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  • Stump appendicitis

    Summary:  A 65-year old woman presented to the emergency department with abdominal pain that began earlier the same day. She complained of nausea and loss of appetite. The patient had been recently diagnosed with osseous metastatic lung cancer. Medications included only acetaminophen/oxycodone for pain management. Her surgical history was significant for a laparoscopic appendectomy with pathology-proven appendicitis performed approximately 29 months prior to this visit.

    Summary:  On admission, the patient’s physical examination revealed severe generalized abdominal tenderness with more focal epigastric tenderness and guarding without rebound. Routine laboratory studies revealed a leukocytosis (white blood cell count = 17.7 cells/ microliter) with an increased percentage of neutrophils (15%). Differential diagnosis included gastroenteritis, inflammatory bowel disease, pancreatitis, peptic ulcer and biliary disease. The emergency physician was concerned about the patient’s abdominal pain and ordered a computed tomography (CT) scan of the abdomen and pelvis following the administration of intravenous and oral contrast agents. 


  • Nutcracker syndrome

    Summary:  A 21-year-old woman with no significant prior medical history was evaluated in the emergency room after being involved in a motor vehicle accident. Contrast-enhanced computed tomography (CT) of the chest, abdomen, and pelvis was performed to assess for trauma-related injuries. There were no trauma-related injuries. However, incidentally an abnormal-appearing left renal vein was observed. Urinalysis revealed proteinuria and hematuria. The patient denied any previous abdominal or pelvic symptoms, including pain.


  • Giant cell tumor of the larynx

    Summary:  A 39-year-old male presented with an enlarging right neck mass he has had for the last 6 months. He reported odynophagia, voice hoarseness, and cough, but denies ear pain, hearing loss, dysphagia, or airway obstruction. Physical exam revealed a large palpable mass of the right neck. Endoscopic examination showed a bulging, nonulcerated mass in the right glottic area extending to the epiglottis. The right vocal cord was obliterated by the mass. The left vocal cord was normal in appearance and motility. The patient had no history of smoking, heavy alcohol use, or radiation exposure.


  • Ruptured giant mucocele of the appendix with pseudomyxoma peritonei

    Summary:  A 46-year-old man presented to the emergency department with complaints of acute right lower abdominal pain and a mild fever for 6months. An intraperitoneal, tender, ballotable, soft lump with smooth margins was palpable in the right iliac fossa. High white blood cell counts of 13,000 cells/µl with neutrophil count of 82% were noted.


  • Arterial injury to an anomalous anterior tibial artery during total knee arthroplasty

    Summary:  Although arterial complications during or after total knee arthroplasty (TKA) are rare; however, their sequelae can be disastrous. This case report describes the injury to an anomalous anterior tibial artery during total knee arthroplasty (TKA) and its successful surgical management. The operation was quite uneventful, but on release of the tourniquet at the end of the procedure, excessive bleeding was encountered. Further exploration to locate the source of the bleeding revealed injury to the anterior tibial artery, which was taking off quite higher off from the popliteal artery (Figure 1). The vessel was however successfully repaired with prolene sutures with no postoperative vascular complications and an uneventful recovery.


  • Angiotropic large cell lymphoma of the superior vena cava

    Summary:  The patient was a 44-year-old woman who was transferred to our institution with a presumed diagnosis of superior vena cava syndrome (SVCS) secondary to thrombus formation. The patient experienced syncope, along with headache, bilateral facial, neck, and upper-extremity swelling, as well as shortness of breath that was progressive over several months. The review of systems was negative for fever, night sweats, chills, myalgias, weight loss or other constitutional symptoms. The patient appeared cyanotic and had edema of the face and upper extremities with engorgement of the superficial neck and chest veins. There was no palpable lymphadenopathy or organomegaly.


  • Epiploic appendagitis

    Summary:  A 62-year-old man presented with acute onset of right lower-quadrant pain that was made somewhat worse by motion. The patient was afebrile and had a normal white blood cell count.


  • Anaplastic spinal cord ependymoma

    Summary:  A 29-year-old pregnant woman presented to her primary care physician with mild right leg weakness and numbness 6 weeks before delivery. The symptoms were attributed to her pregnancy and improved somewhat after delivery, although she continued to have minor symptoms. Approximately 6 months later, her symptoms worsened abruptly. She presented to a neurologist with bilateral lower extremity numbness and impaired vibratory sensation and proprioception. A magnetic resonance imaging (MRI) examination of the lumbar spine was performed (Figure 1), which prompted further MRI of the entire neural axis (Figure 2).


  • Gamekeeper’s thumb (Skier’s thumb)

    Summary:  A 36-year-old man presented with a painful, swollen right thumb following a fall. Examination revealed extreme tenderness over the base of the right thumb. The patient also experienced pain on valgus stress applied to the metacarpophalangeal joint of the right thumb.Anteroposterior (AP) and lateral radiographs revealed a Gamekeeper’s fracture. The patient was treated by immobilization of the thumb in a spica cast for 4 weeks.


  • HIV-related benign lymphoepithelial lesions

    Summary:  An 18-year-old woman presented to the emergency department with dry mouth and difficulty swallowing. She described a longstanding history of bilateral facial swelling. She denied symptoms of fever, pain, and dry eyes. She had a known history of human immunodeficiency virus (HIV) and had been noncompliant with her medication. Her CD4 count and HIV viral load were unknown.



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