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Persistent hiccups as the presenting symptom of a pulmonary embolism  [cached]
Steven Durning,David J. Shaw,Anthony J. Oliva,Michael J. Morris
Chest Disease Reports , 2012, DOI: 10.4081/cdr.2012.e2
Abstract: An 81-year-old male with a history of symptomatic bradycardia controlled by a pacemaker presented to our institution with three days of persistent hiccups. He denied any pulmonary symptoms and his initial evaluation showed no evidence of tachypnea, tachycardia, or hypoxia. Pacemaker malfunction or migration of the pacer leads was ruled out as an etiology and no intracranial pathology was present. Admission chest radiograph was normal but a computed tomography of the chest demonstrated a left lower lobe pulmonary embolus. After treatment with anticoagulation was initiated, the hiccups resolved within the next week. This is a unique case presentation of hiccups as the only presenting symptom of an otherwise asymptomatic pulmonary embolism.
Persistent Hiccups as a Rare Presenting Symptom of Pulmonary Embolism  [cached]
Getaw worku Hassen,Mona Milkha Singh,Hossein Kalantari,Selamawit Yemane-Merriwether
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Pulmonary embolism (PE) is a life-threatening condition that may present as dyspnea, chest pain,cough or hemoptysis, but often occurs without symptoms. It is not typically associated with hiccups.Hiccups are generally self-limiting benign contractions of the diaphragm that may be associated with medications or food but may also be symptomatic of serious disease when persistent. We report 3 cases of PE presenting as persistent hiccups.
Persistent Hiccups Following Stapedectomy  [cached]
Aidonis I,Skalimis A,Kyrodimos E
Online Journal of Health & Allied Sciences , 2010,
Abstract: Objective: We report a case of a 37 year-old man who developed persistent hiccups after elective stapedectomy. Method and Results: The diagnostic approach is discussed as well as the non-pharmacologic and pharmacologic treatments and overall management. The aim is to stress that there is a variety of potential factors that can induce hiccups perioperatively and in cases like this a step by step approach must be taken. Conclusion: Persistent hiccups are very rare following stapedectomy, control of them is crucial for the successful outcome. The trigger may be more than one factors and the good response to treatment may be due to dealing successfully with more than one thing.
Renal abscess in a child with sickle cell anemia  [cached]
Taksande Amar,Vilhekar K
Saudi Journal of Kidney Diseases and Transplantation , 2009,
Abstract: Renal abscess is rare in children and the usual presenting features include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography facilitates an early diagnosis and helps in percutaneous drainage. We herewith report on a child with sickle cell anemia who developed a renal abscess.
Persistent Hiccups—An Unusual Presentation of Bilateral Pheochromocytoma without Syndromic Association: A Case Report
Nitin Aherrao,Nilesh Kumar,Indarajeet Singh Gambhir,Dhiraj Kishore,Suryakumar Singh,Abhinandan Mishra,Aravind Anand
Case Reports in Endocrinology , 2012, DOI: 10.1155/2012/824030
Abstract: Pheochromocytoma is a rare catecholamine-producing tumor arising from chromaffin tissue in the adrenal medulla, occurring in less than 0.2 percent of patients with hypertension. The mean age at diagnosis is about 40 years. Pheochromocytomas are commonly inherited as features of multiple endocrine neoplasia type 2 or several other pheochromocytoma-associated syndromes and have variable clinical presentation. Among the presenting symptoms, episodes of palpitations, headaches, and profuse sweating are typical and constitute a classic triad. We report a case of a 17-year-old male patient with rare bilateral pheochromocytoma presenting with persistent hiccups for 4 months and blurring of vision for 1 week, later followed by hypertensive crisis. There was neither family history of pheochromocytoma nor any classic symptoms. Patient was diagnosed with bilateral pheochromocytoma without any syndromic association. But still this patient needs to be followed for future development of medullary carcinoma of thyroid because it could be an initial presentation of MEN 2A/2B/VHL syndromes. Our paper highlights the importance of maintaining a high level of suspicion for persistent hiccups and careful clinical screening for hypertension even in absence of associated syndromes of pheochromocytoma and classical symptoms to achieve prompt diagnosis and to avoid improper management.
