Case Presentation (two cases)

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Case No 5 : 

Case No 5

History: : 

History: Male 55 years old, smoker Progressive dyspnea, productive cough & chest tightness of 1 month duration Normal stress test, ECG and echo PFT was suggesting asthma Pt was discharged on BA treatment Worsening of symptoms in 3 weeks with blood tinged sputum added.

Slide 3: 

Stressing on history: patient denied any fever, chills, nausea, vomiting or lower limb edema but mentioned traveling 2 months ago for 16 hours driving. P.H: HTN, hypothyroidism, BPH, obesity, sinusitis, OSA, gout, thyroidectomy, breast benign mass lumpectomy, right ankle re-construction.

Examination: : 

Examination: Oral temp.= 35.5 pulse = 78 bpm, regular BP = 90/70 RR= 18 bpm Auscultation: decreased BS on Rt infra-mammary area Normal heart, abdomen, head, neck

Investigations: : 

Investigations: Repeated cardiac enzymes, CBC, metabolic profile were normal. CXR, non-contrast CT were all normal. SO2 = 90% on room air. ECG: normal sinus rhythm, T-wave abn. In antero-lateral walls, incomplete RBBB. Echo: P.HTN (PAP= 80), TR, Rt sided enlargement

Slide 6: 

CT chest angiography:

Slide 7: 

Based on the presentation and the high-resolution CT angiography of the chest, what is the diagnosis? Sarcoidosis Pulmonary embolism Tuberculosis BOOP

Slide 8: 

Based on the presentation and the high-resolution CT angiography of the chest, what is the diagnosis? Sarcoidosis Pulmonary embolism Tuberculosis BOOP

Slide 9: 

Venous duplex is normal for LL and pelvic veins. Pt. admitted to the ICU and started on LMWH and warfarin. Thrombolytics were not initially administered (subacute nature and good general condition) So2 and symptoms continued to improve. ANA , protein C and S, prothrombin mutation, factor V Leiden, lupus anticoagulant, and phosphatidyl antibody, were initiated. Discharged once INR was range of 2-3.

Case No 6 : 

Case No 6

History: : 

History: Male, 18 years old, smoker Sudden mid-sternal stabbing chest pain, radiating to the neck awakened him from sleep at 4 am, worsens with inspiration and associated with dyspnea. No other symptoms. No P.H of trauma, surgery.

Examination: : 

Examination: RR= 20 bpm BP= 100/60 HR= 67 bpm So2 = 95% Temp.= 36.7 Normal general, chest, heart and abdominal examinations.

Investigations: : 

Investigations: WBCs : 12,000 Otherwise normal CBC, metabolic profile, ESR. Normal ECG CXR P-A and lateral views were done followed by CT chest.

Slide 16: 

What is the cause of this man's chest pain? Lookclosely to the heart and surroundings: Pulmonary embolism Pneumomediastinum Aortic dissection Pericarditis

Slide 17: 

What is the cause of this man's chest pain? Lookclosely to the heart and surroundings: Pulmonary embolism Pneumomediastinum Aortic dissection Pericarditis

Treatment: : 

Treatment: Conservative treatment is given: O2, analgesics. 2ry pneumomediastinum is ruled out by CT neck, ENT consultation Repeated CXR daily for regression

Slide 19: 

Pt was discharged 2 days later with improvement and was advised to: Stop smoking, straining, traveling, diving and going up high altitudes for a month. FU CT was done after a month with total resolution.

Thank You : 

Thank You

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