In the setting of polytrauma, several foreign bodies could be aspirated, including avulsed teeth. Because a minimally responsive polytrauma patient could be at risk of airway compromise, emergency intubation is performed which can by itself lead to aspirated tooth. A complete dental examination is required to check for any fracture. A CT scan is the most sensitive modality for diagnosis. A rigid or flexible bronchoscopy is indicated for removal of the foreign bodies.
Evaluation of Macular Circulation in Patient with Sudden Visual Loss Secondary to Behcets Perifoveal Vasculitis by Using (Retinal Flow) Swept Source Optical Coherence Tomography Angiography Map
Objective: To evaluate macular vascular circulation in patient with perifoveal vasculitis secondary to Behcet’s disease by using (Retinal Flow) swept source optical coherence tomography angiography map. Methods: We retrospectively review a 39-y old female patient, with history of Behcet’s disease, presented with history of sudden unexplained central loss of vision which was more significant on the right eye with best corrected vision (BCVA=0.1) and less on the left eye with best corrected visual acuity (BCVA=0.7). The clinical ophthalmic examination of both anterior and posterior segments for the both eyes were normal with no any signs of uveitis. Imaging with DRI Triton Swept Source (SS- OCTA) (Topcon, Japan) was performed for evaluation of both superficial and deep capillary plexus of macular area. Fluorescein angiography (FA) was used also for assessing foveal avascular zone features. Results: The SS-OCTA Retinal Flow map was more sensitive than FA in marking out hypoperfusion in both superficial capillary plexus (SCP), and deep capillary plexus (DCP), especially in the right eye which had the positive correlation with visual acuity. SS-OCTA Retinal Flow map was also sensitive in showing improvement of macular hypoperfusion after treatment of Behcet’s Perifoveal Vasculitis. Conclusion: OCTA is a noninvasive imaging modality that can be used to evaluate macular vascular changes in Bechet’s perifoveal vasculitis and can explain acute visual loss in Behcet.
Ortner syndrome is vocal cord paralysis secondary to left recurrent laryngeal nerve palsy from atrial dilation. We present the case of a 28 year old woman with metastatic appendicular cancer to the peritoneum and pleura who experienced chest pain, progressive dyspnea and change in vocal quality secondary to esophageal impingement on the recurrent laryngeal nerve. This novel case of “Pseudo-Ortner Syndrome” further demonstrates the susceptibility of the laryngeal nerve to palsy secondary to mechanical impingement stemming from an unlikely distal non cardiac source.
Introduction: Renal stones are endemic in low income countries among children below 15 years old. This should not be underestimated due to high association with other morbidity and highly recurrence rate when compared with adults. Objective : To explore the Effectiveness of Extracorporeal Shock Wave In Pediatric Renal Stones. Methodology: Study the case of a child girl reported with renal stone, clinical and laboratory data were obtained , Radiological investigations as US and CT were done, The patient underwent dj stent, then patient received one session of Extracorporeal Shock Wave 4000 us guided storz eswl Lithotripsy for urinary Stones then uralyt-u pediatric dose and allpourinol 100 mg once daily then start to passing stones gravels Results: Follow up by CT for the patient after 3 months revealed no stone, renal scan split function from 12 to 18%. Conclusion: Renal stones could be presented even among pediatric group even with negative family history. Ultrasound is the first choice imaging modality for diagnosis of suspected renal stones , CT could be used for follow up. Dihydroxyadenine stones could be missed during routine diagnosis of renal stones so imaging is mandatory and stones analysis should be done.
A 7-month-old girl with congenital cytomegalovirus (CMV) infection underwent an immune assessment in anticipation of Transfer Factor therapy. She had been symptomatic since birth, with jaundice, rhinorrhea, diarrhea, pneumonia, hepatosplenomegaly, chorioretinitis, hydrocephalus (for which she was shunted), motor retardation, and failure to thrive. Her sputum and urine cultures were positive for CMV and her IgM anti-CMV antibody titer was positive at 1:16-1:32 dilutions. Her baseline immune assessment was normal except for a failure of her peripheral blood mononuclear cells to produce migratory inhibitory factor in response to CMV antigen. Treatment with transfer factor prepared from CMV seropositive donors resulted in clinical improvement, clearance of the virus, normal migratory inhibition factor responses to CMV antigen, and subsequent development of normal growth and development parameters.
Pharyngeal perforation is a rare serious finding with fatal outcomes if not diagnosed and managed promptly(1). The main cause is an iatrogenic injury during pharyngeal instrumentation and commonly present with neck pain, swelling, and subcutaneous emphysema. Many predisposing factors played a major role like difficult instrumentation, pharyngeal infection and old age(2). In our case, we present a patient with prostate cancer who underwent radical prostatectomy and was found to have mediastinal and surgical emphysema.
