Clinical Cases

  • Cerebral toxoplasmosis

    Cerebral toxoplasmosis

    Summary:  A 58-year-old man presented with a 6-month history of progressive blurring of vision and parosmia. Additional symptoms included an altered taste and dizziness. He had past history of intravenous drug abuse, but had not used drugs in many years. His human immunodeficiency virus (HIV) status had been negative in the past. On admission he was afebrile at 97°F. Neurological examination showed a left inferior quadrant field defect. Motor and sensory examinations were normal. Deep tendon reflexes were intact. Laboratory evaluations were unremarkable at the time of admission. On the day of admission, computed tomography (CT) without contrast was performed (not shown). An HIV test was sent under the patient’s permission and had come back positive. The CD 4 count was 11 cells/µl. The toxoplasmosis IgG was positive.


  • Cardiac MRI perfusion and viability imaging: Clinical value in cardiac care

    Cardiac MRI perfusion and viability imaging: Clinical value in cardiac care

    Summary:  Rest-stress perfusion and viability cardiac magnetic resonance imaging (CMRI) tests are performed on a 60-year-old male with known coronary arterial atherosclerotic disease (CAD) (Figures 1-6). Previously, the patient sustained a right coronary artery (RCA) territory myocardial infarction (MI) and underwent successful RCA stent placement. No intervention was performed for left circumflex (LCX) 40% and first obtuse marginal (OM1) 50% stenoses. While the patient is currently asymptomatic, a recent surveillance echocardiography demonstrated worsening global left ventricular function with regional wall-motion abnormalities in the inferior and lateral walls.


  • Aortopulmonary window

    Aortopulmonary window

    Summary A 16-year-old woman presented with progressive dyspnea and syncope episodes. The patient…

  • Autosomal dominant polycystic disease

    Autosomal dominant polycystic disease

    CASE SUMMARY A 57-year old woman was taken to a community hospital for care following a motor…

  • Autosomal dominant polycystic disease (ADPD)

    Summary:  A 57-year old woman was taken to a community hospital for care following a motor vehicle collision.

  • Nonsurgical pneumoperitoneum

    Summary:  A 56-year-old Caucasian female with multiple falls and ataxia was admitted for exacerbation of multiple sclerosis and placed on high dose steroid therapy. The patient’s past medical history was significant for polycystic kidney disease and a kidney transplant, for which she took cyclosporine as an immunosuppressant. There was no recent history of surgery or endoscopic examination.

    Within 12 hours of admission, the patients developed severe hypoxemia requiring mechanical ventilation. Standard ventilatory therapy was inadequate and the patient required high levels of positive end-expiratory pressure with peak airway pressures exceeding 50 mmHg. On the fifth day of admission, the patient developed crepitus over the anterior chest wall. Chest x-ray confirmed bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema (Figure 1). Bilateral chest tubes were placed. The patient’s clinical signs began to deteriorate with radiographic signs of acute respiratory distress syndrome (ARDS).

    The following day, a physical exam revealed abdominal distention, with no rigidity. Pneumoperitoneum and an unknown source of sepsis prompted an exploratory laparotomy. Upon entering the peritoneum a large egress of air was noted. There was no evidence of intraperitoneal fluid. Exploration of all of the hollow organs showed no signs of perforation or signs of inflammatory reaction. Examination of the diaphragm showed no obvious defects. The patient tolerated the procedure well and was returned to the intensive care unit. Over the following days, the patient’s clinical course declined until elective termination of care secondary to cardiorespiratory collapse.

  • Photon-counting digital mammography detects rare breast lesion

    Photon-counting digital mammography detects rare breast lesion

    Adenomyoepithelioma Findings   Screening mammography revealed a 1-cm focal asymmetry with a…

  • Celiac disease

    Celiac disease

    Summary A 41-year-old white woman presented with a 1-day history of fever to 102.6˚F and tenderness…

  • Iatrogenic pulmonary artery pseudoaneurysm

    Iatrogenic pulmonary artery pseudoaneurysm

    Summary An 84-year–old woman presented with hemoptysis during an elective right-heart…

  • Pancreatitis associated with splenic artery pseudoaneurysms

    Summary A 46-year-old man presented with a 5-month history of abdominal pain that had become…

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