A 46-year-old womanpresented with sudden severe pain in the interscapular region. Physical examination, including detailed neurological evaluation, did not disclose any abnormalities.However, magnetic resonance imaging revealed an epidural hematomaanterior to the thoracic spinal cord and its spontaneous resolution thirty days after onset. Her hospital course was uneventful. To our knowledge, this report documents the first case ofa spontaneous spinal spidural hematomawithout neurological deficits. Spinal epidural hematomamay be more commonthan previously thought because some cases have probably been misdiagnosed as transient back pain of unknown etiology. (Internal Medicine 34: 992-994, 1995)
A 56-year-old male with hypertrophic obstructive cardiomyopathy complicated with medically refractory paroxysmal atrial fibrillation and congestive heart failure was treated with percutaneous transluminal septal myocardial ablation. The resting left ventricular outflow tract gradient decreased from 70 mmHg to 0 mmHg after the procedure, and clinical symptoms improved dramatically. However, the patient died suddenly 19 months later and autopsy revealed nontransmural myocardial fibrosis with an irregular border in the interventricular septum.
Key Clinical Message
Although conventional microbiology cultures may be negative, polymerase chain reaction (PCR) can effectively identify both typical and atypical microorganisms. With careful interpretation, PCR could become the gold‐standard diagnostic test for culture‐negative bacterial pericarditis.
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