RESUMEN
Background: Bleeding is a serious cause of hypotension and tachycardia after childbirth and should always be considered. Case presentation: A healthy woman in her thirties who had previously undergone caesarean section, underwent induction and operative vaginal delivery. Postpartum, she experienced chest pain, hypotension and tachycardia, and had signs of ischaemia on electrocardiogram. A CT scan showed a large intraperitoneal haematoma. The patient underwent immediate laparotomy and received a massive blood transfusion. However, no large haematoma was found. The chest pain was attributed to a myocardial infarction caused by hypovolaemic shock. After discharge, the patient experienced significant vaginal bleeding and was transferred to a different university hospital. A CT scan revealed a large retroperitoneal haematoma. Emergency surgery was performed based on the suspicion of active bleeding, but only an older haematoma was found. Re-evaluation of the initial CT scan revealed that the haematoma was in fact located retroperitoneally and was thereby not found in the first operation. Interpretation: This case highlights the importance of bleeding as an important cause in unstable postpartum patients. Additionally, it is a reminder that retroperitoneal haematomas can occur in obstetric patients and can mask typical symptoms of uterine rupture such as abdominal pain. also hindering perioperative diagnosis.
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Dolor en el Pecho , Hematoma , Choque , Humanos , Femenino , Adulto , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/diagnóstico , Dolor en el Pecho/etiología , Choque/etiología , Choque/diagnóstico , Tomografía Computarizada por Rayos X , Embarazo , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Trastornos Puerperales/diagnóstico por imagen , Espacio Retroperitoneal/diagnóstico por imagen , Cesárea/efectos adversos , Electrocardiografía , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/complicaciones , Hemorragia Posparto/etiología , Hemorragia Posparto/diagnósticoAsunto(s)
Influenza Pandémica, 1918-1919 , Gripe Humana , Neumonía Viral , Humanos , Masculino , Adulto Joven , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Pulmón/diagnóstico por imagen , Pulmón/patología , Radiografía Torácica , Fiebre/diagnóstico , Fiebre/etiología , Tos/diagnóstico , Tos/etiología , Gripe Humana/complicaciones , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Influenza Pandémica, 1918-1919/historia , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Historia del Siglo XX , Historia del Siglo XXI , Monitoreo Epidemiológico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Preparación para una Pandemia , Vacunas contra la Influenza/administración & dosificaciónAsunto(s)
Dolor en el Pecho , Estenosis Coronaria , Humanos , Estenosis Coronaria/diagnóstico , Dolor en el Pecho/etiología , Dolor en el Pecho/diagnóstico , Angiografía por Tomografía Computarizada/métodos , Masculino , Angiografía Coronaria/métodos , Persona de Mediana Edad , Femenino , Medición de Riesgo/métodosRESUMEN
BACKGROUND: Physicians often focus on possible cardiac causes in patients presenting with chest pain. However, this case highlights a patient who presented with chest pain caused by ingestion of a foreign body after an uneventful meal eaten an hour prior to presentation. The fishbone was discovered after imaging. The article aims to raise awareness regarding the potential origins of chest pain, highlighting that it may stem from non-cardiac conditions. METHODS: The methodology employed in this study involved conducting a case study that meticulously examined the repercussions and management strategies associated with foreign body ingestion. RESULTS: The case report delineates the scenario of a 27-year-old male patient who inadvertently ingested a fishbone during a routine meal. It details the swift decline in clinical status, the meticulous diagnostic procedures employed, the subsequent management strategies implemented and the ultimate discharge of the patient in a stable condition. CONCLUSION: This case highlights the importance of comprehensive history taking and considering a wide range of causes of chest pain when evaluating a patient. The foreign body ingested with the resulting cardiac complications could have been fatal if not promptly diagnosed.Contribution: This study contributed to advancing awareness surrounding foreign body ingestion, shedding light on potential complications and offering valuable insights into effective management strategies.
