Cardiac catheterization revealed mild non-obstructive coronary arteries and severe aortic regurgitation. A transthoracic echocardiogram demonstrated reduced left ventricular ejection fraction, dilated left ventricle, and severe aortic insufficiency. CASE REPORT We present a case of a 76-year-old woman who presented to the Emergency Department (ED) with shortness of breath associated with orthopnea, paroxysmal nocturnal dyspnea, and mild productive cough with white sputum. However, clinicians should have a high index of suspicion, since this pathology can evolve into potentially life-threatening conditions, including aortic aneurysm, aortic wall rupture, and aortic acute dissection. Giant-cell aortitis usually lacks the classic clinical findings of giant-cell arteritis such as headache, visual symptoms, or jaw claudication, which can be a diagnostic challenge. Large-vessel vasculitis (giant-cell arteritis, Takayasu arteritis, and IgG4-related vasculitis) is the most common non-infectious causes of aortitis. This pathology can be subsequently classified depending on its etiology into inflammatory and infectious causes. Aortitis involves a broad spectrum of disorders characterized by inflammatory changes in the aortic wall. He was found to have pancytopenia on his laboratory panel and had an excellent response to immunosuppressive therapy.īACKGROUND Acute aortic insufficiency can be secondary to multiple conditions, including infective endocarditis, aortic root pathologies (eg, dissection, aortitis), or traumatic injury. Here, we present a case of a 35-year-old male who presented to the emergency room with profuse bleeding after a deep dental cleaning. In patients in whom the reversible cause was not found, patient management depends on age, disease severity, and donor availability. The primary treatment of AA is to remove the offending agent. Patients usually present with non-specific findings, such as easy fatigability, dyspnea on exertion, pallor, and mucosal bleeding.

The most common etiology of AA is considered to be idiopathic. There are three known mechanisms of AA: direct injuries, immune-mediated disease, and bone marrow failure. AA presents at any age with equal distribution among gender and race. Therefore, to minimize this error, a combination of the 3-criterial consideration is ideal.Īplastic anemia (AA) is a severe but rare hematologic condition associated with hematopoietic failure leading to decreased or total absent hematopoietic precursor cells in the bone marrow. Light's criteria misinterpret about 25% of transudative effusions as exudative. Malignancy is the most common cause of nontraumatic, exudative chylothorax. A subsequent pleural fluid cytology found malignant cells consistent with lung adenocarcinoma. This effusion can be classified as transudative as per Light's criteria and exudative as per Heffner's and pleural cholesterol criteria. Pleural fluid analysis demonstrated a triglyceride concentration of 520 mg/dL, a pleural/serum protein ratio of 0.41, a pleural/serum lactate dehydrogenase (LDH) ratio of 0.26, a total pleural LDH of 127 IU/L, and a cholesterol level of 58 mg/dL. Therapeutic drainage of the left pleural effusion resulted in 650 mL of milky-white fluid. He denied fever, orthopnea, and paroxysmal nocturnal dyspnea. A 65-year-old African American man with a past medical history of metastatic right lung adenocarcinoma presented with dyspnea and palpitations. We present a case of chylothorax that occurs in the setting of lung adenocarcinoma. Transudative chylothorax is extremely rare and typically presents due to a secondary cause, such as liver cirrhosis, nephrotic syndrome, or congestive heart failure. Pleural fluid that is white/milky in appearance, with a triglyceride concentration of greater than 110 mg/dL, strongly supports the diagnosis of chylothorax. Chylothorax refers to chyle within the pleural space, which frequently arises from an interruption in the thoracic duct or because of reduced lymphatic drainage.

Paroxysmal nocturnal dyspnea bronchi