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.

Cerebral Infarction ; physiopathology ; Coma ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; Pulmonary Edema ; diagnosis ; physiopathology ; Radiography, Thoracic ; Taiwan

A perforated sigmoid colon cancer within an inguinal hernia is extremely rare. This unexpected finding is usually discovered during surgery and causes an unavoidable septic evolution. Here, we describe the case of an 84-year-old man who presented with fever, abdominal distension, and a painful, enlarged, left scrotum. A CT showed a left, incarcerated, inguinal hernia containing a perforated sigmoid adenocarcinoma (which was confirmed by histopathology). The possibility of an irreducible inguinal hernia in association with perforated sigmoid colon cancer should be considered in the array of diagnoses. A pre-operative CT scan would be helpful in facilitating an accurate diagnosis.
Adenocarcinoma/complications/*radiography/surgery ; Aged, 80 and over ; Colon, Sigmoid/radiography/surgery ; Diagnosis, Differential ; Fatal Outcome ; Fever/etiology ; Hernia, Inguinal/complications/*radiography/surgery ; Humans ; Intestinal Perforation/complications/*radiography/surgery ; Male ; Pain/etiology ; Shock, Septic/complications ; Sigmoid Neoplasms/complications/*radiography/surgery ; Tomography, X-Ray Computed