BMJ case reports
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Case Reports
Successful low-dose spinal anaesthesia for lower segment caesarean section in a patient with Takayasu arteritis.
Takayasu arteritis is a rare, chronic idiopathic, occlusive inflammation of the aorta and its major branches. It is a rare form of non-specific obliterative panarteritis of unknown aetiology. ⋯ We report a 26-year-old woman multigravida who was diagnosed with Takayasu arteritis who underwent an emergency caesarean section under spinal anaesthesia. In this case study, the whole course of anaesthesia and operation was uneventful due to thorough systemic evaluation and planned anaesthetic management.
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The authors present the case of an 11-year-old boy with pharyngitis, treated with amoxicillin, that worsened on day 7, with cough, high fever and refusal to eat. Lethargy and respiratory distress were noted. Based on radiographic findings of bilateral infiltrates he was diagnosed with pneumonia and started on intravenous ampicillin and erythromycin. ⋯ A neck CT-scan showed a large parapharyngeal abscess. His clinical condition improved gradually and after 3 weeks of intravenous antibiotics he was discharged home on oral treatment. This case illustrates the importance of diagnosing Lemierre syndrome in the presence of pharyngitis with localised neck pain and respiratory distress, to prevent potentially fatal complications.
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Spontaneous intracranial hypotension (SIH) is a syndrome of low pressure headache associated with low CSF pressure. The condition is generally considered benign but extreme cases of SIH can lead to changes in the level of consciousness. We describe a case in which alteration in the level of consciousness was prolonged and severe, and could not be explained solely by the presence of subdural collections. MRI of the brain showed evidence of impaired venous flow secondary to brain sagging causing distortion of deep venous structures.
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Pancreaticopleural fistula (PPF) is an uncommon complication of chronic pancreatitis leading to a large and recurrent pleural effusion. Since the patients presented predominantly with respiratory symptoms, diagnosis and treatment were often delayed. ⋯ Multidetector CT is an easily accessible method that is able to show both the thoracic and abdominal findings non-invasively. The clinical and imaging features of this unusual entity are discussed.
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We describe a 73-year-old man with Crohn's disease and previous sternotomies, who developed Salmonella sternoclavicular osteomyelitis subsequent to a Salmonella enteritidis sepsis and closed fracture of his clavicle. We include evidence from several cases related to sternoclavicular osteomyelitis, and Salmonella osteomyelitis. We continue by summarising the aetologies of these diseases, and risk factors that predispose to them.