Rare cause of a common symptom: primary cardiac lymphoma Aiyah Jandali, Amjad Kabach, Shadi Al halabi, M. Chadi Alraies
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.068
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: May 1 2015
x Cardiac tumors may be symptomatic or found incidentally during evaluation for a seemingly unrelated problem or physical finding. Because symptoms may mimic other cardiac conditions, the clinical challenge is to consider the possibility of a cardiac tumor so that the appropriate diagnostic test(s) can be conducted. In this case, we describe an exceedingly rare cardiac tumor.
Sonographic evidence of spontaneous pneumomediastinum Lorraine Ng, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Spontaneous pneumomediastinum (SPM) is defined as a non-traumatic air leak from alveolar, bronchial or esophageal rupture along vascular sheaths and tissue planes into the mediastinum due to increased pressure in the trachea, bronchi, alveoli or esophagus [1]. SPM is rare in children, with a bimodal incidence peaking in children less than 7 years of age and then again in adolescence [1]. Historically, the diagnosis of SPM is made with physical examination findings and chest radiography.
Esophageal rupture diagnosed with bedside ultrasound Charlotte Derr, Jessica Maloney Drake
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.036
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 2 2012
x A 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. The inability to visualize the heart in the normal cardiac windows suggested a diagnosis of pneumopericardium. Based upon the patient's presenting symptoms and ultrasound findings, an esophageal perforation was suspected.
The cardiac literature 2010 Amal Mattu, Michael C. Bond, Semhar Z. Tewelde, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.023
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: May 2 2011
x A. Pokorna M, Necas E, Kratochvil J, et al. A sudden increase in partial pressure end-tidal carbon dioxide (PET CO2 ) at the moment of return of spontaneous circulation. J Emerg Med 2010;38:614-621 .
The spontaneous pneumopyopericardium simultaneously masquerading as acute myocardial infarction and surgical abdomen: a case report Weiping Zhang, Xiaojun Bai, Xiaolin Xue
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.012
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: June 13 2014
x Pneumopyopericardium is a rare disease, presenting clinically as a spectrum of acute myocardial infarction or severe surgical abdomen, which includes various symptoms and changes in cardiac enzymes and electrocardiogram. Here, we report a case of pneumopyopericardium in a 61-year-old male farmer in China. An early diagnosis of pneumopyopericardium was difficult due to his acute myocardial infarction– and severe surgical abdomen–like symptoms and signs. The electrocardiogram, esophagogram, and chest computed tomographic scan commonly revealed pericardial fluid and air and excluded a gastrointestinal perforation in late stage of severe inflammation.
An electrocardiographic sign of tumor invasion of the myocardium Francisco J. Toledano, José Suárez de Lezo, José Segura, Javier Suárez de Lezo, Dolores Mesa
DOI: http://dx.doi.org/10.1016/j.ajem.2011.10.010
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: December 26 2011
x Lung cancer is one of the most common neoplasms associated with cardiac metastasis, and the pericardium is often affected. However, isolated myocardial involvement in these patients is very uncommon. Most tumor invasions into the heart are nonspecific and clinically silent. Myocardial metastasis rarely mimics an acute myocardial infarction. We report a case of a 59-year-old man with a metastatic lung cancer into the myocardium mimicking an acute myocardial infarction.
Resuscitative thoracotomy for nontraumatic pericardial tamponade: case reports and review of the literature Keith A. Corl, Wade N. Sears, Shea C. Gregg, David G. Lindquist
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.015
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: September 18 2014
x Nontraumatic cardiac tamponade is a life-threatening process, and pericardiocentesis is the established treatment designed to relieve tamponade physiology during a cardiac arrest. We report 2 cases, where after traditional resuscitation including serial pericardiocentesis failed, a resuscitative thoracotomy was performed.
Utility of point-of-care ultrasound in acute management triage of earthquake injury Shu Zhang, Da Zhu, Zhi Wan, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.009
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x Earthquake could leads to massive casualty and injury in a short period [1-3]. Rapid screening and proper initial management and transfer triage are critical for improving survival during earthquake [1,4,5]. Point-of-care (POC) ultrasound is a newly diagnostic method that has been widely applied during emergency practice [6,7]. Several reports have shown the potential role of POC ultrasound in evaluation earthquake injury [8-10]. In April 20, 2013, a 7.3 magnitude earthquake struck the Sichuan Lu-Shan city (Epicenter location), causing more than 200 deaths and 10 000 injuries.
Clinical utility of cardiovascular magnetic resonance imaging after out-of-hospital cardiac arrest Edward T.D. Hoey, Jun K. Teoh, Vijayabhaskar Pakala, Helen Simpson, Richard W. Watkin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.014
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: May 22 2013
x Cardiovascular magnetic resonance imaging (MRI) is the reference technique for assessment of structural heart disease including cardiomyopathies and cardiac masses. It has a number of advantages over echocardiography including an unrestricted field of view and excellent soft tissue resolution, which enables accurate identification of myocardial based pathology. We present a case in which cardiovascular MRI was integral to establishing the cause of out-of-hospital cardiac arrest secondary to an intramyocardial metastasis.
Wearing the mask of ST-elevation myocardial infarction: postpericardiotomy syndrome Rajendrakumar C. Patel, Hemant Goyal, Ahmed I. Shah, Jalal K. Ghali
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: February 2 2015
x Postpericardiotomy syndrome (PPS) is an inflammatory process, affecting 15% to 20% of patients, after surgery involving pleura, pericardium, or both. The role of electrocardiogram (ECG) in diagnosing PPS is uncertain because ECG is rarely normal (especially after cardiac surgery). We report a case of PPS that presented initially with localized ST-segment elevation and also discuss proposed mechanisms.
