Patient: Female, 42-year-old
Final Diagnosis: Ebstein’s anomaly
Symptoms: Dyspnoea on exertion • early satiety • fatigue • orthopnea • PND • progressive abdominal swelling • weigh loss
Medication: —
Clinical Procedure: Paracentesis
Specialty: Cardiology
Objective:
Rare co-existance of disease or pathology
Background:
Ebstein’s anomaly (EA) is a rare congenital cardiac abnormality with diverse anatomic and spectra of clinical presentations. This heart anomaly occurs in approximately 1 per 200 000 live births and accounts for <1% of congenital cardiac diseases. The main pathologic finding is “atrialization” of the basal region of the right ventricle. EA has been described extensively in the literature; however, to the best of our knowledge, this is the first reported case of EA presenting with ”egg-on-stick” appearance.
Case Report:
A 42-year-old woman presented on account of 2 years of progressive abdominal swelling, early satiety, and progressive weight loss. There was an associated history of dyspnea on exertion, easy fatigability, paroxysmal nocturnal dyspnea, and orthopnea. General examination revealed egg-on-stick appearance: visible distended abdominal wall veins and massive ascites with no pedal edema. Overall, pertinent cardiovascular examination findings and echocardiographic features are in keeping with EA.
Conclusions:
We present the likely first case of egg-on-stick appearance as part of the presentation of EA, which posed a diagnostic dilemma. Echocardiography can help in unraveling this dilemma.
Gastroesophageal reflux disease (GERD) is a leading indication for gastroscopy and a common cause of serious complications among patients with dyspeptic symptoms. Ethnic variability, gender and geographical locations are some of the factors that determine severity index and complications of GERD. Upper gastrointestinal endoscopy is a reliable method used in confirming clinical suspicion of GERD. This study aimed to determine the endoscopic correlation of clinical presentations and frequency of complications among patients with clinical diagnosis of GERD referred for gastroscopy. Hospital-based cross sectional study conducted between 1 st January, 2013 to 31 st December, 2016. Sociodemographic characteristics and clinical diagnosis of GERD were evaluated alongside endoscopic findings. Endoscopic findings of oesophagitis, strictures, Barrett's oesophagus or oesophageal adenocarcinoma were classified as endoscopy positive while those with symptoms but with normal endoscopic finding were classified as endoscopy negative or Non-erosive reflux Disease. One thousand, five hundred and ninety seven patients were referred for gastroscopy within the study period of which 226 were GERD (14.2%) using the self-administered questionnaire. One hundred and seven (47.3%) were males, with M: F ratio of 1:1.1. Mean age 38.5, SD± 13.1, and range of 15-75 years. The peak age occurred within the fourth decade of life (32.7%). One hundred and seventy seven (78.3%) were endoscopy positive, while 49 (21.7%) were endoscopy negative GERD. Los Angeles grade B was the highest prevalence 41.2%. GERD is not uncommon in our study and younger age groups are particularly more affected. Erosive esophagitis is the commonest complication encountered.
A 57‐year‐old man, with type 2 diabetes mellitus, was admitted with a hyperosmolar hyperglycemic state, who developed in‐hospital venous thromboembolism with huge free‐floating right heart thrombus, and there is no available optimal treatment option for the huge free‐floating right heart thrombus, except anticoagulation with warfarin and low molecular weight heparin with successful outcome.
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