Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 OK. I'll have to give it to Matt. I tried to distract him, but he stuck to the core findings. The patient had situs inversus--a complete reversal of organs. He indeed had left-sided appendicitis. Situs inversus is quite rare and usually an incidental finding. The heart and all other organs are switched. Thus, he had his heart on the right. The radiologist missed this because he thought the x-ray tech accidently put the stickers on the wrong side of the film. Sometimes, people will have just the heart on the right (dextrocardia) which is more common than situs inversus. The diminished heart tones should have clued us in. Situs inversus occurs in embryonic development when organs that are supposed to rotate do not. Another clue is to look at the testicles! In males (with their hearts in the right place), the left testicle will hang a little lower than the right. This is an embryonic result. The lower testicle in our patient was actually his right (although he wondered why the hell we were interested. Thus guys, your lower testicle is on the side of your heart. Good job Matt. You win a pay-your-own way trip to EMStock in May! Bledsoe, DO, FACEP Midlothian, TX RE: Intersting Case >How can you have left sided appendicitis? There is a hint in the physical >exam findings. How can you have a right sided heart? Genetic/structural abnormality of the patient. I told you it was a WAG. *grin* Big question about this gait pain. Are you talking about heel tap pain (pain in the abdomen with walking/tapping on heel of patient), or are you talking about actual painful walking. Matt _________________________________________________________________ The new MSN 8: smart spam protection and 2 months FREE* http://join.msn.com/?page=features/junkmail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 Well then, I wasn't too far wrong, was I? The guy is from a paralell, mirror image universe. But what did rhonchi have to do with the case, and why did the coughing clear it up? Larry > OK. I'll have to give it to Matt. I tried to distract him, but he stuck to > the core findings. > > The patient had situs inversus--a complete reversal of organs. He indeed > had left-sided appendicitis. Situs inversus is quite rare and usually an > incidental finding. The heart and all other organs are switched. Thus, he > had his heart on the right. The radiologist missed this because he thought > the x-ray tech accidently put the stickers on the wrong side of the film. > Sometimes, people will have just the heart on the right (dextrocardia) which > is more common than situs inversus. The diminished heart tones should have > clued us in. > > Situs inversus occurs in embryonic development when organs that are supposed > to rotate do not. Another clue is to look at the testicles! In males (with > their hearts in the right place), the left testicle will hang a little lower > than the right. This is an embryonic result. The lower testicle in our > patient was actually his right (although he wondered why the hell we were > interested. Thus guys, your lower testicle is on the side of your heart. > > Good job Matt. You win a pay-your-own way trip to EMStock in May! > > Bledsoe, DO, FACEP > Midlothian, TX > > > RE: Intersting Case > > >How can you have left sided appendicitis? There is a hint in the physical > >exam findings. > > How can you have a right sided heart? Genetic/structural abnormality of the > patient. I told you it was a WAG. *grin* > > Big question about this gait pain. Are you talking about heel tap pain (pain > > in the abdomen with walking/tapping on heel of patient), or are you talking > about actual painful walking. > > Matt > > > > _________________________________________________________________ > The new MSN 8: smart spam protection and 2 months FREE* > http://join.msn.com/?page=features/junkmail > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 He was a smoker with a little bronchitis! Bledsoe, DO, FACEP Midlothian, TX RE: Intersting Case > > >How can you have left sided appendicitis? There is a hint in the physical > >exam findings. > > How can you have a right sided heart? Genetic/structural abnormality of the > patient. I told you it was a WAG. *grin* > > Big question about this gait pain. Are you talking about heel tap pain (pain > > in the abdomen with walking/tapping on heel of patient), or are you talking > about actual painful walking. > > Matt > > > > _________________________________________________________________ > The new MSN 8: smart spam protection and 2 months FREE* > http://join.msn.com/?page=features/junkmail > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 I was the firs to state the medical findings indicated appendix and you ignored me. Thank you I did not change my statement just because the pain was on the left there is also rebound pain assonated on the left and organ reversal especially in the appendix is not unknown, also he failed the gate test and when a surgeon wants to proof abdominal pain the are betting it is either insignificant or they suspect they are already right about what they will find . thank you I think