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Dolor en el Pecho , Esófago , Cuerpos Extraños , Humanos , Masculino , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/diagnóstico por imagen , Adulto , Dolor en el Pecho/etiología , Esófago/diagnóstico por imagen , Ingestión de AlimentosRESUMEN
Mediastinal mature cystic teratomas are rare benign germ cell tumors that predominantly affect children. Despite their low incidence, they present unique diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. This case report aims to highlight the importance of prompt diagnosis and management of mediastinal mature cystic teratomas in pediatric patients. We present the case of a 10-year-old female patient who presented with persistent chest pain and dyspnea. Imaging studies, including a chest X-ray and contrast-enhanced chest CT scan, revealed a large, well-circumscribed anterior mediastinal mass with calcifications. The patient underwent a right thoracotomy, resulting in the excision of a 6 × 5 × 5 cm mature cystic teratoma. Histopathological examination confirmed the diagnosis. The patient had an uneventful recovery and was discharged in stable condition. Mediastinal mature cystic teratomas pose diagnostic challenges due to their nonspecific symptoms and heterogeneous imaging characteristics. Differential diagnosis includes other mediastinal masses containing fat and calcifications. Surgical excision is the preferred treatment, although complete removal can be challenging due to adhesions to neighboring structures. Close follow-up is necessary to monitor for recurrence and complications. Mediastinal mature cystic teratomas are rare tumors with variable clinical presentations. Early detection and surgical intervention are crucial for optimal outcomes. These tumors should be included in the list of differential diagnoses for mediastinal masses in pediatric patients.
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Neoplasias del Mediastino , Teratoma , Tomografía Computarizada por Rayos X , Humanos , Teratoma/cirugía , Teratoma/diagnóstico por imagen , Teratoma/diagnóstico , Teratoma/patología , Femenino , Neoplasias del Mediastino/cirugía , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/diagnóstico por imagen , Niño , Diagnóstico Diferencial , Toracotomía , Dolor en el Pecho/etiología , Mediastino/patología , Mediastino/diagnóstico por imagen , Mediastino/cirugíaRESUMEN
Takayasu's arteritis-pulmonary artery involvement (TA-PAI) is a chronic, progressive, inflammatory disease affecting the pulmonary artery and its branches. Patients typically present with non-specific respiratory symptoms, such as fever, dyspnea, and chest pain, leading to a high rate of misdiagnosis. The diagnosis of TA-PAI is currently based on the diagnostic criteria of aortitis and imaging evidence of pulmonary artery involvement. However, pulmonary artery involvement is not typically included in the diagnostic criteria for aortitis, which may lead to a significant underestimation of the diagnostic rate of TA-PAI, particularly in cases where pulmonary artery involvement is the only manifestation. This article reports the case of a 26-year-old female patient who presented with recurrent chest pain and fever. She was initially diagnosed with pneumonia in a foreign hospital but did not show significant improvement after four months of treatment. Eventually, she was diagnosed with pulmonary artery involvement in aortitis and was stabilized with hormones, immunosuppressive drugs, and pulmonary vascular intervention. By analyzing the clinical features and diagnostic and therapeutic approaches of this case, and reviewing the relevant literature, clinicians can improve their understanding of TA-PAI.
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Neumonía , Arteria Pulmonar , Arteritis de Takayasu , Humanos , Femenino , Adulto , Arteritis de Takayasu/diagnóstico , Neumonía/diagnóstico , Arteria Pulmonar/patología , Arteria Pulmonar/diagnóstico por imagen , Dolor en el Pecho/etiologíaRESUMEN
BACKGROUND: Elevated susceptibility to acute myocardial infarction and various cardiovascular diseases has been observed in individuals infected with the human immunodeficiency virus compared with the uninfected population, as demonstrated in numerous studies. The precise mechanism by which human immunodeficiency virus infection heightens the risk of acute myocardial infarction remains elusive. The manifestation of acute coronary syndrome in young patients with human immunodeficiency virus may deviate from the typical, displaying distinct pathophysiological and clinical characteristics. The occurrence of myocardial infarction with non-obstructive coronary arteries in young patients with human immunodeficiency virus poses diagnostic and treatment challenges. CASE PRESENTATION: We present the case of a 46-year-old African woman with no traditional atherosclerotic risk factors. She was diagnosed with human immunodeficiency virus-1 infection 2 years prior to her current admission for chest pain. Her troponin levels were elevated, suggestive of acute coronary syndrome. Although coronary angiography ruled out coronary artery stenosis, it revealed mild myocardial bridging in the left anterior descending artery. Cardiac magnetic resonance imaging confirmed myocardial infarction, indicating a myocardial infarction with non-obstructive coronary arteries with an apical thrombus in the left ventricle. Following medical treatment, the patient experienced resolution of chest pain and improvement in ST-segment elevation. CONCLUSIONS: In young female patients without traditional risk factors, human immunodeficiency virus infection is a possible etiological factor for myocardial infarction with non-obstructive coronary arteries. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.
