Tag Archives: diagnostic testing
Transthoracic echocardiogram views revealing collapse of the right atrium during atrial diastole (red arrowheads) and of the right ventricle during ventricular diastole (red arrows).

Cardiac Tamponade: An Unusual Presentation of Systemic Lupus Erythematosus

A 55-year-old Ghanaian man was admitted to our service with 4 days of acute, progressive dyspnea. He developed orthopnea the night prior to his admission. Review of systems revealed progressive asthenia, anorexia, and low-grade fever for the past few months, with an unintentional weight loss of approximately 40 lbs. No other symptoms were elicited. The […]

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(A) Two-dimensional transesophageal echocardiogram image demonstrating the thin, elongated mass extending into the left ventricle and attached to the anterior mitral leaflet. (B) Two-dimensional transesophageal echocardiogram image outlining the mass, which measures 9.85 cm in length.

Elongated Mitral Valve Vegetation

To the Editor: A 41-year-old woman presented with a 2-week history of neck and back pain and suddenly developed pulseless electrical activity cardiac arrest while in the emergency department, with return of spontaneous circulation after 2 rounds of advanced cardiac life support. Physical examination and labs were notable for fever, sinus tachycardia, leukocytosis, and lactic […]

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(A) Computed tomography of the abdomen/pelvis revealed a low attenuating lesion within the right lobe of the liver measuring 5.2 × 5.0 × 5.8 cm and (B) mild pericolonic fat stranding in the sigmoid colon. (C) An abdominal ultrasound scan revealed a 5.6-cm hyperechoic area in the central liver and (D) a thick-walled gallbladder filled with stones. (E) A sonographically guided percutaneous catheter drain was placed into the right liver abscess.

Unusual Case of Fever and Abdominal Pain

Pyogenic liver abscess is an uncommon type of intra-abdominal abscess and occurs in approximately 3.6 per 100,000 hospitalized individuals.1 The incidence of pyogenic liver abscess is increasing.1 Here we present a case of Streptococcus anginosus liver abscess, secondary to acute uncomplicated sigmoid diverticulitis and acute cholecystitis. Case Report A 63-year-old man presented to our tertiary medical center with a […]

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Proportion of patients with at least one unnecessary test based on chart review, frequency with which testing led to a change in patient management and the overall outcome of testing on patients.

The Frequency of Unnecessary Testing in Hospitalized Patients

Testing is an important part of medicine across all specialties and settings. As a result, the volume of testing is enormous, with an estimated 4-5 billion tests performed in the United States each year.1 Unnecessary laboratory testing and diagnostic imaging is believed to be common. Studies looking at testing of patients have found 40%-60% of tests […]

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A bubble study was performed with transesophageal echocardiography. (A) This image was obtained before the bubble study. (B) In the early phase of the bubble study, bubbles (arrow) moved from the right atrium (RA) to the left atrium (LA) through the interatrial septum (IAS). (C) In the late phase of the bubble study, bubbles (arrows) were located in the right atrium. (D) This image was captured after percutaneous closure of the interatrial septum (star).

Falls and Delirium: Platypnea-Orthodeoxia Syndrome

An 85-year-old woman’s inability to remain standing was ultimately connected to an undiagnosed congenital defect. The patient was admitted to the geriatric unit of a university hospital for new frequent falls and subacute delirium, both of which began 1 month before presentation. Her medical history included ischemic stroke 10 years earlier, mild neurocognitive impairment, and […]

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Teaching Diagnostic Reasoning in the Digital Age: The Role of the Mentor

Each case has its lesson—a lesson that may be, but is not always, learnt, for clinical wisdom is not the equivalent of experience. A man who has seen 500 cases of pneumonia may not have the understanding of the disease which comes with an intelligent study of a score of cases, so different are knowledge […]

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