Noon Report: Mastoiditis with Cerebrovascular Venous Thrombosis, Felty Syndrome

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Some great noon reports so far this week! Below is a recap on the high yield learning points from each:

The Purple Team presented the case of a patient who presented with right ear pain and headache, diagnosed with mastoiditis and cerebrovascular venous thrombosis (CVVT)

Take away points:

  • If you suspect mastoiditis, prior to calling ENT, do an otoscope exam specifically looking for otitis media (bulging, erythematous TM, purulent otorrhea, conductive hearing loss), and order an CT of the temporal bone with and w/o contrast

  • Incidental mastoid opacification on imaging does NOT equal mastoiditis.  You must correlate the history and physical exam WITH the imaging findings

  • The treatment for an acute central venous thrombosis involves anticoagulation (heparin gtt), BP control (MAP 60 = goal), and ICP control (range from elevate HOB to decompressive hemicraniectomy).  Even in with pre-existing IPH, the benefits of a heparin gtt often outweigh the risk

The Red Team presented the case of a patient with no significant past medical history who presented with fatigue and vague joint pain, diagnosed with rheumatoid arthritis and Felty syndrome

Take away points:

  • Evaluation of isolated neutropenia includes thorough medical history (including medications) as well as testing for infectious, malignant, nutritional, and autoimmune etiologies​

  • Radiographic findings of rheumatoid arthritis include bony erosions, joint space narrowing, periarticular osteopenia​

  • Felty's Syndrome is characterized by seropositive rheumatoid arthritis with destructive joint involvement, splenomegaly and neutropenia

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Internal Medicine Chiefs