[show abstract][hide abstract] ABSTRACT: BACKGROUND: Splenic injury is normally associated with trauma, but spontaneous splenic rupture has been described in various systemic diseases. CASE PRESENTATION: A 56-year-old male on oral anticoagulation presented to the emergency department with epigastric pain, nausea, and left upper quadrant tenderness. There was no history of trauma. Contrast-enhanced CT imaging revealed a large subcapsular haematoma of the spleen. Oral anticoagulation was antagonised with vitamin K and the patient was discharged in good condition after 3 days of clinical observation. CONCLUSION: Non-traumatic splenic rupture is a rare complication of oral anticoagulation.
International Journal of Emergency Medicine 05/2013; 6(1):16.
[show abstract][hide abstract] ABSTRACT: Importance of the field: The clinical suspicion of acute pulmonary embolism (PE) is frequently raised. However, the diagnosis of PE is confirmed in only 20 - 30% of these patients. The high incidence in addition to the potential harm from false-positive or false-negative diagnostic decisions underline the importance of a standardised diagnostic algorithm with high sensitivity as well as specificity. Areas covered in this review: This article reviews the diagnostic tests for the diagnosis of PE. What the reader will gain: This review provides an overview of the different clinical decision rules (CDRs), D-dimer tests and imaging techniques in patients suspected of PE. Furthermore, the diagnostic process in patients with clinically suspected recurrent PE, suspicion during pregnancy and new research areas are discussed. Take home message: Various diagnostic tests are available to detect or exclude PE with good accuracy. CDRs and D-dimer tests play an important role in the exclusion of PE. Neither is sufficient as a single test, but the combination of an 'unlikely' clinical prediction and a normal D-dimer test result safely excludes PE. In case of a high CDR score and/or an elevated D-dimer concentration, extra imaging is necessary with multi-slice computed tomography pulmonary angiography as first choice modality.
Expert Opinion on Medical Diagnostics 01/2011; 5(1):49-61.