scholarly journals Dysphagia Aortica: A Case Report and Review of Treatment Options

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Komeil Mirzaei Baboli ◽  
Sumeet K. Mittal ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Definitive Treatment ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Feeding Jejunostomy ◽  
High Resolution Manometry ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
Calcified Aorta

A 64-year-old, cachectic man with body mass index (BMI) <19 visited in clinic with the chief complaint of dysphagia for 6 months. He reported a 2-year history of reflux and heartburn, for which he has been taking pantoprazole but reported only 40% relief of reflux symptoms. He reported progressive solid food mid-chest dysphagia. Additional comorbidities included severe pulmonary bronchiectasis and bullous emphysema and a history of treated pulmonary tuberculosis 40 years prior and two previous episodes of spontaneous pneumothorax in the right-sided lung treated with a chest tube. A chest X-ray showed a calcified aorta crossing the midline (Figure 1). A CT scan done for assessment of pneumothorax showed a torturous descending thoracic aorta and a dilated mid-/proximal esophagus. The diameter of the descending aorta was 41 mm, and it crossed the midline. For evaluation of dysphagia, a barium swallow was performed, which showed a narrowing in the mid-esophagus with proximal dilation and lack of peristalsis (Figure 2). Upper gastrointestinal endoscopy showed a dilated esophagus with eccentric extraluminal compression. High-resolution manometry (HRM) showed an absence of peristalsis and a vascular pressure artifact around the mid-esophagus correlating with the external aortic compression (Figure 3). Due to alarming weight loss and a BMI <19, we recommended a feeding jejunostomy to maintain nutrition before scheduling definitive treatment.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

scholarly journals Castleman's Disease: An Intrapulmonary Form with Intrafissural Development

2009 ◽  
Vol 9 ◽  
pp. 940-945 ◽  
Author(s):  
Hajer Racil ◽  
Sana Cheikh Rouhou ◽  
Olfa Ismail ◽  
Saoussen Hantous-Zannad ◽  
Nawel Chaouch ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Castleman’S Disease ◽  
Lower Lobe ◽  
Unknown Etiology ◽  
Castleman's Disease ◽  
Curative Surgery ◽  
Abnormal Shadow ◽  
History Of ◽  
Chest X Ray ◽  
The Right

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Carlo Galdino Riva ◽  
Stefano Siboni ◽  
Veronica Lazzari ◽  
Marco Sozzi ◽  
Emanuele Asti ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Symptom Relief ◽  
Rank Test ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Magnetic Sphincter Augmentation ◽  
Hrql Score ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

scholarly journals A rare cause of wheezing

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Alexander H. Cho ◽  
Jessica Logan ◽  
Jalil Ahari
Keyword(s):  
Granular Cell ◽  
African American Female ◽  
Lobe Bronchus ◽  
Submucosal Tumors ◽  
Sputum Production ◽  
Endobronchial Lesion ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
Tomography Scan

A 24-year-old African American female nonsmoker, with a reported history of asthma presented to the hospital with 2 weeks of shortness of breath and sputum production. She had a chest X-ray and computed tomography scan that displayed evidence of a right upper lobe collapse. She subsequently had a bronchoscopy that revealed an endobronchial lesion at the opening of the right upper lobe bronchus. Biopsies performed were consistent with a granular cell tumor. Granular cell tumors are rare submucosal tumors of Schwann cell origin. Resection of the right upper lobe resolved her symptoms and wheezing.

scholarly journals A Fatal Case of COVID-19 in an Infant with Severe Acute Malnutrition Admitted to a Paediatric Ward in Niger

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Alido Soumana ◽  
Aboubacar Samaila ◽  
Lamine Mahaman Moustapha ◽  
Moumouni Kamaye ◽  
Balkissa Daouda ◽  
...  
Keyword(s):  
Nasal Swab ◽  
Severe Acute Malnutrition ◽  
Fatal Case ◽  
Acute Malnutrition ◽  
Rt Pcr ◽  
X Ray ◽  
Laboratory Confirmation ◽  
History Of ◽  
Chest X Ray ◽  
The Right

