The "Augenblick" diagnosis - med mystery of the day

[George K]

"Augenblick" as in "the blink of an eye."

Fascinating (to me, and perhaps to @bachophile ) thread on how a diagnosis of metastatic bowel cancer is made by looking at someone's neck.

[Mik]

Interesting. Sounds like the patient was on his way out.

[George K]

Actually, even I could make the diagnosis of TR from the video. I just thought the thinking process of going down the tree was interesting.

Causes of TR

Diseases or conditions that can cause tricuspid regurgitation include:

• Bacterial infections. Untreated bacterial infections can cause rheumatic fever, which damages the leaflets of your heart’s valves. When regurgitation and stenosis of the tricuspid valve are both found, it’s almost always for this reason.
• Ebstein’s anomaly. People born with this rare defect have a tricuspid valve that isn’t formed correctly and the right atrium (upper chamber) of their heart is too large. Milder cases can go unnoticed until a person is an adult.
• Connective tissue disorders. Genetic diseases like Marfan syndrome and rheumatoid arthritis are strongly connected to tricuspid regurgitation.
• Carcinoid tumors. This is an uncommon type of cancer that tends to grow slowly and usually starts somewhere in your digestive system. It can sometimes cause tissue to build up inside your heart, interfering with blood flow.
• Endocarditis. This is an inflammation of the inside of your heart caused by infections. You're at higher risk if you need regular dialysis or have a permanent port implanted for intravenous (IV) medications. It's also more common if you have a history of IV drug use.
• Myxomatous degeneration. This happens when the valve's leaflets become too stretchy, which stops them from sealing. While it’s more common in the mitral valve, it can also happen to the tricuspid valve.
• Other heart valve diseases or conditions. Any disease or condition that affects blood flow through the heart may lead to tricuspid regurgitation. This includes heart attack and heart rhythm problems, especially those that cause pulmonary hypertension (high blood pressure in your lungs).

[bachophile]

well....the TR is not a hard find, the obvious neck vein pulses, but to connect that to metastatic carcinoid or VIPoma??? themselves a super rare diagnoses (symptomatic carcinoid ive seen a maybe a few times, VIPoma, never, the rarest of neuroendocrine tumors), and just by looking at him say oh yes, an obvious neuroendocrine tumor....gimme a break, i dont believe it. could have easily guessed a million other things, and once in a while you guess right.

augenblick my ass