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Liver contusion in man reveals a Tako-tsubo cardiomyopathy without chest pain: reality or illusion?

Benali Zel A, Abdedaim H, Omari D - Pan Afr Med J (2014)

Bottom Line: Tako-tsubo syndrome is very rare in male patients, often overlooked by practitioners in its atypical form painless, and who did not always a good prognostic, often revealed in a context of acute stress at any time in the hospital or outside, its pathophysiology remains to discuss, the diagnosis is greatly facilitated by imaging including echocardiography with apical ballooning.We relate this clinical case of a patient admitted to the ICU for a liver contusion with a diagnosis incidentally this syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology & Intensive Care, CHP Eddarak, Berkane, Morocco.

ABSTRACT
Tako-tsubo syndrome is very rare in male patients, often overlooked by practitioners in its atypical form painless, and who did not always a good prognostic, often revealed in a context of acute stress at any time in the hospital or outside, its pathophysiology remains to discuss, the diagnosis is greatly facilitated by imaging including echocardiography with apical ballooning. We relate this clinical case of a patient admitted to the ICU for a liver contusion with a diagnosis incidentally this syndrome.

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Related in: MedlinePlus

Abdominal ultrasonography mode 2 D showed a effusion at the Morrison's pouch with low abundance and contusion of the lower edge of the liver (red arrow)V
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Figure 0001: Abdominal ultrasonography mode 2 D showed a effusion at the Morrison's pouch with low abundance and contusion of the lower edge of the liver (red arrow)V

Mentions: Referring us to a 60 year old male patient, without pathological antecedents, accident victim of the highway with the point of abdominal impact, admitted to the ICU for monitoring, review the admission showed a well oriented in space and time, personality anxious, the palpebral conjunctivae were not pale, stable blood pressure with 120/70 mm hg, painful on palpation of the abdomen in the right upper quadrant, the examination of the chest is normal without pain, cardiac examination is completely normal except for a slight bradycardia to 54 beat / min. ultrasound abdominal (Figure 1) showed a perihepatic effusion of low abundance with contusion of the lower edge of the liver, echocardiography (Figure 2) bedside was systematically whatever reason in any patient admitted to the ICU, showed in our patient: a bollonisation with akinesia ( lack of mobility and thickening myocardial) apical with hyper kinesis basal, the fraction ejection estimated at 45%, no valvulopathy associated, dry pericardium, the ascending and abdominal aorta without abnormality, size and respiratory compliance of the inferior vena cava were normal. This prompted us to do an electrocardiogram outside any chest pain showed that: ST segment elevation in DIII V2 V3 V4 V5 V6 and - aVR (Figure 3), the troponin Ic showed a moderate increase of 2 µg/L, the blood electrolytes and blood count without any special, before the clinical and biological aspect asked cardiac MRI outpatient near hospital (because of the unavailability of technical trays for coronary angiography) showed that left ventricular ballooning with myocardial edema without necrosis or fibrosis and therefore diagnosis of TC syndrome was retained. The patient was put on analgesic, diuretic and platelet aggregation inhibitors without anticoagulants as because of the risk of worsening liver bleeding in a traumatic context. A second echocardiogram after one week showed a total resolution of apical akinesia formally illustrating the TC syndrome.


Liver contusion in man reveals a Tako-tsubo cardiomyopathy without chest pain: reality or illusion?

Benali Zel A, Abdedaim H, Omari D - Pan Afr Med J (2014)

Abdominal ultrasonography mode 2 D showed a effusion at the Morrison's pouch with low abundance and contusion of the lower edge of the liver (red arrow)V
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225153&req=5

Figure 0001: Abdominal ultrasonography mode 2 D showed a effusion at the Morrison's pouch with low abundance and contusion of the lower edge of the liver (red arrow)V
Mentions: Referring us to a 60 year old male patient, without pathological antecedents, accident victim of the highway with the point of abdominal impact, admitted to the ICU for monitoring, review the admission showed a well oriented in space and time, personality anxious, the palpebral conjunctivae were not pale, stable blood pressure with 120/70 mm hg, painful on palpation of the abdomen in the right upper quadrant, the examination of the chest is normal without pain, cardiac examination is completely normal except for a slight bradycardia to 54 beat / min. ultrasound abdominal (Figure 1) showed a perihepatic effusion of low abundance with contusion of the lower edge of the liver, echocardiography (Figure 2) bedside was systematically whatever reason in any patient admitted to the ICU, showed in our patient: a bollonisation with akinesia ( lack of mobility and thickening myocardial) apical with hyper kinesis basal, the fraction ejection estimated at 45%, no valvulopathy associated, dry pericardium, the ascending and abdominal aorta without abnormality, size and respiratory compliance of the inferior vena cava were normal. This prompted us to do an electrocardiogram outside any chest pain showed that: ST segment elevation in DIII V2 V3 V4 V5 V6 and - aVR (Figure 3), the troponin Ic showed a moderate increase of 2 µg/L, the blood electrolytes and blood count without any special, before the clinical and biological aspect asked cardiac MRI outpatient near hospital (because of the unavailability of technical trays for coronary angiography) showed that left ventricular ballooning with myocardial edema without necrosis or fibrosis and therefore diagnosis of TC syndrome was retained. The patient was put on analgesic, diuretic and platelet aggregation inhibitors without anticoagulants as because of the risk of worsening liver bleeding in a traumatic context. A second echocardiogram after one week showed a total resolution of apical akinesia formally illustrating the TC syndrome.

Bottom Line: Tako-tsubo syndrome is very rare in male patients, often overlooked by practitioners in its atypical form painless, and who did not always a good prognostic, often revealed in a context of acute stress at any time in the hospital or outside, its pathophysiology remains to discuss, the diagnosis is greatly facilitated by imaging including echocardiography with apical ballooning.We relate this clinical case of a patient admitted to the ICU for a liver contusion with a diagnosis incidentally this syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology & Intensive Care, CHP Eddarak, Berkane, Morocco.

ABSTRACT
Tako-tsubo syndrome is very rare in male patients, often overlooked by practitioners in its atypical form painless, and who did not always a good prognostic, often revealed in a context of acute stress at any time in the hospital or outside, its pathophysiology remains to discuss, the diagnosis is greatly facilitated by imaging including echocardiography with apical ballooning. We relate this clinical case of a patient admitted to the ICU for a liver contusion with a diagnosis incidentally this syndrome.

Show MeSH
Related in: MedlinePlus