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Angiografía Coronaria , Infecciones por VIH , Infarto del Miocardio , Humanos , Femenino , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Dolor en el Pecho/etiología , Electrocardiografía , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVES: We evaluated the ability of the assessment of regional wall motion abnormalities (RWMA) detected via transthoracic echocardiography to predict the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department. DESIGN: Prospective single-centre observational study. SETTING: Tertiary care university hospital emergency unit. PARTICIPANTS: Patients presenting to the emergency department with acute chest pain suggestive of obstructive CAD. PRIMARY OUTCOME MEASURE: The primary endpoint was defined as the presence of obstructive CAD, requiring revascularisation therapy. RESULTS: Overall, 657 patients (age 58.1±18.0 years, 53% men) were included in our study. RWMA were detected in 76 patients (11.6%). RWMA were significantly more frequent in patients reaching the primary endpoint (26.2% vs 7.6%, p<0.001). In multivariable regression analysis, the presence of RWMA was associated with threefold increased odds of the presence of obstructive CAD (3.41 (95% CI 1.99 to 5.86), p<0.001). Adding RWMA to a multivariable model of the Thrombolysis in Myocardial Infarction (TIMI) risk score, cardiac biomarkers and traditional risk factors significantly improved the area under the curve for prediction of obstructive CAD (95% CI 0.777 to 0.804, p=0.0092). CONCLUSION: RWMA strongly and independently predicts the presence of obstructive CAD in patients presenting with acute chest pain to the emergency department. TRIAL REGISTRATION: The study has been registered online (NCT03787797).
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Dolor en el Pecho , Ecocardiografía , Servicio de Urgencia en Hospital , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Ecocardiografía/métodos , Dolor en el Pecho/etiología , Dolor en el Pecho/diagnóstico por imagen , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/fisiopatología , Síndrome Coronario Agudo/diagnóstico por imagen , Factores de Riesgo , AdultoRESUMEN
Coronary risk scores, such as History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) and Emergency Department Assessment of Chest Pain Score (EDACS) scores, help nurses identify suspected acute coronary syndrome (ACS) patients who have a risk for major adverse cardiac events (MACE) within 30 days. AIM: To compare the accuracy of HEART and EDACS scores in predicting major events among patients suspected of ACS in the cardiac emergency department (ED). DESIGN AND METHODS: A prospective correlational observational study design was performed on cardiac ED patients who presented with suspected ACS. TOOLS: Three tools were utilized to collect data pertinent to the study: Tool I comprises patients' assessment (personal characteristics, risk factors for ACS, and chest pain assessment sheet); Tool II is the risk assessment tool that includes HEART and EDACS scores; and Tool III is MACE incidence among studied patients within 30 days. RESULTS: HEART score was significantly (P < .01) higher among patients for whom MACE was present than absent. However, EDACS score showed no significant difference (P > .05) among patients whose MACE was present or absent. HEART risk score >6 correctly predicted MACE cases with sensitivity and specificity of 77.46% and 48.28%, respectively. However, EDACS score >18 correctly predicted MACE cases with sensitivity and specificity of 42.25% and 75.86%, respectively. CONCLUSION: This study concludes that HEART score has better sensitivity than EDACS in predicting MACE among suspected ACS patients at the cardiac ED. The HEART score provides the nurses with a quicker and more reliable predictor of MACE shortly after the arrival of the suspected ACS patients at the cardiac ED than the EDACS score. The study recommended the implementation of a HEART score in the cardiac ED for predicting MACE in suspected ACS patients. Follow up closely for high-risk patients to MACE. An educational program should be made for nurses about the implementation of the heart score in the cardiac ED.
