11/369. Painless left hemorrhagic pleural effusion: An unusual presentation of dissecting ascending aortic aneurysm.Aortic dissection is a catastrophic event that is commonly associated with severe pain, massive hemorrhage, and high mortality. In this report, we present the case of a 31-year-old man who presented with painless, hemorrhagic left pleural effusion. Further investigation revealed a 9-cm dissecting ascending aortic aneurysm that was thought to be due to a congenitally bicuspid aortic valve. We suggest that ascending aortic aneurysm be included in the differential diagnosis of hemorrhagic pleural effusion, even in the absence of the classic features of aortic dissection, such as chest pain, advanced age, or history of hypertension.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/369. Primary non Hodgkin's lymphoma of the vagina.The genital tract as a primary site of malignant lymphoma in women is extremely rare. This report concerns a 64 year old patient with a primary vaginal non-Hodgkin lymphoma (large cell B lineage according to the REAL classification--centroblastic type according to the Kiel classification--"G" according Working Formulation) with an unusual clinical presentation--pelvic discomfort accompanied by frequent ureteral-like colic. Due to gynecological onset symptoms and the rarity of this extranodal primary site misinterpretation of a primary vaginal lymphoma as a benign inflammatory disease or endometriosis may occur. We emphasize the importance of their recognition and also the differential diagnosis of cervical lymphoma from other neoplastic and non-neoplastic lesions.- - - - - - - - - - ranking = 1.3030602857046keywords = discomfort (Clic here for more details about this article) |
13/369. Hemorrhagic adrenal cyst: an unusual reason of acute hypovolemia.Adrenal cysts are often asymptomatic and included in the larger "incidentaloma" group. They may reach significant size without onset of compressive symptoms and are often left undiagnosed until an ultrasound or CT scan are performed for a vague lumbar or flank discomfort. Intracystic hemorrhage is a rare but life-threatening complication since a sudden and significant blood loss may occur without any evident clinical source, hypovolemic shock resulting as the first symptom. The authors report their personal experience in two patients along with a review of the literature on this insidious emergency, its diagnosis and therapeutic approach.- - - - - - - - - - ranking = 1.3030602857046keywords = discomfort (Clic here for more details about this article) |
14/369. Hemorrhagic pyelitis, ureteritis, and cystitis secondary to cyclophosphamide: case report and review of the literature.OBJECTIVE: Hemorrhagic cystitis is a well-known complication of cyclophosphamide therapy but extensive involvement of the entire urinary tract is far less common. We report here a patient who developed severe hemorrhagic pyelitis, ureteritis, and cystitis after one cycle of cyclophosphamide-containing combination chemotherapy. METHOD: A patient with synchronous carcinoma of the ovary and the uterus developed severe hemorrhagic pyelitis, ureteritis, and cystitis leading to bilateral hydronephroses and acute renal failure after one cycle of combination chemotherapy containing cyclophosphamide. The blood clots in the upper urinary tract were aspirated endoscopically and bilateral internal ureteric stents were inserted. RESULT: She underwent a prolonged diuretic phase with several episodes of hypokalemia, hypomagnesemia, and hypocalcemia and required intensive fluid and electrolytes replacement. Subsequently, she recovered fully with the ureteric stents removed 26 days later. CONCLUSION: In contrast to previous reports, where 2.8 g of cyclophosphamide was estimated to be the minimum cumulative dose required to cause hemorrhagic cystitis, this case illustrates that severe hemorrhagic complication can occur even after a low dose of cyclophosphamide (600 mg/m(2), total dose of 846 mg). Prompt diagnosis and intervention may be life-saving.- - - - - - - - - - ranking = 0.47473208317461keywords = upper (Clic here for more details about this article) |
15/369. Vascular adrenal pseudocyst: cytologic and immunohistochemical study.Adrenal vascular cysts are rare lesions that might be considered in the differential diagnosis of adrenal tumors. Their origin is not clear. We report the clinicopathological findings of a large adrenal hemorrhagic pseudocyst (AHP) in a 73-yr-old man who complained of abdominal pain. An abdominal CT showed a 9 cm tumor in the left adrenal. A fine-needle aspiration biopsy (FNAB) was hemorrhagic and inconclusive. The tumor was excised and touch imprints were taken showing groups of spindled and fusiform cells with elongated nuclei, without atypia. Histologically, the tumor was well delimited by a fibrous capsule and contained numerous cystic spaces lined by endothelial cells and filled with erythrocytes, fibrin thrombus, and necrotic debris. Immunohistochemical study showed strong positivity for factor viii-RA, CD31, and CD34. Also, the remaining adrenal showed a prominent frame of thin and medium caliber vessels, supporting a vascular origin for this entity. This case illustrates the difficulty in making a diagnosis by FNA and to keep in mind AHP when hematic aspirates are obtained from an adrenal tumor mass.- - - - - - - - - - ranking = 8.8353065669051keywords = abdominal pain (Clic here for more details about this article) |
