Year 2020, Volume 4 - Issue 10

Background: Heart diseases are the most common diseases worldwide which cause significant morbidity and mortality. Bradycardia comes under the category of heart diseases and is more common in the elderly. Bradycardia is defined as “heart rate of less than 60 beats per minute (bpm)”. There is a wide range of causes of bradycardia and the road to diagnosis includes extensive investigations. Case Presentation: Here we present the case of a 71-year-old male who presented with a history of dizzy spells, easy fatigueability, syncopal attacks, and memory impairment for 3 months prior to admission. On investigation, his complete blood counts, liver function tests, renal function tests, serum electrolytes, and urine routine examination were normal. His thyroid function tests were also normal. Electrocardiogram showed sinus bradycardia with pauses. Echocardiography was also normal. Holter monitoring showed multiple sinus pauses of 3.15 seconds average. Conclusion: We made a diagnosis of cardiogenic dementia due to sinus node dysfunction. The patient underwent permanent pacemaker implantation therapy and his symptoms improved. Our case highlights the importance of early diagnosis of the culprit disease and early intervention to prevent further complications.

Background: Post-ischemic ventricular rupture is a rare late complication of acute myocardial infarction and despite improvements in diagnosis, in medical and surgical treatment; it is still associated with a high mortality rate. Case Presentation: We present a case of septal rupture in a patient with an asymptomatic inferior STEMI, whose clinical examination was significant only for a systolic heart murmur. Diagnosis was made in the Emergency Department, about 6 hours from triage and about 1 hour from first medical evaluation. A multidisciplinary team managed the patient, who underwent an emercency PCI and reperfusion and then a late surgery at day 8 from diagnosis. Conclusion: Although it is a rare event, septal rupture is a life-threatening event and should be suspected in patients with myocardial infarction when a rapid hemodynamic deterioration, heart murmur, or right ventricle overload is observed. Bedside echocardiography allows early diagnosis and the management of the patient.

Background: Aspergillosis is an infection caused by a common mold (type of fungus) named Aspergillus. Its spores are present in air but usually do not cause any disease in immune-competent people. However, it can cause various types of diseases, which most commonly involve the respiratory system. Early recognition and treatment are important for better outcomes. Case Presentation: A middle-aged diabetic male presented with high blood glucose levels leading to hyperosmolar hyperglycemic non-ketotic coma and was treated accordingly. His baseline chest X-ray showed reticulo-nodular shadowing and cavitatory lesion in left middle zone and was being treated on the lines of pneumonia. After 4 days of treatment, the patient did not improve and had had contrast enhanced CT-scan chest showing a reverse halo sign along with a fungal ball in the lung cavity. His white blood cells were increased, erythrocyte sedimentation rate was normal, and sputum for acid-fast bacilli was negative, but positive for Aspergillus species. Conclusion: Diagnosis of pulmonary aspergillosis was made and the patient was managed accordingly with intravenous antifungal therapy. Early diagnosis and treatment is necessary.

Background: Cemento-ossifying fibroma (COF) is a relatively rare benign nonodontogenic fibro-osseous lesion, which arises from the mesenchymal blast cells of the periodontal ligament and involves immature bone trabeculae and cementoid formations. Case Presentation: A 45-year-old female patient presented with a unilocular lesion placed in the posterior region of the mandible. Uniform, rounded swelling was present in the buccal vestibule of the mandible. Clinical, radiologic, and histologic features of COF are discussed in this article. Conclusion: Although the COF etiology is not exact as yet, clinicians may keep in mind that tooth extraction history may accompany COF, as seen in this case.

Background: 99mTc-Methylene diphosphonate (MDP) bone scan of a patient with known breast carcinoma showed a solitary osteoblastic lesion in the femoral head. Solitary bone metastatic lesion and a benign cause-like remodeling phase of avascular necrosis (AVN) were the top most differential diagnoses and therefore can easily be misinterpreted for each other. Magnetic resonance imaging (MRI) is considered as the gold standard for diagnosis of AVN and can help in differentiation between AVN and skeletal metastasis. Case Presentation: A 40-year-old female patient of right breast carcinoma, treated with mastectomy, chemotherapy, and radiotherapy underwent 99mTc-MDP bone scintigraphy for pain in left hip with restricted movements. The bone scan showed focal uptake in the head of left femur with suspicion of AVN, which turned out to be a metastatic lesion on MRI. Later on, longitudinal follow-up of bone scan after 1 year showed a lesion in the left femoral head extending up to the trochanteric region with additional new lesions confirming skeletal metastasis. Conclusion: Solitary skeletal metastatic lesion in the head of femur is a rare finding, although in the presence of local symptoms AVN always remains at the top of the list for differential diagnosis of solitary osteoblastic focus in the femoral head. Bone scan is a primary tool for skeletal metastatic survey due to high sensitivity but due to low pathognomonic specificity, additional imaging with MRI must be considered as a safe, non-invasive, and easily available option for further characterization of solitary lesions.

