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A Hard Calculus: Submandibular Sialolithiasis

  Eating worsened the discomfort a 52-year-old woman was experiencing, who presented with a 4-day history of painful swelling on the left side of the neck. The consumption-related symptom is common among those with her diagnosis. Assessment A tender, firm, warm swelling was identified in the patient’s left submandibular region. Intraoral examination revealed a hard […]

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An Unusually Long Process: Eagle Syndrome

For a tiny subset of patients, an anomaly in the skull’s architecture can precipitate significant symptoms. That was true for a 34-year-old woman who presented with a 5-month history of diffuse neck pain that increased with movement. For the previous 3 months, discomfort was associated with the feeling that she had a lump in the […]

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No Structural Signposts: Afterload-Dependent Mitral Regurgitation

Bad news seemed to generate alarming symptoms in a 61-year-old woman. After learning of a stressful family situation, she presented to an outside hospital with acute, severe dyspnea and mild chest discomfort. Her past medical history included paroxysmal atrial fibrillation, remote pulmonary embolism, hypertension, hypothyroidism, and questionable mitral valve prolapse. The patient also reported that […]

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Her Aching Bones: Atypical Parathyroid Adenoma

A radiologic investigation of lower back pain captured something unusual: multiple osteolytic lesions with fluid-fluid levels. The patient was a 34-year-old Portuguese woman of Romani ethnicity. Previously healthy, she presented to our emergency department with a 6-month history of lumbar pain. Her medical history was unremarkable aside from 2 cesarean sections and a bilateral tubal […]

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Fool Me Once, Fool Me Twice

A thorough evaluation suggested the patient’s initial diagnosis was not quite right; but it was not wrong, either. An 83-year-old woman with presumed aortic stenosis was referred to our medical center for aortic valve replacement. She first presented at another facility with a 3-month history of worsening shortness of breath, particularly on exertion. Whereas she […]

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