1/87. Dissecting intramural haematoma of the oesophagus.The largest series of patients (n = 10) with dissecting intramural haematoma of the oesophagus is described. The typical features, chest pain with odynophagia or dysphagia and minor haematemesis are usually present but not always elicited at presentation. If elicited, these symptoms should suggest the diagnosis and avoid mistaken attribution to a cardiac origin for the pain. precipitating factors such as a forced Valsalva manoeuvre cannot be identified in at least half the cases. Early endoscopy is safe, and confirms the diagnosis when an haematoma within the oesophageal wall or the later appearances of a longitudinal ulcer are seen. Dissecting intramural haematoma of the oesophagus has an excellent prognosis when managed conservatively.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
2/87. Expanding mesh stent in the emergency treatment of Boerhaave's syndrome.Boerhaave's syndrome, or spontaneous esophageal perforation, is a life threatening condition demanding early diagnosis and rapid aggressive management to prevent fulminant mediastinitis and death. We describe a patient treated in an emergency situation with an expanding esophageal mesh stent to bridge the esophageal rent together with chest and mediastinal drainage, resulting in complete recovery and return to the community. We also describe the partial recovery of the stent in the convalescent period.- - - - - - - - - - ranking = 0.056221351064011keywords = chest (Clic here for more details about this article) |
3/87. Thoracoscopic excision with mini-thoracotomy for a bronchogenic cyst of the esophagus.A 19 year-old man with a history of dysphagia and chest pain was diagnosed as having a cyst of the esophagus by endoscopic ultrasonography and magnetic resonance imaging. The patient's bronchogenic cyst was treated by video-assisted thoracoscopic excision with mini-thoracotomy. This procedure is applicable for patients who require repair of the esophageal wall after excision of a lesion and reduces post-operative complications.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
4/87. Spontaneous intramural hematoma of the esophagus.Spontaneous intramural hematoma of the esophagus (SIHE) is a rare condition, usually presenting with severe acute chest pain. vomiting, dysphagia, odynophagia, and hematemesis may appear later. We herein report a case of this disease in a patient treated with low doses of aspirin, and review the literature for possible etiologies for this condition. In addition, we compare the utility of the various diagnostic modalities in this uncommon condition.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
5/87. Treatment of severe esophageal Crohn's disease with infliximab.Esophageal ulceration with fistula is an uncommon manifestation of Crohn's disease. Typical presentation of symptomatic esophageal Crohn's disease may include dysphagia, odynophagia, weight loss, and chest discomfort. We present a patient with severe esophageal and skin involvement of Crohn's disease that was progressive despite conventional therapy including prednisone and 6-mercaptopurine. The diagnosis of Crohn's was based on the presence of typical clinical, endoscopic, and pathologic findings, including granulomas in the skin ulcer and the absence of infectious etiologies. The patient had a nearly complete resolution of her esophageal disease with a single infusion of infliximab.- - - - - - - - - - ranking = 0.056221351064011keywords = chest (Clic here for more details about this article) |
6/87. Odynophagia in a woman with known coronary artery disease and ischemia on electrocardiogram.Esophageal intramural hematoma can mimic other causes of chest pain. When the patient is known to have coronary artery disease, the diagnosis may be difficult. Moreover, the course may be complicated and may harm the patient if antiplatelet drugs, thrombolytics, and anticoagulants are used. The presence of odynophagia should alert the clinician to the possibility of an esophageal origin, even in a patient with known coronary artery disease. We present a case in which early recognition of the clinical presentation prevented potential iatrogenic complications.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
7/87. Quality-of-life study on four patients who underwent esophageal resection and delayed reconstruction for Boerhaave's syndrome.Boerhaave's syndrome is the condition of spontaneous rupture of the esophagus as a consequence of the strain of emesis with or without predisposing esophageal disease. It is a condition with high mortality. We describe four patients who underwent a transthoracic esophagectomy to remove the rupture of the intrathoracic esophagus, closure of the esophageal gastric junction, fashioning of a feeding gastrostomy, and formation of a left cervical esophagostomy. Three patients underwent reconstruction with subcutaneous colon. We suggest that this method of management may be considered where primary repair is impossible in those patients too ill for prolonged reconstruction or as a salvage procedure where other methods have failed. The poor quality of life after esophagectomy is improved by reconstruction. Other surgical options include covering the repaired opening with a circumferential wrap of pleura, chest wall muscle, or omentum or closing the repair around a T-tube of large caliber. Esophageal exclusion using absorbable staples is another approach.- - - - - - - - - - ranking = 0.056221351064011keywords = chest (Clic here for more details about this article) |
8/87. Endoscopic and radiological features of intramural esophageal dissection.A 41-year-old woman was admitted to our hospital complaining of chest pain, dysphagia, and odynophagia after an upper respiratory tract infection and nasogastric tube insertion. An upper endoscopy showed a large submucosal bulge along the posterior wall from the upper esophagus with mucosal tears and bridge formation, extending down to the lower esophagus. A barium esophagogram revealed a "double-barreled" esophagus, and chest computed tomography (CT) scan showed eccentric thickening of the esophageal wall. The diagnosis of intramural esophageal dissection (IED) was made and the patient was managed conservatively with nothing by mouth and intravenous hydration. The clinical course was uneventful; the patient was discharged later and up to the time of writing has been completely asymptomatic, with normal swallowing function.- - - - - - - - - - ranking = 1.056221351064keywords = chest pain, chest (Clic here for more details about this article) |
9/87. Boerhaave's syndrome: a pediatric case.BACKGROUND: The term Boerhaave's syndrome refers to esophageal rupture after a sudden increase in intraluminal pressure. This syndrome is most common among alcoholic adult men. This case report is that of a pediatric patient with a similar pathologic process. STUDY: A 6-month-old Hispanic boy with acute lymphoblastic leukemia on chemotherapy arrested 3 weeks into his induction therapy. Diagnostic and therapeutic procedures revealed a hydropneumothorax, which was managed with chest tube drainage. The underlying etiology was revealed 10 days later when feeds were introduced and found exiting the chest tube. A contrast study confirmed esophageal perforation, which was surgically repaired. CONCLUSION: A nontraumatic hydropneumothorax should raise the possibility of Boerhaave's syndrome (spontaneous esophageal rupture), even in pediatric patients. Such a finding warrants a contrast study to facilitate early diagnosis.- - - - - - - - - - ranking = 0.11244270212802keywords = chest (Clic here for more details about this article) |
10/87. Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma.Ingestion of a foreign body, the commonest being a coin, is a common problem in children. In most cases the coin will pass uneventfully through the gastrointestinal tract. However, on rare occasions it may become lodged in the oesophagus with subsequent extraluminal migration with the potential for serious complications such as vascular fistula or chronic suppurative infection. A case is presented of extraluminal migration of a coin in the oesophageal associated with abscess formation in a 15 month old boy. This case is particularly important because the presenting symptom of wheezing led to the erroneous diagnosis of asthma, which resulted in a three month delay in investigation and treatment. In addition, it raises the issue of whether to perform chest radiography on newly diagnosed asthmatic patients to rule out the presence of a foreign body and thereby prevent serious complications.- - - - - - - - - - ranking = 0.056221351064011keywords = chest (Clic here for more details about this article) |
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