Background: Two male patients, one with small cell lung cancer and one with squamous cell lung cancer, presented within a few days of each other with incidental pneumothoraces on their routine staging computed tomograms. Case Presentation: Both patients were sent to the accident and emergency from the radiology department. The patient with small cell lung cancer was seen out of hours, had a chest drain, and was admitted. The drain fell out with resultant extensive surgical emphysema. Specialist pleural advice was sought and instead of further interventions, simple observation in a place of safety enabled resolution of the pneumothorax, the surgical emphysema and symptoms. The second patient was seen within working hours with specialist pleural advice: simple observation over time allowed resolution of symptoms. Conclusion: We hence describe the harm that a chest drain performed out of hours caused harm.

Background: The most common cause of a spinal accessory nerve (SAN) lesion is iatrogenic injuries that occur during operations on the posterior cervical triangle of the neck. Dorsal scapular nerve (DSN) lesions occur rarely and are usually caused by compression of the nerve by the hypertrophic middle scalene muscle or stretching of the nerve as a result of traumatic movements. Case Presentation: We present a case with SAN and DSN lesions due to neck surgery because it is a rare case and we think it will contribute to the literature. To the best of our knowledge, this is the first presentation of a case of iatrogenic injury to both the SAN and DSN. As a result of the examination and evaluation by ultrasonography of the patient, we suspected the accompanying DSN lesion and confirmed it with electromyography (EMG) examination. Conclusion: Musculoskeletal ultrasound can be used as an assistive or alternative technique for EMG examination in the diagnosis of chronic peripheral nerve lesions by measuring muscle thickness.

Background: Idiopathic Atrophoderma of Pasini and Pierini (IAPP) is a rare dermatological disease that has histopathological and epidemiological differences from morphea and linear atrophoderma of Moulin. Case Presentation: This is the first case, to the authors’ knowledge, describing multiple systemic arterial aneurysms in a patient with IAPP. Conclusion: More longitudinal studies are needed for patients with IAPP to determine if patients with congenital IAPP inherit a risk of developing arterial aneurysms later in life.

Background: Femoral neuropathy is a clinical condition that may be associated with a wide variety of etiologies and may cause severe walking difficulties. Symptoms and signs of femoral neuropathy vary depending on the severity and level of the lesion. Clinical examination, electrophysiological studies, and radiological evaluation are very important in diagnosis. Treatment is planned according to the symptoms and the underlying cause, and surgical or conservative approaches can be applied. Case Presentation: A 39-year-old man presented with weakness and thinning in the right leg and numbness, burning, and tingling in the medial of the right lower extremity. A diagnosis of idiopathic femoral nerve neuropathy was made as a result of neurological examination, electrophysiological, and radiological evaluations. Conclusion: Isolated femoral neuropathy is a rare condition that can be misdiagnosed and may result in treatment delays and permanent damage. Clinicians must be aware of this clinical picture.

Background: Physiologic periostitis (PP) is characterized by periosteal reaction without any inflammatory condition, and with a more common presentation in pediatric age group involving long bones. It can easily be misinterpreted for a pathological process due to asymmetrical presentation in some cases. 99mTc-methylene diphosphonate (MDP) bone scintigraphy is one of the effective tools for its diagnosis as it helps to localize multiple lesions in the whole skeleton. Case Presentation: A male child, 1 month of age, was referred to the nuclear medicine department of our hospital with swelling involving the right hip for 2 weeks with no history of fever and trauma. There was a mild skin discoloration at the site of swelling along with restricted leg movements. The 99mTc-MDP bone scan (BS) showed abnormal increased uptake in the proximal and distal ends of the right femur along with increased uptake in proximal right humerus. X-ray images showed periosteal reaction involving diaphyseal ends of respective long bones, and these findings together with the patient’s history and normal biochemical profile suggested the presence of PP in this case. The patient’s condition was improved later after treatment with non-steroidal antiinflammatory drugs (NSAIDs), thus confirming our diagnosis. Conclusion: PP is one of the differential diagnoses in children presenting with pain or swelling in upper or lower limbs. As the condition is self-limiting, it is important to accurately diagnose this condition before subjecting the child to vigorous testing and treatments. Exceptional behavior of this condition on BS should also be kept in mind.