Aortic dissection (AD) is a cardiovascular emergency whose most frequent symptom is chest pain. However, clinical presentation can also be varied and atypical. In the present study we report a case of painless AD, which resulted in a sudden memory loss at presentation. Physical examination and laboratory tests regarding the patient did not show any abnormal findings and a benign transient global amnesia was diagnosed. The day after being discharged, the patient came back to the emergency department because a recurrent episode of severe memory impairment occurred. This time, additional clinical and laboratory signs suggested clinical suspicion of AD. A chest computed tomography angiogram was performed and an extensive AD type A involving carotid and iliac arteries was found. Our case report shows that acute aortic dissection diagnosis can be difficult if clinical presentation is atypical and must be assessed in the light of various clinical signs and laboratory data
(1) Background: The prompt diagnosis of anterior mediastinal lesions is a challenge due to their often being categorized as malignant tumours. Ultrasound-guided Transthoracic Core Needle Biopsy (US–TCNB) is an innovative technique that is arousing increasing interest in clinical practice. However, studies in this area are still scarce. This study aims to compare the diagnostic accuracy and complication rate of US–TCNB with those of traditional surgical methods—Anterior Mediastinotomy and Video Assisted Thoracoscopic Surgery (VATS)—in patients with anterior mediastinal lesions. (2) Methods: This retrospective study involved patients evaluated between January 2011 and December 2021 who had undergone US–TCNB at the Interdepartmental Unit of Internal and Interventional Ultrasound, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy. Personal data, diagnostic questions, and technical information concerning the bioptic procedure, periprocedural complications and histological reports were collected. (3) Results: Eighty-three patients were included in the analysis. Histological examination was performed in 78 cases, with an overall diagnostic accuracy of 94.0% (sensitivity 94%; specificity 100%). Only in 5 patients was a diagnosis not achieved. Complications occurred in 2 patients who were quickly identified and properly treated without need of hospitalization. The accuracy of US–TCNB was comparable to the performance of the main traditional diagnostic alternatives (95.3% for anterior mediastinotomy, and 98.4% for VATS), with a much lower complication rate (2.4% vs. 3–16%). The outpatient setting offered the additional advantage of saving resources. (4) Conclusions: a US-guided needle biopsy can be considered effective and safe, and in the near future it may become the procedure of choice for diagnosing anterior mediastinal lesions in selected patients.
Asthma is a chronic inflammatory disease affecting small airways, associated with hyperresponsiveness, reversible airflow-limitation and respiratory symptoms. During exhacerbations, the symptoms severity may vary from mild dyspnea to fatal status asthmaticus. Non-invasive ventilation is a respiratory support method that in COPD has been used succesfully in the last 20 years; there is an increasingly interest about using non-invasive ventilation also in asthmatic patients. However, its role in status asthmaticus has not been yet established. In this article we report a case of a patient succesfully treated with non-invasive ventilation and we also review the literature about non-invasive ventilation in acute asthm
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