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Síndrome Coronario Agudo , Dolor en el Pecho , Servicio de Urgencia en Hospital , Humanos , Síndrome Coronario Agudo/diagnóstico , Estudios Prospectivos , Masculino , Femenino , Medición de Riesgo , Persona de Mediana Edad , Anciano , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Factores de Riesgo , Electrocardiografía , Troponina/sangre , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Pleural effusion indicates an imbalance between pleural fluid formation and removal. Classified into exudative and transudative, with common symptoms of dry cough, dyspnea and pleuritic chest pain. Confirmed etiology has to be established for effective treatment. OBJECTIVE: Correlate clinical and biochemical profile of various etiologies of pleural effusion. MATERIALS & METHODS: Retrospective observational study of 2 years in the department of respiratory medicine, GMC Bhopal on 280 cases of pleural effusion. RESULTS: Most common etiology was tubercular 202 (72.4%) followed by malignant in 36 (12.8%). With respect to tubercular, malignant pleural effusion has relative risk (RR) of 0.138 (p value < 0.05) in the age group of 51-60 years, which is statistically significant. Patients of tuberculosis complained of fever 158 (78.2%) whereas with malignancy complained of chest pain 16 (44.4%) followed by hemoptysis 12 (33.3%). For hemoptysis, with respect to tubercular, malignant effusion has RR of 5.68 (p value < 0.05) which is significant. History of smoking was significant in malignant effusion with RR of 2.57 (p value < 0.05) as compared to tubercular. Pleural fluid ADA was >70 in 83.7% in tubercular effusion, glucose was <60 mg/dl in 79% tubercular, malignant and bacteriological cause, LDH was >1000 in 88.4% in bacteriological and 72.3% in malignant effusion. CONCLUSION: Lack of tools for confirming diagnosis leads to diagnostic dilemma and delay in treatment initiation, leading to deterioration and untoward fatality in some cases. Our goal is early diagnosis by correlating clinical symptoms with biochemical profile and help initiate rapid treatment.
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Derrame Pleural , Centros de Atención Terciaria , Humanos , Estudios Retrospectivos , Persona de Mediana Edad , India/epidemiología , Masculino , Femenino , Derrame Pleural/etiología , Derrame Pleural/diagnóstico , Derrame Pleural/epidemiología , Derrame Pleural/metabolismo , Adulto , Anciano , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiología , Derrame Pleural Maligno/metabolismo , Tuberculosis Pleural/diagnóstico , Tuberculosis Pleural/epidemiología , Adulto Joven , Hemoptisis/etiología , Hemoptisis/epidemiología , Dolor en el Pecho/etiología , Adolescente , Adenosina Desaminasa/análisis , Fumar/epidemiología , Fiebre/etiologíaRESUMEN
BACKGROUND: Patients with low HEART (History, Electrocardiogram, Age, Risk factors, and Troponin level) risk scores who are discharged from the emergency department (ED) may present clinical challenges and diagnostic dilemmas. The use of downstream non-invasive stress imaging (NISI) tests in this population remains uncertain. Therefore, this study aims to investigate the value of NISI in risk stratification and predicting cardiac events in patients with low-risk HEART scores (LRHSs). METHODS: We prospectively included 1384 patients with LRHSs between March 2019 and March 2021. All the patients underwent NISI (involving myocardial perfusion imaging/stress echocardiography). The primary endpoints included cardiac death, non-fatal myocardial infarction and unplanned coronary revascularisation. Secondary endpoints encompassed cardiovascular-related admissions or ED visits. RESULTS: The mean patient age was 64±14 years, with 670 (48.4%) being women. During the 634±104 days of follow-up, 58 (4.2%) patients experienced 62 types of primary endpoints, while 60 (4.3%) developed secondary endpoints. Multivariable Cox models, adjusted for clinical and imaging variables, showed that diabetes (HR: 2.38; p=0.008), HEART score of 3 (HR: 1.32; p=0.01), history of coronary artery disease (HR: 2.75; p=0.003), ECG changes (HR: 5.11; p<0.0001) and abnormal NISI (HR: 16.4; p<0.0001) were primary endpoint predictors, while abnormal NISI was a predictor of secondary endpoints (HR: 3.05; p<0.0001). CONCLUSIONS: NISI significantly predicted primary cardiac events and cardiovascular-related readmissions/ED visits in patients with LRHSs.
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Dolor en el Pecho , Ecocardiografía de Estrés , Servicio de Urgencia en Hospital , Humanos , Femenino , Masculino , Persona de Mediana Edad , Medición de Riesgo/métodos , Estudios Prospectivos , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Ecocardiografía de Estrés/métodos , Anciano , Imagen de Perfusión Miocárdica/métodos , Factores de Riesgo , Pronóstico , Estudios de Seguimiento , Valor Predictivo de las Pruebas , Electrocardiografía , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico por imagenRESUMEN
BACKGROUND: The incidence of coronary heart disease (CHD) in youth is rapidly increasing but difficultly recognized in the early stage. METHODS AND RESULTS: In this retrospective study, 194 CHD patients under the age of 45 who previously experienced chest pain symptoms and 170 non-CHD patients were included and demographic data were collected. Systemic inflammation index (SII) and systemic inflammation response index (SIRI) were increased in young CHD patients (p < 001). Spearman's correlation analysis showed that both SII and SIRI were negatively correlated with HDL and positively correlated with hypertension, Gensini score, and hsTnI. Logistic regression analysis indicated that SII and SIRI were independently associated with the presence of CHD in youth with chest pain symptoms. The area under the ROC curve (AUC) of the SII model for young CHD patients was 0.805 (0.728-0.869), and the sensitivity and specificity were 0.65 and 0.823, respectively. Meanwhile, the AUC for the SIRI model was 0.812 (0.739-0.872), and the sensitivity and specificity were 0.673 and 0.8022. The calibration curves of both SII and SIRI models are in good agreement with the actual curves. And the decision curves of both models indicated their clinical practicality. CONCLUSION: SII and SIRI are independent risk factors for CHD in young adults, which can quickly and effectively identify CHD patients among young adults who have previously experienced chest pain symptoms.
