A 20-year-old man presented to our outpatient clinic with hemoptysis, cough, and pleuritic chest pain. His chest radiograph and pulmonary function tests (PFT) were normal. A bronchoscopy showed a small yellowish patch with a regular surface. A direct bronchoscopic biopsy was performed. The pathologic findings showed a benign granular cell tumor. The respiratory symptoms resolved after biopsying the tumor. On follow?up, there were no signs of recurrence of the granular cell tumor after a period of 24 months.
Adult ; Chest Pain/*diagnosis/pathology ; Granular Cell Tumor/*diagnosis/pathology ; *Hemoptysis ; Humans ; Male ; Tracheal Neoplasms/*diagnosis/pathology

Benign fibrous mesothelioma of the pleura is a relatively rare neoplasm originated from pleural mesothelial cell, often asymptomatic or presenting with a specifical sign. One of the main problems, concerns the preoperative differential diagnosis, mainly because it is difficult to differentiate between benign and malignant type. A 62-year old woman presented with recurrent chest pain. The chest radiography in a patient was suspected localized pleural mesothelioma. The chest computed tomography scan showed that mass like lesion of well marginated ovoid shape with homogenous attenuation on anterior-basal segment of right lower lobe. After resection of a pleural mass by thoracoscopic extirpation from right hemithorax, Localized benign fibrous mesothelioma of the pleura was confirmed by pathology and immunohisto-chemical staining. We report here one case of pleural benign fibrous mesothelioma with some considerations on its diagnosis and treatment.
Chest Pain ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Mesothelioma ; Middle Aged ; Pathology ; Pleura* ; Radiography ; Solitary Fibrous Tumor, Pleural* ; Thorax

OBJECTIVETo investigate the value of an early diagnosis grading model derived from the clinical manifestation, laboratory and imaging data for the diagnosis of aortic dissection (AD).

METHODSAn early diagnosis grading model was established based on the clinical manifestation, laboratory and imaging data from 182 AD patients who admitted to our department during the last 3 years, 184 patients with chest and back pain served as controls.

RESULTSThe sensitivity and specificity of diagnosing AD with the score of 5 is 96.7% and 81.0%, respectively.

CONCLUSIONThe emergency diagnose of AD could be improved based on the established early grading model based on the stabbing and severe pain, rapid blood pressure increase, asymmetry of the blood pressure and/or the pulse, widened aortic knob, mediastinum or descending aorta on X-ray, and significantly increased D-dimmer level.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; diagnosis ; Aorta, Thoracic ; pathology ; Aortic Aneurysm ; diagnosis ; Back Pain ; Chest Pain ; Diagnostic Imaging ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity

BACKGROUND: Early recognition of thoracic aortic disease is critical for managing the patients to reduce morbidity and mortality. In emergency department(ED), transesophageal echocadiography(TEE) has recently challenged traditional diagnostic modality for assessing thoracic aortic disease such as computed tomogram(CT) scan, aortography and magnetic resonance imaging(MRI) because of it's safety, rapid acquisition time, high sensitivity and portability. The purpose of this study was to evaluate the diagnostic role of TEE as the first imaging modality in nontraumatic and traumatic thoracic aortic disease in emergency department. METHODS: From May 1993 to Feburary 1995, twenty six patients(nontrauma : 13 cases, trauma : 13 cases) who were suspicious of thoracic aortic disease and received tee as the first diagnostic tool in emergency department were enrolledd. Indications of emergency TEE in the suspicious thoracic aortic disease were typical chest pain, mediastinal widening or massive left side hemothorax. RESULTS: Of the 26 patients undergoing TE, CT scan were performed sequentially in patients(except 4 patients who died immediately in ED). Aortic pathology was detected in 18 patients (65%). Aortic pathology of nontraumatic patients were as followings : DeBakey type I dissction was in 4 cases(36%), type II dissection in 3 cases (28%), and type III dissection in 4 cases(36%). Six of 13 traumatic patients (46%) had thoracic aortic injury. Findings of aortic injury were aortic tear(2 cases), aortic aneurysm and aortic dissection in each. Of six traumatic thoracic aortic lesions which were detected by TEE, 4 lesions (2 aortic tear, subintimal hematoma, and aortic aneurysm) were not detected dby CT scan. Only 4 cases(15%) underwent emergency operation after TEE. There was no significant hemodynamic deterioration or procedure-related dddeath during TEE. CONCLUSION: In emergency department, TEE may be considered as the first diagnostic tool in detecting acute thoracic aortic disease. In considering of it's high sensitivity, no contrast injection, short procedure time and portability at bedside, TEE should be prefered in patients with suspected thoracic aortic disease from trauma.
Aortic Aneurysm ; Aortic Diseases* ; Aortography ; Chest Pain ; Diagnosis* ; Echocardiography, Transesophageal* ; Emergencies* ; Emergency Service, Hospital ; Hematoma ; Hemodynamics ; Hemothorax ; Humans ; Mortality ; Pathology ; Tomography, X-Ray Computed

Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.
Adrenergic beta-Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Catecholamines/blood ; Chest Pain ; Diuretics/therapeutic use ; Female ; Humans ; Middle Aged ; Takotsubo Cardiomyopathy/*diagnosis/drug therapy/pathology ; Thrombosis ; Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology

BACKGROUNDDelay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.

