Tag Archives: diagnostic dilemma

What’s in a Mass?: Large Native Mitral Valve Mass

After an elective cystectomy, a 77-year-old man developed postoperative atrial fibrillation, resulting in a surprising new finding and a challenging diagnosis. He had no cardiovascular symptoms or cardiac history. The preoperative electrocardiogram was normal. Transthoracic echocardiogram identified a mass on the mitral valve (Figure 1A), new 3+ aortic valve regurgitation, and 2+ mitral valve regurgitation. Left ventricular […]

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Curious Case of Wheezing: Carcinoid Heart Disease

  A 58-year-old African American woman with a history of well-controlled hypertension (on amlodipine and lisinopril) presented with a 2-month history of anorexia, early satiety, dysgeusia, and intermittent loose stools, symptoms that had progressed to the point that she had experienced a 20-pound weight loss. These abdominal symptoms also were accompanied by progressive exertional dyspnea […]

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A Rarity in a Common Disease: Thyroid Paraganglioma

Thyroid nodule is extremely common in clinical practice. An evaluation of thyroid nodule is often straightforward. However, pathologic findings can occasionally be surprising. A 42-year-old previously healthy man was referred to the endocrinology clinic with asymptomatic neck enlargement noted during evaluation of acid reflux symptom. He had no previous radiation exposure to the head and […]

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Still Febrile After All These Weeks

A previously healthy 28-year-old man was admitted to an outside hospital with fever, pharyngitis, and diarrhea. His symptoms began with generalized fatigue, fever, night sweats, pharyngitis, diffuse myalgias and arthralgias, and 10-pound weight loss. He self-administered a 5-day course of azithromycin. Afterwards, he developed malodorous and watery diarrhea, abdominal cramping, tenesmus, and incomplete evacuation. On […]

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A Red Herring in the Green Grass: Syphilitic Membranous Glomerulonephritis

Physical discomfort attributed to a routine chore was actually an unusual presentation of an insidious infection. A 51-year-old man presented to the emergency department and reported 1 week of persistent, localized lower back pain that began after he had spent the day mowing his lawn. He denied any trauma, rash, dysuria, discoloration of urine, or […]

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