1/12. Painful swelling of the thigh in a diabetic patient: diabetic muscle infarction.A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabetes mellitus presented with a painful, firm and warm swelling in her right thigh. Pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, major inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal white blood cell count and normal creatine kinase level. Plain radiographs were normal, and there were no signs of thrombophlebitis at Doppler ultrasound. magnetic resonance imaging (MRI) showed diffuse enlargement and an oedematous pattern of the adductors, vastus medialis, vastus intermedius and sartorius of the right thigh. The patient's symptoms improved dramatically, making biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complication of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly controlled longstanding Type 1 diabetes with established microangiopathy. Differential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflammatory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential complications as well as unnecessary investigations. rest, symptomatic pain relief and adequate control of diabetes usually ensure progressive total recovery within a few weeks. Recurrences may occur in the same or contralateral limb.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. giant cell arteritis complicated by spinal cord infarction: a therapeutic dilemma.spinal cord involvement is uncommon in giant cell arteritis (GCA) and spinal cord infarction is extremely rare. We describe an 80-year-old man with active GCA who developed sudden paraplegia and dissociated sensory loss while receiving steroid treatment. magnetic resonance imaging showed high signal abnormality consistent with spinal cord infarction in the anterior spinal artery territory at the level of D10. The case illustrates the elusive nature of GCA and the diagnostic and therapeutic dilemmas faced by the physician caring for these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Traumatic diaphragmatic rupture in a pediatric patient: a case report.Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Lingual infarction: a review of the literature.Lingual infarction, although a very rare entity has been reported in 16 cases since 1961. The goal of this article is to alert the physician to the symptoms of tongue claudication to prevent the morbid effects of tongue infarction and blindness due to cranial arteritis. A discussion of the disease and the differential diagnosis is included.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Diabetic muscle infarction of the peroneus brevis: a case report.Diabetic muscle infarction of the peroneus brevis is a rare complication of diabetes mellitus. It often presents with an acute leg pain without any obvious signs. Due to poor awareness of this condition, it is often misdiagnosed and results in anxiety of the patient and unnecessary investigations. It is ominous as it usually indicates vascular disease of the end organs. We report a case where the patient presented to several physicians for leg pain without any other clinical signs. The diagnosis was suspected on ultrasound and confirmed with biopsy. The symptoms improved dramatically after excision. Although most literature suggests conservative treatment by non-weight bearing and analgesia, the recovery period can last for more than 6 weeks, with a recurrence rate of 50%. We feel that there is a role for excision biopsy of the lesion for both diagnosis and treatment. In this case, symptoms improved remarkably and the patient was able to ambulate without pain 2 days after the operation without needing any analgesia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Antepartum pituitary necrosis in diabetes mellitus.Pituitary infarction occurred during pregnancy in two insulin-dependent diabetic patients aged 32 and 33 years. The diagnosis was delayed in each case before being confirmed biochemically and radiologically. A decreasing insulin requirement and recurrent hypoglycaemia made it possible to determine the exact time that pituitary infarction occurred during pregnancy. The clinical features of these cases should alert physicians to the possibility of pituitary infarction in diabetic pregnancy and minimize the delay in diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. Acute gastric necrosis in anorexia nervosa and bulimia. Two case reports.In recent years we have treated two patients with gastric infarction as a complication of anorexia nervosa and bulimia. We found only three other cases reported in the literature. Surgical intervention was delayed in all five patients either because the diagnosis was missed by the physician or because the patient failed to seek medical attention. physicians should be alerted to the possibility of acute gastric dilatation if a young woman, who may be undernourished and anorexic, complains of abdominal pain after ingestion of a large meal. Often this condition can be treated conservatively before irreversible damage to the gastric wall has taken place. If the gastric dilatation progresses, the stomach loses its contractility, resulting in venous occlusion, infarction, and gastric perforation. An extensive operation is required, and the patient undergoes an often complicated and prolonged hospital course.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Inadvertent inflation of the balloon: a rare but serious complication of Miller-Abbott intubation.Inadvertent injection of contrast medium or tube feedings into the wrong port of a Miller-Abbott tube can be catastrophic. Four cases are reported, three of which required emergency surgery and two resulted in small-bowel infarction. This complication can easily be avoided if the attending physician and radiologist are aware of the entity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Clinical imaging with indium-111 leukocytes: uptake in bowel infarction.leukocytes labeled with indium-111 accumulated in are area of small-bowel infarction, mimicking a paracolic abscess. Evidence of subacute bowel obstruction should alert the nuclear medicine physician to the former possibility.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. A case of Purtscher's retinopathy.This article describes a case of Purtscher's retinopathy, a syndrome believed to be caused by microembolic infarction of the retina, in a 20-year-old man after remote extraocular trauma. The patient jumped from a 20-meter high building. He suffered multiple crush injuries, but a computed tomographic scan of the brain and orbit was normal. More than 1 month after injury, his visual acuity diminished to light perception in the right eye and counting fingers in the left. The ophthalmoscopic picture was characteristic of Purtscher's retinopathy with cotton-wool exudates and retinal hemorrhages localized to the posterior pole. His vision was improved only slightly 6 months later. Although rare, emergency physicians should be familiar with this entity as a cause of diminished vision associated with extraocular trauma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |