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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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Intermittent Gastric Volvulus Mimicking Acute Coronary Syndrome

Intermittent gastric volvulus plagued a 61-year-old white woman with chest pain for months before it was observed on esophagogastroduodenoscopy (EGD). She presented to the Emergency Department with complaints of progressively worsening localized, burning, left-sided and substernal chest pain that was identical to her previous myocardial infarction. Her chest pain was associated with nausea, vomiting, and […]

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An Uncommon Cause of Obstructive Jaundice: An Infrequent Neoplasm

A 42-year-old man was admitted to the Johns Hopkins Hospital with right upper quadrant abdominal pain and scleral icterus of 3 weeks duration. The pain was described as aching and cramping in quality that typically occurred after meals. He had no vomiting or diarrhea but did note acholic stools and had more recently developed diffuse […]

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Double Jeopardy: Autoimmune Myelofibrosis with Pyoderma Gangrenosum

A 33-year-old African American woman with no significant past medical history presented to an outside hospital with 3 months of oropharyngeal ulcers and odynophagia. She was also noted to be pancytopenic (hemoglobin 7.4 g/dL, mean corpuscular volume 81 fL, platelets 100,000/mm3, white blood cells 3000/mm3, absolute neutrophil count 600/mm3) with blood smear findings of teardrop […]

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Inside Out: Bone Marrow Necrosis and Fat Embolism

  Neurologic symptoms initially attributed to infection were ultimately the result of a devastating hematologic condition. The patient, a 57-year-old woman, was rushed to the emergency department for somnolence and slurred speech. She had experienced low back pain during the preceding week. Her medical history was notable for a ventriculoperitoneal shunt placed several years ago […]

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