◽  
Bouzid ABDELMALEK
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Young Women ◽  
Gestational Hypertension ◽  
Acute Chest Pain ◽  
Successful Outcome ◽  
Computed Tomography Scan ◽  
Chest Computed Tomography ◽  
Pregnancy Hypertension ◽  
Tomography Scan

Aortic dissection is unusual in young women, but when it occurs it is frequently associated with pregnancy and more importantly with pregnancy hypertension. A 37 old women with gestational hypertension was presented with chest pain during delivery by cesarean section and chest computed tomography scan was done and showed an aortic dissection; she was operated in an emergency with a successful outcome after delivery. Our aim is to put the point on the need to suspect the diagnosis of aortic dissection in a patient with preeclampsia and who complains of acute chest pain.

Differential Cardiovascular and Renal Benefits of SGLT2 Inhibitors and GLP1 Receptor Agonists in Patients With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Chee Hae Kim ◽  
In-Chang Hwang ◽  
Chang Ho Ahn ◽  
Yeonyee E. Yoon ◽  
Goo-Yeong Cho
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Coronary Revascularization ◽  
Control Group ◽  
Laboratory Findings ◽  
Renal Outcomes ◽  
Receptor Agonists ◽  
Coronary Syndrome ◽  
Ischemic Events

Abstract Background: The differential benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) in cardiovascular or renal outcomes have not been fully investigated. This study sought to compare the real-world cardiovascular and renal outcomes between SGLT2i and GLP1RA in patients with type 2 diabetes.Methods: Patients with diabetes prescribed SGLT2i or GLP1RA were retrospectively identified. Patients treated with antihyperglycemic medications other than SGLT2i or GLP1RA were used as a control group. After 2:1:3 propensity score matching among 24,752 eligible patients, 614 patients treated with SGLT2i, 307 patients treated with GLP1RA, and 921 control patients were analyzed. Primary outcomes were composite ischemic events (acute coronary syndrome, coronary revascularization, and stroke) and a composite of heart failure and renal events (hospitalization for heart failure, renal death, initiation of renal replacement therapy, and renal admission). Serial changes in laboratory findings according to medication use were compared.Results: During a median 38.7 months of follow-up, the incidence of composite ischemic events tended to be lower in the GLP1RA group (annualized rate 0.82% per person-year) than in the other groups (1.68% per person-year in the SGLT2i group and 1.36% per person-year in the control group). The risk of a composite of heart failure and renal outcomes was significantly lower in the SGLT2i group than in the GLP1RA and control groups (0.86% per person-year, 2.33% per person-year, and 1.48% per person-year, respectively; SGLT2i vs. GLP1RA, hazard ratio [HR] 0.384, 95% confidence interval [CI] 0.194-0.763, p=0.006; SGLT2i vs. control, HR 0.426, 95% CI 0.242-0.751, p=0.003). The SGLT2i group had a slower decline in renal function over time compared to that in other groups.Conclusions: SGLT2i showed more benefits in heart failure and renal outcomes, whereas GLP1RA tended to have more favorable ischemic outcomes. The observed differential benefit profiles of SGLT2i and GLP1RA may be applied to the selection of antidiabetic medication in clinical practice.

scholarly journals Role of Creatine Kinase in the Troponin Era: A Systematic Review

2021 ◽  
Vol 22 (6) ◽  
pp. 1291-1294
Author(s):  
Daniel Beamish ◽  
Tetyana Maniuk ◽  
Muhammad Mukarram ◽  
Venkatesh Thiruganasambandamoorthy
Keyword(s):  
Systematic Review ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Cardiac Injury ◽  
Final Analysis ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Pain Patients ◽  
Negative Conclusion

Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.

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