Monday, April 11, 2011

Interesting Imaging (2)

A man with unknown comorbid was brought in with unresponsiveness. No history could be obtained from patient or family. Some of his clinical signs (Panel A, B):
And the CT Brain is shown in Panel C.
Correlating the CT Brain findings with the clinical signs, what would you highly suspect? Please give the complete diagnosis.


Chong_86 said...

Picture 1 :

Presence of finger clubbing and splinter hemorrhages

Picture 2 :

Subconjunctival petechiae

CT brain :

Massive Cerebral Infarction (which explains the patient's unresponsiveness)

Provisional Diagnosis :

Infective Endocarditis complicated with Ischaemic Stroke due to Septic Embolism

Echocardiography to look for vegetations.

Darren Lee said...

This patient has a left-sided IE, hence the septic embolism.

Where are you from, Chong? Sorry I've seen your comment a few times but not too sure about your details. ;)

Chong_86 said...

I'm a final year student from MMMC.
4 months left to go.

Really enjoy solving every cases you've posted, great learning experience.

By the way, Dr, may I know what's the cause of this patient's IE?

Darren Lee said...

Chong: The patient is an active IVDU. But they more commonly (not always though) get right-sided IE instead of left.

You can see why in the comments session of my another post:

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