This 70 year-old man presented with sudden onset of central chest pain that radiated
through to his back. Examination showed a reduction in the blood pressure in his right arm compared to his
left. He had no neurological compromise. On cardiac auscultation he had an early diastolic
murmur. The diagnosis of aortic dissection was suspected. A Type A dissection was confirmed on a CT
scan. He proceeded to emergency surgery but died on the intensive care unit three days later.
This 73 year-old ex-smoker presented with intermittent right- sided weakness lasting
for approximately 30 minutes. He made a complete recovery between these episodes. Clinical examination
at assessment was normal except for a left-sided carotid bruit. Both a carotid colour-flow doppler and a
carotid angiogram were performed. These showed a 60% stenosis of the left internal carotid artery. He
proceeded to a left carotid endarterectomy and made an uncomplicated recovery.
This 68 year-old man fell in the street. He fell against a bench and sustained a
right-sided chest injury. On admission, he was in severe pain. He was breathless at rest. He had
extensive right-sided surgical emphysema. Despite a thoracic epidural, he became increasingly dyspnoeic and
cyanosed. A repeat chest x-ray confirmed the rib fractures and surgical emphysema. It also showed
evidence of consolidation. He required CPAP on a high dependency unit. After three weeks in hospital
he made a full recovery from his injuries.
This 25 year-old rugby player was injured in a tackle. He complained of severe pain and limited movement
in his right shoulder. Examination showed loss of the normal shoulder contour. The head of the humerus
was palpable below the coracoid process. The diagnosis of an anterior dislocation of the glenohumeral joint
was confirmed on x-ray. The dislocation was reduced under general anaesthesia. He was managed in
collar-and-cuff for 2 weeks. This was followed by physiotherapy and he was able to play rugby again within 2