No abstract

Belching is a ubiquitous symptom in clinical practice. It could be due to gastrointestinal disease or behavioral, functional and physiological causes. It’s association with acute myocardial infarction, more frequently, with inferior myocardial infarction, has been well established. But exertional belching as a cardinal symptom of coronary artery disease is not well documented and its presence is not mentioned in any standard textbooks. It is rarely reported in the literature. Here we present a female diabetic, who presented with exertional belching as a lone complaint. She was confirmed to have significant coronary artery disease necessitating an intervention. So it may be prudent if clinicians are aware of the fact that exertional belching could be of cardiac origin and needs further evaluation and intervention.

No abstract

Tuberculosis is a common etiological factor for fever of unknown origin in developing countries even today. Tuberculous mediastinal lymphadenitis is a disease of children as a part of primary tuberculosis. Mediastinal lymphadenitis without a parenchymal disease is unusual in an adult. Mediastinal tuberculous lymphadenitis presenting as fever of unknown origin could be mysterious when chest x ray was normal. Modern techniques like Computerised Tomography of chest and Endobronchial Ultrasound and Transbronchial Needle Aspiration (EBUS & TBNA) made it possible to make an early diagnosis in such clinical situations. We present a case of an adult with mediastinal tuberculous lymphadenitis with esophageal compression symptoms who presented with fever difficult to diagnose. And also we depict how modern techniques helped us to make an early and accurate diagnosis.

Achalasia cardia usually presents in the age group of 25 to 60 and rare in children. Dysphagia, regurgitation, vomiting and chest pain are the cardinal symptoms. If they present mainly with respiratory symptoms diagnosis may be difficult and delayed. Bilateral bronchiectasis is rarely reported in patients with achalasia both in adults and children. Sometimes children may be erroneously diagnosed as eating disorder as both may present with similar symptoms hence information that achalasia can occur in children reduces such risk. In those children presenting with chronic respiratory symptoms it is prudent to look for esophageal motility disorders. CT scan, endoscopy, manometry are useful diagnostic tools but gold standard is barium esophgogram to diagnose Achalasia. Chest postural drainage may be delayed in bronchiectatic patients with achalasia. Heller myotomy is standard surgical treatment for children. Untreated Patients may end up with megaesophagus, a progressively dilated esophagus.