Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report.

INTRODUCTION: Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain. CLINICAL CASE REPORT: A 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium. CLINICAL CONCLUSION: A successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.

Pulmonary embolism secondary to popliteal vein aneurysm: case report and literature review.

Aim: Aneurysms are rarely detected in the popliteal vein as only a few cases have been reported in the literature so far. However, such aneurysms can be fatal due to thromboembolic complications or rupture. Case presentation: A 47-year-old male who had multiple bilateral pulmonary embolisms secondary to saccular right popliteal vein aneurysm discovered by lower limb duplex ultrasound and successfully treated with tangential aneurysmectomy with venorrhaphy. Conclusion: Popliteal vein aneurysm should be ruled out as a cause of pulmonary embolism, and medical treatment should be started rapidly, but surgical management remains the gold standard.

Best management modality of trichobezoar: A case report.

INTRODUCTION: Trichobezoar is a rare condition, usually diagnosed in children and young female especially with psychiatric illness. Diagnosis of trichbezoar is usually dependent on the disease history, examination, diagnostic modality including CT scan. Generally this condition can be treated by endoscopy, laparoscopy or laparotomy. Here, we have presented a rare case of trichobezoar which has failed to be treated endoscopically but was eventually treated successfully by laparotomy. CASE REPORT: A 17 years old girl was presented with the initial complaint of epigastric pain for about 9 months duration with symptoms including vomiting and weight loss. Clinical examination showed tenderness and hard mass over epigastric area and it was extending towards the right hypochondrial area. CT scan results also showed that the stomach was filled with large intra-luminal abnormal mass like contents with mottled air pattern extended to fill the pylorus and first part of the duodenum. These findings were the proofs for possible trichobezoar. Endoscopic surgery failed significantly and hence laparotomy was performed, as a result, trichbezoar was removed successfully. DISCUSSION: Trichobezoar can be treated by using endoscopy for removal of hair, laparoscopy or Laparotomy. Laparotomy had 100% successful rate while 5% for endoscopy and 75% for laparoscopy. CONCLUSION: Laparotomy is the best treatment method for trichobezoare. Psychiatric management should be done for any patient with trichotillomania to avoid trichobezoar.

Mediastinal ectopic thyroid mass with normal thyroid function and location: Case report.

INTRODUCTION: Mediastinal Ectopic Thyroid Gland is a rare entity, accounting for 1% of all mediastinal tumours. Here, we present a rare case of mediastinal mass that was proved to be an ectopic thyroid with normal thyroid function tests and normal thyroid gland in the cervical location. CASE PRESENTATION: A 32-year-old lady had a road traffic accident, with the incidental discovery of a mediastinal mass on chest radiography. Thyroid function tests were normal. CT scans of the neck and chest revealed a large mediastinal mass compressing the trachea from the left side and extending to the superior part of the anterior mediastinum with normal thyroid gland in the cervical position. Midline Partial Sternotomy was done with complete surgical excision of the mass. It was well circumscribed, multinodular, had firm inconsistency, and grossly looked like a thyroid tissue. Histopathology revealed ectopic thyroid tissue negative for malignancy. Postoperative thyroid ultrasound showed normal thyroid lobes in the neck. DISCUSSION: Ectopic thyroid tissue (ETT) occurs due to failure of the thyroid gland to migrate from foramen ceacum to its normal position in the cervical region in front of the trachea. The most common site of ETT is lingual thyroid and accounts for about 90% of all cases reported in the literature. ETT in the mediastinum is very rare, with only a few cases reported in the literature. CONCLUSION: ETT in the mediastinum is very rare and can be associated with normal thyroid function and normal thyroid anatomical location. It should be differentiated from substernal goiter.

Successful treatment of acute renal failure secondary to complicated infective endocarditis by peritoneal dialysis: a case report.

BACKGROUND: Infective endocarditis is one of the most common infections among intravenous drug addicts. Its complications can affect many systems, and these can include acute renal failure. There is a scarcity of cases in the literature related to acute renal failure secondary to infective endocarditis treated with peritoneal dialysis. In this paper, the case of a 48-year-old Saudi male is reported, who presented with features suggestive of infective endocarditis and who developed acute kidney injury that was treated successfully with high tidal volume automated peritoneal dialysis. To our knowledge, this is the second report of such an association in the literature. CASE PRESENTATION: A 48-year-old Saudi gentleman diagnosed to have a glucose-6-phosphate dehydrogenase deficiency and hepatitis C infection for the last 9 years, presented to the emergency department with a history of fever of 2 days' duration. On examination: his temperature = 41 °C, there was clubbing of the fingers bilaterally and a pansystolic murmur in the left parasternal area. The results of the blood cultures and echocardiogram were supportive of the diagnosis of infective endocarditis, and the patient subsequently developed acute kidney injury, and his creatinine reached 5.2 mg/dl, a level for which dialysis is essential for the patient to survive. CONCLUSION: High tidal volume automated peritoneal dialysis is highly effective as a renal replacement therapy in acute renal failure secondary to infective endocarditis if no contraindication is present.

Hodgkin's Lymphoma as a Multiloculated Lung Cavity Lesion.

BACKGROUND: Pulmonary manifestation of Hodgkin's lymphoma is common, and recently, single and/or multiple lung cavities with air-fluid levels has been reported as a primary manifestation of Hodgkin's lymphoma. However, the unusual presentation of the lung cavity itself has not been previously reported for Hodgkin's lymphoma, especially as the first presentation of the disease. CASE PRESENTATION: We report a 16-year-old male who presented to the emergency department with chief complaints of fever, unintentional 10-kilogram weight loss, a productive cough and pulmonary cavity for investigation. The patient's CT scan indicated multiloculated cavity lesions in the middle lobe with an air-fluid level and multiple enlarged mediastinal lymph nodes, which have not been previously reported as a primary presentation for Hodgkin's lymphoma or in the histopathology of the nodular sclerosing type of classical Hodgkin's lymphoma. CONCLUSION: Pulmonary manifestation of Hodgkin's lymphoma has already been reported and must be part of the differential diagnosis of lung cavity lesions, even if the likelihood is low based on previous reports, especially in younger individuals. Multiloculated lung cavities can be the first presentation of Hodgkin's lymphoma.

Is Cronbach's alpha sufficient for assessing the reliability of the OSCE for an internal medicine course?

BACKGROUND: The number of medical students accepted into medical programs is increasing, which has made the traditional long/short case style of examination difficult to conduct. At Dammam University, the program is shifting to the use of the Objective Structural Clinical Examination (OSCE), which may solve some of these difficulties, including issues with reliability, validity index and exam duration. RESULTS: A pilot study was conducted over one semester. A total of 207 examinees in three groups took the OSCE and written exams. The OSCE consisted of 18 clinical stations and required 3-4.3 h/day. The written exam contained 80 multiple-choice questions. The Cronbach's alpha for each group was 0.7, 0.8, and 0.9. Correlations for all stations ranged from 0.7 to 0.8, which indicated good stability and internal consistency with minor differences in the progression of the indexes. The reliability of the written exam was 0.79, and the validity of the OSCE was 0.63, as assessed using Pearson's correlation. CONCLUSION: No single reliability index can be considered a perfect assessment tool to solve this issue. Thus, at least two to three indexes should be used to ensure the reliability of the OSCE.