Persistent Hiccups—An Unusual Presentation of Bilateral Pheochromocytoma without Syndromic Association: A Case Report  [PDF]
Nitin Aherrao,Nilesh Kumar,Indarajeet Singh Gambhir,Dhiraj Kishore,Suryakumar Singh,Abhinandan Mishra,Aravind Anand
Case Reports in Endocrinology , 2012, DOI: 10.1155/2012/824030
Abstract: Pheochromocytoma is a rare catecholamine-producing tumor arising from chromaffin tissue in the adrenal medulla, occurring in less than 0.2 percent of patients with hypertension. The mean age at diagnosis is about 40 years. Pheochromocytomas are commonly inherited as features of multiple endocrine neoplasia type 2 or several other pheochromocytoma-associated syndromes and have variable clinical presentation. Among the presenting symptoms, episodes of palpitations, headaches, and profuse sweating are typical and constitute a classic triad. We report a case of a 17-year-old male patient with rare bilateral pheochromocytoma presenting with persistent hiccups for 4 months and blurring of vision for 1 week, later followed by hypertensive crisis. There was neither family history of pheochromocytoma nor any classic symptoms. Patient was diagnosed with bilateral pheochromocytoma without any syndromic association. But still this patient needs to be followed for future development of medullary carcinoma of thyroid because it could be an initial presentation of MEN 2A/2B/VHL syndromes. Our paper highlights the importance of maintaining a high level of suspicion for persistent hiccups and careful clinical screening for hypertension even in absence of associated syndromes of pheochromocytoma and classical symptoms to achieve prompt diagnosis and to avoid improper management. 1. Introduction Pheochromocytomas are rare catecholamine-producing tumours derived from the sympathetic or parasympathetic nervous system. They arise from chromaffin tissue in the adrenal medulla. These tumours may arise sporadically or be inherited as features of multiple endocrine neoplasia type 2 or several other pheochromocytoma associated syndromes. The clinical presentation is so variable that pheochromocytoma has been termed “the great masquerader.” They are estimated to occur in 2–8 of 1 million persons per year, and about 0.2% of hypertensive patients harbour a pheochromocytoma. The mean age at diagnosis is about 40 years, although the tumours can occur from early childhood until late in life. About 10% of pheochromocytomas are bilateral, however these percentages are higher in inherited syndromes. However, a pheochromocytoma can be asymptomatic for years, and some tumours grow to a considerable size before patients note symptoms. Here we report a case of bilateral pheochromocytoma presenting with persistent hiccups for 4 months and blurring of vision for 1 week. Patient presented without any classic symptoms of pheochromocytoma and did not have any syndromic association or significant
A Case of Brainstem Cavernous Angioma Presenting with Persistent Hiccups
Mohammad Ali Arami
Acta Medica Iranica , 2010,
Abstract: "nIntractable hiccup most be considered as a symptom of underlying serious pathologies. We report a case of medulla oblongata cavernous angima presented with persistant hiccup and without any improvement during routine nonpharmacologic and pharmacologic treatment regimns. The patient is under our follow up visits and surgery is very high risk for this young girl.
Aortic Root Abscess Presenting as Pyrexia of Unknown Origin and the Importance of Echocardiography  [PDF]
Prashanth Panduranga
Case Reports in Critical Care , 2013, DOI: 10.1155/2013/636519
Abstract: Aortic root abscess in patients with aortic endocarditis is not uncommon. Aortic root abscess may cause persistent sepsis, worsening heart failure, conduction abnormalities, fistula formation, and an increased need for surgery. We present a young patient with aortic root abscess presenting as pyrexia of unknown origin. She had acute severe aortic and mitral regurgitation which produced very soft murmurs that were easily missed. This report reiterates that a high index of suspicion is needed in suspecting valvular endocarditis as well as a comprehensive transthoracic and transesophageal echocardiographic examination to diagnose complications like aortic root abscess. 1. Introduction Aortic root abscess in patients with aortic endocarditis is not uncommon. Aortic root abscess may cause persistent sepsis, heart failure, conduction abnormalities, fistula formation, and an increased need for surgery. We present a young patient with aortic root abscess presenting as pyrexia of unknown origin that was diagnosed by echocardiography. 