this was a rigged game RE: Intersting Case >How can you have left sided appendicitis? There is a hint in the physical >exam findings. How can you have a right sided heart? Genetic/structural abnormality of the patient. I told you it was a WAG. *grin* Big question about this gait pain. Are you talking about heel tap pain (pain in the abdomen with walking/tapping on heel of patient), or are you talking about actual painful walking. Matt _________________________________________________________________ The new MSN 8: smart spam protection and 2 months FREE* http://join.msn.com/?page=features/junkmail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 Sorry. That was supposed to go to the other list. Two people said appendicitis right off. In 1987, I did too--but the surgeon said I still had quite a bit to learn. Sorry. Just wanted people to thing it through. Bledsoe, DO, FACEP Midlothian, TX Re: RE: Intersting Case I was the firs to state the medical findings indicated appendix and you ignored me. Thank you I did not change my statement just because the pain was on the left there is also rebound pain assonated on the left and organ reversal especially in the appendix is not unknown, also he failed the gate test and when a surgeon wants to proof abdominal pain the are betting it is either insignificant or they suspect they are already right about what they will find . thank you I think this was a rigged game RE: Intersting Case >How can you have left sided appendicitis? There is a hint in the physical >exam findings. How can you have a right sided heart? Genetic/structural abnormality of the patient. I told you it was a WAG. *grin* Big question about this gait pain. Are you talking about heel tap pain (pain in the abdomen with walking/tapping on heel of patient), or are you talking about actual painful walking. Matt _________________________________________________________________ The new MSN 8: smart spam protection and 2 months FREE* http://join.msn.com/?page=features/junkmail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 What was a throw off to the eventual DX was this statement. A flat and upright abdominal x-ray is normal as is the CXR (per the radiologist). Good thinking case AL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 I was precepting a group of paramedic students at a hospital in Houston few years ago when a young man (20 something) was brought in from an MVA. His x-rays created quite a bit of interest - situs inversus. There was a language barrier, and he hadn't told the staff about it prior to the x-rays. He came from another (poor) country, with very little medical care as a child, and hadn't known he had this condition until he was an adult. I managed to get a copy of his chest x-ray. I love to hold it up in front of a group of students: Me - " What's wrong with this x-ray? " Student - " You're holding it backwards. " Me - " No, I'm not. " Maxine Pate hire-Pattison EMS ----- Original Message ----- > > The patient had situs inversus--a complete reversal of organs. He indeed > had left-sided appendicitis. Situs inversus is quite rare and usually an > incidental finding. The heart and all other organs are switched. Thus, he > had his heart on the right. The radiologist missed this because he thought > the x-ray tech accidently put the stickers on the wrong side of the film. > Sometimes, people will have just the heart on the right (dextrocardia) which > is more common than situs inversus. The diminished heart tones should have > clued us in. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2003 Report Share Posted February 22, 2003 Hey maxine hope everything is great, just checking on where we are on meeting about ems stuff. God Bless Ashby, CMRS American Medical Service Center -- Re: RE: Intersting Case > > I was precepting a group of paramedic students at a hospital in Houston few years ago when a young man (20 something) was brought in from an MVA. His x-rays created quite a bit of interest - situs inversus. There was a language barrier, and he hadn't told the staff about it prior to the x-rays. He came from another (poor) country, with very little medical care as a child, and hadn't known he had this condition until he was an adult. I managed to get a copy of his chest x-ray. I love to hold it up in front of a group of students: Me - " What's wrong with this x-ray? " Student - " You're holding it backwards. " Me - " No, I'm not. " Maxine Pate hire-Pattison EMS ----- Original Message ----- > > The patient had situs inversus--a complete reversal of organs. He indeed > had left-sided appendicitis. Situs inversus is quite rare and usually an > incidental finding. The heart and all other organs are switched. Thus, he > had his heart on the right. The radiologist missed this because he thought > the x-ray tech accidently put the stickers on the wrong side of the film. > Sometimes, people will have just the heart on the right (dextrocardia) which > is more common than situs inversus. The diminished heart tones should have > clued us in. > Quote Link to comment Share on other sites More sharing options...
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