American Journal of Medical Case Reports

This case is presented for its rarity in the presentation of this dreaded skeletal dysplasia and it is important to differentiate this skeletal dysplasia from others due to overlapping appearance of features with other dysplasia.

American Journal of Medical Case Reports. 2016, 4(1), 35-37. DOI: 10.12691/ajmcr-4-1-10
Pub. Date: February 16, 2016

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Pickering Syndrome precipitated by Angiotensin Converting Enzyme Inhibitor

by Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Robert Adrah, Abhishek Sharma and Debabrata Sen

Case Report

Pickering syndrome is an under recognised cardio-renal syndrome where life threatening flash pulmonary edema develops in the setting of diastolic dysfunction of the heart. Renal artery stenosis induced activation of sympathetic nervous system and renin-angiotensin-aldosterone system result in fluid retention; such fluid retention in the setting of diastolic dysfunction results in flash pulmonary edema. Most patients who present with pickering syndrome have normal coronary circulation and left ventricular systolic function. We here present a case of pickering syndrome that was precipitated by initiation of angiotensin converting enzyme inhibitor therapy in a patient with undiagnosed unilateral renal artery stenosis. The incidence of flash pulmonary edema decreases on revascularization of renal artery stenosis. Underlying renal artery stenosis should be suspected in a patient with recurrent flash pulmonary edema as such patients merit from revascularization of renal artery stenosis. To the best of our knowledge we are the first to report angiotensin converting enzyme inhibitors as a precipitator of pickering syndrome.

American Journal of Medical Case Reports. 2016, 4(1), 31-34. DOI: 10.12691/ajmcr-4-1-9
Pub. Date: February 03, 2016

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Clinical Significance of Inferior Right Hepatic Vein

by Xin Li, Xu Xuesong and Gong jianping

Review Article

Liver resection is the golden-standard treatment for hepatocellular carcinoma. The extent of liver resection is a balance between complete removal of tumor and the maximum preservation of tumor-free hepatic parenchyma. Bisegmentecomy 7-8 can be an alternative choice to more extensive liver resections if a thick inferior right hepatic vein (IRHV) occurs. This review briefly describes the conception of inferior right hepatic vein (IRHV) and its significant role in live hepatectomy and other clinical practice.

American Journal of Medical Case Reports. 2016, 4(1), 26-30. DOI: 10.12691/ajmcr-4-1-8
Pub. Date: February 03, 2016

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Biatrial Cardiac Myxoma: A Case Report

by Mohammad Reza AghajankhahTamijani

Case Report

A 37 years old man presented with acute ataxia and vertigo. An axial brain CT Scan without contrast showed multiple subcortical hyperdence lesions. Brain MRI with gadolinium showed multiple hyperintence lesions. Transthoracic echocardiography showed large mobile biatrial masses. Biatrial masses were resected surgically. Both tumors had the histopathological features of benign cardiac myxoma. The clinical diagnosis was multiple brain emboli from cardiac myxoma. Myxoma is a primary benign cardiac tumor with a reported incidence of 0.0017% among the general population. The patient may present with constitutional symptoms, sequelae of valvular obstruction, embolic events or sudden death. Early diagnosis and treatment of these life threatening neoplasms is the challenge for physicians. Myxomas which arise from two different cardiac chambers are uncommon.

American Journal of Medical Case Reports. 2016, 4(1), 22-25. DOI: 10.12691/ajmcr-4-1-7
Pub. Date: February 02, 2016

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Benign Fibrous Histiocytoma in a Child -A Case Report

by Diaconescu Smaranda, Moisa Stefana, Mihaila Doina, Plamadeala Petru, Ciubara Anamaria and Miron Ingrid

Case Report

Benign fibrous histiocytoma is a tumor mostly dealt with in ambulatory settings due to its often paucisimptomatic presentation and to the fact that clinicians may not always recognize its potential for metastasis and reccurence. We present the case of a 4 years old male child operated for a tumor with very atypical localization (adjacent to the sixth cervical vertebra), mobile on the underlying and overlying structures, with no other abnormalities of the clinical examination. No biochemical anomalies were present, except for a mild iron deficiency. No predisposing factors (trauma, insect bites or vaccines) were noted during anamnesis. Postoperative evolution was favorable, with no recurrences over a 3 year follow-up period.

American Journal of Medical Case Reports. 2016, 4(1), 19-21. DOI: 10.12691/ajmcr-4-1-6
Pub. Date: January 22, 2016

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A Case of Periprocedural Discontinuation of Apixaban Resulting in Intra-aortic Thrombosis

by Sabu John, Pramod Theetha Kariyanna, Jonathan Marmur, Kamal Preet Singh and Mary Mallappallil

Original Research

Apixaban, a novel oral anticoagulant is approved for anticoagulation in non-valvular atrial fibrillation. Apixaban is found to be superior to warfarin in prevention of stroke and thromboembolism and is associated with lesser risk of bleeding. Peri-procedural discontinuation of apixaban is safe, but the risk of thrombosis exists. We here present a case of arterial thrombosis that lead to lower limb ischemia upon periprocedural discontinuation of apixaban.

