Neurogenic pulmonary oedema misdiagnosed as acute myocardial infarction in a comatose patient.
- Author:
Vei Ken SEOW
1
;
Shih Yu KO
;
Meng Kai HUANG
;
Chee Fah CHONG
Author Information
- Publication Type:Case Reports
- MeSH: Cerebral Infarction; physiopathology; Coma; Diagnosis, Differential; Diagnostic Errors; Humans; Male; Middle Aged; Myocardial Infarction; diagnosis; Pulmonary Edema; diagnosis; physiopathology; Radiography, Thoracic; Taiwan
- From:Annals of the Academy of Medicine, Singapore 2007;36(8):684-686
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONWe report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).
CLINICAL PICTUREThis 52-year-old man presented with acute loss of consciousness with normal brain computed tomography (CT). He was treated as non-ST-elevation AMI complicated with pulmonary oedema based on findings of chest radiograph (bilateral pulmonary oedema), electrocardiogram (marked ST-T changes in leads V3 to V6), and cardiac enzymes [elevated creatinine kinase (CK) and CK-MB]. However, coronary angiogram and serial cardiac enzymes were inconclusive. Anisocoria developed after admission and a repeat brain CT was evident for large left cerebral infarct.
TREATMENTDecompressive craniectomy was carried out.
OUTCOMEMortality.
CONCLUSIONSThe diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain CT. It can be mistaken for cardiogenic pulmonary oedema secondary to AMI.
