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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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(A) Inferior vena cava-right atrium thrombus. (B) Right atrium thrombus. (C) Right atrium thrombus.

An Oscillating Thrombus Inside the Inferior Vena Cava

Thrombosis of the inferior vena cava is an under-recognized entity that is associated with significant morbidity and mortality.1 It is estimated that 2.6%-4% of patients with deep vein thrombosis of the lower extremities have inferior vena cava thrombosis. The most common cause of inferior vena cava thrombosis is the presence of an unretrieved inferior vena cava […]

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Progressive Dysphonia: Ortner Syndrome

A 68-year-old woman with known idiopathic heart failure and severe reduced ejection fraction was admitted for aggravation of dyspnea and recurrent dysphonia over the past 6 months, progressing to constant hoarseness. Vitals signs were normal. Laboratory tests showed normal hemoglobin and white blood cell count, increased levels of N-terminal pro-brain natriuretic peptide (NT-proBNP; 10574 pg/mL), […]

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