[Unexpected diagnosis after abnormal ecg]. / Onverwachte diagnose bij afwijkend ecg.

A 60-year-old man was referred to the outpatient clinic due to dyspnea of effort and productive coughing and rhinorrhea. Physical examination revealed swollen ankles and yellow, hyperkeratotic nails. HRCT showed bronchiectasis. This triad of symptoms indicates yellow nail syndrome. Vitamin E improved the yellow nails, while optimal expiration techniques alleviated respiratory symptoms.

[A woman with acute dyspnea]. / Een vrouw met acute dyspneu.

A 54 year old female with a history of pneumothorax, COPD GOLD IV and emphysema visits the ED with acute onset of dyspnea and right thoracic pain. Chest X-ray shows recurrent pneumothorax and, surprisingly, suggestion of subdiaphragmatic air. Follow-up CT confirms pneumothorax with additional pneumoperitoneum due to a diaphragm defect.