BMJ case reports
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A 64-year-old woman presented with shortness of breath, right-sided pleuritic chest pain and dry cough. She was systemically anticoagulated with warfarin for a pulmonary embolism diagnosed 3 months previously, with an international normalised ratio (INR) of 3.0 on presentation. Chest radiograph demonstrated a new right paratracheal abnormality, and CT scan showed a large mediastinal mass not present 3 weeks earlier. ⋯ The haematoma slowly resolved on serial follow-up with no additional intervention. Spontaneous mediastinal haematoma is a rare but life-threatening diagnosis that frequently presents with chest pain, dry cough and dysphagia. It is frequently associated with therapeutic anticoagulation and may potentially be caused by sudden, atraumatic rise in intrathoracic pressure (ie, cough or emesis).
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Case Reports
Swyer-James-McLeod's syndrome and pneumothorax on same side: delay in chest drain removal despite full expansion.
Swyer-James-McLeod's syndrome (SJMS) occurs as a result of childhood recurrent respiratory infections. As this condition presents with few symptoms, if any, it may pass unnoticed until adulthood. ⋯ Chest CT pulmonary angiogram was needed to confirm the diagnosis of unilateral SJMS. Diagnostic difficulty arose because both conditions were on the same side.
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Review Case Reports
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD): a case with additional features and review of the literature.
A rare syndrome of rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) has been recently described. We report the first patient with this syndrome in Southeast Asia and review reported cases to date. Our patient was good health with normal development until the age of 2. ⋯ Tumours of the sympathetic nervous system are known to be associated with this syndrome but had not been found in our patient at the time of reporting. We highlight the difficulty of achieving the diagnosis of ROHHAD syndrome and its overlap with other well-established disease entities. The mortality and morbidity resulting from the high incidence of cardiorespiratory arrest may be prevented by early ventilatory support.
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Review Case Reports
Bilateral infarction of paramedian thalami: a report of two cases of artery of Percheron occlusion and review of the literature.
Artery of Percheron is a normal variant of the paramedian branches of posterior cerebral artery. This artery supplies the paramedian areas of the thalami and upper midbrain. Occlusion of this artery is rare and results in a multitude of neurological signs and symptoms, which might prompt the physician think of an aetiology other than vascular insults, and therefore change the management plan. The authors report two ischaemic strokes, which developed because of this arterial occlusion; their presentation differed from each other.
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An 80 year-old former cattle-breeder committed suicide with a captive bolt gun. He was transmitted unconscious to emergency department. He had a large penetrating wound in right temporal area. ⋯ CT verified a large rounded entry site and bony defect at the right pterion. It disclosed a wide, zonal-like haemorrhagic wound canal bearing intraparenchymal bony fragments at its end with no associated metallic fragments. Subarachnoid haemorrhage with bilateral subepidural hematomas and significant brain oedema was demonstrated.