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A correction has been published: N Engl J Med 2004;350(17):1803.

Case Records of the Massachusetts General Hospital
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Volume 349:2147-2155 November 27, 2003 Number 22
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Case 37-2003 — A 79-Year-Old Man with Coronary Artery Disease, Peripheral Vascular Disease, End-Stage Renal Disease, and Abdominal Pain and Distention
Peter B. Kelsey, M.D., Steven Chen, M.D., and Gregory Y. Lauwers, M.D.

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Presentation of Case

A 79-year-old man was admitted to the hospital because of occlusion at a vascular access site in the right forearm for hemodialysis and worsening intermittent claudication.

There was a history of hypertension and coronary artery disease, and the patient had had an acute anterior myocardial infarction six years before this admission, for which he had received tissue plasminogen activator (alteplase); atheroemboli complicated the procedure, and intermittent claudication in both legs and end-stage renal disease developed. After four years of peritoneal dialysis (two years before the current admission), hemodialysis was initiated. Coronary-artery bypass grafting was performed three months after the infarction . . . [Full Text of this Article]

Differential Diagnosis

Preexisting Conditions

            Vascular Disease

            Atheroemboli

            Amyloidosis

Exposures and Changes during Hospitalization

            Drugs and Metabolic Abnormalities

            Infection and Inflammation

            Circulatory Problems

Summary

Clinical Diagnosis

Dr. Peter B. Kelsey's Diagnoses

Pathological Discussion

Anatomical Diagnoses


Source Information

From the Departments of Medicine (P.B.K.), Radiology (S.C.), and Pathology (G.Y.L.), Massachusetts General Hospital and Harvard Medical School, Boston.



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