Abnormal presentation of haemorrhagic adrenal cyst.

An 81-year-old patient presented with fever and lethargy for 3 weeks. There were no other signs or symptoms of infection. Detailed history revealed a fall onto his right flank, prior to the start of fever. All microbiological, autoimmune and oncological investigations were negative. CT scan of chest, abdomen and pelvis showed haemorrhage in a previously diagnosed simple adrenal cyst. The cyst was non-functioning. The patient continued to spike fever in the following 4 weeks, otherwise remained stable. The patient was managed conservatively as haemoglobin level was stable. Repeated scan showed signs of improvement. He was discharged after 5 weeks. He remained afebrile and asymptomatic at the planned endocrinology outpatient follow-up after 8 weeks.

Pulmonary embolism mimicking left-ventricular hypertrophy on ECG.

Patients with pulmonary embolism (PE) can show changes on the ECG. Here, we report the case of a 48-year-old man who initially presented with calf discomfort and swelling. He was discharged with no anticoagulation after a negative complex duplex venous ultrasonography for deep vein thrombosis (DVT). He presented 4 days later with shortness of breath and pleuritic chest pain. Multiple pulmonary emboli were found on CT pulmonary angiogram. His ECGs showed left-ventricular strain which is unusual for PE. He was anticoagulated and discharged. Despite presenting 2 days later with PE-related complications, he eventually recovered well.

Coronary and cardiovascular risk estimation in uncomplicated mild hypertension. A comparison of risk assessment methods.

OBJECTIVE: To compare the accuracy of five risk assessment methods in identifying patients with uncomplicated mild hypertension at high coronary heart disease (CHD) and cardiovascular disease (CVD) risk.DESIGN Comparison of risk estimates using each risk assessment method with CHD risk 15% and CVD risk 20% over 10 years calculated using the Framingham risk functions. SETTING: British population. SUBJECTS: People aged 35-64 years with uncomplicated mild systolic hypertension (systolic blood pressure (SBP) 140-159 mmHg, = 202) from the 1995 Scottish Health Survey. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values. RESULTS: Compared with CHD risk 15% over 10 years, the Sheffield table and Joint British Societies (JBS) Chart had good sensitivity and specificity ( 90%). The New Zealand (NZ) Chart had sensitivity 83% and specificity 89%. Compared with CVD risk 20% over 10 years the Sheffield table had sensitivity 81%, the JBS Chart had sensitivity 63%, and the NZ Chart had sensitivity 75%. All had good specificity ( 90%). For CHD risk and CVD risk the World Health Organization/International Society of Hypertension (WHO-ISH) and United States Joint National Committee VI (JNC-VI) methods had high sensitivity at the cost of very poor specificity ( 50%). CONCLUSION: In patients with uncomplicated mild hypertension, the Sheffield table and JBS Chart both identified CHD risk 15% over 10 years with acceptable accuracy, while the NZ Chart was less accurate. Compared with CVD risk 20% over 10 years, these three risk assessment methods were all less accurate, but the Sheffield table retained the highest sensitivity ( 0.05 versus JBS Chart, = NS versus NZ Chart). The WHO-ISH and JNC-VI methods had unacceptably low specificities compared with both measures of risk and failed to differentiate between those at high and low risk.