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Published on: September 19, 2019
Neurogenic pulmonary oedema misdiagnosed as acute myocardial infarction in a comatose patient
Vei Ken Seow1, Shih Yu Ko, Meng Kai Huang
1Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan.
Introduction:
We report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).
Clinical Picture:
This 52-year-old man presented with acute loss of consciousness with normal brain computed tomography (CT). He was treated as non-ST-elevation AMI complicated with pulmonary oedema based on findings of chest radiograph (bilateral pulmonary oedema), electrocardiogram (marked ST-T changes in leads V3 to V6), and cardiac enzymes [elevated creatinine kinase (CK) and CK-MB]. However, coronary angiogram and serial cardiac enzymes were inconclusive. Anisocoria developed after admission and a repeat brain CT was evident for large left cerebral infarct.
Treatment:
Decompressive craniectomy was carried out.
Outcome:
Mortality.
Conclusions:
The diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain CT. It can be mistaken for cardiogenic pulmonary oedema secondary to AMI.
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