Incidental Diagnosis After a Car Accident

Abstract

Tetralogy of Fallot (TOF) is a heterogeneous congenital heart disease that is occasionally diagnosed during adulthood. However, although they are often asymptomatic, adult patients with uncorrected TOF often have a poor prognosis. Poor outcomes indicate the importance of the identification and management of these patients, especially in the context of intercurrent disease or noncardiac surgery. We describe a case of clinically silent TOF in a 51-year-old woman. TOF was unmasked during a major noncardiac surgery for a polytrauma and successfully treated with the cooperation of a multidisciplinary team. ( Level of Difficulty: Advanced. )

Recurrent Hemoptysis in an Adult Patient With an Unfamiliar Cause

“…Very few case reports of these uncorrected TOF in an adult patient are present in the medical literature [ 11 , 12 ]. As our patient denied surgery and he was hemodynamically stable, hemoptysis was treated by BAE and continued on conservative medical management.…”

The Meaning of Clinical Normality

“…Usually, the latter are internal processes not directly observable, so the inference from clinical test to underlying normal or abnormal function is indirect, and in some cases tortuous. This section offers a small zoo of examples [25] meant to stress the distinction between "normality" of a clinical test (which we have just seen is a confusing term) and truly medical normality: healthy function.…”

“…24 (iv) A young woman's tetralogy of Fallot, a congenital heart malformation, was revealed by her chest X-rays following a car accident. 25 And (v) in 1950, a little boy named Christy was hosting a sizeable tapeworm, which made its appearance after the ether used in his tonsillectomy killed it. [29] In that case it was treatment, not diagnosis, that revealed the pathological condition.…”