Picture Quiz: A Case of Sudden Severe Chest Pain

2007 ◽  
Vol 6 (1) ◽  
pp. 27-27
Author(s):  
Mustafa Abu Rabia ◽  
◽  
P Sullivan ◽  
Stavros M Stivaros. ◽  
◽  
...  
Keyword(s):  
Chest Pain ◽  
Medical History ◽  
Chest Wall ◽  
Epigastric Pain ◽  
Anterior Chest Wall ◽  
Sudden Onset ◽  
Severe Chest Pain ◽  
History Of ◽  
Previous Medical History

An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

Chest wall mass: what lies beneath?

2018 ◽  
Vol 35 (10) ◽  
pp. 586-586
Author(s):  
Claire Elaine Richards ◽  
Ahmed Mamdouh Taha Mostafa ◽  
Amr Elmoheen
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Medical History ◽  
Chest Wall ◽  
Vital Signs ◽  
Cervical Lymphadenopathy ◽  
Anterior Chest Wall ◽  
List Type ◽  
History Of ◽  
Wall Mass ◽  
Chest Wall Mass

Clinical introductionA 24-year-old Filipino man attended the ED with a 1-month history of a discrete swelling over his upper anterior chest wall that was rapidly increasing in size and tenderness. He denied any other symptoms. His medical history was unremarkable.Examination revealed a tender, 7 cm × 6 cm mass over the upper part of the sternum (figure 1). The surface was smooth, it was immobile, non-compressible and the overlying skin was normothermic but mildly erythematous. Cervical lymphadenopathy was present. His vital signs were normal.Figure 1Chest wall mass.QuestionWhat is the most likely diagnosis?LipomaChondrosarcomaLymphomaMycobacterium tuberculosis (TB)

Penetrating Atherosclerotic Ulcer of the Aorta

2001 ◽  
Vol 8 (5) ◽  
pp. 534-538 ◽  
Author(s):  
Aditya K. Samal ◽  
Christopher J. White ◽  
James B. Kot
Keyword(s):  
Computed Tomography ◽  
Ventricular Hypertrophy ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Descending Thoracic Aorta ◽  
Penetrating Atherosclerotic Ulcer ◽  
Severe Chest Pain ◽  
Mediastinal Hematoma ◽  
History Of ◽  
Mediastinal Widening

Purpose: To describe a case of penetrating atherosclerotic ulcer of the aorta with a review of its natural history, diagnosis and management. Case Report: An elderly patient with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to the back. The electrocardiogram showed left ventricular hypertrophy; the chest radiograph revealed mediastinal widening. Computed tomography was suspicious for a mediastinal hematoma without aortic dissection. Transesophageal echocardiography was also negative for dissection. An aortogram revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta. The patient underwent successful resection and repair of the lesion. Conclusions: Penetrating atherosclerotic ulcer of the aorta is a potentially lethal lesion that must be promptly diagnosed and treated.

scholarly journals EP06 COVID-19 masquerading as myositis and myopericarditis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alexa José Escudero Siosi ◽  
Hudaifa Al Ani ◽  
Antoni Chan
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Pericardial Effusion ◽  
Respiratory Tract ◽  
Medical History ◽  
Muscle Weakness ◽  
Cardiac Involvement ◽  
Sudden Onset ◽  
Pulmonary Manifestations ◽  
Rare Manifestation