A Fatal Case of Non- typhoidal Salmonella Pyogenic Pericardial Effusion in an Immunocompetent Adolescent
BACKGROUND Salmonella infection is common in tropical countries including Malaysia. It is invasive in immunocompromised and those of extreme ages. It typically presents with gastrointestinal symptoms such as diarrhea, abdominal pain or vomiting. Extra-intestinal manifestations are seen in 30% of salmonellosis cases. These atypical manifestation leads to difficulty and delay diagnosis thus poorer outcome. Pericardium involvement is estimated to be less than 2% of all cases and has mortality rate as high as 50%1. As high as 70% of pericarditis cases were identified to be immunosuppressed2; these include chronic immunosuppressant usage, autoimmune disease, end stage renal failure, malignancy and etc. Herein, we report a fatal case of pyogenic pericardial effusion by Salmonella enteritidis in an immunocompetent adolescent. CASE PRESENTATION A 16-years-old Malay boy was referred from GP to our centre in April 2015 with CXR finding suggestive of pericardial effusion. He had prolonged cough for 8 months, associated with breathlessness and failure symptoms. He had on and off fever but denied gastrointestinal symptom. He had multiple visits to private practitioners and was investigated for Tuberculosis, which yielded negative result. His condition continued to deteriorate. Of note, he had no significant medical and surgical illness. There was no history of contact with tuberculosis patients, recent travelling history or high risk behaviour. Upon admission, he was tachypnea and in shock. His blood pressure was 90/56mmHg with a pulse rate of 102bpm. His JVP was raised and heart sound was muffled. Lung examination revealed reduced breath sound bilaterally with generalized rhonchi. Initial blood investigations revealed leukocytosis with predominant neutrophils (16 x 109/L). ABG showed type 1 respiratory failure. ESR was raised, 100mm/hour. Chest X-ray showed a congested lung field consistent with pulmonary oedema. Bedside echocardiogram revealed a large pericardial effusion with diastolic right atrium and ventricle collapsed, indicating temponade effect. Emergency pericardialcentesis drained…
A 40-year-old male presented to the emergency department with the complaint of a sudden, painful left eye and swelling after episodes of sneezing. A day earlier, he had sustained a blunt trauma to the left orbit as the result of a fall from motorcycle. The initial examination showed subcutaneous and subconjunctival emphysema. Visual acuity in the left eye was 20/40 (0.50), the pupils were reactive with no relative afferent pupillary defect, and there were limitations in levoduction, dextroduction, infraduction and supraduction. A slit-lamp examination revealed normal anterior and posterior segments with an intraocular pressure of 24mmHg. An orbital computed tomography scan showed orbital, subconjunctival, and subcutaneous emphysema associated with a small fracture of medial wall of the left eye. Following conservative management with broad-spectrum oral antibiotics, a topical antiglaucoma drug, low dose systemic steroid drug, and lubricating eye drops, the patient improved dramatically within one week.
Q fever is an endemic zoonotic infection in Australia cause by Coxiella burnetii. It has been recognised in other parts of the world, especially among livestock rearing occupations, stock yard and abattoir workers. Majority (65%) of patients infected with C.burnetti are asymptomatic while symptoms similar to those of respiratory and hepatitis are the most common making diagnosis difficult in the early stages. We report a case of a young man who was exposed to and infected with Q fever as an occupational hazard. He presented in an unusual way with the predominant initial symptoms of abdominal pain, fever, hepatitis and sterile peritonitis necessitating an emergency surgical procedure to explore a suspected surgical abdomen. Respiratory involvement ensued only several days later. The diagnosis of Q fever was confirmed with positive convalescent serology phase II IgM and IgG antibodies to Coxiella burnetii. A marked clinical response to doxycycline pending serological confirmation was supportive of this highly suspected diagnosis in an at-risk patient.
An unusual Cause of upper airway obstruction in newborn: Congenital nasal pyriform aperture stenosis
Congenital nasal pyriform aperture stenosis (CNAPS) is a rare cause of pediatric nasal airway obstruction that clinically mimics choanal atresia in a neonate. CNPAS is suspected clinically and confirmed with CT scanning. Early diagnosis and management is essential for this potentially life-threatening condition. Because of the association this anomaly has with other midline defects, such as holoprosencephaly, it is important to recognize it and pursue a thorough workup. Patients can be managed conservatively or surgically. Surgical treatment is usually reserved for those patients that fail conservative treatment. We present a case of CNPAS, to highlight the importance of recognizing the classic signs of CNPAS on cross-sectional imaging to prevent fatal outcome.