BMJ case reports
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We present the case of a 65-year-old man with an atypical presentation of pulmonary embolism (PE) as ST elevation myocardial infarction (STEMI) with high troponin. He presented with acute exertional dyspnoea without chest pain. Since the initial ECG showed ST elevation anteroseptal (V1-V4) with concomitant deep Q waves, a delayed STEMI with probable left ventricular aneurysm was the working diagnosis and was treated accordingly. ⋯ The patient made good clinical recovery and his ST elevation resolved with anticoagulation. The source was found to be a deep vein thrombosis in his right leg. The treatment was not compromised by the delayed diagnosis as he received timely anticoagulation as part of STEMI management.
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A 49-year-old man presented to our department with an acute history of right leg tenderness, rash, swelling and fever. CT of the chest, abdomen and pelvis and a transoesophageal echocardiogram confirmed the diagnosis of mitral valve infective endocarditis with distal splenic emboli. Positive blood cultures revealed the causative organism to be Streptobacillus moniliformis. The patient was treated with high-dose antibiotics and had mitral valve replacement surgery.
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Metastases to the breast from lung cancer are rare. Carcinoma en cuirasse is an unusual form of metastatic cutaneous carcinoma, almost exclusively described as deposits secondary to breast carcinoma. A 63-year-old woman presented with dyspnoea. ⋯ The patient received docetaxel and carboplatin with initial good response. The painful lesions were subsequently treated with radiotherapy, which provided symptomatic relief. To the best of our knowledge, this is the only case of metastatic lung adenocarcinoma mimicking carcinoma en cuirasse.
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Ludwig's angina is a deep neck space infection. Unlike other abscesses elsewhere in the body, rapid progression of the disease results in serious complications such as airway oedema, distortion, total obstruction with loss of airway and death. ⋯ Radiological investigations such as ultrasound and computer tomography (CT) are commonly ordered by surgeons and emergency physicians to know the extension of disease, but airways and larynx are seldom included. We discuss the role of ultrasound in airway assessment in such critical cases to ensure safe and uncomplicated airway access.