Online Clinical Case Study (April 2008)

Clinical Cardiology Series
臨床心臟科個案研究

The content of the Office Cardiology Series is provided by:
Dr. TAM Chi Ming
M.B.B.S. (HK), M.R.C.P. (UK), F.H.K.C.P., F.H.K.A.M. (Med), Specialist in Cardiology
 Dr. LI Siu Lung, Steven
F.H.K.A.M. (Med), F.R.C.P. (Glasg), F.R.C.P. (Edin), F.R.C.P. (Lond),
Specialist in Cardiology
 Dr. WONG Shou Pang, Alexander
F.R.C.P., F.H.K.A.M.(Med.), F.H.K.C.P., Specialist in Cardiology

臨床心臟科個案研究之內容誠蒙譚志明醫生、李少隆醫生及王壽鵬醫生提供。

A 45-year-old man presented to the A&E department because of severe shortness of breath at rest

A 45-year-old man presented to the A&E department because of severe shortness of breath at rest. He denied any history of chest pain. His BP was 90/50 with a HR 120/min.

His ECG on presentation:

A therapeutic procedure was done and the following is his ECG after the procedure:

Answers

1.

What is the abnormality on his ECG?
a. Fast atrial fibrillation
b. Pre-excitation with re-entry tachycardia
c. Ventricular tachycardia
d. Sinus tachycardia with electrical alterna
 

d.

The patient's ECG showed sinus tachycardia with low limb leads voltage and electrical alternan at precordial leads due to massive pericardial effusion and thus continuously changing cardiac axes.
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2. What is the patient's diagnosis and the therapeutic procedure?
a. Acute myocardial infarction and urgent PTCA
b. Supra-ventricular tachycardia and cardioversion
c. Cardiac tamponade and pericardiocentesis
d. Pulmonary embolism and thrombolytic therapy
 

c.

After urgent pericardiocentesis, the heart no longer swung within pericardial effusion and thus the electrical alternan disappeared.
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Dermatology Series 皮膚科病例研究

A 30-year-old female presents with a growing lesion on the dorsal aspect of her left index finger

A 30-year-old female presents with a growing lesion on the dorsal aspect of her left index finger for a month, now measuring about 0.5 cm in diameter. She does not recall any preceding history of trauma. The lesion is asymptomatic.

The content of the Dermatology Series is provided by:
Dr. CHOW Ka Yuen, Dr. TANG Yuk Ming, William, Dr. CHAN Loi Yuen & Dr. MAK Kam Har.
Specialists in Dermatology & Venereology
皮膚科病例研究之內容誠蒙周家源醫生、鄧旭明醫生、陳來源醫生及麥錦霞醫生提供。

Answers

1.

What is the clinical diagnosis?

The clinical diagnosis is acquired digital fibrokeratoma. The exact incidence of the condition is not known, but it is not an uncommon acquired condition. There may be a slightly higher male predominance, but the lesion is reported in both sexes and all races. It can occur in young children, adults and the elderly, with the majority occurring in the middle-aged adults. Patient usually presents with an asymptomatic, solitary, skin-coloured, domeshaped papule or tall finger-like protrusion with a hyperkeratotic surface. Most lesions are small and do not exceed 1.5 cm diameter, but giant lesions measuring in excess of 3 cm have been reported. An important clinical sign is a collarette of slightly raised skin that encircles the base of the lesion.
 

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2.

What are the differential diagnoses?

Differential diagnoses to be distinguished include corn, cutaneous horn, supernumerary digit, wart, pyogenic granuloma, infantile digital fibromatosis and periungual fibroma.
 

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3.

What is the aetiology of the condition?

Despite the fact that most patients do not recall a history of preceding trauma, it is believed that subclinical injury contributes to the development of the lesion.
 

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4.

On which part of the body does the lesion commonly occur?

Fibrokeratoma typically occurs on the volar aspect of the hand (palm and finger) and foot (toe or sole). Lesions have been reported less commonly on other parts of the distal limbs.
 

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5.

What treatment can you offer for the patient?

Simple surgical excision is curative if the lesion is troublesome to the patient.
 

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