1/20. Bilateral metachronous rupture of the patellar tendon.We present a case of a 37-year-old man who sustained a rupture of his left patellar tendon approximately 48 hours after rupturing his right patellar tendon. This temporal pattern illustrates two important aspects of patellar tendon injury-that rupture of the degenerated patellar tendon may occur without any prodromal warning and that it may elude detection even if the patient is examined by several physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/20. Spontaneous bilateral rupture of the achilles tendon in a patient with chronic obstructive pulmonary disease.A 69-year-old man with chronic obstructive pulmonary disease (COPD) presented with an exacerbation of cough and breathlessness, as well as a 5 day history of sudden-onset bilateral calf tenderness. He had been commenced on inhaled steroids 41/2 years earlier and then received maintenance oral prednisone. Upon examination, there was a haematoma inferior to the medial malleolus with no Achilles tenderness on the left side. On the right side, there was focal tenderness over the mid-portion of the achilles tendon with pain accentuated upon dorsi flexion. A venous duplex study confirmed superficial venous thrombosis involving the left gastrocnemius vein extending proximally to the popliteal vein junction. The major axial deep veins of the left lower leg were patent. Findings on the right side were normal. A subsequent diagnostic ultrasound demonstrated unequivocal bilateral achilles tendon ruptures. The patient subsequently underwent corrective surgery. There have been several reports of bilateral achilles tendon rupture associated with long-term corticosteroid use. It is likely that this entity is underdiagnosed because of a lack of awareness of this association by physicians. Recognition and surgical intervention are likely to reduce morbidity and improve outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/20. 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) |
4/20. Traumatic disruption of the anterior tibial tendon while cross-country skiing. A case report.Closed spontaneous rupture of the anterior tibial tendon is an uncommon injury that occurs after relatively minor trauma in middle-aged and elderly men. A 72-year-old retired physician sustained a complete anterior tibial tendon rupture while he was skiing cross-country. Direct primary repair of the tendon resulted in satisfactory restoration of muscle strength and return to an active life-style.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/20. Latent fatality due to hydatid cyst rupture after a severe cough episode.Hydatid disease is a parasitic disease caused by echinococcus granulosus characterised by cyst formation in various organs. The infestation mostly involves the liver. Hydatid cysts of the liver can rupture either spontaneously or due to trauma. incidence of rupture is about 3-17% of all cases with hydatid disease. Unless treated surgically, rupture can result in death. Here, we present a case of hydatid cyst ruptured after a severe cough episode and disseminated first to the subcapsular area, then to the peritoneal space. Probably due to a decrease in parenchymal pressure in the liver after decompressive effect of rupture, the patient felt an improvement in abdominal pain, refused operation, and left the hospital on his own responsibility. This unfortunate relief resulted in a delay of 55 hours in management. The leakage of liquid materials into peritoneal space resulted in a severe inflammatory reaction and eventually death of the patient. The patient died of a late peritonitis rather than anaphylaxis, which is the most common reason for death in such patients. As a conclusion, physicians should be aware of a temporary relief in abdominal pain after cyst rupture that may cause a delay in management and in turn loss of patient due to peritonitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/20. Gluteus medius tendon rupture as a source for back, buttock and leg pain: case report.A 67-year-old woman with chronic lumbosacral and hip symptoms involving gluteus medius tendon rupture and strain injury is presented here. We report her work-up and management. Although this is an uncommonly reported pathology, many patients with back, buttock and leg pain see physicians who often focus on lumbar spinal stenosis, lumbar radiculopathy or hip/knee osteoarthritis. Careful physical examination guided us to this patient's diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/20. sports-induced spontaneous rupture of the extensor pollicis longus tendon.Two cases of spontaneous extensor pollicis longus tendon rupture are presented. One occurred in a 17-year-old diver and the other in a 69-year-old physician tennis player. Neither patient experienced pain, and only the diver had premonitory wrist discomfort. The diver was treated by an extensor indicis proprius transfer. The physician denied any disability and elected to have no treatment.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/20. Traumatic tricuspid insufficiency with chordae tendinae rupture: a case report and literature review.With the increase in the number of automobile accidents, traumatic tricuspid insufficiency, a rare complication of non-penetrating blunt chest injury, has become an important problem. This kind of injury has been found more frequently during the last decade, partly because of better diagnostic procedures and a better understanding of the pathology. Here, we report a 22-year-old male patient who suffered chest trauma from an automobile accident. echocardiography demonstrated tricuspid chordae tendinae rupture with remarkable tricuspid regurgitation. We discuss this case in comparison with the previous literature. This case reminds us that physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/20. Massive bilateral diaphragmatic rupture after an apparently minor automobile accident.A case of massive bilateral diaphragmatic rupture following a low impact motor vehicle accident is described. The patient experienced herniation of intraabdominal contents into the thoracic cavity, but suffered no additional injuries. Few cases of bilateral diaphragmatic rupture have been reported and no cases of acute bilateral rupture have been described as an isolated injury. Diaphragmatic rupture in general may be a difficult injury to recognize. Based on our review of recent cases of diaphragmatic rupture (1979-1990), most patients presenting acutely have additional trauma (89.9%) but only vague symptoms related to their diaphragmatic insult. A chest roentgenogram may be a useful diagnostic tool, although many patients with diaphragmatic rupture have only nonspecific findings. A nasogastric tube placed prior to chest roentgenogram may enable the physician to recognize the injury more readily. A high index of suspicion is required to recognize diaphragmatic rupture and should be maintained for all victims of motor vehicle accidents with abnormal but nondiagnostic chest roentgenograms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/20. Evaluation of acute scrotum pain with testicular scanning.Emergency room physicians frequently are faced with the evaluation of the patient with acute testicular pain. The rapid differentiation between testicular torsion and acute epididymitis is necessary although frequently difficult due to an atypical presentation. We describe four patients with testicular pain in whom testicular scanning provided useful adjunctive information regarding diagnosis. This technique clearly differentiates acute torsion, acute epididymitis, testicular rupture, and missed torsion with abscess formation, prompting appropriate therapy in each case. Testicular scanning provides a rapid, noninvasive method to assist in the evaluation of testicular pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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