Neurogenic pulmonary oedema misdiagnosed as acute myocardial infarction in a comatose patient.
BACKGROUND
We report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).


METHODS
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.


METHODS
Decompressive craniectomy was carried out.


RESULTS
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.
Seow
Vei Ken
VK
Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan.
Ko
Shih Yu
SY
Huang
Meng Kai
MK
Chong
Chee Fah
CF
D002544:Cerebral Infarction / Q000503:physiopathology; D003128:Coma; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000503:physiopathology; D013902:Radiography, Thoracic; D013624:Taiwan