The American journal of emergency medicine
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Spontaneous epidural abscess formation is a rare finding in all populations and even more so in the pediatric population. Its rarity and varied presentations often lead to misdiagnosis. ⋯ Literature suggests utilizing three simple physical exam findings that may improve the first visit diagnosis of spontaneous epidural abscesses in children. Findings of any two of the following signs should guide the clinician to consider SEA as a possibility prior to discharge: fever, back or neck pain, extremity weakness or inability to walk.
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A 55-year-old man presented with the emergency department after having a short syncopal episode and angina during the exertion for 1 month. His initial electrocardiogram showed minimal ST-segment changes on precordial leads. While waiting for the laboratory tests, abruptly, the patient went into cardiopulmonary arrest. ⋯ Recombinant tissue plasminogen activator bolus (25 mg) was given 2 times at 5-minute intervals immediately into pulmonary artery by pig-tail catheter under the cardiopulmonary resuscitation. The patient had an excellent response to high-dose bolus thrombolytic therapy. We conclude that in the case of massive pulmonary embolism with small chance of resuscitation, the catheter-directed high-dose bolus injection of recombinant tissue plasminogen activator could enrich the therapeutical possibilities.
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Pneumatosis intestinalis (PI) is a rare clinical condition, which is commonly associated with mesenteric vascular ischemia, bowel obstruction, and chemotherapy. Although the pathophysiology of PI remains unclear, 2 theories, one mechanical and the other bacterial, have been proposed. Nonoperative medical treatment and observation should be considered in mild cases, but occasionally, the situation requires emergency surgical intervention. In cases of suspectful complicated PI, the clinician should not avoid performing diagnostic laparoscopy to rule out bowel ischemia and perforation.
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Infliximab is a commonly used biologic agent in the treatment of various autoimmune diseases. Although it is generally well tolerated in most patients, infliximab has been associated with some rare but serious adverse events. Aseptic meningitis is one such distinctly uncommon side effect. ⋯ To our knowledge, this is the fifth case of infliximab-induced aseptic meningitis reported in literature. Because of atypical presentation, the diagnosis can be easily missed. It is vital to increase awareness of this potentially severe side effect among internists and community physicians.
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Spontaneous splenic artery aneurysm (SAA) is a rare but a life-threatening condition. Thus, early diagnoses may increase the chance of survival. A 52-year-old female patient was admitted to the emergency department with a pain that starts from the chest and epigastric region and radiates to back and left arm. ⋯ The patient originally presented with SAA, although she was primarily observed in the emergency department with acute myocardial infarct diagnosis because of similar symptoms and clinical findings to cardiovascular diseases. When changes in the clinical picture occurred, the patient was reevaluated and had undergone an operation because of SAA rupture. Therefore, physicians should take into consideration of aneurysm rupture in the differential diagnosis of the cardiovascular conditions; otherwise, the patient may lose his/her life.