Cases reported "Dyspnea"

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1/36. radiation-induced bronchial stenosis: a new cause of platypnea-orthodeoxia.

    Platypnea-orthodeoxia is encountered in a variety of cardiac, pulmonary, and hepatic disorders. We report its occurrence in a 59-year-old man who had had combined external-beam and high dose-rate iridium brachytherapy for a stage I non-small-cell carcinoma of the right upper lobe 2 years earlier. The post-radiation course was complicated by a severe radiation bronchitis; the onset of platypnea-orthodeoxia signalled the development of severe bronchial stenosis that was transiently relieved, initially by dilatation, and later by stent placement, though the patient ultimately died of a pulmonary hemorrhage. The dosage of brachytherapy given, the combined external-beam therapy, and the long survival after completion of radiation therapy were likely factors in the development of bronchial stenosis. We discuss the tomographic and bronchoscopic features of radiation-induced bronchial stenosis.
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ranking = 1
keywords = stenosis
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2/36. myocardial infarction with moyamoya disease and pituitary gigantism in a young female patient.

    myocardial infarction is very rare in young female patients with systemic vascular disorders. moyamoya disease is a cerebrovascular disease associated with an abnormal vascular network. This report presents a 19-year-old female patient who suffered from chest pain and exertional dyspnea for 2 months prior to admission. She had a history of moyamoya disease and pituitary gigantism since childhood. Her ejection fraction on echocardiogram was 20% and a perfusion defect with partial reversibility in the anterior wall was demonstrated on stress single photon emission computed tomography (SPECT). Diagnostic coronary angiogram revealed critical stenosis in the middle left anterior descending artery, which was treated by coronary stenting. Her subjective symptoms were relieved and the perfusion defect seen on SPECT decreased after coronary intervention.
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ranking = 0.14285714285714
keywords = stenosis
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3/36. An unusual cause of tracheal stenosis.

    PURPOSE: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. CLINICAL FEATURES: The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage. CONCLUSION: The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.
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ranking = 116.07100266821
keywords = tracheal stenosis, stenosis
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4/36. A case of pulmonary arteritis with stenosis of the main pulmonary arteries with positive myeloperoxidase-antineutrophil cytoplasmic autoantibodies.

    A 53-year-old woman was referred to our hospital with the main symptoms of productive cough, fever and exertional dyspnoea. Chest X-ray revealed enlargement of the left hilar shadow and cavitary infiltration in the right upper lobe. 99mTechnetium-macroaggregated albumin (99mTc-MAA) perfusion scintigram showed complete hypoperfusion through the entire right lung. A pulmonary angiogram revealed stenotic lesions in the right and left main pulmonary arteries. Right cardiac catheterization showed an elevated right ventricular systolic pressure. There was no evidence of systemic arterial lesions nor vasculitis. The patient was positive for myeloperoxidase (MPO)-antineutrophil cytoplasmic autoantibodies (ANCA) (168 EU). The mycobacterium avium complex sputum culture was positive. The pulmonary stenotic lesions were surgically resected. The resected pulmonary arterial lesions were pathologically diagnosed as non-specific vasculitis. The cavitary lesion disappeared 6 months after the surgery. Two years after the surgery, although the MPO-ANCA level had decreased to 12 EU, stenosis of the pulmonary arteries reappeared. It is suggested that the patient became positive for MPO-ANCA in association with the mycobacterium avium complex infection, and that the presence of MPO-ANCA may not be related to the development of pulmonary stenosis of the main pulmonary arteries.
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ranking = 0.85714285714286
keywords = stenosis
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5/36. Upper airway obstruction due to rhinoscleroma: case report.

