Table of Contents
Washington University Experience | VASCULAR | Infarct - Remote | 19A0 Case 19 History
Case 19 History ---- The patient was a 53 year old man diagnosed with small cell lung carcinoma when he presented with superior vena cava obstruction. He was status-post chemo- and radiation-therapy. On the day of his final admission he was found weak and lethargic in the bathroom. There was melena, however there was no evidence of bright red blood per rectum. He denied ETOH abuse, non-steroidal anti-inflammatory use, smoking, peptic ulcer disease, or liver disease. At admission he was hypotensive (53/40) and had tachycardia (130). He was resuscitated with fluids and packed red blood cells. A CT of brain showed an old left middle cerebral artery infarct in keeping with the past history of a stroke 12 years previously. On his terminal day he was endoscoped to show a 1 cm superficial esophageal ulcer with a fungating center, and a large blood clot in the stomach. He was treated with Prilosec and was scheduled for re-endoscopy. During the night the patient coded with copious amounts of bright red emesis. The bleeding source could not be localized by a repeat upper endoscopy. The patient remained hypotensive despite pressors and multiple transfusions and died. ---- At general autopsy an aorto-esophageal fistula with a massive upper gastrointestinal bleed was demonstrated.
