Cases reported "Lung Injury"

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1/15. Syndromes in amoebic liver abscess.

    A series of 137 patients with amoebic liver abscess has been studied. Recognition of clearly defined but diverse clinical syndromes was found to be necessary not only in diagnosis but also in planned surgical management. The majority of patients had the classic syndrome of fever, right abdominal or chest pain, hepatomegaly, hepatic tenderness and radiological abnormalities. Other syndromes of presentation included the silent abscess, acute amoebic colitis, the acute abdomen, the intraabdominal lump, the external sinus, pyrexia of obscure origin, obstructive jaundice and renal, pleuro-pulmonary and cardiac symptoms. The syndromes due to an abscess in different parts of the right lobe and in the left lobe of the liver are to some extent distinct. In spite of the varied modes of presentation of amoebic liver abscess, the key to diagnosis is an understanding of the chronological sequence of the disease and its progression from one syndrome to another. Diagnostic methods of value and the mortality are discussed.
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2/15. Intrathoracic gastric volvulus mimicking pyloric stenosis.

    A 5-week-old-infant presented to hospital following the acute onset of non-bilious vomiting with clinical and acid-base features suggestive of pyloric stenosis. A chest radiograph obtained because of intercurrent infection unexpectedly revealed a left-sided congenital diaphragmatic hernia. A barium meal demonstrated the presence of an intrathoracic gastric volvulus, requiring urgent surgical management. We discuss the presentation and management of this rare surgical cause of non-bilious vomiting in infancy.
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3/15. Acute abdomen due to wandering spleen infarction: a case report.

    We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.
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4/15. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.

    Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. Correctly diagnosing a spinal epidural abscess in a timely fashion is often difficult, particularly if the clinician does not actively consider the diagnosis. The most common presenting symptoms of spinal epidural abscess include backache, radicular pain, weakness, and sensory deficits. However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.
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5/15. death, after swallowing and aspiration of a high number of foreign bodies, in a schizophrenic woman.

    A 46-year-old woman who had had a long-term schizoid psychosis collapsed on the street. Upon admission to the hospital, she was determined to have an acute abdomen. The chest radiograph showed metallic foreign bodies in both main bronchi; foreign bodies in the stomach were not observed clinically. The woman died from repeated cardiac arrest shortly after hospital admission. At the autopsy a screw and a nail were found in both main bronchi. The abdominal cavity contained 2 L of greenish purulent fluid and a massive fibrinoid peritonitis was observed. Two perforations of the stomach, each 1 cm in diameter, were detected. The stomach was completely filled with a mass of metallic foreign bodies, greenish fluid, and a bezoar of a total weight of 1,400 g; 422 distinguishable and mostly metallic foreign bodies were counted. death was attributed to cardiac arrest in delayed shock after massive purulent peritonitis caused by two gastric perforations combined with obstruction of the airways by aspirated foreign bodies. Cases of massive swallowing of foreign bodies are mainly restricted to mentally handicapped persons, especially schizophrenics, whereas acute impaction of the larynx by large food particles occurs nearly exclusively in heavily intoxicated adults.
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6/15. Emergency surgery and refractory immune thrombocytopenic purpura. A case report.

    A 35-year-old woman with post-splenectomy refractory immune thrombocytopenia presented with an acute abdominal emergency requiring laparotomy. Her platelet count was raised from 10 to 96 X 10(9)/l using a combination of high-dose methylprednisolone, plasma exchange against fresh-frozen plasma, infusion of gammaglobulin and a single mega-unit of platelets. The surgical procedure was uneventful, and with no further therapy the platelet count rose to a peak of 244 X 10(9)/l, but over the following 7 days fell back slowly to 10 X 10(9)/l, at which time the patient was discharged well.
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7/15. Abdominal catastrophes.

    The patient in our case report presented with an acute abdomen but stable vital signs and ABCs. The differential diagnosis initially included most of the entities discussed in this chapter. The ECG ruled out an acute MI. The patient improved with IV hydration and oxygen administration. Abdominal x-ray films ruled out a bowel obstruction, and chest x-ray films ruled out a pulmonic process. Laboratory tests revealed hemoconcentration and leukocytosis. No other laboratory test results were abnormal. While waiting for the surgeon to arrive, the patient remains stable, so the ED physician orders a CT scan of the abdomen. Taking another look at the plain x-ray films, the emergency physician in our case presentation sees a suggestion of free air under the right hemidiaphragm above the liver on the CXR and between the liver and the right abdominal wall on the decubitus ABD x-ray. The CT scan confirms the presence of free air within the peritoneal cavity, and the patient is taken to surgery for an exploratory laparotomy. The final diagnosis is perforated peptic ulcer. With hindsight, the patient and wife recall a previous diagnosis of a possible ulcer in the past.
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8/15. Thoracoabdominal radiculopathy.

    Thoracic nerve root dysfunction (TNRD) manifested as abdominal pain is an infrequently reported condition. We present data on six patients who had chronic intermittent thoracoabdominal pain originating in the back. Diabetes and osteoarthritis of the spine were the chief causes of these symptoms. The electromyogram in all patients showed changes consistent with an acute radiculopathy. All patients responded to anti-inflammatory therapy in combination with phenytoin, carbamazepine, amitriptyline, or local nerve block. TNRD is a condition that may be diagnosed earlier if clinical suspicion is increased, thus sparing patients excessive testing and surgery, and affording quicker relief.
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9/15. Chest disease presenting as an acute abdomen.

    Four patients with primary disease in the chest are discussed, each coming to laparotomy. The final postoperative diagnoses were empyema, pulmonary tuberculosis, pulmonary embolism and bacterial endocarditis. These cases well illustrate the real risk of confusing an acute chest condition with an acute abdomen.
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10/15. Acute gastric volvulus. A study of 25 cases.

    Twenty-five patients with acute gastric volvulus were studied. The two types, organoaxial and mesenteroaxial, are compared with respect to clinical characteristics, diagnosis, pathogenesis and treatment. An understanding of the varied features, including both thoracic and abdominal manifestations, is essential to early recognition and prompt treatment. In addition to Borchardt's triad, this study suggests three important features: (1) minimal abdominal findings when the stomach is in the thorax; (2) a gas-filled viscus in the lower chest or upper abdomen shown by chest radiography (Figure 8), and (3) obstruction at the site of volvulus shown by emergency upper gastrointestinal series. The high incidence of strangulation (28 percent) in this series attests to the urgency of this condition and is a compelling reason for the elective repair of paraesophageal hiatal hernias whenever possible.
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