Tag Archives: diagnostic dilemma

An Unusual Presentation of Thrombotic Thrombocytopenic Purpura

  We describe a patient with sudden and severe postoperative thrombocytopenia whose diagnosis was delayed. The patient was a 58-year-old black man with diabetes mellitus type 2, hypertension, and chronic kidney disease, who presented to our institution with 4 days of abdominal pain. He had a history of remote exploratory laparotomy for an abdominal gunshot […]

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Double the Trouble: Acute Coronary Syndrome and Ischemic Stroke in Polycythemia Vera

Vague symptoms turned out to be life-threatening conditions. A 50-year-old man with a history of polycythemia vera presented to the hospital with epigastric discomfort and clumsiness of the right hand for 5 days. Polycythemia vera was diagnosed 1 year prior, with good control of hematocrit by intermittent phlebotomy. He did not have any other medical […]

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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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