Neurogenic pulmonary oedema misdiagnosed as acute myocardial infarction in a comatose patient
Seow, V.Ken.; Ko, S.Yu.; Huang, M.Kai.; Chong, C.Fah.
Annals of the Academy of Medicine Singapore 36(8): 684-686
2007
ISSN/ISBN: 0304-4602 PMID: 17767340 Document Number: 607706
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.