Omair Ali

Platypnea orthodeoxia: a ‘laid-back’ case of dyspnoea

A man with end-stage liver disease who presented with shortness of breath. He exhibited clinical platypnea (worsening shortness of breath on sitting up) and orthodeoxia (oxygen desaturation on sitting up). Follow-up investigations led to the diagnosis of hepatopulmonary syndrome.

Bedside cardiac testing in acute cor pulmonale

We present a case where an ECG and echocardiogram suggested pulmonary embolism and early treatment led to a positive outcome.

A hiding in the lining: painful pericardial cyst

A pericardial cyst is a rare and benign congenital malformation, usually discovered in the third or fourth decade of life. Its clinical presentation is variable, as it may be asymptomatic or present with chest pain, shortness of breath, or rarely with cardiac tamponade and arrhythmias. We present an interesting case of a woman presenting with chest pain who was found to have a pericardial cyst.

Anomalous venous circuit: a detour to the heart

We report a case of a complicated vascular access secondary to systemic venous defects, which have not been previously reported. Evaluation revealed an atypical coursing of a subclavian vein-persistent superior vena caval system into the hemizygos–azygos system and ultimately into the right (proper) superior vena cava. The clinical and surgical considerations of such an anomaly are discussed therein. We look at embryological origins of such a merger and share our experience in troubleshooting through the anomaly.

THE DIRECT EFFECTS OF NIFEDIPINE ON CHOLESTEROL CRYSTALLIZATION AND VULNERABLE PLAQUE’S

We have previously demonstrated that cholesterol expands when crystallizing from a liquid to a solid state forming sharp tipped crystals that can tear fibrous membranes. This model might provide insight into the mechanism of plaque rupture.The present study evaluated the potential direct effects of

Xanthogranulomatous cholecystitis mimicking gallbladder cancer

Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.

Out in the cold: the hypothermic heart response

We present an interesting case of a 49-year-old woman with hypothermia and associated Osborn waves (also called J waves) on ECG. She was found on the floor of her home and difficult to arouse. On arrival to the emergency department (ED), her rectal temperature was 87.5°F. ECG showed Osborn waves in diffuse leads. She was intubated in the ED and was started on vasopressor support for hypotension refractory to intravenous fluid boluses. She was transferred to the critical care unit for continued respiratory and cardiovascular support. With active external rewarming her core body temperature continued to improve. Blood pressure also improved and vasopressor was tapered off. She was extubated and was transferred to the medical floor for continued supportive care. Osborn waves on ECG resolved within 12 h of achieving normal range body temperature. The patient was eventually discharged home with medical follow-up.

A Case of Primary Cardiac Sarcoma

Primary cardiac sarcomas are extremely rare tumors of the heart with a very poor prognosis. The treatment of choice of these rare tumors is complete excision of the tumor but it is dependent upon the stage and the extent of infiltration at presentation. We present to you two cases of Primary Cardiac Sarcoma with features of a presumed pulmonary embolism which was ruled out by investigations but did reveal a large pericardial effusion and disturbed contours of the heart in Case 1. The initial differential diagnoses included Cardiac Sarcoma, Malignant Sarcoma, Lymphoma and melanoma; but cardiac biopsy proved that it was a Cardiac Sarcoma. In our second case we present an old man with initial presenting symptoms of a worsening flu shortness of breath and shoulder pain later confirmed after investigations as Primary cardiac sarcoma. The patients were treated by excision of the tumor. Currently aggressive treatment with complete excision of the Primary Cardiac Sarcomas seems to be the best available treatment option for an otherwise fatal disease.

Acute pre-renal failure: acquired chloride diarrhea after bowel resection

A 58-year old male with a history of small bowel resection and ileostomy presented with severe dehydration and high ostomy output. Laboratory investigation indicated hypochloremia, hypokalemia, hyponatremia, metabolic alkalosis, chloride-rich diarrhea, acute renal failure, and low urinary chloride excretion. Due to striking similarities to congenital chloridorrhea (CCD) reported in neonates, we empirically diagnosed acquired chloridorrhea (ACD, chloride diarrhea). This is a rare disorder resulting in profuse chloride-rich diarrhea and classic metabolic derangements affecting adults with chronic intestinal inflammation, often in association with bowel surgery. In this report, we review the relevant literature and discuss the genetic defects likely contributing to both the congenital and acquired forms of chloridorrhea.

Trapdoor ischaemia: coronary ostial occlusion by an aortic dissection.

We present an interesting case of an elderly man with acute myocardial infarction due to retrograde dissection of the aortic root occluding the coronary ostia.