Restrictive cardiomyopathy secondary to cardiac amyloidosis is an underdiagnosed cause of heart failure and it is associated with significant morbidity and mortality. The most common types of amyloidosis are light chain amyloidosis, transthyretin amyloidosis and secondary amyloidosis. We report the case of a 84year-old man that presented with new onset signs and symptoms of heart failure. Multimodality imaging with echocardiogram and bone tracer cardiac scintigraphy along with biomarkers, monoclonal proteins analysis and genetic test allowed to diagnosed a wild-type transthyretin amyloidosis. We discuss the clinical and diagnostic features and review the current literature about cardiac amyloidosis. This paper aims to increase clinicians' awareness of cardiac amyloidosis to promptly recognize, diagnose and treat it.
Thymomas and thymic carcinomas are rare mediastinal neoplasms arising from thymic epithelial cells, and the presence of synchronous or metachronous primary thymic neoplasms in a single patient is an extremely rare event. Thymoma patients appear to have an inherent predisposition toward developing additional neoplasms. This additionally presents a diagnostic challenge, revealing the importance of multidisciplinary expertise to the management of these patients. This is a case report of a patient with a thymoma and thymic carcinoma, submitted to surgical resection and postoperative radiotherapy.
Abdominal pain in the elderly patient is a common symptom and reason to resort to the emergency service. Geriatric ill patients present unique challenges in the anamnesis, physical examination and to determine expectations for rehabilitation and meaningful recovery. We present the case of an 80-year-old man, dependent on activities of daily living due to dementia. He was admitted to the emergency department with a clinic of abdominal pain and constipation. Abdominal radiography revealed dilatation of the sigmoid colon (coffee bean sign), as did abdominal CT, suggesting the diagnosis of intestinal volvulus. He underwent decompression colonoscopy with resolution. There was no evidence of neoplasia on abdominal CT or endoscopic study, or of another obstructive cause. Sigmoid volvulus is common in men over 70 years, with neuropsychiatric pathology and as a risk factor the patient had immobility and a long and redundant colon described in the endoscopic examination. This is a pathology with high mortality and risk of recurrence to be recognised in institutionalized elderly people.
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