Introduction: Hemothorax can occur both spontaneously and traumatically, with larger fluid collections possibly leading to hypoxia and hemodynamic instability
thoracentesis, yielding 1L of frank sanguineous- appearing fluid. The effusion was exudative per Light’s Criteria. Pleural fluid cell count demonstrated 2,109,271 RBCs per microliter. Cytology was negative for malignant cells. The patient’s dyspnea improved after thoracentesis. MRI of Abdomen and Pelvis was performed and revealed multiple foci of endometriosis. Repeat chest x-ray and chest CT showed resolution of pleural effusion. Gynecologic- Oncological Surgery believed this to be an atypical case of endometriosis, either due to ectopic endometrial glands in the thorax or translocation of sanguineous fluid into the thorax from active ectopic abdominal endometrial glands. Her clinical condition improved, so further invasive diagnostics were deferred in the acute setting. She was discharged home as her oxygen requirements abated. Discussion: Hemothorax has a wide differential diagnosis and spontaneous hemothorax is relatively uncommon. Causes of spontaneous hemothorax include vascular rupture, use of anticoagulant medications, endometriosis, coagulopathies, and pulmonary infarctions.
Case: A 40-year-old woman with hypertension presented with complaints of epigastric pain and dyspnea, which began suddenly on the day of arrival. Initial vital signs were T 99.4 F, HR 126, BP 109/75, RR 22, SpO2 84% on room air. Physical exam revealed an uncomfortable-appearing woman with decreased breath sounds in the right posterior lung fields and epigastric abdominal tenderness without guarding or rebound. Laboratory studies significant for H/H of 10.9g/dl/32.0% (baseline 15g/dl/45%). Single-view CXR and CT Chest showed a moderate right-sided pleural effusion and no abnormalities of thoracic vasculature. CT of the Abdomen and Pelvis showed moderate hemoperitoneum and an irregularly heterogeneous uterus. She was started on supplemental oxygen at 2L by nasal cannula with improvement in her oxygen saturation to 99%. She was given multiple boluses of Lactated Ringers with improvement in her heart rate and constitutional symptoms. Pulmonology performed
DOUBLE CATASTROPHE: SPONTANEOUS TUMOR LYSIS SYNDROME AND LARGE PERICARDIAL EFFUSION IN A PATIENT WITH MYELOFIBROSIS. Andikan Udoh, Ifeoluwa Stowe, Gift Echefu, Karthik Reddy; Department of Medicine, Baton Rouge General Medical Center, Baton Rouge, LA.
Introduction: Tumor lysis syndrome (TLS) is an oncologic emergency typically occurring following initiation of chemotherapy, associated with multiorgan failure. Spontaneous tumor lysis syndrome (STLS), a rarer entity, occurs in the absence of ongoing chemotherapy and has been reported in certain hematologic malignancies. Occasionally, STLS may herald the initial diagnosis of underlying malignancy. Case: A 66-year-old male with myelofibrosis for 12 years being managed with surveillance presented to the hospital from his oncologist’s office for management of TLS after outpatient labs revealed hyperuricemia and AKI. He had a 3-week history of generalized myalgia, anorexia, oliguria. He underwent a recent bone marrow biopsy which demonstrated progression of his myelofibrosis and treatment plan was underway. At presentation, patient was nontoxic appearing
with stable vital signs. He had multiple subcutaneous nodules over his scalp, forearm, chest and abdomen. Abdominal exam revealed mild distension with non-tender splenomegaly. Investigations revealed hyperuricemia, hyperphosphatemia, leukocytosis and elevated creatinine. A diagnosis of TLS complicated by acute kidney injury was made. He was managed with aggressive IV fluids, Rasburicase and Hydroxyurea. Despite appropriate therapy, he continued to decline; clinically becoming hypoxic and tachycardic with worsening renal function. Chest Xray revealed increased cardiac silhouette and retroperitoneal shadowing prompting an emergent transthoracic echocardiogram which revealed a large pericardial effusion with pre- tamponade physiology. Patient subsequently expired on day 2 despite optimal management. Discussion: The exact patho-mechanism of STLS remains unknown but studies have suggested that 18
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