Case Report Archives - Page 15 of 21 - The Western Journal of Emergency Medicine

Choledochal Cyst Mimicking Gallbladder with Stones in a Six-Year-Old with Right-sided Abdominal Pain

Volume 16, Issue 4, July 2015.
Subramony, MD, et al.

Choledochal cysts are rare but serious bile duct abnormalities are found in young children, usually during the first year of life. They require urgent surgical intervention due to the risk of developing cholangiocarcinoma. Clinicians should consider this diagnosis and perform a point-of-care ultrasound (POCUS) when a child presents to the emergency department (ED) with findings of jaundice, abdominal pain, and the presence of an abdominal mass. We present the case of a six-year-old child presenting only with abdominal pain upon arrival to our ED and was ultimately diagnosed by POCUS to have a choledochal cyst.

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Point-of-care Ultrasound to Identify Distal Ulnar Artery Thrombosis: Case of Hypothenar Hammer Syndrome

Volume 16, Issue 4, July 2015
Jonathan Ken, MD, et al.

Hypothenar hammer syndrome (HHS) is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. We present a case of HHS for which point-of-care ultrasound (POCUS) was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered in the emergency department (ED). This case demonstrates the utility of POCUS to aid the Emergency Physician in the diagnosis and management of patients with extremity vascular issues in the ED, and details a rarely seen clinical entity in the ED.

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Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

Volume 16, Issue 3, May 2015
Quan M. Bui, BS, et al.

We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation.

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Horner’s Syndrome after Superficial Cervical Plexus Block

Volume 16, Issue 3, May 2015
Stefan Flores, MD, et al.

Ultrasound-guided nerve blocks are becoming more essential for the management of acute pain in the emergency department (ED). With increased block frequency comes unexpected complications that require prompt recognition and treatment. The superficial cervical plexus block (SCPB) has been recently described as a method for ED management of clavicle fracture pain. Horner’s syndrome (HS) is a rare and self-limiting complication of regional anesthesia in neck region such as brachial and cervical plexus blocks.

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Emergent Presentation of Decompensated Mitral Valve Prolapse and Atrial Septal Defect

Volume 16, Issue 3, May 2015
Jessie Kang, BSc, et al.

Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death.

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Anaphylaxis Due to Head Injury

Volume 16, Issue 3, May 2015
Heather C. Bruner, MD, et al.

Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

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Morel-Lavallee Lesion Initially Diagnosed as Quadriceps Contusion: Ultrasound, MRI, and Importance of Early Intervention

Volume 16, Issue 3, May 2015
Nicholas A. Weiss, DO, et al.

Morel-Lavallee lesions (MLL) are rare, closed degloving injuries caused by trauma that delivers a shearing force to the soft tissue most commonly of the hip. If not treated in the acute and subacute setting these lesions are often complicated by re-accumulation of fluid, infection, or chronic pain. We present a unique case of a recurrent, massive medial knee/thigh MLL in which proper treatment was delayed due to initial diagnosis of a quadriceps contusion.

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Bleb Point: Mimicker of Pneumothorax in Bullous Lung Disease

Volume 16, Issue 3, May 2015
Christopher Gelabert, MD, et al.

In patients presenting with severe dyspnea, several diagnostic challenges arise in distinguishing the diagnosis of pneumothorax versus several other pulmonary etiologies like bullous lung disease, pneumonia, interstitial lung disease, and acute respiratory distress syndrome. Distinguishing between large pulmonary bullae and pneumothorax is of the utmost importance, as the acute management is very different. While multiple imaging modalities are available, plain radiographs may be inadequate to make the diagnosis and other advanced imaging may be difficult to obtain.

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Diagnosis of a Strangulated Laparoscopic Incisional Hernia with Point-of-Care Ultrasonography

Volume 16, Issue 3, May 2015
Niran Argintaru, MD, et al.

The use of point-of-care ultrasound for the diagnosis of bowel obstructions and hernias is becoming increasingly common in the emergency department (ED). Using a relatively rare case of an incisional port hernia, we demonstrate the ultrasound findings of a strangulated hernia causing a partial small bowel obstruction. A 46-year-old female presented four days following a laparoscopic surgery complaining of abdominal pain, nausea and lack of bowel movements.

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Spontaneous Pneumomediastinum on Bedside Ultrasound: Case Report and Review of the Literature

Volume 16, Issue 2, March 2015
Sybil Zachariah, MD et al.

Spontaneous pneumomediastinum is a rare disease process with no clear etiology, although it is thought to be related to changes in intrathoracic pressure causing chest pain and dyspnea. We present a case of a 17-year-old male with acute chest pain evaluated initially by bedside ultrasound, which showed normal lung sliding but poor visualization of the parasternal and apical cardiac views due to significant air artifact, representing air in the thoracic cavity. The diagnosis was later verified by chest radiograph. We present a case report on ultrasound-diagnosed pneumomediastinum, and we review the diagnostic modalities to date.

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Bedside Ultrasound Identification of Infectious Flexor Tenosynovitis in the Emergency Department

Volume 16, Issue 2, March 2015
Kevin Padrez, MD et al.

Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement. Despite the growing use of point-of-care ultrasound (POCUS) by emergency physicians there is only one reported case of the use of POCUS for the diagnosis of infectious FTS in the emergency department setting. We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand. Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

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Complications of New Medications

Volume 16, Issue 1, January 2015
Carlos J. Roldan, MD et al.

