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Caught on Colonoscopy: Schistosomiasis Manifesting as a Single Colonic Polyp

A screening colonoscopy identified an unexpected diagnosis in a 64-year-old male patient. He was an asymptomatic landscaper who presented for a first-time screening colonoscopy based on age. His only active medical issue was psoriasis, for which he took apremilast. At the time of colonoscopy, he denied any bright red blood per rectum, melena, changes in […]

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Cloudy, amber, ascitic fluid had a triglyceride level of 375 mg/dL. A level >200 mg/dL is consistent with chylous ascites.1

When Appearance Is Everything: Chylous Ascites

The patient had numerous bouts of ascites, but this time the fluid’s color and composition heralded a new and ominous diagnosis. A 75-year-old woman with cirrhosis secondary to nonalcoholic steatohepatitis was admitted with abdominal pain. Her medical history also included coronary artery bypass grafting, congestive heart failure with a reduced ejection fraction of 40%, chronic […]

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Still frame of long-axis parasternal view on 2-dimensional color flow transthoracic echocardiogram showing severe aortic regurgitation. as depicted by arrow. The thick arrow at the bottom depicts the point of recording of the diastolic frame. AO = ascending aorta; LA = left atrium; LV = left ventricle.

‘Landolfi’s Sign’—Eyes Don’t See What the Mind Does Not Know!

To the Editor: A 60-year-old woman was admitted with progressively worsening dyspnea on exertion associated with intermittent lightheadedness and palpitations. On physical examination, a 3/6 diastolic decrescendo murmur was audible along the left sternal border. The murmur was most prominently heard in the left third intercostal space at end expiration with the patient in the […]

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Dorsum of tongue showing erythematous patches with white borders (black arrows).

Geographic Tongue

A 45-year-old female patient presented to our clinic with a painless, erythematous lesion on her tongue. Medical history was negative, with absence of any allergies or habits. The patient recalled that she had a similar lesion on her tongue 6 months earlier, which resolved spontaneously. Clinical examination of the dorsal surface of the tongue revealed […]

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Axial computed tomography of the abdomen/pelvis following intravenous contrast showing no evidence of paraspinal muscle pathology but an incidental finding of left greater than right quadratus lumborum muscle asymmetry.

An Uncommon Cause of Low Back Pain

A 21-year-old active duty Air Force male without past medical history presented to our Emergency Department with low back pain. The patient had been performing general resistance strength training, including specific exercises focusing on the low back region, for about 2 months. A few hours after a workout session, he developed acute pain to the […]

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Prominent superficial veins over the right upper arm and shoulder, reflective of Urschel's sign.

Urschel’s Sign in Paget Schroetter Syndrome

A 32-year-old man, employed as a deckhand, was referred for right upper extremity swelling and pain of 3 months’ duration. Physical examination revealed swelling of the right upper extremity and prominent superficial veins over the right upper arm and shoulder (Urschel’s sign; Figure). Blood work including thrombophilia screen was unremarkable. Right upper extremity venous duplex ultrasonography […]

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