11/131. life-threatening haemorrhage from a sternal metastatic hepatocellular carcinoma.rupture of the tumour is a catastrophic complication of hepatocellular carcinoma. The prognosis in patients with a ruptured hepatocellular carcinoma is usually unfavourable. We describe a 46-year-old man who suffered from visible massive tumour haemorrhage due to a hepatitis b-related hepatocellular carcinoma that metastasized to the sternal bone. The prominent tumour mass was bulging over the anterior chest wall on the sternum of the patient, and bled spontaneously. This episode of life-threatening haemorrhage was stopped by surgical ligation of the bleeding site. Palliative radiotherapy shrank the tumour mass size and prevented further possible bleeding. This is likely to be the first reported case with a visible spontaneous tumour bleeding from a sternal metastatic hepatocellular carcinoma.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/131. recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.- - - - - - - - - - ranking = 1.8124304253826keywords = plexus (Clic here for more details about this article) |
13/131. cardiac tamponade due to post-cardiac injury syndrome in a patient with severe haemophilia A and hiv-1 infection.An 18-year-old man with severe haemophilia A (FVIII:C < 1%) and human immunodeficiency virus 1 (hiv-1) infection was admitted to the hospital with fever and chest pain for 7 days. Eight weeks prior to his admission he had an accident for which he underwent, at another hospital, clinical and laboratory examination that revealed bone fractures of the nose cavity, and he was given factor viii concentrates for seven days due to nasal bleeding. On admission, chest roentgenogram showed a large cardiac silhouette and echocardiography confirmed the presence of a large quantity of pericardial fluid. A presumptive diagnosis of the post-cardiac injury syndrome was made and he was given anti-inflammatory drugs plus infusion of recombinant factor viii concentrate (35 units kg-1 b.i.d.). On the seventh day he exhibited cardiac tamponade for which he underwent subxiphoid pericardiotomy with drainage of approximately 1500 mL of bloody exudate. He had an uncomplicated recovery and 10 days later he left hospital. He was given a continuous prophylactic treatment of 15 units kg-1 of recombinant FVIII every 2 days for 6 months, and 30 months after this episode the patient is free of any symptom.- - - - - - - - - - ranking = 3.2869342664076keywords = chest pain, chest (Clic here for more details about this article) |
14/131. Disseminated fungal infection complicated with pulmonary haemorrhage in a case of acute myeloid leukaemia.Pulmonary haemorrhage is a common necropsy finding in acute leukaemia, however, it is rarely diagnosed during life. A man with acute myeloid leukaemia is reported who presented with disseminated fungal infection, anaemia, thrombocytopenia, and subconjuctival and petechial haemorrhages. During the course of the patient's illness, the chest infection was complicated with bilateral pulmonary haemorrhage. The diagnosis of pulmonary haemorrhage was based on characteristic clinical and radiological findings. The patient improved on treatment.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
15/131. escherichia coli chest-wall hemorrhagic cellulitis associated with central-line placement.cellulitis is a common clinical entity. Hemorrhagic cellulitis is distinctly unusual and is most frequent in compromised hosts. In normal or near normal hosts, hemorrhagic cellulitis may rarely complicate gram-negative sepsis. Usually, hemorrhagic cellulitis occurs below the waist. The differential diagnosis includes invasive streptococcal infection, mixed aerobic and anaerobic infection, gram-negative sepsis, and gross gangrene. We present the first-known case of escherichia coli chest-wall hemorrhagic cellulitis associated with a central line in a patient with renal failure.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
16/131. Endovascular therapeutic occlusion following bilateral carotid artery bypass for radiation-induced carotid artery blowout: case report.A patient with breast cancer received radiation therapy to the upper chest wall. Twenty-two years later, she presented with repeated severe bleeding through a left lower neck ulcer. She was taken to surgery for hemostasis, which was not successful because the carotid artery was surgically inaccessible. To manage for explosive carotid blowout, we performed common carotid artery ligation and endovascular coil embolization after contralateral-external-carotid to ipsilateral-common-carotid artery bypass with a polytetrafluoroethylene (PTFE) graft. The patient has experienced no ischemic events or bleeding since this treatment.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
17/131. Cardiac vein thrombosis and haemorrhagic myocardial necrosis; report of a case with review of the literature.A 29-year-old woman, addicted to heroin since the age of 15 years, presented with a 4-day history of acute inspiratory chest pain, dyspnoea and vomiting associated with hypoventilation. She died 3 h after admission to the intensive care unit in spite of active resuscitative measures. The main autopsy findings were limited to the heart, which showed widespread cardiac vein thrombosis, and both ventricles and the atria were associated with multiple areas of haemorrhagic myocardial necrosis. We review the literature of this uncommon pathological entity and discuss its possible pathogenesis.- - - - - - - - - - ranking = 2.2869342664076keywords = chest pain, chest (Clic here for more details about this article) |
