BMJ case reports
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Case Reports
Midgut malrotation presenting with left-sided acute appendicitis and CT inversion sign.
In patients presenting with abdominal pain, appendicitis is the most common surgical disorder. Appendicitis causing pain in the left lower quadrant is extremely rare and can occur with congenital abnormalities that include true left-sided appendix or as an atypical presentation of right-sided long appendix, which projects into the left lower quadrant. We report a case of a 69-year-old man showing midgut malrotation with acute appendicitis presenting as left lower quadrant abdominal pain.
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A 1-year-old child with no pre-existing cardiac or respiratory disease developed frank pulmonary oedema after administration of a neostigmine-glycopyrrolate mixture to reverse neuromuscular blockade during general anaesthesia. Possible cardiac and extra-cardiac factors that could cause pulmonary oedema in this child were ruled out by appropriate investigations. As the pulmonary oedema manifested shortly after administration of the neostigmine-glycopyrrolate mixture, we concluded that neostigmine was the most probable cause. This article briefly reports the occurrence of events and successful management of perioperative pulmonary oedema.
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We report a previously well 9-year-old boy who presented with an acutely swollen left arm after horse riding. Left subclavian vein thrombosis was demonstrated by MR venography but there was no evidence of an underlying anatomical abnormality. ⋯ In this case and literature review, we demonstrate that individuals with effort-induced UEDVT show demographic characteristics and presenting features that are distinct from other patient groups with venous thromboembolic disease. We also highlight the difficulties in counselling affected individuals about modifying occupational and recreational activities to minimise the risk of recurrent thrombosis.
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Case Reports
Lung ultrasound-guided emergency pneumothorax needle aspiration in a very preterm infant.
Pneumothorax is a frequent critical situation in the neonatal intensive care unit. Diagnosis relies on clinical judgement, transillumination and chest radiogram. We report the case of a very preterm infant suddenly developing significant and persistent desaturation and bradycardia. ⋯ A lung ultrasound scan showed evidence of right pneumothorax that was promptly aspirated. Approximately 20 min later, a chest radiogram confirmed the ultrasound diagnosis. Point-of-care lung ultrasound is a useful tool for detecting symptomatic pneumothorax and accelerating its treatment.
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We report the rare case of a 75-year-old man who was hospitalised following referral by his general practitioner with a 4-day history of worsening groin pain. Initial radiographs demonstrated an isolated avulsion fracture of the lesser trochanter. ⋯ Further investigation revealed a renal mass almost certainly consistent with a renal cell carcinoma. This case emphasises the importance of having a high index of suspicion for neoplastic pathology when low impact injuries result in fractures.