While there have been very few fatal cases, SARS-CoV-2 has been reported in paediatric patients. This study aims to describe a fatal case of COVID-19 in a child with severe acute malnutrition. The eight-month-old child presented with fever, diarrhoea, and difficulty in breathing. The mother of the child had fever and shortness of breath four weeks before she died. Physical examination revealed lethargy, dehydration, and severe weight loss with a weight of 5 kg at a height of 78 cm tall. The weight-for-height index was less than three Z-scores, which corresponds to severe acute malnutrition. The pulmonary examination revealed moderate respiratory distress, and the chest X-ray presented features suggestive of pneumonia in the right lung area. In the context of the COVID-19 outbreak in Niger and the circumstances of the mother’s death, a nasal swab was taken for laboratory confirmation. Treatment provided to the child included intranasal oxygen, antibiotics, and a dietary program with therapeutic milk. The child died 48 hours after his admission. The history of contact with a SARS-CoV-2 suspect or positive patient should lead to screening for infection by using RT-PCR. It is important to investigate malnutrition as a potential risk factor for severe SARS-CoV-2 infection and resultant mortality.

scholarly journals Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Salvatore Maria Antonio Campo ◽  
Roberto Lorenzetti ◽  
Marina de Matthaeis ◽  
Cesare Hassan ◽  
Angelo Zullo ◽  
...  
Keyword(s):  
Old Age ◽  
Iron Deficiency Anaemia ◽  
Gastrointestinal Endoscopy ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Metal Stent ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Progressive Dysphagia

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

scholarly journals Lifelong Idiopathic Unilateral Diaphragmatic Paralysis With Recurrent Pneumonia: A Case Report

2020 ◽  
Vol 10 (1) ◽  
pp. 26743
Author(s):  
Khosrow Agin ◽  
Akram Sabkara ◽  
Farzaneh Sadat Mirsafai Rizi ‎ ◽  
Bita Dadpour ◽  
Maryam Vahabzadeh ◽  
...  
Keyword(s):  
Primary Diagnosis ◽  
Diaphragmatic Paralysis ◽  
Recurrent Pneumonia ◽  
Emergency Center ◽  
Diabetes Mellitus Type Ii ◽  
X Ray ◽  
Breath Sounds ◽  
History Of ◽  
Chest X Ray ◽  
The Right

A 50-year-old woman was admitted to the emergency center with dyspnea, cough, and fever symptoms. She had a medical history of diabetes mellitus type II, rheumatoid arthritis, as well as several admission records due to aspiration pneumonia. The primary diagnosis was diabetic ketoacidosis and pneumonia. Normal breath sounds were reduced on the lower posterior right side of the thorax. A standard chest x-ray and lung Computed Tomography (CT) scan revealed collapse consolidation in the Right Lower Lobes (RLL) and Right Middle Lobes (RML). We here presented a case of unilateral diaphragmatic paralysis with a history of recurrent pneumonia.

scholarly journals Martorell’s ulcer: a literature review and own clinical observation

2021 ◽  
Vol 18 (1) ◽  
pp. 55-70
Author(s):  
B. V. Boldin ◽  
P. Yu. Golosnitskiy ◽  
V. Yu. Bogachev ◽  
S. V. Rodionov ◽  
I. M. Dizengof
Keyword(s):  
Clinical Observation ◽  
Treatment Options ◽  
Local Treatment ◽  
Local Therapy ◽  
Pain Syndrome ◽  
Definitive Treatment ◽  
Outpatient Basis ◽  
Narcotic Analgesics ◽  
Wide Range ◽  
The Right

