BMJ case reports
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We present the case of a 22-year-old primigravida with symptoms of neck swelling and difficulty breathing 3 hours after uneventful vaginal delivery. On examination, there was surgical emphysema. A CT scan confirmed air in the subcutaneous tissues and also revealed pneumomediastinum. ⋯ Pneumomediastinum is one of the rare causes of shortness of breath and chest pain during the postpartum period, and it should be considered in the differential diagnosis. Despite the significant abnormalities seen on plain radiography and CT scan, this condition spontaneously resolves. Although postpartum pneumomediastinum has been related to prolonged labour, this was not the case in our patient.
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Omental infarction in adults is a rarely occurring phenomenon, with left-sided omental infarction being even more seldom. The importance of this case report lies in raising awareness of the diagnosis omental infarction as a cause of acute abdomen among doctors who work in the emergency department, in order to prevent unnecessary surgical interventions as conservative treatment generally solves the problem. ⋯ Because of the rich vasculature of the greater omentum, anastomoses reorganise the vascularisation, which explains the mostly benign course of omental infarction. By adding omental infarction to the list of differential diagnoses in patients who present with acute abdominal pain, future management of patients with an acute abdomen can be adjusted for the optimal approach to not overlook any surgery-requiring diagnosis as well as to prevent overtreatment.
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Patent blue is one of the most used dyes for the identification of sentinel lymph nodes in breast cancer. This report describes a case of an anaphylactic shock reaction to patent blue dye in a patient with cross-reactivity to methylene blue. Therefore, after allergy confirmation, the operation was repeated avoiding blue dye and an alternative labelling technique with 99mTc albumin nanocolloids was used.
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Platypnoea Orthodeoxia syndrome is defined by dyspnoea and hypoxaemia exacerbated by orthostatic positioning and alleviated in recumbency. This condition has been reported in association with pulmonary, hepatic and cardiac disease. ⋯ A Patent Foramen Ovale (PFO) with a right to left shunt was evident on echocardiogram employing colour doppler and agitated normal saline studies. Definitive management, with closure of the patent foramen ovale lead to a complete resolution of symptoms and normalisation of arterial blood gas parameters in both the supine and erect positions.
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Case Reports
Case of idiopathic isolated unilateral hypoglossal nerve palsy with spontaneous recovery.
Isolated hypoglossal nerve palsy is uncommon because of its intimate relationship with the other lower cranial nerves. Keane reported that tumours, predominantly malignant, were the most common cause of hypoglossal nerve palsy. We report a case of isolated idiopathic unilateral hypoglossal nerve palsy in a 45-year-old Caucasian male where no cause could be identified despite extensive investigations. ⋯ In the absence of a cause, an early referral to the speech and language therapist was made and interestingly our patient made an almost complete recovery within 18 months of onset. In a small case series, it has been reported that though rare, idiopathic hypoglossal nerve palsy has an excellent outcome in most cases, similar to the more common idiopathic seventh cranial nerve palsy (Bell's Palsy). We recommend an early referral for physiotherapy in such cases.