American Journal of Medical Case Reports. 2016, 4(1), 16-18. DOI: 10.12691/ajmcr-4-1-5
Pub. Date: January 21, 2016

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Acute Type A Aortic Dissection with the Presentation of Right Shoulder Pain

by Mohammad Mostafa Ansari-Ramandi, Samaneh Ansari-Ramandi and Mahdi Motaie

Case Report

Introduction: Although aortic dissection is not common but its outcome is frequently fatal, and many patients with aortic dissection die before getting to the hospital or any diagnostic testing. The symptoms of aortic dissection can be similar myocardial ischemia, and physical findings in the physical examination of aortic dissection may be absent. Case presentation: A 59 years old male referred to our hospital with right shoulder pain from 3 days before for evaluation of acute coronary syndrome. He had a history of Coronary artery bypass grafting 3 years before and hypertension from 20 years before. On presentation to our hospital he had stable vital signs. In electrocardiography he had T inversion in leads I, avL and v4-v6 which were new changes with respect to his previous electrocardiography. On physical examination he had an early to mid-diastolic murmur in the right sternal border. On transthoracic echocardiography suspicious flap of dissection was seen in the ascending aorta and CT angiography was done for the patient which confirmed the diagnosis. Discussion: In the case presented a catastrophic condition with high mortality has been presented to our hospital with an unusual symptom of the disease and further evaluation with regards to our physical examination has led us to find the diagnosis and have prompt treatment for the patient. Conclusion: It is of great importance to have great clinical suspicion for aortic dissection in patients referring to the hospital with predisposing factors.

American Journal of Medical Case Reports. 2016, 4(1), 12-15. DOI: 10.12691/ajmcr-4-1-4
Pub. Date: January 12, 2016

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A Rare Presentation of Medullary Carcinoma Thyroid

by Balakrishnan valliyot, Saroshkumar KK, Sarin SM, Kadeeja beevi B, Nirmal mathew alex and Tency joshu thomas

Case Report

Medullary Thyroid Carcinoma (MTC) is a rare thyroid tumor that arises from neural crest-derived Calcitonin producing Para follicular C cells and accounts for approximately 4 % of thyroid malignancies. This neuroendocrine tumor typically is an aggressive cancer, with secretion of several neuro-humoral mediators. We report a case of 49 year old male patient who presented with episodes of chest discomfort and abdominal pain associated with loud screaming of unknown etiology, on evaluation found to have Medullary Thyroid Carcinoma as its cause. MTC usually present as palpable firm to hard thyroid nodules or enlargement of regional lymph nodes. Since the systemic symptoms of MTC are nonspecific, it is challenging to diagnose MTC when patients first presents with systemic symptoms as in our patient. This case is reported to highlight the unusual presentation of this rare thyroid tumor and to emphasize the need for meticulous clinical examination and high index of suspicion to diagnose it.

American Journal of Medical Case Reports. 2016, 4(1), 8-11. DOI: 10.12691/ajmcr-4-1-3
Pub. Date: January 08, 2016

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A Successfully Treated Case of Aspergillus Flavus Fungal Keratitis Caused by Stale Bread Corneal Injury

by Tariq Debasi, Abdulkareem M. Al Bekairy, Abdulmalik M. Alkatheri, Yazeed A. Al-Ferayan, Abdullmajeed S. Al-Fakhri and Thamer Alenazi

Case Report

Fungal keratitis is difficult to treat that can result in corneal blindness requiring penetrating keratoplasty and in fungal endophthalmitis. We report a case of fungal keratitis following a recent eye trauma by stale bread particle. Ophthalmological and Microbiological investigation revealed a fungal keratitis with aspergillus flavus. The case was successfully treated with oral antifungal (voriconazole), and combination of topical antifungal medications. The patient responded well to the antifungal treatment and gain 20/20 vision with complete resolution of the fungal keratitis and absence of recurrence. Early presentation and diagnosis are the key factor toward successful management of fungal keratitis.

American Journal of Medical Case Reports. 2016, 4(1), 5-7. DOI: 10.12691/ajmcr-4-1-2
Pub. Date: January 07, 2016

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A Unique Case of Bilateral Frontal Lobe Abscesses in a Young Male

by Mary Mathews, Yousef Botros, Ariel Fromowitz, Alex Riss, Ali Zahran and Michael Lange

Case Report

A brain abscess is a serious complication that may arise from a source of infection from within the cranium or from an extracranial source. We discuss a unique case of a 36 year-old male with a history of heroin abuse who presented with pan-sinusitis and bilateral frontal lobe abscesses. The patient presented with the symptoms of prolonged drowsiness and a left eyelid infection for which he was already receiving treatment. He had a normal neurological exam upon admission. CT scan of the head was performed which showed left orbital cellulitis, pan-sinusitis, and bilateral frontal lobe abscesses. A follow-up MRI was performed as well which showed cerebral edema. The patient was started on broad spectrum antibiotics, and neurosurgical aspiration and drainage of the abscesses was performed. Microbiological culture results enabled us to narrow the spectrum of the antibiotics. The patient completed his course of antibiotics. At a follow up exam 6 weeks later, the patient had no neurological deficits, and the abscesses seemed to be improving as seen in the imaging.

American Journal of Medical Case Reports. 2016, 4(1), 1-4. DOI: 10.12691/ajmcr-4-1-1
Pub. Date: January 05, 2016

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