Numerous mandibular pathologies are diagnosed in the emergency department (ED). We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ).

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Delayed Diagnosis of Gastric Outlet Obstruction from Bouveret Syndrome in a Young Woman

Volume 16, Issue 1, January 2015
Zachary Smith, DO et al.

Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. This is an infrequent although clinically significant cause of abdominal pain, almost exclusively in the elderly.

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Acute Idiopathic Compartment Syndrome of the Forearm in an Adolescent

Volume 16, Issue 1, January 2015
Kelley Smith, MD et al.

Acute compartment syndrome (ACS) is a condition typically associated with long bone fractures or severe trauma; however, non-traumatic etiologies also occur. We describe a case of an otherwise healthy female pediatric patient presenting with unilateral forearm pain without an inciting injury.

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Necrotizing Fasciitis Caused by Hypermucoviscous Klebsiella pneumoniae in a Filipino Female in North America

Volume 16, Issue 1, January 2015
Daniel Ng, MD et al.

Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis.

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Hemi Orolingual Angioedema After tPA administration for Acute Ischemic Stroke

Volume 16, Issue 1, January 2015
Bryan Madden, MD et al.

As studies continue to demonstrate the efficacy of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke, the exclusion criteria continue to narrow, and the time-window continues to increase. The most dreaded adverse effect of tPA, hemorrhagic conversion of an ischemic stroke, is well known and well published.

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Survival from Cervical Necrotizing Fasciitis

Volume 16, Issue 1, January 2015
Jeniffer S. Gausepohl, MD et al.

A 59-year-old Caucasian man with past medical history significant for hypertension and hyperlipidemia presented to the emergency department with a four-day history of increasing throat pain and bilateral neck swelling. Associated symptoms included voice hoarseness, shortness of breath, dysphagia, and odynophagia.

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Bedside Echocardiography for Undifferentiated Hypotension: Diagnosis of a Right Heart Thrombus

Volume 16, Issue 1, January 2015
James F. Kenny, MD et al.

A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival.

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Half-dose Alteplase for Sub-massive Pulmonary Embolism Directed by Emergency Department Point-of-care Ultrasound

Volume 16, Issue 1, January 2015
Richard Amini, MD et al.

This report describes a patient with sub-massive pulmonary embolism (PE) who was successfully treated with half-dose thrombolytics guided by the use of point-of-care (POC) ultrasound. In this case, POC ultrasound was the only possible imaging since computed tomography was contraindicated.

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Ultrasound-Guided Diagnosis and Aspiration of Subdeltoid Abscess from Heroin Injection

Volume 15, Issue 7, November 2014
Amanda Clauson, MD et al.

A 49-year-old man presented to the emergency department (ED) with shoulder pain after intramuscular injection of heroin into his right deltoid muscle. Point-of-care (POC) ultrasound identified a subdeltoid abscess, and ultrasound-guided aspiration of the fluid collection was performed.

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Gastrointestinal Manifestations of Hereditary Angioedema Diagnosed by Ultrasound in the Emergency Department

Volume 15, Issue 7, November 2014
Christine Riguzzi, MD et al.

Abdominal angioedema is a less recognized type of angioedema, which can occur in patients with hereditary angioedema (HAE). The clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis.

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Chikungunya Fever in Los Angeles, California

Volume 15, Issue 7, November 2014
Katherine R. Harter, MD, MPH et al.

We report the case of a 33-year-old woman returning from Haiti, presenting to our emergency department (ED) with fever, rash and arthralgia. Following a broad workup that included laboratory testing for dengue and malaria, our patient was diagnosed with Chikungunya virus, which was then reported to the Centers for Disease Control and Prevention for initiation of infection control.

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A Gut Feeling: An Extremely Rare Case of Missed Appendicitis

Volume 15, Issue 7, November 2014
Ashley Pilgrim, MD et al.

This case outlines the emergency department and surgical course of a 63-year-old male presenting with acute onset abdominal pain.

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Sydenham Chorea: Rare Consequence of Rheumatic Fever

Volume 15, Issue 7, November 2014
Paul J. Myers, DO, et al.

Sydenham Chorea (SC) is an acute rheumatic fever complication. SC is the most common acquired childhood chorea, usually affecting children five to fifteen years of age.1 It occurs following an untreated group A streptococcal infection and a latent period of one to six months.1,2 Despite rheumatic fever diminishing, 18% to 36% of acute rheumatic fever patients develop SC.3 Full recovery often takes several months; some patients suffer permanent neurologic sequelae.1

An 11-year old male presented to the Emergency Department with two days of uncontrolled body twitching. The movements affected his right arm and leg, with occasional lip twitches; he experienced intermittent confusion and hyperactivity. The patient denied recent illness, but recalled a fever with headache and vomiting several months prior. Besides the above findings, his physical examination was normal.

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Acute Pulmonary Edema Associated With Propofol: An Unusual Complication

Volume 15, Issue 7, November 2014
Mian Adnan Waheed, MD et al.

Propofol is frequently used in the emergency department to provide procedural sedation for patients undergoing various procedures and is considered to be safe when administered by trained personnel.

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High Altitude Pulmonary Edema in an Experienced Mountaineer. Possible Genetic Predisposition

Volume 15, Issue 7, November 2014
Kenneth S. Whitlow, DO et al.

High altitude pulmonary edema (HAPE) is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid.

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