Volume 16, Issue 5, September 2015.
Jason D. Heiner, MD
A 72-year-old otherwise healthy female presented to
the emergency department with two weeks of worsening
abdominal pain. She was afebrile with normal vital signs. Her
physical examination was notable for moderate abdominal
tenderness without rebound to the left and suprapubic
regions of the abdomen. Laboratory studies were remarkable
for a white blood cell count of 13,000/mm3
. A focused
bedside ultrasound over the patient’s region of maximal
discomfort revealed a thickened bowel wall and several
small contiguous hypoechoic projections surrounding a
hyperechoic center, suggestive of diverticulitis.
Volume 16, Issue 5, September 2015.
Caroline T. Brandon, MD, et al.
A 34-year-old male with diabetes presented to the
emergency department with four days of progressively
worsening redness, swelling and pain to his left buttock.
The patient denied fevers, chills, rectal pain or purulent
drainage from his rectum. His initial vital signs were heart
rate of 82; blood pressure of 146/92; and temperature of
98.2°F. The left buttock had a poorly circumscribed area of
induration; however, there was no fluctuance or crepitace.
Rectal exam was unremarkable. Because the patient’s
buttock pain was disproportionate to his exam findings,
a point-of-care ultrasound was performed to determine
if a more extensive process was present. The ultrasound
demonstrated cobblestoning, fascial thickening with edema,
and a large 4.5cm fluid collection extending and adjacent
to the rectum.
Volume 16, Issue 5, September 2015
Jill Tirabassi, MD, et al.
A 25-year-old male presented to the ski clinic after
colliding with a tree while snowboarding. He had immediate
sharp pain at his “tailbone,” but denied numbness and
weakness. Past medical history was initially reported as
unremarkable. On exam, he demonstrated midline tenderness
over the sacrum. Pelvic radiography was performed (Figure).
Volume 16, Issue 5, September 2015
Jagdipak Heer, MD, et al.
A 31-year-old gravida 3 Para 3 female with no past
medical history, presented to the emergency department
complaining of a painless “boil” to the right groin, which
had been enlarging for over two months. Although it
was generally painless, she did suffer mild dyspareunia
at times. Antibiotics prescribed by her primary doctor
failed to resolve this mass so she decided to present to the
emergency department.
Volume 16, Issue 5, September 2015.
Stephen L. Thornton, MD, et al.
A previously healthy two-year-old boy presented to the
emergency department with vomiting. He was cyanotic with
mottling of both lower extremities. He was in respiratory
distress with retractions and diminished breath sounds. His
abdomen was distended and rigid. He had a pulse of 170 beats
per minute, blood pressure of 144/69mmHg and respiratory
rate of 42 breaths per minute. He was endotracheally
intubated. Chest and abdominal radiographs demonstrated a
tension pneumoperitoneum.
Volume 16, Issue 5, September 2015.
Tomohiro Sonoo, MD, et al.
A 67-year-old woman complaining of continuous fresh
vaginal hemorrhage came to our emergency department in a
pre-shock state. Examinations revealed an irregularly shaped
mass in the uterus and active arterial bleeding. Emergent
hysterectomy and interventional radiology were not
immediately available. Foley catheter with 20mL water was
inserted into the uterine cavity, then the balloon was pulled
to obstruct the uterus output (Figure). Her vital signs became
stabilized, and she was transferred to another hospital two
days later.
Volume 16, Issue 4, July 2015.
Patrick Burns, MD, et al.
A 48-year-old male presented with body aches and a chronic rash. He had no medical history aside from two unsuccessful treatments for presumed scabies and a recent diagnosis of psoriasis. Physical exam revealed hypotension, tachycardia, and profound, diffuse yellow crusting of the skin with erythematous erosions covering non-crusted areas. The patient was resuscitated and treated for septic shock while microscopic evaluation of scrapings of the crusted skin was performed.
Volume 16, Issue 4, July 2015.
Nobuhiko Kimura, MD, et al.
A 30-year-old man presented to the emergency department
for two weeks of diffuse abdominal pain and an episode of
emesis. He denied fever, prior surgery, or any other illnesses.
The patient reported going on a “crash diet regimen” one
month prior, resulting in an intentional weight loss of 25lbs in
30 days.
A 26-year-old female presented to the emergency department with a chief complaint of dizziness. Further history revealed that she was experiencing generalized weakness and intractable vomiting for three days, without complaint of abdominal pain or lower gastrointestinal symptoms. Physical examination uncovered mild dehydration with stable vital signs and non-fatigable, horizontal nystagmus consistent with internuclear opthalmoplegia.
Volume 16, Issue 4, July 2015.
Christian, MD, et al.
A 54-year-old man with a history of alcohol use presented with hematochezia and syncope. Upon arrival to the hospital, his bleeding had stopped. He was hemodynamically stable with hemoglobin of 11g/dL, international normalized ratio of 1.8 and platelets of 37K/mcL. Nasogastric aspirate found bilious gastric contents without blood.
Volume 16, Issue 4, July 2015.
Anderson, MD, et al.
