Tag Archives: diagnostic dilemma

Segmental Arterial Mediolysis: An Important but Often Overlooked Cause of Multi-Vessel Thrombosis

A 52-year-old man with a past medical history significant for hypercholesterolemia and systemic hypertension presented to an outside hospital with acute-onset, diffuse abdominal and bilateral flank pain without fever, constitutional symptoms of infection, or vomiting. On physical examination, abdominal tenderness was present, but abdominal guarding, peritoneal signs, and costovertebral angle tenderness were absent. Computed tomography […]

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Thoracoabdominal Aneurysm in a Professional Body Builder

A 71-year-old man with a history of Parkinson’s disease experienced a sudden decline in function, with multiple falls over 2 weeks. He had previously been able to ambulate independently but had become chair-bound over this period. Forty-eight hours into admission he was noted to be spiking fevers of 38°C-39°C daily, without chills or rigors. There […]

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‘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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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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Slowly Growing Adrenal Mass: A 20-Year Incubation

A 68-year-old Japanese woman was referred for the evaluation of bilateral adrenal masses. These masses were incidentally discovered 20 years previously on computed tomography (CT) when they measured 2.5 cm and 2.0 cm (Figure 1A, B). At that time she had no signs or symptoms of adrenal cortical hormone excess or deficiency. The plasma corticotropin (ACTH) concentration was […]

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