1/8. 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 = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. Leber's miliary aneurysms associated with telangiectasia of the nasal mucosa.A 20-year-old woman, treated with cryopexy and xenon- and argon-laser photocoagulation for Leber's miliary aneurysms in her right eye, suffered from repeated epistaxis. She underwent an endoscopy that showed an unusual number of telangiectatic veins. Laboratory results and routine physical and neurologic examinations showed normal values. Dematologic examination revealed no signs of hereditary hemorrhagic telangiectasis (Osler's disease). Nevertheless, it seems reasonable to assume that the combination of microvascular disturbances in one eye and in the nasal mucous membrane is not a coincidental finding.- - - - - - - - - - ranking = 0.074911850266712keywords = physical (Clic here for more details about this article) |
3/8. Hemotympanums secondary to spontaneous epistaxis in a 7-year-old.Hemotympanum is a well-known physical finding most often associated with basilar skull fractures and therapeutic nasal packing. A literature review demonstrated only five cases of hemotympanum associated with spontaneous epistaxis in adults. To our knowledge, there have been no reported cases in children. We present a case of a 7-year-old child with bilateral hemotympanums secondary to spontaneous epistaxis.- - - - - - - - - - ranking = 0.074911850266712keywords = physical (Clic here for more details about this article) |
4/8. BIPP madness; an iatrogenic cause of acute confusion.An 81-year-old man, admitted under the Ear, nose and Throat Team with persistent epistaxis, developed an acute confusional state. He was previously physically independent and mentally competent. Immediate investigations did not reveal a cause for his deterioration. He eventually made a full recovery and returned home. Subsequently, his serum bismuth level was noted to be within the toxic range and was felt to have been the cause of his confusional state.- - - - - - - - - - ranking = 0.074911850266712keywords = physical (Clic here for more details about this article) |
5/8. Recurrent epistaxis from an intranasal glomus tumor: the 22nd case report.The case of a 66-year-old Thai woman who was treated at King Chulalongkorn Memorial Hospital due to recurrent epistaxis for two years is presented. Her physical examination revealed a 0.7-cm tumor mass on the right nasal septum. A biopsy was subsequently done and the tissue was sent for pathological examination. The lesion was then diagnosed as "glomus tumor of the nasal septum". Histologically, the tumor was rather well-circumscribed and located in the submucosal region. The neoplastic cells were uniform, round to ovoid in shape and contained bland-looking, finely chromatic nuclei and moderate amount of cytoplasm with ill-defined cell borders. These cells were intervened by tortuous vascular structures. Immunohistochemically, the tumor cells were strongly reactive to smooth muscle actin and negative to cytokeratin and S-100 protein. A glomus tumor is rare in the sinonasal region. So far, there have been only 21 reported cases in the literature. Almost all cases of sinonasal glomus tumor are benign and are usually cured by complete excision.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/8. Hemotympanums secondary to spontaneous epistaxis.Three cases of hemotympanum that resulted from spontaneous, atraumatic epistaxis are presented. Hemotympanum is a well known physical finding associated with traumatic basilar skull fractures but has not been reported to follow spontaneous nose bleeds that have not been previously treated with nasal packing. A discussion of epistaxis and hemotympanum is presented, and their implication for emergency physicians is discussed.- - - - - - - - - - ranking = 0.074911850266712keywords = physical (Clic here for more details about this article) |
7/8. Fractures of the medial orbital wall.Two cases of patients with isolated medial orbital wall fractures are described. Presenting physical findings were minimal; however, both patients were noted to have bleeding into the nasopharynx from unidentified sources. Routine radiographs failed to disclose the fractures, which were clearly shown by computed tomography. Reconstructive surgery was planned for one patient. Frequently overlooked, this injury may be the cause of delayed enophthalmos, meningitis, or blindness. The presentation, diagnosis, and management of medial orbital wall fractures are reviewed.- - - - - - - - - - ranking = 0.074911850266712keywords = physical (Clic here for more details about this article) |
8/8. infant with epistaxis and absent femoral pulses.Coarctation of the aorta is a congenital cardiac abnormality that can lead to congestive heart failure in early infancy or can go undetected for many years. We discuss the case of an infant who presented to our emergency department with epistaxis and was found to have this lesion based on the physical examination. The identification of this lesion before the onset of symptoms leads to improved survival in these patients. A cardiac murmur and differential blood pressure between upper and lower extremities are the most reliable physical findings for identifying patients with coarctation of the aorta. Absent femoral pulses are a hallmark of this lesion, but not a dependable finding.- - - - - - - - - - ranking = 1.0749118502667keywords = physical examination, physical (Clic here for more details about this article) |