A 38-year-old Haitian woman with a cough, fever, and a right paratracheal mass

Article Abstract:

A 38-year-old Haitian woman had taken ill about four or five weeks prior to hospitalization. Upon physical examination, she appeared to be acutely ill and her primary symptoms were cough, fever, and a right paratracheal tissue mass near the windpipe. Extensive blood chemistry tests were performed and in the meantime no improvement was observed in the patient. Intermittent fever persisted along with the development of a sore throat. Several possible diagnoses were considered, including Hodgkin's disease, non-Hodgkin's lymphoma and chronic Epstein-Barr infection. Diagnosis was tentatively narrowed down to lymphoma or tuberculosis. Additional tests included a mediastinoscopic examination, which involves an incision into the tissues and organs which separate the lungs, and biopsy of the tracheal mass. When tissue cultures were analyzed, Mycobacterium tuberculosis was found to be present. Tuberculosis was confirmed and a nine-month treatment of antitubercular therapy was begun. A test for human immunodeficiency virus (HIV) was positive, suggesting that the tuberculosis may have been an opportunistic infection, able to take advantage of the depressed immunity associated with AIDS-related complex (ARC). A high incidence of HIV-infection in Haitians, as well as the fact that this women had had a boyfriend who had most likely died of AIDS seven years before, made AIDS-related complex very likely. Tuberculosis is also common in Haitians, but atypical tuberculosis of the type observed in this patient indicated a very high risk for development of AIDS. Subsequent anatomical diagnosis confirmed tuberculosis of mediastinal lymph nodes and lungs with HIV-infection-related lymph node irregularities.

Health aspects, Tuberculosis, Haiti, AIDS-related complex, Diagnosis, Differential, Differential diagnosis, Zibrak, Joseph D.

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A 36-year-old man with peripheral vascular disease

Article Abstract:

A 36-year-old man was admitted to the hospital because of poor blood circulation in the left foot. The patient was diagnosed as suffering from Buerger's disease affecting an artery close to the surface of the knee. Digital subtraction, a blood vessel imaging procedure, was used to assist in the diagnosis. Buerger's disease is characterized by numbness of the foot or pain confined to one toe, and cramps in legs, especially while walking. Buerger's disease may be caused by a clot in a blood vessel, usually in medium-sized arteries and veins of the extremities. Following the development of a clot, which blocks blood flow, inflammatory infiltrates (e.g., white blood cells, leukocytes) collect in the layers of the vessel wall. There is controversy, however, whether the inflammation of the wall or the thrombus is the event which initiates the disease. While the cause of Buerger's disease remains unknown, cigarette smoking is thought to be related to the development of the disease. The patient in this case had been a cigarette smoker, but switched to pipe smoking several years prior to the onset of the symptoms associated with the disease. Patients suffering from the disease are also known to have an increased cellular immune response to collagen Types I and III, connective tissue types found in vessel walls. The affected area was catheterized for drainage, the clot was removed, and an infusion of the enzyme urokinase was begun in order to prevent formation of additional clots.

Peripheral vascular diseases, Arteries, Thromboangiitis obliterans, Buerger's disease, Imaging, O'Donnell, Thomas F.

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A 60-year-old man with a large right atrial mass

Article Abstract:

A 60-year-old man with a questionable history of a heart attack 15 years prior was admitted to the hospital because of a mass detected in his heart. Symptoms included abnormal heart rhythms, obstructive lung disease and chest pain. Careful examination revealed a fatty tumor in the septum between the atrial portions of the heart, which was removed. This was a rare occurrence. Usually the tumors are only found at autopsy.

Analysis, Magnetic resonance imaging, Echocardiography, Atrial septal defects, Garan, Hasan

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