A 16 year old female was admitted with a one week history of headache and swelling of both upper eyelids. Other symptoms included nausea, tiredness, dizziness and photophobia with no symptoms of skin rash, or neck stiffness. She had been previously very well with no significant past medical history.
An unusual Cause of Periorbital Swelling in a Young Female Read More
Case Outcome
Urgent Duplex ultrasound demonstrated ilio-femoral deep vein thrombosis (DVT) with involvement of the long saphenous and short saphenous superficial veins. Arterial Doppler waveforms were normal distally with no evidence of stenosis. The diagnosis was therefore Phlegmasia cerulea dolens (PCD), resulting from an extensive, proximal DVT with total or near total venous outflow occlusion.
Picture Quiz: An Acute, Blue, Swollen, Painful Leg (Answer) Read More
Case History
A 55 year old male presented to the Acute Medical Unit with a one hour history of pain and swelling of his right leg with resultant inability to weight bear. He denied any preceding history of trauma. Previous medical history was unremarkable. He was taking no regular medications, and did not use recreational drugs. There was no prior weight change, or alteration in bowel habit, no associated chest pain or dyspnoea and there were no risk factors for venous thromboembolism or arterial thrombotic disease. He was a lifelong non-smoker.
Picture Quiz: An Acute, Blue, Swollen, Painful Leg Read More
Case history
A 52-year old gentleman was referred to acute medicine by an out-of-hours general practitioner, with an unexplained ‘collapse’. The patient stated to have just ‘tripped and fallen’ with no new preceding symptoms immediately beforehand. Closer questioning revealed that he also been suffering from general malaise, shortness of breath, and five days of right upper quadrant pain and abdominal swelling. In the last six months he had lost thirtyeight kilograms in weight. He was diagnosed with a deep vein thrombosis in 1999 for which he had been treated with Warfarin. Both his parents had deep vein thromboses in their late 60s. He was a non-smoker, drank minimal alcohol and worked as a janitor. He was no longer anti-coagulated.
An Unusual Cause of Abdominal Pain and Anaemia Read More
There is no ‘gold standard’ non-invasive test to diagnose myocarditis. It is a clinico-histopathological diagnosis.1 Clinical manifestations include: heart failure, chest pain (from either pericarditis or angina from coronary artery spasm/inf lammation), sudden cardiac death and arrhythmias (sinus tachycardia, ectopics, ventricular tachycardia, heart blocks). Examination may reveal raised JVP, pulmonary crackles, a gallop rhythm or a pericardial rub.
A young patient with heart failure – Picture Quiz Answer Read More
A 28 year old gentleman presented after an episode of collapse with loss of consciousness.
He gave a history of non-specific malaise and myalgia over the previous 7 days, with fever, a generalised rash and a non productive cough. He developed progressive shortness of breath with sharp, pleuritic chest pain that was unresponsive to antibiotics in the community.
A young patient with heart failure – picture Quiz Question Read More
A 38 year old woman presented with one day history of acute onset frontal headache which progressively generalised over a few hours. The headache was dull in nature and did not respond to analgesics. A day prior to the onset of headache her family members and the patient had noticed a distinct change in the appearance of her eyes. The headache was not associated with symptoms of meningism, vomiting, seizures, syncope or loss of consciousness. She did not report any weakness in her extremities. There was no recent history of neck trauma or neck pain and no other systemic symptoms.
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A 17 year old male was referred to the Accident and Emergency department (A&E) by his GP after he had experienced an episode of palpitations associated with dyspnoea whilst attempting exercise. He did not have any past cardiac history.
Picture Quiz: A young man with palpitations Read More
Further investigations revealed a negative autoimmune screen and aspergillus preciptins, but a raised total IgE level of 350ku/l. She underwent a bronchoscopy and lavage which was negative for routine culture and acid-fast bacilli, and revealed a normal cell differential.
A traveller with haemoptysis – Answers Read More
A 22 year old woman was admitted to hospital after coughing up approximately 500ml of fresh blood. She was a lifelong non-smoker with no significant prior respiratory history; however she described coughing up a small quantity of fresh blood on one occasion during the previous year. She had also been diagnosed with chronic idiopathic urticaria one year earlier.
A traveller with haemoptysis Read More