SECTION 1 – QUIZ Case A 70-year-old woman with unknown medical history and no regular follow-up was admitted in the emergency department due to abdominal pain persisting for 2 weeks, which had worsened h before her first contact. She transported room severe hypoxemia hemodynamic instability. tachypneic (respiratory frequency of 22 bpm) an oxygen delivery 10 L/min via facial mask maintain a peripheral saturation 92%. Her heart rate 93 bpm blood pressure 62/35 mmHg, cold cyanotic extremities....

Abstract Aspiration of barium sulfate is possible during radiographic contrast procedures and potentially life‐threatening in severe cases. In patients with dysphagia or suspected tracheoesophageal fistula, compounds may be used, considering lateral projection fluoroscopy the pharyngeal phase swallowing, but iso‐osmotic agents should also considered.

Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment endoscopic therapy argon plasma coagulation (APC). There high recurrence rate, but some evidence suggests that thalidomide could play an important role in controlling refractory anaemia due to GAVE. authors present the case cirrhotic patient recent diagnosis GAVE, who underwent multiple treatments and blood transfusions because haematemesis. started 6...

Aortic dissection is a life-threatening clinical emergency and challenging diagnosis. Depending on its initial location, it may present with several symptoms the most common being chest pain. We describe case of 62-year-old man admitted to Emergency Department acute neurological deficits triaged for stroke protocol. After unexpected findings physical examination, other diagnostic hypotheses were evaluated, culminating in diagnosis aortic haemothorax mimicking stroke.Aortic high rate...

Pleural involvement in Non-Hodgkin Lymphoma (NHL) is well documented, but primary pleural lymphomas are extremely rare, occurring mostly immunosuppressed patients or associated with chronic inflammation. Nevertheless, the pathogenesis and therapeutic approaches to counteract still matter of debate. The authors present clinical case an 81-year-old female respiratory constitutional symptoms. A valvular heart disease bilateral effusion were known. study carried out showed a large right...

Postobstructive pneumonia is a pulmonary infiltrate distal to bronchial obstruction. It presents diagnostic challenge, and full attention should be on recognition of this entity, identify, treating the obstructive lesion secondary infection. In adults, malignancy main cause; however, others etiologies must investigated.

Tuberculous pericarditis is a rare extra-pulmonary manifestation of tuberculosis observed mainly in developed countries. It usually presents with concomitant tuberculous infection at different site and, due to the lack clinical specificity, diagnosis can be difficult. Thus, diagnostic delay frequent, entailing increased morbidity and mortality. The authors present case disseminated predominantly cardiac symptoms multiple negative samples for Mycobacterium tuberculosis, which evolved...

Abstract Pyelocaliceal obstruction is a diagnostic challenge, and it important to identify the cause. Some patients present extra‐renal compressive masses that need further imagiologic investigation biopsy, establish diagnosis.

Abstract Forestier disease is a condition characterized by calcification and ossification of ligaments entheses particularly affecting axial skeleton. Diagnosis difficult mandates high suspicion level, but unexpensive accessible examinations like simple radiography might provide useful diagnostic clues in these challenging clinical scenarios improve assistance.

Objective: Mortality rate is a major healthcare quality indicator and the study of its features important to improve clinical outcomes. Recent data suggest that blood pressure (BP) variability promotes increased cardiovascular risk independently BP may be associated mortality. The authors evaluated association between in acute hospitalized patients an Internal Medicine ward outcome. Design method: Retrospective all discharged first month 2015 average-size hospital ward. Odds ratios (OR)...

Objective: Pulse wave velocity (PWV) is considered a marker of cardiovascular (CV) risk prognosis. The authors aimed to evaluate an hypertensive group patients who was submitted PWV and study association between this indicator other features. Design method: Retrospective all evaluated by in Portuguese average-size hospital Arterial Hypertension Consultation (n = 373). Continuous variables are expressed as mean were compared using the unpaired Student's t-test. Categorical frequencies...

The elimination of the aetiological factors causing liver injury is an important cornerstone in preventing progression and increasing survival patients with cirrhosis. authors present case a 63-year-old woman history long-term alcohol abuse consequent Over years, patient presented progressive deterioration severe malnutrition had multiple hospital admissions due to decompensated cirrhosis, including refractory ascites, variceal bleeding extensive portal vein thrombosis (PVT). Anticoagulant...

Livedo reticularis (LR) is a net-like cyanotic skin pattern resulting from cutaneous blood flow disturbance associated with several medical conditions. The authors present case of 77-year-old woman history asthenia over one year, admitted to the hospital sepsis by pneumonia. During her hospitalization, she developed livedoid rash, and biopsy revealed infiltrates atypical mononuclear cells causing capillary lumen obstruction. Intravascular large B-cell lymphoma was suspected confirmed bone...

Abstract Hemophagocytic lymphohistiocytosis poses a diagnostic dilemma due to the absence of specific clinical and laboratory findings, especially in adults. Despite greater recognition disease, secondary idiopathic forms are still reported.

Forestier disease is a condition characterized by calcification and ossification of ligaments entheses. It’s prevalence expected to rise as air related older age metabolic syndrome. The clinical relevance beyond unstable spinal fractures involvement the cardiovascular, respiratory gastrointestinal systems.