1/13. Unusual sites (thorax and umbilical hernial sac) of endometriosis.Extra-pelvic endometriosis in the thorax or umbilical hernia is rare. We report a case of thoracic endometriosis presenting with isolated chest pain and a case of endometriosis in an umbilical hernial sac mimicking incarceration. The clinical course and management of the patients and a literature review of these two unusual sites of endometriosis are discussed.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
2/13. paraparesis after excision of intrathoracic meningoceles in a patient with neurofibromatosis.Intrathoracic meningocele associated with neurofibromatosis is a rarity. We treated a 16-year-old boy with neurofibromatosis, marked kyphoscoliosis, and two right-sided intrathoracic meningoceles. Because his chief complaints of cough and chest pain were thought to be caused by the meningoceles, resection of these lesions was performed prior to correction of the spinal deformity. On the day after the resection, complete paraplegia developed, followed by recovery to paraparesis. Decompressive lumbar puncture was performed, but intraspinal pressure was normal. Postoperative spinal cord damage and consequent paresis may have resulted from a loss of pressure buffering by the meningocele, which rendered the cord vulnerable to injury. The possibility of a similar unusual complication should be borne in mind when treating patients with intrathoracic meningocele associated with neurofibromatosis.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
3/13. Anesthetic implications of thoracic endometriosis.endometriosis occurs in 5% to 10% of women of childbearing age and involves the proliferation of endometrial tissue outside the uterine cavity. Thoracic endometriosis is the most frequent extrapelvic manifestation of endometriosis, numbering some 100 reported cases. It may include spontaneous pneumothorax, hemoptysis, chest pain, bronchiectasis, pneumomediastinum, or mediastinal bleeding. Because the tissue is hormonally responsive, all of these manifestations are related to the menstrual cycle (catamenial) and are likeliest to occur during menses. We report the successful anesthetic management of a patient with thoracic endometriosis and recurring catamenial pneumothorax who presented for elective pelvic surgery.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
4/13. Coronary angiographic, echocardiographic, and electrocardiographic studies on a patient with variant angina due to coronary artery spasm.A 45-year-old Caucasian female patient with a clinical rehistory and ECG's conforming to the syndrome of variant angina as characterized by Prinzmetal is presented. ECG's recorded during spontaneous pain demonstrated ST-segment elevation and symmetrical peaking of the T-waves in the lateral precordial leads and short runs of ventricular tachycardia. Similar ECG changes were recorded during treadmill exercise- and hand-grip exercise-induced chest pain. An echocardiogram recorded during angina induced by hand-grip exercise demonstrated progressive flattening of septal motion. Multiple views of the coronary system by selective coronary cineangiography were normal with the patient at rest. Angina was then induced by hand-grip exercise and a repeat right anterior oblique view of the left coronary system revealed marked spasm of the left anterior descending artery proximal to the first septal perforator.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
5/13. menstruation in an unusual place: a case of thoracic endometriosis in Kampala, uganda.While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in uganda is given. A 34-year-old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered blood were tapped from her right pleural space. Worried about a possibility of a malignant process, an urgent chest CT scan was performed. A right posterior pleural mass and pleural effusion were found. A pleural biopsy was taken and confirmed at histology as endometrial tissue. She did well on surgical excision and hormonal therapy. This was a rare case of endometriosis which shows the usefulness of imaging in the patient work up.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
6/13. Intrathoracic kidney.Intrathoracic kidney is a rare congenital anomaly. However, it should be included in the differential diagnosis of posterior mediastinal masses, as confirmation of the diagnosis obviates the need for further clinical studies, further treatment, and unnecessary surgery. Chest computed tomography (CT) is an important and efficient tool in confirming the diagnosis. We report a 50-year-old man who suffered from nonspecific chest pain for 2 years. He denied a history of major traumatic chest injury. Chest radiograph revealed a left posterior mediastinal mass, which was later confirmed by chest CT to be a congenital intrathoracic kidney.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
7/13. Multifocal mesenchymal hamartoma of the chest wall.Chest wall hamartomas are extremely rare. Frequently mesenchymal hamartomas are presented as a single mass and contain some primitive mesenchymal elements such as chondroid and trabecular bone structures. A 60-year-old man presented to hospital with chest pain. Thirteen years earlier, his CXR and thoracic CT showed three masses on the right and two masses on the left, but he had not received any treatment thereafter. His CT showed the same masses present 13 years earlier, but they were bigger and right thoracotomy was undertaken. At thoracotomy, two sections of the mass in the right posterior mediastinum and one section of the mass in the right apex were excised. They had an occasional bloody appearance and contained small cystic areas, and some areas were extremely hard. Microscopic examination showed that the lesions consisted of mature adipose tissue, a large number of veins of different diameters and collagen tissue. Besides, primitive mesenchymal elements, lymphoid cell accumulations and trabecular bone structures were seen focally. Bilateral chest wall hamartomas are extremely rare and may be confused with malignancy.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
8/13. Atraumatic sternal fractures secondary to osteoporosis.We describe two cases of spontaneous sternal fracture with no underlying pathology other than a severe dorsal kyphosis resulting from osteoporosis. Both patients complained of chest pain. Sternal fractures are particularly likely to occur in the elderly when the costal cartilages become ossified and there is an associated thoracic kyphosis. In elderly patients with a kyphosis the lateral thoracic radiograph should include the sternum to ensure recognition of this complication.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
9/13. Thoracic splenosis. diagnosis of a case by fine needle aspiration cytology.Fine needle aspiration cytology was used to study chest wall nodules in a patient who presented with fever, cough, pleuritic chest pain and cytomegalovirus infection and who had a previous history of abdominal trauma. The finding of splenic red pulp and white pulp in the aspirate, combined with the results of a radionucleotide liver-spleen scan, led to a diagnosis of thoracic splenosis, a relatively rare condition. splenosis is thought to result from transplantation of splenic tissue after trauma and may provide some added protection against certain infectious conditions, both of which were present in this case.- - - - - - - - - - ranking = 1keywords = chest pain (Clic here for more details about this article) |
10/13. High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia.Esophageal manometric tracings obtained using low-compliance pneumohydraulic infusion systems were reviewed from patients with symptoms of chest pain and/or dysphagia. Using this sytem, we report on 7 symptomatic patients with markedly increased esophageal peristaltic amplitude. Maximal peristaltic amplitude for these 7 patients (225-430 mmHg) was greater than for normals (75-175 mmHg). Mean peristaltic amplitude for the 7 was 170 mmHg, which was greater than for normals (81 /- 30 mmHg, mean /- 2 SD). This finding is believed to reflect the sensitivity of currently available manometric systems. It may be possible with these techniques to define more clearly the bulk of presumed esophageal dysfunction, which is at present poorly characterized. The relationship of clinical symptoms to abnormal esophageal motility is often less than optimal and may result from an inability to define "normal" or from inadequacies of currently available techniques. Our observations of a subset of symptomatic patients having peristaltic contractions with amplitudes exceeding the normal range seem to characterize one form of esophageal motility defect. This abnormality was seen more frequently than diffuse esophageal spasm in our laboratory.- - - - - - - - - - ranking = 5keywords = chest pain (Clic here for more details about this article) |
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