16/369. Diffuse alveolar hemorrhage syndrome due to 'silent' mitral valve regurgitation.A variety of clinical diseases are associated with diffuse alveolar hemorrhage. Although mitral valve disease can cause hemoptysis, it rarely is associated with diffuse alveolar hemorrhage at presentation. A 49-year-old woman was admitted to the hospital with the abrupt onset of fever, anemia, dyspnea, azotemia, and diffuse alveolar infiltrates. Two-dimensional echocardiography done several months earlier to evaluate atypical chest pain had been unremarkable. Fiberoptic bronchoscopy 2 days after admission to the hospital revealed fresh blood throughout the tracheobronchial tree. The infiltrates resolved rapidly and completely during systemic steroid therapy only to reappear as the steroids were tapered, suggesting a beneficial therapeutic response. Results of serologic evaluation were negative. Transbronchial biopsies showed inflammation and hemosiderin-laden macrophages; no specific diagnosis was established. The patient was scheduled for open lung biopsy. The surgeon was concerned about the history of chest pain and requested placement of a pulmonary artery catheter, which revealed severe pulmonary hypertension. Transesophageal echocardiography and subsequent cardiac catheterization showed severe mitral regurgitation. mitral valve replacement resulted in complete elimination of symptoms.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
17/369. A bleeding tendency as the first symptom of a choledochal cyst.We report an 8-month-old male presenting with gingival hemorrhages and nasal bleeding as the first symptom of a choledochal cyst (CC). On physical examination, there was a large cystic mass in the right upper abdominal quadrant. Laboratory studies on admission revealed moderate liver dysfunction and a bleeding tendency due to vitamin k deficiency. After administration of 5 mg vitamin K the bleeding tendency disappeared. At laparotomy, a large CC 5 cm in diameter was found and the liver showed moderate cholestasis. The sudden onset of a bleeding tendency in infants with congenital liver or biliary-tract disease may suggest not only biliary atresia, but also CC.- - - - - - - - - - ranking = 0.47473208317461keywords = upper (Clic here for more details about this article) |
18/369. Use of high-dose corticosteroids and high-frequency oscillatory ventilation for treatment of a child with diffuse alveolar hemorrhage after bone marrow transplantation: case report and review of the literature.BACKGROUND: Other than relapse, pulmonary complications are the most common cause of mortality in patients who undergo bone marrow transplantation (BMT). Diffuse alveolar hemorrhage (DAH) is one noninfectious pulmonary complication of BMT. Presenting clinical findings include nonproductive cough usually without hemoptysis, dyspnea, hypoxemia, a decrease in hematocrit, and diffuse infiltrates on chest radiograph. PATIENT: We report a case of DAH after allogeneic BMT in a 6-yr-old female patient. Although a chest radiograph revealed patchy bilateral alveolar densities and large volumes of bright red blood were suctioned from the endotracheal tube, there was no evidence of coagulopathy and no infectious agent was identified on examination of bronchoalveolar lavage fluid, blood, and urine. INTERVENTION: The child was treated with high-dose corticosteroids and high-frequency oscillatory ventilation and experienced a complete clinical recovery from her pulmonary disease. RESULTS: The definition, presenting symptoms, findings and timing, and associated risk factors of DAH after BMT are reviewed. Prospective hypotheses for the pathogenesis of DAH after BMT are presented. Evidence for the role of high-dose corticosteroids for treatment of DAH after BMT and the role of high-frequency oscillatory ventilation for treatment of acute hypoxemic respiratory failure in children with diffuse alveolar disease is also reviewed. CONCLUSION: This case supports the contention that early treatment with high-dose corticosteroids is warranted in children with DAH after BMT.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
19/369. Haemorrhage into non-functioning adrenal cysts--report of two cases and review of the literature.Adrenal cysts are a rare condition and are usually non-functioning and asymptomatic. Most of the reported cases were incidental findings or discovered at autopsy. However, large cysts have a tendency to develop complications such as intracystic haemorrhage and rupture, which can present as an acute surgical emergency. We report two cases of adrenal cysts with intracystic haemorrhage. One patient presented with persistent non-specific upper abdominal pain, investigations with ultrasound (US) scan and computed tomographic (CT) scan revealed a left adrenal cyst and gallstones. Simultaneous cholecystectomy and adrenalectomy was performed with resultant relief of symptoms. The second patient presented with acute abdominal pain simulating acute surgical abdomen. Preoperative CT scan showed a large cystic lesion in the region of the tail of the pancreas with radiological evidence of haemorrhage but was unable to confirm its origin. The cyst was found to have arisen from the left adrenal gland at laparotomy; left adrenalectomy with complete excision of the cyst was done. histology showed pseudocyst with haemorrhage in both cases. Pseudocyst is the commonest histological type encountered clinically. We believe the second case is related to pregnancy and childbirth as the patient presented during puerperium and the cyst, even though very large in size (25 x 15 x 15 cm), was not noted during antenatal screening with US scan.- - - - - - - - - - ranking = 77.213194449843keywords = upper abdominal pain, abdominal pain, upper (Clic here for more details about this article) |
20/369. Pulmonary haemorrhage after percutaneous paravertebral block.We describe the management of a 65-yr-old woman anaesthetized for thoracotomy. The patient suffered a pulmonary haemorrhage after percutaneous paravertebral injection performed using the loss of resistance to saline technique. thoracotomy at a later date revealed that the lung tissue had become adherent to the chest wall and that the paravertebral space was fibrosed secondary to previous surgery. This particular complication of percutaneous paravertebral block has not been reported previously and raises the question of risk vs benefit of this pre-emptive analgesic technique.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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