RESUMO
Subclavian steal syndrome results from subclavian artery stenosis that results in retrograde blood flow through the ipsilateral vertebral artery. Rarely, this retrograde flow can affect the vertebrobasilar junction and cause vertebrobasilar insufficiency, ischemia, and even aneurysm formation. We describe a unique presentation of a vertebrobasilar aneurysm presenting with subarachnoid hemorrhage in the setting of subclavian steal syndrome. The subclavian stenosis was endovascularly managed, with complete resolution of both retrograde flow and the dissection itself. Reestablishment of native flow mechanics in the subclavian artery may treat aneurysms at the vertebrobasilar junction, potentially eliminating the need for further interventions.
RESUMO
When evaluating a patient with ST-segment elevation on ECG and acute chest pain, providers often rapidly arrive at the diagnosis of ST-elevation myocardial infarction (STEMI). As myocardial infarction is deadly and time is of the essence in establishing reperfusion, it is reasonable to place it at the top of the differential. However, doing so should not come at the expense of conducting a thorough clinical evaluation, considering all causes of ST-segment elevation, and creating a comprehensive differential. Myocarditis, in particular, can present similarly to myocardial infarction and misdiagnosis can lead to unnecessary and sometimes harmful interventions such as thrombolytic therapy, vasodilator therapy, or coronary angiography. We present a case of myocarditis mimicking STEMI and discuss diagnosis and treatment of myocarditis.
RESUMO
Small pneumoconiotic opacities in coal miners are usually described as rounded, regular, and upper zone predominant. We aim to characterize chest radiographic patterns in New Mexico coal miners in comparison with other miners. Of the 330 chest radiographs reviewed, small pneumoconiotic opacities in New Mexico miners were almost always irregularly shaped, and lower lung zone predominant, consistent with diffuse dust-related pulmonary fibrosis. There was no significant difference in patterns of opacities between miners with exposure to coal mine dust exclusively, mixed coal and noncoal mine dust, and no coal dust. Our findings indicate that New Mexico coal miners demonstrate a different pattern of small pneumoconiotic opacities than the classic nodular pneumoconiosis described in the literature, predominantly from Appalachian miners. This may indicate differences in racial/ethnic characteristics or in the silica/silicate content of dust between the Appalachian and Mountain West regions.