Abstract Case report - Introduction Coronavirus (SARS-COV-19) typically targets the respiratory tract; however extra-respiratory manifestations such as myositis and myopericarditis may be the only presenting feature. We present a patient with myopericarditis who developed sudden onset muscle weakness. CT thorax showed typical appearance of COVID-19 with an absence of respiratory symptoms. MRI of both thighs revealed diffuse symmetrical myositis. Her clinical and paraclinical abnormalities improved with the aid of steroids. We present our approach to the case and highlight that clinicians should consider myositis as another COVID-19 manifestation when reviewing the differentials. Case report - Case description A 50-year-old female, non-smoker, presented with few days history of central chest pain radiating to her back. This was exacerbated by lying down and inspiration. Associated with mild shortness of breath on exertion. She denied upper respiratory tract symptoms. Her past medical history included hypertension and myopericarditis in 2012 and 2013 requiring pericardiocentesis. In 2017 she presented with post-streptococcal erythema nodosum and reactive arthritis in left ankle. On auscultation her heart sounds were normal, and chest was clear. Initial investigations revealed a mild lymphopenia 0.63, a C-reactive protein of 11mg/L, and a raised troponin 77 and 103 on repeat. D-dimer, Chest x-ray were normal. ECHO showed trivial anterior pericardial effusion, good biventricular function. Treatment included colchicine 500 micrograms four times a day and Ibuprofen 400 mg three times a day. On her second day of admission she developed hypotensive episodes BP 75/49 mm/Hg and mild pyrexia of 37.5 degrees. Her chest pain continued. Electrocardiogram was normal, repeat echocardiogram showed stable 1.40 cm pericardial effusion. CT thorax revealed no dissection or features suggesting pulmonary sarcoidosis but ground-glass opacity changes in keeping with COVID-19. Her COVID-19 swab test came back positive. On the 4th day of admission, she complained of sudden onset of severe pain affecting her thighs, shoulders, and arms, with marked proximal lower limbs and truncal weakness. Because of this, she struggled to mobilise. There was a rapid rise in her creatine kinase from 6.423U/L (day 5) to 32.230 U/L (day 7). ALT increased to 136. MRI showed diffuse myositis with symmetrical appearances involving the anterior, medial, and posterior muscle compartments of both thighs. In view of her previous and current presentation, autoimmune screen and extended myositis immunoblot were sent and were negative. Interestingly, her clinical and paraclinical abnormalities improved dramatically after few days with no steroids initially. Case report - Discussion The identification of extra-pulmonary manifestations neurological, cardiac, and muscular have recently increased as the number of COVID-19 cases grow. This case highlights cardiac and skeletal muscle involvement could perhaps represent early or only manifestation of COVID-19. Cardiac involvement in COVID-19 commonly manifests as acute cardiac injury (8–12%), arrhythmia (8.9–16.7%) and myocarditis. In our case the cardiac MRI demonstrated evidence of myocarditis in the basal inferoseptum and apex. Myalgia and muscle weakness are among the symptoms described by patients affected by COVID-19. Some studies report the prevalence of myalgia to be between 11%-50%. The onset of symptoms and the fact that her symptoms improved rapidly led us to consider a viral myositis as the underlying cause, the viral component being COVID-19. We also considered other potential causes. There are reported cases of colchicine myopathy however this is more common in patients with renal impairment, which was absent in this case. On further examination she did not have other clinical signs or symptoms of connective tissue disease or extra muscular manifestation of autoimmune myositis. Her abnormal ALT may be derived from damaged muscle, and therefore in this context is not necessarily a specific indicator of liver disease. Interestingly abnormal liver function tests have been attributed in 16 - 53% of COVID-19 cases. Little is known about the multiple biologic characteristics of COVID-19 and there are no established clinic serological criteria for COVID-19 related myositis nor useful values/cut offs to exclude cardiac involvement in myositis, further research is therefore warranted. In conclusion, clinicians should be aware of the rare manifestation of COVID-19 and consider this in the differentials. Of course, it is important in the first instant to rule out any serious underlying disease or overlap disorder before attributing symptoms to COVID-19. Case report - Key learning points  Myositis is a rare manifestation of COVID-19 that clinicians should be aware of.Detailed medical history, examination and investigations identifies the most likely underlying cause.In the right clinical context, COVID-19 – 19 testing should be included in baseline tests of patients presenting with myositis.

A palpable chest wall mass in a 4-year-old boy

2021 ◽  
pp. e20200053
Author(s):  
Jakob M Domm ◽  
Joanne M Langley
Keyword(s):  
Chest Pain ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Chest Wall ◽  
Respiratory Infection ◽  
Lower Respiratory Tract ◽  
Atypical Presentation ◽  
History Of ◽  
Wall Mass ◽  
Chest Wall Mass

Empyema necessitans (EN) is a rare but dangerous complication of a lower respiratory tract infection. The diagnosis can be difficult to make and therefore delayed. We describe a case of a child with an atypical presentation of EN. He was afebrile and without chest pain and presented with a palpable chest wall mass after a history of recent respiratory infection. The threshold of suspicion for EN should be low, and it must be suspected in all children with a chest wall mass and recent history of respiratory infection.

scholarly journals Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

2019 ◽  
Vol 25 ◽  
pp. 107602961985216 ◽  
Author(s):  
Mert Özcan ◽  
Murat Erem ◽  
Fatma Nesrin Turan
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Medical History ◽  
Symptomatic Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Contraceptive Usage ◽  
Venous Thromboembolic Events ◽  
History Of ◽  
Deep Vein ◽  
Previous Medical History

Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient’s medical history and current medical conditions. In this study, smoking, DM, and previous history of DVT increased DVT risk significantly, and thromboprophylaxis should be kept in mind for these patients.

scholarly journals Uncommon cause of chest pain in a postoperative spinal patient

2018 ◽  
pp. bcr-2018-225293
Author(s):  
Rajesh Dwivedi
Keyword(s):  
Chest Pain ◽  
Spinal Surgery ◽  
Anterior Chest Wall ◽  
Sternal Fracture ◽  
Pulmonary Angiogram ◽  
Chest Wall Trauma ◽  
History Of ◽  
Ct Pulmonary Angiogram ◽  
Chest X Ray ◽  
Sternal Fractures

An 84-year-old woman with previous spinal operations including vertebroplasty and lumbar decompressions was admitted electively under the spinal team for right-sided L4/5 decompression for worsening back pain which she undergoes using a posterior approach. Postoperatively, she develops stabbing upper central chest pain and given unremarkable chest X-ray, ECG and cardiac troponin, she undergoes a CT pulmonary angiogram which shows a fracture of the upper part of sternum but no pulmonary embolism. There is no history of recent trauma and this is deemed to be secondary to prolonged spinal surgery in the prone position in a patient with osteopenic bones. To date, we have not come across a case of spontaneous sternal fracture as a complication of spinal surgery at our regional spinal unit. Most cases of sternal fractures are secondary to blunt anterior chest wall trauma with spontaneous fractures and stress fractures being rare.