METHODSBetween November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.

RESULTSThe median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%), radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P < 0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P < 0.001) compared to those who interpreted their symptoms as cardiac in origin.

CONCLUSIONSSymptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).

Aged ; Chest Pain ; diagnosis ; pathology ; Cross-Sectional Studies ; Emergency Medical Services ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; pathology ; Patient Acceptance of Health Care ; statistics & numerical data ; Time Factors

BACKGROUND: Acute heart failure negatively affects short-term outcomes of patients with acute coronary syndrome (ACS). Therefore, reliable and non-invasive assessment of pulmonary congestion is needed to select patients requiring more intensive monitoring and therapy. Since plasma levels of natriuretic peptides are influenced by myocardial ischemia, they might not reliably reflect congestion in the context of ACS. The novel endothelial biomarker, soluble CD146 (sCD146), presents discriminative power for detecting the cardiac origin of acute dyspnea similar to that of natriuretic peptides and is associated with systemic congestion. We evaluated the performance of sCD146 for the assessment of pulmonary congestion in the early phase of ACS. METHODS: One thousand twenty-one consecutive patients with ACS were prospectively enrolled. Plasma levels of sCD146, brain natriuretic peptide (BNP), and high-sensitive troponin T were measured within 24 hr after the onset of chest pain. Pulmonary congestion on chest radiography was determined and classified in three groups according to the degree of congestion. RESULTS: Nine hundred twenty-seven patients with ACS were analyzed. Ninety-two (10%) patients showed signs of pulmonary edema on chest radiography. Plasma levels of sCD146 reflected the radiological severity of pulmonary congestion. Higher plasma levels of sCD146 were associated with the worse degree of pulmonary congestion. In contrast to BNP, sCD146 levels were not affected by the level of troponin T. CONCLUSIONS: The novel endothelial biomarker, sCD146, correlates with radiological severity of pulmonary congestion in the early phase of ACS and, in contrast to BNP, is not affected by the amount of myocardial cell necrosis.
Acute Coronary Syndrome/*diagnosis/diagnostic imaging ; Aged ; Antigens, CD146/blood ; Biomarkers/blood ; Chest Pain/diagnostic imaging/*pathology ; Electrocardiography ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Natriuretic Peptide, Brain/*blood ; Severity of Illness Index ; Troponin T/blood

BACKGROUND/AIMS: Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized form of eosinophilic esophagitis (EoE) that responds to PPI therapy. It remains unclear whether PPI-REE represents a subphenotype of gastroesophageal reflux disease, a subphenotype of EoE, or its own distinct entity. The aim was to evaluate the clinicopathologic features of PPI-REE. METHODS: Six patients were diagnosed with PPI-REE based on symptoms, endoscopic abnormalities, esophageal eosinophilia with > or =15 eosinophils/high-power field, and a response to PPI treatment. Symptoms and endoscopic and pathological findings were evaluated. RESULTS: The median follow-up duration was 12 months. Presenting symptoms included dysphagia, heartburn, chest pain, foreign body sensation, acid reflux, and sore throat. All patients had typical endoscopic findings of EoE such as esophageal rings, linear furrows, nodularity, and whitish plaques. Three patients had a concomitant allergic disorder, and one had reflux esophagitis. Four patients exhibited elevated serum IgE, and five had positive skin prick tests. All patients experienced symptomatic resolution within 4 weeks and histologic resolution within 8 weeks after starting PPI therapy. There was no symptomatic recurrence. CONCLUSIONS: PPI therapy induced rapid resolution of symptoms and eosinophil counts in patients with PPI-REE. Large-scale studies with long-term follow-up are warranted.
Adult ; Asian Continental Ancestry Group ; Chest Pain/etiology ; Deglutition Disorders/etiology ; Diagnosis, Differential ; Eosinophilic Esophagitis/complications/*drug therapy/*pathology ; Esophagus/pathology ; Female ; Follow-Up Studies ; Gastroesophageal Reflux/etiology ; Heartburn/etiology ; Humans ; Male ; Middle Aged ; Pharyngitis/etiology ; Phenotype ; Proton Pump Inhibitors/*therapeutic use ; Republic of Korea ; Retrospective Studies ; Sensation Disorders/etiology ; Treatment Outcome ; Young Adult