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Fiber-optic bronchoscopic image showing multiple submucosal nodules characteristically sparing posterior membranous (A). Narrow-band imaging not showing the intraepithelial capillary loop pattern with dark brown dots (B). Axial and coronal scan depicting calcifications within the tracheal lumen (C and D).

Polypoidal Trachea: A Clinician’s Predicament

A 44-year-old asymptomatic female patient with no known comorbidities was scheduled for donor kidney harvesting for her husband. During intubation, the anesthetist found multiple polypoidal lesions just below the vocal cords, studding the tracheal wall. A diagnosis of multiple tracheal papillomatosis was made, and the patient was referred to the Otorhinolaryngology Department for further evaluation. […]

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Gallium scintigraphy findings. (A) Coronal section and (B, C) axial on gallium scintigraphy show marked uptake (arrows).

Reactive Arthritis Caused by Haemophilus parainfluenzae in a Diabetic Patient

We report the first likely known case of reactive arthritis caused by Haemophilus parainfluenzae. An 84-year-old woman developed polyarthritis of the neck, shoulders, and hips. Two months prior to admission, she had received dental treatment for caries; 1 week later, she noted fever and extremity pain. Physical examination revealed that the range of motion of both […]

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Chest computed tomography showing consolidation in lower lobe of right lung.

Connecting the Dots—Acute Abdomen, ST Elevation, and a Consolidating Lung Mass

Community-acquired pneumonia (CAP) is a commonly treated disease and yet may present in unfamiliar ways that if missed may result in unnecessary testing, procedures, and potential harm. Case We present a 38-year-old male with no prior medical history who presented with 3 days of severe, cramping lower abdominal pain. This was intermittent, non-radiating, and exacerbated […]

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Complicated Necrotizing Otitis Externa Progressing to Coalescent Mastoiditis and Temporal Lobe Abscess

A 77-year-old man with a history of hypertension, chronic kidney disease, and poorly controlled type 2 diabetes mellitus presented to our intensive care unit from an outside hospital with complicated necrotizing otitis externa. One month prior, the patient developed purulent drainage from the right external auditory canal with associated hearing loss. One week prior, he […]

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Magnetic resonance cholangiopancreatography demonstrating small filling defects in the distal common bile duct.

A Simpler Answer – After All This Time

There is an allure associated with a rare diagnosis. Diagnosis momentum refers to the “stickiness” of a diagnosis once it is attached to the patient,1 and is one example of a cognitive bias that can lead to diagnostic errors. This can lead to misattribution of symptoms to a patient’s existing (even incorrect) diagnosis if clinicians do […]

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Brainstem miliary pattern on admission.

CLIPPERS: An Increasingly Recognized Chronic Inflammatory Central Nervous System Disorder

Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) is a rare chronic inflammatory neurological syndrome affecting multiple regions of the brain, including brainstem, cerebellum, and spinal cord, that has become increasingly recognized since its introduction in 2010 by Pittock et al.1 The hallmark neuroimaging finding for CLIPPERS consists of multiple punctate, curvilinear lesions, […]

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