Risk factors of vitamin K antagonist overcoagulation

2008 ◽  
Vol 100 (10) ◽  
pp. 685-692 ◽  
Author(s):  
Gwenaëlle Cadiou ◽  
Rémi Varin ◽  
Hervé Levesque ◽  
Vanessa Grassi ◽  
Jacques Benichou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Medical History ◽  
Vitamin K ◽  
Female Gender ◽  
Vitamin K Antagonist ◽  
High Morbidity ◽  
Duration Of Hospitalization ◽  
History Of ◽  
Previous Medical History

SummaryThe aims of this case-control study were to identify in vitamin K antagonist (VKA)-treated unselected patients, factors associated with international normalised ratio (INR) values: (i) greater than 6.0.;and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. During a two-month period, 4,188 consecutive and unselected patients were referred to our Emergency Department. At admission, the medical records of each patient and two age- and sex-matched controls were reviewed for: both duration and indication of VKA therapy, previous medical history of VKA-related haemorrhage, underlying co-morbidities, concomitant medications other than VKA, duration of hospitalization and deaths’ causes. Of these 4,188 subjects,50 case-patients (1.19%) were identified; both case-patients and controls did not differ as regards indications and patterns of VKA therapy. Interestingly, two-thirds of case-patients were women, suggesting that female gender may be a risk factor of VKA over-coagulation onset. We identified the following risk factors of VKA over-coagulation: previous medical history of INR levels over therapeutic range, therapy with antibiotics, amiodarone and proton pump inhibitors, as well as fever. A total of 88% of case-patients were hospitalized; mean duration of patients’ hospitalization was seven days [range:1–56 days];no patient died from major bleeding. Our study underscores that it is of utmost importance to consider the strength of indication before starting VKA therapy, as this therapy has been responsible for as high as 1.19% of admissions in unselected subjects referred to an Emergency Department. Our data therefore suggest that internists should be aware of VKA-related high morbidity, particularly in situations at risk of VKA over-coagulation.

scholarly journals Noncompaction and Takotsubo Syndrome in a Neuromuscular Disorder

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Josef Finsterer ◽  
Claudia Stöllberger ◽  
Walter Benedikt Winkler
Keyword(s):  
Chest Pain ◽  
Beta Blockers ◽  
Liver Cyst ◽  
Neuromuscular Disorder ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Troponin Elevation ◽  
History Of ◽  
St Elevation

Background. Takotsubo syndrome (TTS) in patients with left ventricular hypertrabeculation/noncompaction (LVHT) has been reported in four patients, and a TTS plus LVHT plus a neuromuscular disorder (NMD) was only reported once so far. Here, we present the fifth patient with LVHT and TTS and the second patient with LVHT, TTS, and a NMD. Methods and Results. The patient is a 68 yo female hobby choir singer with a history of skin dermatofibroma, skin fibrokeratoma, arterial hypertension, hyperlipidemia, hypothyroidism, anemia, hyponatremia, diverticulosis, LVHT detected at age 60 y, five syncopes, a liver cyst, and carotid endarterectomy 2 months prior to admission because of sudden-onset chest pain. Workup revealed ST elevation, troponin elevation, and mild coronary artery sclerosis. Ventriculography and transthoracic echocardiography (TTE) showed the apical type of a TTS. ECG normalised within 10 w and TTE within 6 w under beta-blockers and ATII-blockers. The TTS was triggered by being offended of being unable to sing anymore after endarterectomy. Neurological workup suggested the presence of a NMD. Conclusions. This case shows that LVHT occurs in NMD patients and that patients with LVHT and a NMD may develop a TTS. Whether patients with LVHT and a NMD are particularly prone to develop a TTS requires further confirmation. NMD patients with LVHT should avoid stress not to trigger a TTS.

scholarly journals Integrating Osteopathic Evaluation and Treatment in a Case Report of Acute Chest Pain

2019 ◽  
Vol 29 (2) ◽  
pp. 27-30
Author(s):  
Sheldon. C. Yao
Keyword(s):  
Health Care ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Chest Wall ◽  
Financial Burden ◽  
Acute Chest Pain ◽  
Anterior Chest Wall ◽  
Patient Response ◽  
Pain Syndromes ◽  
Musculoskeletal Education

Abstract Chest pain is an emergent presentation associated with a wide differential diagnosis including cardiac, pulmonary, gastrointestinal, and musculoskeletal origins. The evaluation of acute chest pain can be costly and can be a financial burden on the health care system. Integrating osteopathic diagnosis and treatment can assist with identifying and alleviating potential musculoskeletal sources of pain. This case illustrates how applying osteopathic manipulative medicine (OMM) benefited a 61-year-old woman presenting with anterior chest wall pain. Patient response to OMM can assist physicians with better managing acute chest wall pain syndromes. Improved musculoskeletal education can potentially improve medical management of chest pain of musculoskeletal origin.

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