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Enfermedad Coronaria , Inflamación , Humanos , Masculino , Femenino , Enfermedad Coronaria/inmunología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/sangre , Estudios Retrospectivos , Inflamación/inmunología , Inflamación/sangre , Inflamación/diagnóstico , Adulto , Adulto Joven , Curva ROC , Adolescente , Factores de Riesgo , Dolor en el Pecho/inmunología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/epidemiología , Dolor en el Pecho/etiología , Biomarcadores/sangreRESUMEN
A pericardial cyst is a rare and benign lesion, most commonly of congenital origin. A female patient of 35 years old was admitted to the emergency department of our institution, for non-irradiating thoracic pain associated with a dyspnea. A CT-Scan was performed, and a pericardial cyst of a large size was found. A surgical procedure through thoracoscopy was performed to enhance the symptomatology of the patient and to eradicate the cyst. The diagnosis of these lesions is most commonly sporadic after a radiography performed for other causes. Most of the time these lesions are asymptomatic (although thoracic pains, chronic cough and dyspnea amongst others may be observed). In case of suspicion (related to radiography or an eventual symptomatology) a thoracic scan is performed with a contrasting product for the confirmation and localization of the cyst. In addition to the diagnosis and the localization, it is best to perform a transthoracic ultrasound which enables a differential diagnosis with other lesions (lipoma, aortic aneurysm, solid tumour, and a left ventricle aneurysm etc.). A surgical treatment is recommended in symptomatic cases. In non-symptomatic cases, a transthoracic ultrasound is recommended.
Le kyste péricardique est une lésion rare, bénigne et le plus souvent congénitale. Nous rapportons le cas d'une patiente de 35 ans admise aux urgences de notre institution dans le cadre d'une douleur thoracique associée à une dyspnée. La réalisation d'un scanner thoracique permet de mettre en évidence un kyste péricardique d'une grande taille. Une intervention par chirurgie thoracoscopique vidéo-assistée a été réalisée afin de mettre à plat le kyste et, ainsi, d'améliorer la symptomatologie de la patiente. Le diagnostic de ces lésions est le plus souvent fait de manière fortuite, sur une radiographie réalisée pour une autre raison. Il s'agit généralement de lésions asymptomatiques bien que des douleurs thoraciques, une toux chronique ou encore une dyspnée sont retrouvées dans certains cas. En cas de suspicion, un scanner thoracique avec produit de contraste permet de confirmer et localiser précisément la lésion. Une échographie trans-thoracique permet, en plus, de réaliser un diagnostic différentiel avec d'autres lésions (lipome, anévrysme aortique, tumeur solide, anévrysme du ventricule gauche, etc ). En cas de lésion symptomatique, une prise en charge chirurgicale est recommandée. Dans les cas asymptomatiques, un suivi par échographie trans-thoracique est recommandé.
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Quiste Mediastínico , Humanos , Femenino , Quiste Mediastínico/cirugía , Quiste Mediastínico/diagnóstico , Quiste Mediastínico/diagnóstico por imagen , Adulto , Tomografía Computarizada por Rayos X , Toracoscopía/métodos , Dolor en el Pecho/etiología , Diagnóstico DiferencialRESUMEN
Infectious esophagitis (IE) is the leading cause of esophagitis, second only to gastroesophageal reflux disease. Infectious esophagitis is typically observed in immunocompromised individuals due to neutropenia, HIV/AIDS, solid organ malignancies, cancer-directed therapy, or chronic steroid use. The most common causes of IE are herpes simplex virus (HSV), cytomegalovirus (CMV), and Candida albicans. Acute bacterial esophagitis is exceedingly rare, particularly in immunocompetent patients. Herein, we describe a unique case of acute streptococcal esophagitis in a male patient with no pertinent medical history. The patient's substernal chest pain and odynophagia resolved after antibiotic treatment.