The value of prehospital echocardiography in shock management Pierre-Marie Brun, Hichem Chenaitia, Jonathan Gonzva, Jacques Bessereau, Xavier Bobbia, Michael Peyrol, WINFOCUS (World Interactive Network Focused On Critical UltraSound) Group France
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.021
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: August 6 2012
x Establishing the cause is a key part of prehospital management of shock. It is essential to determine whether the condition is of cardiac or noncardiac origin. Herein, we discuss the case of a patient undergoing prehospital management of acute dyspnea associated with shock. Transthoracic echocardiography (TTE) at the bedside allowed early diagnosis of tamponade due to hemopericardium resulting from overdose of vitamin K antagonists (VKAs). Prehospital TTE, which can be performed at the bedside for patients with unstable hemodynamic status, constitutes a precious tool in establishing the diagnosis, adjusting therapy, and directing patients quickly toward the appropriate hospital department.
Streamlined focused assessment with sonography for mass casualty prehospital triage of blunt torso trauma patients Hai Hu, Yarong He, Shu Zhang, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.014
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: March 20 2014
x Without prompt medical attention and often expedient emergency surgery, earthquake victims having blunt torso trauma will experience increased mortality [1]. Rapid identification of necessary emergent medical vs surgical interventions is critically important. Accurate triage is a necessity, particularly with limited medical resources in the chaos after a mass casualty event. The Simple Triage and Rapid Treatment (START) triage method [2] sorts patients into 4 colored tag categories, dependent upon respiratory rate, perfusion (presence of radial pulse and capillary refill time), and mental status (response to commands): red (critically ill patients requiring immediate medical care), yellow (patients in urgent condition, which may receive delayed medical care), green (patients having minor injuries), and black (patients deceased or expectantly soon to be deceased) (Fig. 1).
Luxatio cordis—surgical treatment followed by venovenous extracorporal membrane oxygenation F. Rademacher, J. Reichert, T.A. Schildhauer, J. Swol
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.008
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x We report about a 54-year-old male patient who was involved in a motorcycle accident. On day 15 after trauma, a tension pneumothorax was suspected based on radiography because of the right-side shift of the heart. A computer tomographic scan detected a pneumothorax on the left side and pneumopericardium. A chest drain was inserted on the left side. The postinterventional radiograph showed a further dislocation of the heart to the right side. The diagnosis of luxatio cordis was suspected. The patient was taken into the operating theater in a hemodynamic stable state.
The fifth chamber of the heart: huge left atrial aneurysm Hsiao-Feng Hu, Tsun-Hou Chang, Chien-Sheng Chen, Sy-Jou Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.035
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: August 22 2011
x Cardiomegaly is a common but nonspecific finding in the emergency department. The etiology may be explained by left ventricular dilation, biventricular dilation, right ventricular dilation, or pericardial abnormalities, or it may be found to be spurious on the echocardiogram. Rarely, isolated abnormalities of the atrium, particularly the left atrium, may cause abnormalities on the chest radiograph but will not cause true cardiomegaly. We reported a 37-year-old woman who presented with persistent palpitation of a 6-hour duration.
Electrical alternans as a manifestation of pulmonary embolism Kyle B. Nichols, Laszlo Littmann
DOI: http://dx.doi.org/10.1016/j.ajem.2010.09.016
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: October 22 2010
x In acutely ill patients, electrical alternans is an important electrocardiographic finding because it typically indicates large pericardial effusion and possible cardiac tamponade [1]. In cardiac tamponade, electrical alternans is due to a 2:1 pendular rotation of the heart within the fluid-filled pericardial sac [2]. In addition to the mechanical alternation seen in pericardial effusion, electrical alternans may be due to alternation of cardiac depolarization, usually in association with ischemia or severe tachycardia [3].
ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis Johanna E. Bischof, Christine Worrall, Peter Thompson, David Marti, Stephen W. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.035
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x ST-segment elevation (STE) due to inferior STE myocardial infarction (STEMI) may be misdiagnosed as pericarditis. Conversely, this less life-threatening etiology of ST elevation may be confused for inferior STEMI. We sought to determine if the presence of any ST-segment depression in lead aVL would differentiate inferior STEMI from pericarditis.
Diagnosing poststernotomy mediastinitis in the ED Jan J. van Wingerden, Mario Maas, Richard L. Braam, Bas A. de Mol
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.048
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 21 2015
x Poststernotomy mediastinitis (PSM), the severe chest wall and mediastinal infection that may arise at any time after a sternotomy, causes significant morbidity and mortality globally. Late recognition and diagnosis are the major contributors to a poor outcome. This review focuses on recent advances in diagnosing PSM (particularly after cardiovascular surgery) at the earliest opportunity—in the emergency department.
Pneumomediastinum caused by isolated oral-facial trauma Gerard DeMers, Jacob L. Camp, Donald Bennett
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.022
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: August 16 2010
x Pneumomediastinum from isolated blunt or penetrating oral-facial trauma is a rare occurrence, which can be associated with facial fractures or may be iatrogenic. We present two cases caused by high-pressure-induced facial injuries that had very different management and outcomes. The first patient had asymptomatic pneumomediastinum and an uncomplicated recovery, whereas the second had a complicated clinical course requiring extensive surgical debridement. Neither patient developed mediastinitis as a complication of pneumomediastinum.
Use of intra-aortic balloon pump support for oozing-type cardiac rupture after acute myocardial infarction Zhi-Ping Zhang, Xi Su, Cheng-Wei Liu, Dan Song, Jian Peng, Ming-Xiang Wu, Yu-Chun Yang, Bo Liu, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.054
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: June 13 2015
x Left ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day.
Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma Huai-min Liang, Qiu-lin Chen, Er-yong Zhang, Jia Hu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.075
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: July 29 2015
x Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62% [1]. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000 [2]. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.