2. Case A 26-year-old female with no past medical problems was admitted to critical care unit of our hospital with history of intermittent high-grade fever (39-40°C) for 3-week duration. She was extensively investigated in other hospitals with results yielding negative blood culture, autoimmune profile, and immunodeficiency profile. She was diagnosed to have pyrexia and sepsis of unknown origin. She had received multiple antibiotics during this period from other hospitals. Apparently previous cardiac examination was normal. Clinically she was febrile, tachycardic, tachypneic, and hypotensive. Chest X-ray showed pulmonary edema. Careful clinical examination revealed elevated jugular venous pressure, soft aortic early diastolic murmur, and a soft pan systolic murmur at apex. ECG showed sinus rhythm with normal PR interval. An urgent bedside transthoracic echocardiogram (TTE) revealed dilated left ventricle, large vegetation attached to base of anterior mitral leaflet with severe mitral and aortic regurgitation with EF 45%. The aortic valve looked edematous, but no clear-cut aortic root abscess was seen. The valves were thickened suggesting rheumatic etiology. Laboratory investigations revealed anemia, leucocytosis with markedly elevated inflammatory markers. She was immediately shifted to OR, and a transesophageal echocardiogram (TEE) confirmed TTE findings. In addition there was an aortic root abscess behind the noncoronary cusp (Figure 1) along with perforation of anterior mitral leaflet with severe aortic and mitral regurgitation
Squamous Upper Tract Carcinoma Presenting as a Perinephric Abscess  [PDF]
M. Lopes,D. Rauber,F. Carvalho,M. Nicodem,J. A. Noronha,G. F. Carvalhal
Case Reports in Urology , 2013, DOI: 10.1155/2013/789097
Abstract: Perinephric abscesses are life-threatening conditions, which are rarely associated with neoplasms of the kidney or upper tract collecting system. We report, to our knowledge, the first case of squamous carcinoma of the upper tract presenting as a perinephric abscess, diagnosed after radical nephrectomy. 1. Introduction Renal and perinephric abscesses are life-threatening conditions, which may occur in different clinical scenarios [1, 2]. Generally, they result from ascending infections complicating an obstructed upper tract. Diabetes mellitus and urolithiasis are important risk factors for these abscesses [3]. Roughly, 30% of all perinephric and renal abscesses are of hematogenic origin, secondary to bacteria located elsewhere in the body (e.g., Staphylococcus aureus) [2]. Recently, a new syndrome of renal and perinephric abscesses was associated with infections by methicillin-resistant Staphylococcus aureus, in which prompt diagnosis and treatment were key to therapeutic success [4]. Malignant neoplasms are very rarely associated with renal and perirenal abscesses. We report an unusual case of perirenal abscess secondary to a squamous cell carcinoma and discuss the differential diagnosis and therapy. 2. Case Presentation A 82-year-old man presented to the emergency room prostrated, with recent onset of fatigue and malaise. A few days earlier, he started feeling urinary urgency and had started treatment with oral fluoroquinolones for an alleged prostatitis. Physical examination was unremarkable, there were no abdominal masses, and Giordano’s sign was negative. Laboratory revealed mild anemia (Ht: 33%; Hb: 11.3?mg/dL), leukocytosis (29.570?WBCs/mm3; 1% myelocytes, 6% band neutrophils), and altered renal function tests (serum creatinine: 2.65?mg/dL; urea: 80?mg/dL). Urinalysis showed leukocyturia (10?leukocytes/field) and hematuria (10?blood cells/field). Urine culture was negative. A chest X-ray was normal. An abdominal ultrasound showed a 9.6?cm right kidney with poorly defined limits and an internal image suggestive of a choraliform stone. Left kidney was normal, as well as the remainder of the abdominal organs. The patient was started on IV antibiotics (cefepime) and hydration. After the initial treatment, the patient evolved with worsening of his clinical and laboratory findings. A noncontrasting abdominal and pelvic computerized tomography (CT) revealed a large heterogeneous mass in the right kidney, in contiguity with the lumbar musculature, the liver, and the vena cava, also dislodging the pancreatic head and the duodenum. In the collecting system
Tuberculous Mastitis Presenting as Breast Abscess
Leo Francis Tauro
Oman Medical Journal , 2011,
Abstract: Tuberculous mastitis is a rare clinical entity and usually affects women from the Indian sub-continent and Africa. It often mimics breast carcinoma and pyogenic breast abscess clinically and radiologically, may both co-exist. Routine laboratory investigations are not helpful in its diagnosis. Fine needle aspiration cytology (FNAC) / biopsy are essential for diagnosis and tuberculosis culture when positive may be very useful to guide antimicrobial therapy. Antitubercular drugs in combination with aspiration or surgical drainage are usually associated with an excellent outcome.
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