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Antibacterianos , Esofagitis , Infecciones Estreptocócicas , Humanos , Masculino , Esofagitis/microbiología , Esofagitis/tratamiento farmacológico , Esofagitis/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/complicaciones , Antibacterianos/uso terapéutico , Inmunocompetencia , Dolor en el Pecho/etiologíaRESUMEN
BACKGROUND: Primary esophageal motility disorders present with a spectrum of symptoms where manometry plays an important role. We designed this study to evaluate the utility of esophageal manometry among various symptoms. MATERIALS AND METHODS: This is a single-center observational study conducted over 5 years in a tertiary referral center. A total of 564 patients who underwent high-resolution esophageal manometry (HREM) using a 16-channel water perfusion system were included in the study. Their clinical profile and manometric findings, as per the Chicago classification version 4.0, were recorded, and the diagnostic utility of HREM with respect to symptoms was studied. RESULTS: Motility disorders were identified in 48.8% of patients, the most common being Achalasia cardia (32.4%). Dysphagia (55.5%) was the most common indication of manometry, followed by gastroesophageal reflux disease (GERD) (34.9%), chest pain (6.2%), and symptoms such as belching, globus, and hiccoughs (3.4%). Among those who were re-classified from Chicago classification v3.0 to v4.0, 21.2% had a newer diagnosis. Among the patients with dysphagia, HREM revealed the highest yield of detecting an abnormal esophageal motility test (70.6%); meanwhile, this yield was much lower in those with GERD (21.8%), chest pain (22.8%), and other symptoms (15.7%). The most common finding among those with dysphagia was Achalasia cardia (55.9%), while the study was normal among those with GERD (78.1%), chest pain (77.1%), and other symptoms (84.2%). The sensitivity and specificity of dysphagia for major motility disorders were 65% and 91%, respectively, with a positive predictive value of 90%. CONCLUSION: HREM has high accuracy and a good diagnostic yield among patients with dysphagia, with the most common finding being Achalasia cardia.
Résumé Contexte:Les troubles primaires de la motilité Åsophagienne se manifestent par un spectre de symptômes dans lesquels la manométrie joue un rôle important. Nous conçu cette étude pour évaluer l'utilité de la manométrie Åsophagienne parmi divers symptômes.Matériels et méthodes:Il s'agit d'un centre unique étude observationnelle menée sur 5 ans dans un centre de référence tertiaire. Au total, 564 patients ayant subi une chirurgie Åsophagienne à haute resolution la manométrie (HREM) utilisant un système de perfusion d'eau à 16 canaux ont été incluses dans l'étude. Leur profil clinique et leurs résultats manométriques, selon la classification de Chicago version 4.0, ont été enregistrés et l'utilité diagnostique du HREM en ce qui concerne les symptômes a été étudiée.Résultats:Des troubles de la motilité ont été identifiés chez 48,8 % des patients, la plus fréquente étant l'Achalasia cardia (32,4 %). La dysphagie (55,5 %) était la l'indication la plus courante de la manométrie, suivie du reflux gastro-Åsophagien (RGO) (34,9 %), des douleurs thoraciques (6,2 %) et des symptômes tels que comme les éructations, les globus et le hoquet (3,4 %). Parmi ceux qui ont été reclassés de la classification de Chicago v3.0 à v4.0, 21,2 % avaient un diagnostic. Parmi les patients atteints de dysphagie, l'HREM a révélé le rendement le plus élevé de détection d'un test de motilité Åsophagienne anormale (70,6 %); dans le même temps, ce rendement était beaucoup plus faible chez les personnes souffrant de RGO (21,8 %), de douleurs thoraciques (22,8 %) et d'autres symptômes (15,7 %). Le plus courant le résultat parmi les personnes souffrant de dysphagie était l'achalasie cardiaque (55,9 %), tandis que l'étude était normale chez les personnes souffrant de RGO (78,1 %), douleur thoracique (77,1 %) et autres symptômes (84,2 %). La sensibilité et la spécificité de la dysphagie pour les troubles majeurs de la motilité étaient de 65 % et 91 %, respectivement, avec une valeur prédictive positive de 90 %.Conclusion:HREM présente une grande précision et un bon rendement diagnostique chez les patients atteints de dysphagie, la pathologie la plus fréquente étant l'achalasie cardiaque.