1/6. Haemoptysis as a late complication of a Mustard operation treated by balloon dilation of a superior caval venous obstruction.Haemoptysis was the presenting symptom in a 27-year-old male. He had undergone a Mustard operation for connection of complete transposition at the age of 2 years. For 6 months prior to admission, he had complained of dyspnoea without chestpain, and swelling of the fingers during hard physical work. Chest radiography and computer tomographic scans showed normal features of the pulmonary parenchyma, and no sign of cardiomegaly or vascular stasis. Fiberoptic bronchoscopy demonstrated a blood clot in the upper right bronchus, without any associated abnormalities of the bronchial tree. Doppler echocardiography showed obstruction of the superior caval vein, which was verified by cardiac catheterization. Balloon dilation at the site of obstruction increased the diameter of the vein from 0.5 to 1.7 cm, and the mean pressure in the superior caval vein was reduced significantly from 18 to 10 mmHg. The haemoptysis did not recur, and no complaints of dyspnoea or swelling of fingers during physical activity was reported 2 years later. Transthoracic echocardiography undertaken at this time revealed no obstruction of the superior caval vein. We conclude that hemoptysis is a rare complication of increased venous pressure in the upper body of patients with superior caval venous obstruction, which can be treated by balloon dilation or stenting.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Wegener's granulomatosis diagnosed by testicular biopsy.Urogenital involvement, other than the kidneys, is extremely rare in Wegener's granulomatosis (WG) and occurs in less than 1% of the cases. When encountered it is confined to prostate, bladder, urethra, cervix, and vagina. Granulomatous infiltration of the testis from WG has not been cited in the medical literature. We report a case of WG in a Hispanic male who presented with sensorineural hearing loss and hemoptysis. He had a pulmonary lesion and a painless right testicular mass, which was found to have necrotizing granulomas on excisional biopsy. This may be the first reported case of WG diagnosed by testicular biopsy as testicular involvement is rare in WG. We believe that the actual incidence of testicular involvement in WG may be higher as genital examination may be ignored during routine physical examinations.- - - - - - - - - - ranking = 6.6657652785289keywords = physical examination, physical (Clic here for more details about this article) |
3/6. hemoptysis: a manifestation of pulmonary disease confidently managed by military physicians.Military physicians can confidently manage hemoptysis with a systematic approach and optimal timing of consultation. Begin with a thorough history, physical examination, and chest x-ray. In our series of 177 cases, a cause for hemoptysis was found in 78% of those with abnormal chest x-rays but in only 21% of those with normal chest x-rays. All 36 cases of bronchogenic carcinoma were associated with an abnormal chest x-ray. A normal chest x-ray was associated with no cause found for the hemoptysis (44 cases) or bronchitis (25 cases), with no carcinomas developing upon a 2-year follow-up. hospitalization is indicated with excessive bleeding or to allay patient or physician) anxiety. Diagnostic bronchoscopy is usually indicated, especially to localize the bleeding in massive hemoptysis (greater than 600 cc per 24 hours) when surgery may be indicated. Prompt referral should be the rule with bleeding from a mycetoma, diffuse bronchiectasis, or with recurrent significant hemorrhage (greater than 200 cc). In an active-duty population, these instances are fortunately rare, and conservative management and elective referral are the norm.- - - - - - - - - - ranking = 6.6657652785289keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Malignant fibrous histiocytoma of the heart presenting as hemoptysis. association with pseudothrombocytopenia.A 24-year-old patient presented with hemoptysis. Pulmonary evaluation was unrevealing. After being lost to follow-up, he again presented with worsening symptoms and physical findings of severe pulmonary hypertension. A large left atrial mass was found on echocardiogram. This was subsequently found to be a malignant fibrous histiocytoma. He also had pseudothrombocytopenia due to platelet cold agglutinins. Left atrial masses must be considered in unexplained hemoptysis.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/6. Endobronchial tuberculosis: report of three cases.Three patients are presented who had had a chronic cough for several months, a normal physical examination and a negative chest X-ray. Fiberoptic bronchoscopic examination revealed ulcerohaemorrhagic and/or stenotic lesions which proved to be of tuberculous origin. In one case there was a life-threatening haemoptysis, and a pneumonectomy was performed.- - - - - - - - - - ranking = 6.6657652785289keywords = physical examination, physical (Clic here for more details about this article) |
6/6. Radionuclide localization of massive pulmonary hemorrhage.lung scans with technetium sulfur colloid were performed in ten patients with life-threatening hemoptysis and nondiagnostic chest roentgenograms. Localized deposition of radionuclide was demonstrated in five of the six patients who were studied during active bleeding. These abnormalities were confirmed bronchoscopically in four patients, and lung scans provided clinically useful information regarding the bleeding site that had not been available from the medical history, physical examination, or chest roentgenogram. Evaluation with radionuclide scanning may complement bronchoscopic and roentgenographic studies in selected patients with massive pulmonary hemorrhage.- - - - - - - - - - ranking = 6.6657652785289keywords = physical examination, physical (Clic here for more details about this article) |