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­An 83-year-old woman with a history of hypertension, diabetes and paroxysmal atrial fibrillation anticoagulated with acenocoumarol was brought to the emergency department due to dyspnoea. At admission, the patient reported a 1-week history of malaise, shortness of breath and non-productive cough. She denied fever but reported pain on the left flank. On examination, auscultation showed arrhythmic tones and crackles in the left lower lung field. Laboratory findings showed leucocytosis of 15.32×103/μL, and the C reactive protein was 177 mg/L. The activated partial thromboplastin time was 54.8 s, and the international normalised ratio was 7.09. A chest X-ray showed left lower lobe consolidation with pleural effusion. Point-of-care ultrasound was performed using a low-frequency curved transducer (2–5 MHz). The probe was placed in the left posterior axillary showing a pulmonary consolidation, but also a hypoechoic lesion in the spleen was found (figure 1).Figure 1Ultrasound image of the spleen in longitudinal section demonstrating a large, hypoechoic, wedge-shaped lesion.QuestionWhat is the most likely diagnosis?Splenic abscessSubcapsular splenic haematomaSplenic infarctionSplenic hydatid cystFor answer see page 2

Background To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30 mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features. Patients and methods Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55 years and women >65 years who had a high or very high CVR. Results The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71 ± 8.7 years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95% CI: 1.02–1.1; P Conclusions The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65 years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease.

Resumen Objetivo Determinar la prevalencia de aneurisma de aorta abdominal (AAA), definido por un diametro arterial ≥ 30 mm, en pacientes con alto o muy alto riesgo cardiovascular (RCV) y evaluar sus caracteristicas clinicas. Pacientes y metodos Estudio observacional, transversal y multicentrico realizado en servicios de Medicina Interna del pais a varones con edad > 55 anos y mujeres > 65 anos que tenian un RCV alto o muy alto reclutados durante 24 meses. Resultados Se incluyeron 659 pacientes. La prevalencia de AAA fue del 8% (53 pacientes). El 76,9% fueron varones, con edad media de 71 ± 8,7 anos. El analisis multivariante demostro asociacion entre AAA y la edad (OR: 1,06; IC 95%: 1,02-1,1; p Conclusiones La prevalencia de AAA en pacientes de alto RCV es elevada. El cribado ecografico puede ser realizado por medicos generalistas. Pueden beneficiarse de un cribado oportunista los varones de mas de 65 anos, con RCV elevado, especialmente si presentan tabaquismo activo o arteriopatia periferica.

An 83-year-old man with hypertension, type 2 diabetes, hypercholesterolaemia, stage 3 chronic kidney disease and bronchial asthma was admitted to the hospital for community-acquired pneumonia. The patient’s home medications were candesartan, gliclazide, metformin, simvastatin and a combination of inhaled fluticasone and salmeterol; in the hospital, he was treated with intravenous levofloxacin and ceftriaxone. Although his pneumonia improved, on day 4 he experienced sudden pain and swelling in the anterior region of the right arm (figure 1). Figure 1 Deformity in the anterior mid-upper arm. What …

Peritoneal mesothelioma, a rare tumour originating from the mesothelial cells of the peritoneum, is linked to asbestos exposure and usually identified incidentally.1 2 A 74-year-old man was admitted to the emergency room after experiencing right hypochondrium pain for 1 month. The patient’s medical records include a 7-year history of diabetes and a benign prostatic hyperplasia. No occupational exposure to asbestos was noted. During the abdominal examination, a painful abdominal mass …

The collection and consumption of wild mushrooms by individuals with no mycological knowledge and their accidental ingestion by minors are responsible for a growing increase of poisonings. It is not usual for emergency care of a patient affected by mushroom poisoning to be based on recognition of the responsible species of fungus or access to a sample of the mushroom consumed. It is this reason knowledge of toxidromes is crucial. In the majority of cases, the symptoms are weak. Mortality is usually related to the development of potentially fatal liver necrosis after consumption of the fungus Amanita phalloides and others which contain amatoxins. Treatment is based on support measures but no specific treatments exist that are based on scientifically proven studies. In the following article the clues used in diagnosing which make it possible to carry out a syndromic diagnosis based on a period of latency will be analyzed. The mushrooms that are responsible for the most common syndromes, therapeutic options, as well as varieties of toxic fungus which may produce peculiar and exceptional symptoms are also reported.

en la zona. Una semana antes de la sintomatologia actual describia lesiones migratorias similares en los miembros inferiores y en el torax, que habian desaparecido en pocos dias y que fueron interpretadas como urticaria aguda. En la exploracion destacaba un ligero eritema y edema en la cara interna del brazo izquierdo, siendo el resto del examen normal. El recuento leucocitario era de 7.500/ l, con un 20% de eosinofilos. La bioquimica elemental y el estudio radiologico simple de la zona fueron normales.