Introduction. Martorell’s ulcer is a rather rare pathology that occurs exclusively in patients with long-term and poorly controlled arterial hypertension and continues to be one of the poorly studied areas of modern surgery. There are few reports on the occurrence of this pathology in the medical literature and, as a rule, describe extremely rare clinical cases. The issues of etiology, pathogenesis and differential diagnosis of this disease continue to cause debate. The article provides a review of the literature on this rare surgical pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.Clinical case. A 56-year-old patient was admitted with complaints of a non-healing trophic ulcer on the lateral surface in the lower third of the right leg since one year ago with severe pain syndrome not adequately controlled with non-narcotic analgesics. he received treatment in an outpatient department and in the hospital, underwent courses of rheological therapy to the ulcer region as a local therapy, used a wide range of dressings of domestic and foreign origin. No positive effect was reported on the top of already administered combination therapy, the ulcer continued to increase in size. A Martorell’s ulcer was diagnosed, and a decision was made to provide a course of presurgical conservative rheological therapy with PGE1 (VAP 20 mg), antibiotic therapy, and local therapy aimed at maximal ulcer necrotic tissue clearance before the forthcoming planned surgical treatment. The patient underwent the surgery – autodermatoplasty of the trophic ulcer of the right leg with a mesh graft, continued local treatment of the ulcer using dressings with peruvian balsam and other medications on an outpatient basis without chemical and biological components from the antiseptics and healing stimulants group. Two months after the surgery, the patient had no complaints, the pain syndrome in the ulcer region completely regressed, no edema occurred in the lower operated leg, the right let ulcer completely healed with the formation of a permanent scar.Conclusion. Surgical management is the final and definitive treatment for Martorell’s chronic hypertensive ulcer and should be carried out promptly to minimize the spread of the ulcer and minimize a pain syndrome.

Viral and bacterial coinfection of the respiratory tract in a 10-month-old child

2020 ◽  
Vol 13 (7) ◽  
pp. e235295
Author(s):  
Sandhya Govindarajan ◽  
Saha Bivan
Keyword(s):  
Respiratory Tract ◽  
Work Of Breathing ◽  
Acute Respiratory Tract Infection ◽  
Blood Film ◽  
History Of ◽  
Chest X Ray ◽  
Syncytial Virus ◽  
Bacterial Coinfection ◽  
The Right

A 10-month-old child, immunised appropriately for age, presented with a history of cough, vomiting, diarrhoea, increased work of breathing and eye redness for 1 week. She was treated for suspected bronchiolitis with supportive oxygen and hypertonic saline nebulisation. In view of continuing fever spikes and persistent oxygen requirement, she was evaluated further. Her inflammatory markers were raised, blood film showed neutrophils left shift with toxic granulations and chest X-ray was suggestive of the right upper lobe segmental atelectasis suggestive of a bacterial infection. Her nasopharyngeal aspirate for multiplex tandem PCR was positive for adenovirus, respiratory syncytial virus and Bordetella species. She was treated with oral clarithromycin for 5 days which improved her symptoms. She was discharged with further follow-up. Coinfection with bacteria or atypical bacteria in children with acute respiratory tract infection is common and this coinfection can induce serious illness.

scholarly journals Meningococcal Pneumonia in a Young Healthy Male

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Abdullah M. Al Alawi
Keyword(s):  
Emergency Department ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Cell Counts ◽  
History Of ◽  
Chest X Ray ◽  
White Blood Cell Counts ◽  
The Right ◽  
Local Guideline

A 23-year-old male presented to the emergency department with one-day history of right-sided pleuritic chest pain, haemoptysis, and fever. In the emergency department, the blood pressure was 140/60 mmHg, heart rate 89/min, body temperature 40°C, respiratory rates 20 breaths/min, and oxygen saturation 98% in room air. Physical examination revealed rales and bronchial breathing in the right infrascapular region. Laboratory analysis showed raised white blood cell counts and elevated inflammation markers. Chest X-ray showed right lower lobe consolidation. Intravenous(IV) ceftriaxone and doxycycline were started for the management of community-acquired pneumonia as per the local guideline. Later, on admission, blood culture was positive for Neisseria meningitidis (N. meningitidis). Ceftriaxone was continued for 4 days, and the patient was discharged while being on oral amoxicillin (1 gm TDS) for another 3 days. He remained well during the outpatient follow-up.

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