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Chest radiograph demonstrating 2 bilateral cavitating pulmonary infiltrates (A) and chest radiograph 9 months later demonstrating complete resolution of the infiltrates after immunosuppressive therapy (B).

Granulomatosis with Polyangiitis Presenting as Hypophysitis

A 20-year-old healthy woman presented to a local hospital with 3 months of headaches and fatigue and 3 weeks of intermittent fevers to 40°C. Physical examination was normal. White blood cell count was 6.1 × 109/L, hemoglobin 10 g/dL, sodium 153 mmol/L, and creatinine 0.80 mg/dL. Magnetic resonance imaging demonstrated a 2.1 × 1.8 × 0.9-cm cystic sellar lesion. Hormone testing […]

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Doppler assessment by transesophageal echocardiogram of severe mitral stenosis.

Diagnostic and Management Dilemma: Massive Hemoptysis from Severe Mitral Stenosis

Severe hemoptysis in a critically ill patient must prompt rapid development of a broad differential. We present an unusual case that presented a diagnostic and management dilemma. A 55-year-old man presented to the Emergency Department with dyspnea and hemoptysis. He was hemodynamically unstable, requiring intubation and pressor support. Assessment On examination, he was afebrile and […]

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Hematoxylin-eosin stain showing patchy perivascular and interstitial granulomas (original magnification, 40×).

Sarcoidosis Presenting as Isolated Anasarca and Hypercalcemia

A 62-year-old woman presented to clinic for a second evaluation. Previously healthy, she initially presented for care several months earlier with anasarca. Initial workup was notable for normal renal function, calcium level, and liver function tests, no proteinuria, and echocardiogram demonstrating mild diastolic dysfunction and concentric left ventricular hypertrophy but preserved systolic function. One month […]

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Computed tomography cystography in the coronal plane after administration of contrast through Foley catheter showing collapsed urinary bladder (white arrow) with extensive extravasation of contrast material into the peritoneal cavity including perivesical, right paracolic gutter, and perihepatic locations (black arrows).

Ruptured Urinary Bladder After a ‘Simple’ Fall

An independent 99-year-old community-dwelling man was admitted after being found on the floor, confused and complaining of diffuse abdominal pain and difficulty voiding. His past medical history included obesity, diabetes, hypertension, and benign prostatic hyperplasia. Examination showed a stuporous patient, abdominal distention, and diffuse abdominal tenderness. Bladder catheterization yielded 600 mL of bloody urine. Laboratory […]

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Relevant diagnostics and physical examination data. (A) Initial electrocardiogram on presentation to the critical care unit. (B) Still image of clonus on physical examination (refer to supplementary materials for video). (C) Electrocardiogram on discharge after successful treatment of serotonin syndrome.

Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm

A 60-year-old woman with bipolar disorder presented to a local hospital after being found unresponsive at home. When assessed by emergency medical services, she was found to be tachycardic to 180 beats per minute and received 3 doses of adenosine on transport with no effect. Given concern for altered mental status, she was intubated for […]

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Apical 4-chamber view of the cardiac metastasis in the right ventricle.

Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell Lung Cancer

Cardiac tumors have generally been considered to be rare. They are often found incidentally, as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac […]

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