Chest
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A 43-year-old man was admitted for right upper and lower limb weakness and aphasia. He had suffered dizziness and transient blindness 6 months ago and had also been found lying in the bathroom on another occasion. Multiple cerebral infarctions were confirmed by brain CT scan and MRI. ⋯ A fistula was found between the pulmonary and azygos veins with turbulent flow from pulmonary to azygos at rest. Cavography revealed that the pulmonary vein appeared simultaneously with the superior cava vein during Valsalva maneuver. In summary, the pathway of cerebral embolism was based on three pathologic mechanisms: (1) increased inferior vena cava pressure, (2) enlarged right azygos aneurysm, and (3) the presence of a fistula between the azygos and pulmonary veins.
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Limited understanding of the presentation and course of influenza A(H5N1) infection in humans hinders evidence-based management. ⋯ Early diagnosis and effective treatment of human influenza A(H5N1) infection remains challenging. Most patients were referred late with advanced disease. Oseltamivir had limited clinical impact. Elevated D-dimer levels, consistent with fibrinolysis, and hyperglycemia warrant more research to determine their underlying mechanisms and optimal treatment.