A 68-day-old former 30-week infant presented with listlessness, apnea and bradycardia. The patient was intubated for airway protection. After intubation, breath sounds were auscultated bilaterally and a Pedi-Cap carbon dioxide detector had color change from purple to yellow. A nasogastric tube (NGT) was placed and a post-procedural chest radiograph was obtained.
Volume 16, Issue 3, May 2015
Rebekah Heckmann, MD, et al.
An 11-year-old healthy female presented to the emergency department with three days of worsening suprapubic pain, urinary retention, and constipation. She was afebrile with normal vital signs. Her physical examination was notable for suprapubic distention and bulging pink vaginal tissue at the introitus. Bedside ultrasound suggested a distended bladder.
Volume 16, Issue 3, May 2015
Kimberly Stillman, DO, et al.
A 76-year-old male presented to the emergency department complaining of intense abdominal pain. He reported one week earlier an upper respiratory illness with violent coughing spells. Past medical history included recent percutaneous coronary intervention for a myocardial infarction 6 months prior where he received three drug-eluting stents and was subsequently discharged home on Prasugrel (Effient) and Aspirin.
Volume 16, Issue 3, May 2015
Karim El-Kersh, MD, et al.
A 62-year-old man presented to the emergency department with hypotension and diarrhea secondary to Clostridium difficile infection. Due to poor peripheral access, a left internal jugular vein triple lumen central venous catheter (CVC) was inserted for fluid resuscitation. The CVC was placed under real-time ultrasound guidance, which revealed normal anatomy, with no resistance during placement.
Volume 16, Issue 3, May 2015
Kubwimana M. Mhayamaguru, MD, et al.
A 61-year-old female presented to the emergency department complaining of constipation and vaginal bulge with valsalva 89 days after a robotic-assisted hysterectomy. The patient had intercourse three days prior to presentation and experienced postcoital abdominal discomfort with vaginal bleeding. She denied any other trauma. She had no other complaints and denies fevers, chills, nausea, vomiting, abdominal distension, or constipation. Physical exam revealed exposed bowel protruding through the vaginal cavity.
Volume 16, Issue 3, May 2015
Demis N. Lipe, MD, MSc, et al.
A 42-year-old man with history of esophageal strictures and esophageal dilation presented to the emergency department with 12 hours of dysphagia and non-bloody emesis. His symptoms started upon waking and included sharp retrosternal pain during each attempt at swallowing. Dysphagia occurred with both solids and liquid. He denied difficulty initiating swallowing, pain with eating the previous night, halitosis and hematemesis.
Volume 16, Issue 2, March 2015
Alice Chao, MD et al.
An 86-year-old female was brought in by ambulance for severe abdominal and back pain. She was hypotensive en route and appeared to be in distress upon arrival to the emergency department. Her abdomen was tense and distended with diffuse tenderness to palpation present.
Volume 16, Issue 2, March 2015
Pablo Aguilera, MD et al.
A 22-year-old healthy male university student presented to the emergency department (ED) complaining of syncope. He had five episodes of loss of consciousness from 10 to 40 seconds in length, with loss of postural tone and full recovery without intervention in the last month.
Volume 16, Issue 2, 2015
Michael Butterfield, MD et al.
A nine-month-old girl was brought to the emergency department because of right neck swelling. She had recently been discharged from the same hospital after a brief admission for pneumonia that had followed influenza.
Volume 16, Issue 2, March 2015
Thomas M. Nappe, DO et al.
An 18-year-old female presented to the emergency department with three days of worsening left flank pain. Past medical history included asymptomatic bacteriuria. She denied prior similar episodes or inciting events, and was currently being treated with trimethoprim sulfamethoxazole by an urgent care center for a urinary tract infection, although she denied having any urinary symptoms.
Volume 16, Issue 2, March 2015
Kristof Nemeth, MD et al.
We report an unusual presentation of a 63-year-old female who presented with a five-day history of right-sided loin to groin pain. On assessment she was afebrile and her observations were stable. She had right iliac fossa pain and tenderness in the right renal angle.
Volume 16, Issue 2, March 2015
Allen D. Chang, MD et al.
An 87-year-old male with multiple medical problems and percutaneous endoscopic gastrostomy (PEG) tube placement presented to the emergency department for recurrent dysphagia, constipation, and concern for stool appearing in his PEG tube.
Volume 16, Issue 2, March 2015
Sow A. Kobayashi, MD et al.
A healthy, uncircumcised 34-year-old male presented to an emergency department (ED) in Tinian (Commonwealth of the Northern Mariana Islands) after a parrot fish bite. The patient was spearfishing in the Philippine Sea and impaled a 15-pound parrot fish. As the patient was attempting to grasp the speared fish it bit him in the groin exterior to his swimming trunks.
Volume 16, Issue 1, January 2015
Stephanie Spring, DO et al.
A 13-year old female patient presented to the emergency department (ED) with four days of intermittent non-radiating, left upper quadrant pain, associated with non-bloody, non-bilious emesis and decreased appetite. The patient had been evaluated by a gastroenterologist three months prior for abdominal pain.
Volume 16, Issue 1, January 2015
Erica Cacioppo, MD et al.
A 42-year-old male with a history of multiple shoulder dislocations presented to the emergency department via emergency medical services with both arms locked above his head, stating that he had been jumped at a bar and had since been unable to move his arms.
