Subject(s)
Embolism, Fat , Fractures, Bone , Multiple Organ Failure , Accidents, Traffic , Adolescent , Embolism, Fat/etiology , Embolism, Fat/pathology , Fatal Outcome , Femoral Fractures/complications , Femoral Fractures/diagnostic imaging , Femoral Fractures/therapy , Fibula/diagnostic imaging , Fibula/injuries , Fractures, Bone/complications , Fractures, Bone/diagnostic imaging , Fractures, Bone/therapy , Humans , Male , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Tibial Fractures/complications , Tibial Fractures/diagnostic imaging , Tibial Fractures/therapy , Tomography, X-Ray ComputedABSTRACT
A 61-year-old man was admitted to our department with radicular back-pain and progressive gait-difficulties. On examination he had flaccid paraparesis and bladder-retention. He subsequently developed palsy of n. oculomotorius, dysarthria, right-sided Bells palsy and weakness of his right arm over a 4-week period. He became disoriented and died without a diagnosis. MRI of the brain and columna were negative. Extensive search for malignancies yielded negative results. Cytology specimens were inconclusive and repeated liquor-examinations showed very low glucose levels, mild pleocytosis, elevated protein. Autopsy revealed a small adenocarcinoma of the lung and meningeal carcinomatosis originating from the adenocarcinoma.
Subject(s)
Adenocarcinoma , Back Pain , Lung Neoplasms , Meningeal Carcinomatosis , Sciatica , Adenocarcinoma/pathology , Autopsy , Back Pain/diagnosis , Cerebrospinal Fluid/cytology , Diagnosis, Differential , Fatal Outcome , Gait Disorders, Neurologic/diagnosis , Humans , Lung Neoplasms/pathology , Magnetic Resonance Imaging , Male , Meningeal Carcinomatosis/pathology , Middle Aged , Paraparesis/diagnosis , Paresis/diagnosis , Pulmonary Fibrosis/diagnostic imaging , Pulmonary Fibrosis/pathology , Radiography , Sciatica/diagnosis , Sciatica/pathologyABSTRACT
MATERIAL AND METHODS: A 38-year-old psychostimulant abuser was admitted to hospital after syncope. He had lost much of his weight over the last 6 months, had abdominal pain the last 10 days and bloody diarrhoea and hypotension upon admittance. The abdomen was soft and non-tender. Due to renal failure and metabolic acidosis with base excess of -16 to -22 mmol/L and lactate from 9.5 to 16 mmol/L, haemodialysis was given twice. Acidosis worsened. He suffered from respiratory arrest twice and was resuscitated once before a laparotomy 30 hours after admittance revealed total ischemia of the bowels. The patient died. At autopsy the coeliac trunk was compressed by thrombi in a dissecting space. A dissection was also found from the proximal aorta to the common iliac arteries. The heart was hypertrophic and weighed 640 g. DISCUSSION: Bowel ischemia due to dissecting arteries may have caused the dramatic weight loss. Cardiac hypertrophy is often found after cocaine and amphetamine misuse, and frequent hypertensive episodes may cause aortic dissection. INTERPRETATION: Abdominal pain and lactic acidosis should bring bowel ischemia to mind even if the abdomen is non-tender. Drug abuse also in young persons is associated with serious cardiovascular pathology.
Subject(s)
Abdomen, Acute/diagnosis , Acidosis, Lactic/diagnosis , Amphetamine-Related Disorders/complications , Cocaine-Related Disorders/complications , Intestines/blood supply , Ischemia/diagnosis , Weight Loss , Abdomen, Acute/chemically induced , Abdomen, Acute/etiology , Acidosis, Lactic/chemically induced , Acidosis, Lactic/etiology , Adult , Diagnosis, Differential , Fatal Outcome , Humans , Intestines/drug effects , Intestines/pathology , Ischemia/chemically induced , Ischemia/etiology , MaleABSTRACT
The authors describe a diagnostically challenging case where a patient with previous squamous cell carcinoma of the tonsil developed a putative second primary squamous cell carcinoma in the lung (stage IV with lung and bone metastases). During palliative chemotherapy several episodes of severe infection occurred, eventually resulting in abscess formation in the hip and brain. The dilemma of distinguishing between metastasis and abscess and the therapeutic implications are discussed.