Pulmonary embolism is and has been an established medical dia gnosis. The complications, however, seem to awe physicians and healthcare workers across the globe. The purpose of this report is to bring to awareness a case involving a 37-year-old female with pulmonary embolism which was complicated by develop ment of right-sided empyema. This patient initially presented with shortness of breath, heart rate/pulse of 109 beats per minute and right sided pleuritic chest pain and was diagnosed with pulmona ry embolism and started on apixaban. Upon discharge after three days, she continued to have persistent progressively worse right sided chest pain. She was readmitted five weeks later, and further investigation resulted in the diagnosis of right sided pleural effu sion. CT guided drainage of the effusion was consistent with em pyema with cultures growing streptococcus intermedius. The aim of this report is to present a readmission of a 37-year-old woman patient who developed streptococcus intermedius empyema after initial diagnosis and management for acute pulmonary embolism. 2. Introduction Acute pulmonary embolism results in pulmonary infarct at a rate of approximately 16% to 31% . The predisposing risk factors for pulmonary infarct are active smoking and increase body height. Patients are often of younger age groups without cardiopulmonary comorbidities [10, 11]. 4% to 7% of patients with pulmonary in farction develop cavitary lesions due to necrosis or superinfection of the necrotic tissue [8, 12]. Pulmonary infarction is a wedge shaped area that usually extends to the pleural surface and causes pleural effusion due to increase pulmonary capillaries permeabi lity from ischemia or release of vasoactive cytokines [6, 9]. 23% to 52% of patients with Pulmonary embolism have pleural effusion on computed tomography . The pleural effusion is usually exu dative and hemorrhagic [2, 9]. Delayed onset of pleural effusion or late enlargement in the course are associated with either recurrent pulmonary embolism or superinfection . Empyema is a collection of pus [fluid filled with immune cells, dead cells, and bacteria] in the pleural cavity . The risk factors for empyema include pneumonia, chronic lung disease, diabetes mellitus, prolonged corticosteroid use, illicit drug use, alcohol abuse, aspiration, thoracic or esophageal surgery or trauma . Empyema had rarely been associated with pulmonary embolism [3, 7]. The implicated pathogens in empyema include gram po sitive bacteria especially viridans strep species in community ac q
COVID-19 infection initiates a multi systemic inflammatory syn drome with various organ manifestations. Although respiratory symptoms are the most common presentation for COVID-19, neu rological manifestations have still been reported, but with devas tating outcomes. A 57-year-old male smoker was admitted with severe COVID-19.
From our experience and description of colleagues, SARS-CoV2-patients who are ventilated on intensive care unit (ICU) require complex sedation.
Intramural hematoma of esophagus after lifting a heavy sack of rice which mimicking cardiovascular disorder
We report here a case of an intramural hematoma of the esophagus. The extension of this was from cervical esophagus to lesser curvature of stomach intramural hematoma.
Myeloid neoplasm with eosinophilia is a kind of unusual hematological malignancy. Back in the morphological diagnosis era, the prognosis was generally poor and the best treatment for these cases was allo-stem cell transplantation. According to the classification of eosinophilic diseases revised in the 2008 WHO scheme of myeloid neoplasms and reaffirmed in 2016, more detailed cytogenetic rearrangement and molecular mutations were included in the diagnosis and treatment algorithm.
Condyloma acuminata are soft, skin colored, fleshy warts that are caused by the Human Papilloma Virus (HPV), typically HPV 6 and 11 genotypes.
Denys-Drash syndrome consists of the triad of progressive nephropathy characterised by diffuse mesangial sclerosis (DMS), genital abnormalities, and Wilms tumour. Nephropathy may range from early onset proteinuria to nephrotic syndrome to end stage renal failure. Genital malformations affects both external and internal genitalia.