Wellens pattern as the debut of acute pulmonary embolism: A case report.

The Wellens pattern is an electrocardiographic finding seen in patients with chest pain and atherosclerotic coronary artery disease and is described as a symmetrical T-wave inversion or biphasic T-wave inversion in precordial leads. The deep inversion of the precordial T wave is a sign associated with various etiologies, including left ventricular hypertrophy, vasospasm, and pulmonary embolism. We present the case of a patient who debuts with chest pain and electrocardiographic findings consistent with the Wellens and McGinn-White patterns, who was subsequently diagnosed with intermediate-risk pulmonary embolism after ruling out obstructive coronary artery disease. We discussed the differential diagnostic approach to T-wave inversion as a sign associated with high-risk conditions.

Tuberculosis vertebral con afectación pleural: reporte de un caso / Spinal tuberculosis with pleural involvement: a case report

Resumen La tuberculosis extrapulmonar representa hasta el 25% de todos los casos de tuberculosis. Los órganos más frecuentemente afectados son los ganglios linfáticos y la pleura. Alrededor del 10-11% de casos de tuberculosis extrapulmonar tienen afectación osteoarticular y de ellos la mitad con compromiso vertebral. La infección es causada por la diseminación hematógena del bacilo desde un foco primario al hueso esponjoso de los cuerpos vertebrales torácicos o lumbares principalmente. El síntoma característico es el dolor crónico de la columna vertebral, generalmente en el sitio afectado, sin otros síntomas o signos concomitantes. La asociación de tuberculosis vertebral con afectación pleural sin un foco pulmonar establecido es infrecuente, se ha descrito en 2.5% de pacientes e intriga acerca de su fisiopatología. En Colombia, no se encontraron reportes similares. Se describe el caso de una paciente joven con historia de dolor lumbar crónico que debutó con síntomas respiratorios persistentes asociado a síntomas constitucionales; en quien se comprobó la infección por Mycobacterium tuberculosis en vértebras toracolumbares y pleura. Este caso evidencia una historia natural atípica de la enfermedad, en la cual el mecanismo fisiopatológico parece haber sido la diseminación directa por contigüidad, y resalta la importancia de la sospecha clínica para garantizar un diagnóstico y tratamiento oportuno. MÉD.UIS.2020;33(3): 67-73

Abstract Extrapulmonary tuberculosis represents up to 25% of all cases of tuberculosis. The most frequently affected organs are lymph nodes, pleura and bone. Around 10-11% of cases of extrapulmonary tuberculosis have osteoarticular involvement and a half of them present vertebral involvement. The infection is caused by hematogenous spread of the bacillus from a primary focus to the cancellous bone of the thoracic or lumbar vertebral bodies mainly. The characteristic symptom is the chronic pain in the spine, usually in the affected site, without other concomitant symptoms or signs. The association between vertebral tuberculosis and pleural involvement without an established pulmonary focus is infrequent, it has been described in 2.5% of patients, an intrigue about its pathophysiology. Similar cases in Colombia have not been reported. This article describes a case of a young patient with a history of chronic low back pain that debuts with persistent respiratory symptoms associated with constitutional symptoms; whose Mycobacterium tuberculosis infection was proven in thoracolumbar vertebrae and pleura. This case shows an atypical natural history of the disease, in which the pathophysiological mechanism of the disease would seem to have been the direct dissemination by contiguity, and emphasizes the importance of clinical suspicion to ensure timely diagnosis and treatment. MÉD.UIS.2020;33(3): 67-73