2018 Southern Regional Meeting

2018 Journal of Investigative Medicine  
5 Figure 1 There was no significant change in mean cFGF23 concentration Abstracts Abstracts 358 Case report Pneumonia is the infection of the lung parenchyma that can be life-threatening if not managed appropriately. Most community acquired pneumonias have good prognosis, with majority recovering within a month. However, when it is recurrent in the same anatomical location, it is important to do further investigation to look for the cause. With this inquisitive clinical approach, an undiagnosed
more » ... aberrant right subclavian artery (ARSA) was found to be the cause of recurrent pneumonia. A sixty five year old female with a recent history of two episodes of right middle lobe(RML) pneumonia, within the previous five months, presented for a hospital follow up. Chest X-ray from both hospital visits suggested RML processes which resolved with levofloxacin. A detailed history during our encounter uncovered intermittent dysphagia to solids and liquids. The recurrent RML pneumonia and the remote history of dysphagia suggested significant pulmonary aspiration. A video fluoroscopy showed compression of the oesophagus. A CAT scan showed the presence of an ARSA that was compressing the upper oesophagus. We discovered that an ARSA compressed the upper oesophagus, which caused recurrent aspiration pneumonia. ARSA is an uncommon congenital anatomical variant where the right subclavian artery comes directly off the aortic arch instead of the brachiocephalic trunk. It travels posterior to the oesophagus towards the right upper extremity; causing esophageal compression. If symptomatic, it will usually present in infants with respiratory symptoms or after decades as dysphagia along with chest pain, hoarseness or anorexia. Our patient had two upper endoscopies however no imaging study was done to evaluate for extrinsic esophageal compression. Despite the appropriate workup, vascular causes can be missed if not considered. This case demonstrated a presentation of an ARSA compressing the upper oesophagus and causing dysphagia in a patient with recurrent RML pneumonia. Patients with recurrent pneumonia in the same anatomic location needs further workup and detailed questioning about dysphagia or aspiration events. Case 61-year-old female with PMH of hypertension presented with acute confusion, hand tremors, and gait ataxia. Workup revealed negative RPR, normal TSH and Vitamin B12. Urine toxicology, blood alcohol, salicylate, and acetaminophen levels were negative. Lab work uncovered refractory hypokalemia and normal AG metabolic acidosis. Non-contrast head CT and brain MRI showed age-related atrophy, subacute/chronic bilateral thalamic enhancement and old basal ganglia lacunar infarctions. Family disclosed her overuse of Pepto-Bismol for dyspepsia. Bismuth toxicity was suspected due to progressive neurological decline, new onset RTA and history of Pepto- Abstracts
doi:10.1136/jim-2017-000697.1 fatcat:ro2yual7zvfgzdeucsalwgsg54