Category Archives: Lethargy

Lethargy, Confusion, and a Mediastinal Abnormality in a 68-Year-Old Woman: Syndromes

Sinus of Valsalva aneurysms may also develop as acquired lesions that result from the valvular disruption that occurs in patients with bacterial endocarditis, syphilitic aortitis, or rheumatoid heart disease, and as a developmentally acquired defect in patients with Marfan’s and Ehlers-Danlos syndromes.
Sinus of Valsalva aneurysms may exist as asymptomatic lesions but pose a risk for sudden rupture into the right atrium or right ventricle. Patients may also present with aortic insufficiency, as in the present patient, or rarely, right-sided outflow obstruction from an enlarging aneurysm. Elective surgical repair of asymptomatic aneurysms is generally advised because of the unpredictable potential for rupture.

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Lethargy, Confusion, and a Mediastinal Abnormality in a 68-Year-Old Woman: Conclusion

Lethargy, Confusion, and a Mediastinal Abnormality in a 68-Year-Old Woman: ConclusionThe existence of a left-sided third mogul positioned just below the left mainstem bronchus is never normal. If present, it most commonly represents a prominent left atrial appendage due to left atrial enlargement. Less commonly, a third left mogul may be caused by a sinus of Valsalva aneurysm or an abnormal right ventricular outflow tract. An abnormal right ventricular outflow tract may be caused by a corrected transposition, tetralogy of Fallot, a single ventricle with a rudimentary chamber, or Ebstein’s anomaly. flovent inhaler

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Lethargy, Confusion, and a Mediastinal Abnormality in a 68-Year-Old Woman

Lethargy, Confusion, and a Mediastinal Abnormality in a 68-Year-Old WomanA 68-year-old woman was brought to the hospital because of increasing lethargy and confusion. She continued to breathe spontaneously but required intubation to protect her airway shortly after arrival. The patient had a past history of hypertension, asthma, cerebrovascular disease, and seizures.
Vital signs: temperature, 37.4°C; pulse, 110/min; respirations, 24/min; blood pressure, 170/70 mm Hg. Neck: estimated central venous pressure <5 cm H2O. Eyes: pupils equal and reactive. Chest: bilateral end-expiratory wheezes. Cardiac: normal Sj and S2, grade 3/6 nonradiating diastolic murmur at the lower left sternal border, grade 2/6 apical holosys-tolic murmur radiating to the axilla, bisferiens carotid pulses, pistol shot pulses of Traube, positive Duroziez’s sign. Neurologic: obtunded without focal findings.
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