    rhinoscleroma is a very rare cause of upper airway obstruction with only isolated reports in the literature of rhinoscleroma with isolated tracheal obstruction. The course is usually chronic with the presentation most often being non-specific. We report a 54-year-old woman with progressive shortness of breath and wheezing over 7 years' duration. She was diagnosed and treated as bronchial asthma without improvement in her symptoms. At the time of referral to our institution, her flow-volume loop revealed fixed upper airway obstruction. Her chest radiography and other laboratory tests were normal. bronchoscopy revealed a 70-80% irregular concentric stenosis of the trachea beginning immediately below the vocal cords and extending 4 cm distally. biopsy showed characteristic Mikulicz histiocytes containing numerous gram-negative intracellular coccobacilli consistent with a diagnosis of rhinoscleroma. The patient was treated with laser resection of the stenosis followed by a course of ciprofloxcin and trimethoprim-sulfamethoxazole. She has remained asymptomatic over a year follow-up period and repeated biopsies have shown no evidence of recurrence.
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ranking = 0.28571428571429
keywords = stenosis
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6/36. Temporary stenting for malignant tracheal stenosis due to esophageal cancer: a case report.

    We present a case of a 56-year-old male with esophageal cancer who underwent successful temporary tracheal stenting followed by a surgical procedure. The trachea was obstructed owing to endotracheal metastasis and the patient had severe dyspnea. A silicone Y-stent was initially inserted into the tracheal stenosis to secure the airway, and then tumor-specific chemo-radiotherapy was applied. The tumor was reduced, the stent was removed and a pathological study indicated that the tracheal metastasis had disappeared. The patient then underwent esophagectomy and tumor-specific chemo-radiotherapy was continued after the surgery. The patient has remained alive and free of esophageal cancer for 18 months after the airway stent emplacement. These findings suggested that the silicone stent was suitable as a temporary measure and that temporary stenting combined with tumor-specific therapy was effective as part of the aggressive therapeutic strategy with which to treat the malignant airway stenosis due to esophageal cancer.
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ranking = 96.511549842555
keywords = tracheal stenosis, stenosis
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7/36. Paroxysmal postural dyspnea related to a left atrial ball thrombus.

    We report herein an uncommon clinical observation of a 82-year-old woman with paroxysmal postural dyspnea related to a giant ball-thrombus located in the left atrium and partly protruding through the mitral orifice. No mitral stenosis was otherwise disclosed. The patient had a previous medical history of chronic atrial fibrillation without any anticoagulant therapy. The atrial mass was easily removed and the postoperative course was uneventful. disclosure of such a free-floating ball-thrombus in the left atrial cavity requires prompt surgical treatment because of high risks of acute hemodynamic decompensation due to obstruction of the left ventricular inflow or, more rarely, systemic embolic events.
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ranking = 0.14285714285714
keywords = stenosis
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8/36. Double respiratory sequelae of head injury: subglottic stenosis and bilateral pneumothoraces.

    An 18-yr-old man with insulin-dependent diabetes developed severe subglottic stenosis after a very brief period of intubation. Emergency tracheostomy was complicated by the development of bilateral pneumothoraces. This case highlights the importance of making an early diagnosis to minimize the risk of complications and examines postintubation subglottic stenosis in the context of poorly controlled insulin-dependent diabetes mellitus.
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ranking = 0.85714285714286
keywords = stenosis
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9/36. A coconut left atrium 23 years after mitral valve replacement for chronic mitral stenosis.

    We present the case of a 65 year-old female who was admitted to the hospital because of deterioration of chronic dyspnea. Twenty-three years prior to this admission, mitral valve replacement for chronic mitral stenosis was performed using a Starr-Edwards caged-ball prosthesis. There was severe pulmonary hypertension. On transthoracic echocardiography and on cineradiography, the function of the mitral valve prosthesis was unimpaired. However, cineradiography showed extensive mural calcification of the left atrium; we report this remarkable finding.
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ranking = 0.71428571428571
keywords = stenosis
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10/36. Mitral stenosis in the Maroteaux-Lamy syndrome: a treatable cause of dyspnoea.

    The case is reported of a young woman with the Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) who presented with rapidly progressive dyspnoea due to mitral stenosis. mitral valve replacement was performed and the appearance of the valve was typical of mucopolysaccharide infiltration. Dyspnoea in patients with the Maroteaux-Lamy syndrome may be due primarily to cardiac valve involvement, and in this setting, valve surgery is safe and effective.
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ranking = 0.71428571428571
keywords = stenosis
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