18/131. Combined choriocarcinoma and adenocarcinoma of the lung occurring in a man: case report and review of the literature.BACKGROUND: Human chorionic gonadotropin (hCG)-producing large or giant cell carcinoma of the lung is not uncommon, but primary pulmonary choriocarcinoma is an extremely rare entity. Even rarer are cases occurring in males; to date the authors have found only 12 reported cases in the English literature. methods: The clinical record of a 61-year-old man who presented with hemoptysis is described. A review of the literature regarding patients with primary pulmonary choriocarcinoma also is reported. RESULTS: Computed tomography scan of the chest demonstrated an expanding thickness of the bullous wall within areas of emphysematous change in the lower lobe of the right lung. Moreover, a new, round tumor near the thickness appeared and rapidly expanded evenly into the surrounding lung tissue. Exploratory thoracotomy revealed the previous tumor to be adenocarcinoma with a small foci of choriocarcinoma, and the new tumor to be a hemorrhage with choriocarcinoma. Because of the pleural dissemination, the patient was treated with chemotherapy. At last follow-up he was alive and well with a gradually increasing serum hCG-beta level in spite of chemotherapy. CONCLUSIONS: Primary pulmonary choriocarcinoma occurring in men is an extremely rare entity with a fatal prognosis. Of the 12 cases reported to date in the English literature, 3 cases of choriocarcinoma with the coexistence of another type of pulmonary carcinoma were reported. To the authors' knowledge the clinical relation between these two types of carcinoma are unknown because all cases to date have been detected at the time of autopsy. Only in the current study case could the clinical course of the disease be followed and pathologic confirmation achieved, although the pathogenesis of the two types of carcinoma could not be determined.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
19/131. Traumatic adrenal hemorrhage in children: an indicator of visceral injury.Adrenal hemorrhage (AH) was identified in 1% of 313 children admitted to the trauma unit with abdominal or thoracoabdominal blunt trauma within a 10-year period (1989-1999). Ultrasound examination was useful as a first diagnostic measure in stable children, but computed tomography (CT) is considered to be a better diagnostic tool. Associated visceral injury is common, and liver trauma was present in all 3 cases. Lesions are mainly right-sided, but left-sided or bilateral injuries have also been reported. A few cases are only recognized during surgery or necropsy. Lower-chest injury was seen in one-half of the cases and can result in severe morbidity. AH should not be considered rare, and the widespread use of CT proves that it is a strong indicator of associated visceral injury.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
20/131. Rapidly progressive antineutrophil cytoplasm antibodies associated with pulmonary-renal syndrome in a 10-year-old girl.CONTEXT: The term pulmonary-renal syndrome has been used frequently to describe the clinical manifestations of a great number of diseases in which pulmonary hemorrhage and glomerulonephritis coexist. The classic example of this type of vasculitis is Goodpastures syndrome, a term used to describe the association of pulmonary hemorrhage, glomerulonephritis and the presence of circulating antiglomerular basement membrane antibodies (anti-GBM). Among the several types of systemic vasculitides that can present clinical manifestations of the pulmonary-renal syndrome, we focus the discussion on two types more frequently associated with antineutrophil cytoplasm antibodies (ANCA), microscopic polyangiitis and Wegener's granulomatosis, concerning a 10 year old girl with clinical signs and symptoms of pulmonary-renal syndrome, with positive ANCA and rapidly progressive evolution. CASE REPORT: We describe the case of a 10-year-old girl referred to our hospital for evaluation of profound anemia detected in a primary health center. Five days before entry she had experienced malaise, pallor and began to cough up blood-tinged sputum that was at first attributed to dental bleeding. She was admitted to the infirmary with hemoglobin = 4 mg/dL, hematocrit = 14 %, platelets = 260,000, white blood cells = 8300, 74 % segmented, 4 % eosinophils, 19 % lymphocytes and 3 % monocytes. Radiographs of the chest revealed bilateral diffuse interstitial alveolar infiltrates. There was progressive worsening of cough and respiratory distress during the admission day, when she began to cough up large quantities of blood and hematuria was noted. There was rapid and progressive loss of renal function and massive lung hemorrhage. The antineutrophil cytoplasm antibody (ANCA) test with antigen specificity for myeloperoxidase (anti-MPO) was positive and the circulating anti-GBM showed an indeterminate result.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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