Hereditary angioedema (HAE) is a genetic disorder associated with recurrent episodes of angioedema in the absence of urticaria and pruritus. Hereditary angioedema is inherited in an autosomal dominant pattern and results in a quantitative deficiency (HAE type I) or dysfunction (HAE type II) of the C1-esterase inhibitor (C1-INH) protein. A very rare third type of HAE which is associated with normal quantitative and functional levels of C1-INH (HAE-nl-C1-INH) has been described.
Takotsubo syndrome (TTS) expresses transient wall motion abnormality of the left ventricle, reportedly induced by sympathetic overstimulation. Takotsubo syndrome is unlikely to be included in the differential diagnosis of heart transplant patients with sudden cardiac dysfunction given the complete denervation occurring during the transplantation.
A pericapsular nerve group (PENG) block is unique compared to other regional anesthetic techniques (femoral nerve and fascia iliaca blocks) because it is a motor-sparing block. It also provides anesthesia to more nerves that innervate the anterior capsule of the femoroacetabular joint when compared to the femoral nerve and fascia iliaca blocks. Additionally, regional anesthesia carries fewer risks and requires less resources when compared with procedural sedation, which is the typical method for reducing a dislocated femoroacetabular joint.
An 83-year-old male with a history of prostate cancer and prior prostatectomy presented with lower abdominal pain, urethral leakage, and hematuria after a routine suprapubic catheter exchange, which was found to be incorrectly positioned in the bulbar urethra, leading to obstructive nephropathy with mild hydronephrosis.
We present an image and discussion of spontaneous evisceration, or “burst abdomen,” from an anterior abdominal wall hernia. A 61-year-old female with prior history of alcoholic cirrhosis and ascites presented to our emergency department with frank evisceration of multiple loops of small bowel from an open anterior abdominal wall dehiscence. Approximately one year prior to this visit she had also been seen in our department for spontaneous rupture of the skin overlying an umbilical hernia and large-volume external leakage of ascites (Flood syndrome1). She required surgery to repair the abdominal wall at that time but had subsequently developed a new ventral hernia extending from the umbilicus across a large portion of her left lower abdomen as well as several other postoperative complications. On the day of presentation, she suffered dehiscence of that one-year-old surgical site resulting in spontaneous evisceration of her small bowel. She was transferred to a facility with acute care surgical capabilities where she remained in critical condition.
A male patient in his thirties with a history of polysubstance use presented to the emergency department (ED) due to an abrasion on his left forehead caused by banging his head against a wall in self-injurious behavior. A non-contrast computed tomography of the head obtained to rule out intracranial injury incidentally demonstrated a radiodense foreign body in the left external ear canal. A round metallic foreign body was subsequently visualized on otoscopic examination. The aural foreign body (AFB) was identified as a metallic bead that the patient had placed into his own ear; however, he reported no associated discomfort, hearing changes, or discharge. Traditional approaches for removing AFBs were considered; however, due to the position and smooth surface of the bead, there was concern they would be unsuccessful. Recognizing the metallic nature of the AFB, the clinician held a ceramic donut magnet adjacent to the patient’s ear and subsequently extracted the AFB without complication or patient discomfort.
A 33-year-old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-segment depression. An emergent catheterization was performed, which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications.
A 21-year-old woman with a history of eczema presented to the emergency department with a painful rash over the previous three days spreading from her left axilla to her left arm, left chest and left abdominal wall. The rash consisted of clusters of small, erythematous vesicles on hyperpigmented patches of skin. The patient was treated empirically with intravenous acyclovir for eczema herpeticum with improvement. Polymerase chain reaction testing of the fluid obtained from the rash vesicles later confirmed the presence of herpes simplex virus-1.
A 78-year-old male was admitted to the hospital due to acute-on-chronic liver failure with spontaneous bacterial peritonitis. About six liters of a yellow, turbid fluid were collected via indwelling urinary catheter (UC) overnight. He subsequently developed neurological and cardiac dysfunctions. Imaging confirmed bladder perforation and intraperitoneal placement of the UC, establishing the diagnosis of paracentesis-induced circulatory dysfunction due to unintended ascitic fluid drainage. He was stabilized with albumin replacement. The UC was removed, and the bladder injury resolved spontaneously.
An 18-year-old male presented with severe left ankle pain and inability to bear weight after jumping from a three-foot platform. Physical examination revealed decreased range of motion of the left ankle without visible deformity or neurovascular deficits. Imaging studies showed a vertical fracture of the distal tibia—a pilon fracture without fibular involvement.
A 33-year-old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-segment depression. An emergent catheterization was performed, which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications.
