Postpneumonectomy syndrome (PPS) is a rare postoperative phenomenon characterized by dynamic airway obstruction and circulatory collapse resulting from excessive mediastinal shifting and rotation of critical structures. This paper presents a novel case of PPS manifesting approximately 3 decades after pneumonectomy in an acutely symptomatic 28-year-old man with clinical findings concerning for impending airway collapse. Cardiac computed tomography and pulmonary function testing were used as alternative, noninvasive means of monitoring for disease advancement. Approximately 113 incidences of PPS appear in the literature. Although a diagnosis of exclusion, it is important to consider the phenomenon given the life-threatening consequences. For this reason, virtually no powered data investigating the rate of disease regression has been published in the medical literature to date. Although space-occupying surgery serves as the most frequently used treatment modality, there remains no consensus on PPS management, patient selection, or timing of intervention among thoracic societies.

CASE PRESENTATION:We describe a delayed case of tension pneumocephalus in a newly altered patient 21 days status-post auto-vs-pedestrian accident. After her initial hospital course, the patient was discharged to an acute rehabilitation facility in stable condition with Glasgow Coma Scale 15. The patient returned to the emergency department for an acute change in mental status.DISCUSSION:Tension pneumocephalus is a neurosurgical and otolaryngological emergency.

Ogilvie’s syndrome (acute colonic pseudo-obstruction) is a rare disorder characterized by an acute dilation of the colon measuring greater than 10 centimeters. Common symptoms associated with Ogilvie’s include abdominal distension, abdominal pain, nausea, vomiting, constipation, and diarrhea. This report presents an uncommon case of a quadriplegic presenting to the emergency department with complaints of abdominal distention. Computed tomography and radiographic imaging studies were consistent with Ogilvie’s syndrome. The patient was admitted to the hospital and started on stool softeners and bowel rest with resolution of symptoms. Topics Ogilvie’s syndrome, quadriplegic, abdominal distension, colonic pseudo-obstruction.

CASE PRESENTATION:A 38-year-old male presented to the emergency department with methamphetamine-induced agitation. Physical exam showed clouding of the left cornea, with gelatinous appearance and associated conjunctivitis, consistent with corneal melt, or keratolysis.DISCUSSION:Keratolysis is dissolution of the corneal stroma that can lead to corneal ulceration and vision loss. Smoking stimulants has been shown to be associated with this pattern of ocular injury, although this is a relatively rare presentation. Acute keratolysis is a unique complication of methamphetamine preparation and ingestion via smoking that can lead to corneal ulceration and loss of vision.

An eleven-month-old male was brought in for a 1-day history of abdominal distension and anorexia associated with increased fussiness and multiple bouts of non-bloody diarrhea without any vomiting. A kidney, ureter and bladder (KUB) radiograph and abdominal ultrasound were obtained (Figure 1). (Figure 1). After placing a nasogastric (NG) tube (Figure 2), a repeated KUB showed gastric decompression with the NG tube extending into the stomach. An abdominal ultrasound showed transient small bowel to small bowel intussusception in the left lower quadrant, which spontaneously decreased during the course of the examination (Figure 3).

Background Pulmonary artery dissection is a rare condition that is usually diagnosed in patients exhibiting chronic pulmonary arterial hypertension, congenital heart abnormalities or secondary to iatrogenic injury. Diagnosis is often made at autopsy as many patients experience sudden death when the pulmonary artery dissection progresses rapidly and ruptures into the pericardium, resulting in acute cardiac tamponade. Case Presentation We report a case of pulmonary artery dissection, which resulted from blunt thoracic trauma diagnosed in the emergency department.

Introduction Patients with acute unilateral upper and lower facial palsy frequently present to the emergency department fearing they have had a stroke, but many cases are benign Bell’s palsy. Case Report We present a rare case of a medial pontomedullary junction stroke causing upper and lower hemifacial paralysis associated with severe dysphagia and contralateral face and arm numbness. Conclusion Although rare, pontine infarct must be considered in patients who present with both upper and lower facial weakness. Unusual neurologic symptoms (namely diplopia, vertigo, or dysphagia) and signs (namely gaze palsy, nystagmus, or contralateral motor or sensory deficits) should prompt evaluation for stroke.

Literature on ulnar artery thrombosis and acute finger ischemia is scant and usually related to underlying hypercoagulable or occlusive states, such as atrial fibrillation, thrombangiitis obliterans, vasospasm, trauma, and neurovascular compression at the root of the upper limb. An elderly hypertensive male without an underlying hypercoagulable state, and in otherwise good health, presented to our emergency department with acute multi-finger ischemia, and ulnar artery and palmar arch thromboses. Given his innocuous history, this case demonstrates the importance of maintaining acute arterial thrombosis on the differential for hand pain despite the obvious propensity toward mechanical injuries in the extremities.

A 10-year-old male vaccinated against varicella had developed left-sided rashes on his thoracic region in single dermatomal distribution, which is consistent with herpes zoster. Although herpes zoster is uncommon in children, especially with the current vaccination regimen, this case report serves as a reminder to consider it in one’s differential diagnoses, even in the immunocompetent, fully immunized pediatric patient. This is a case report of a previously healthy, fully vaccinated child who developed herpes zoster.

Author(s): Barkataki, Kieron; Wang, Nathan; Quesada, Daniel; O'Donnell, Rachell; Rosbrugh, James W.; Aguiniga-Navarrete, Phillip

CASE PRESENTATIONA 19-year-old primigravida female presented with three weeks of intermittent suprapubic and left lower quadrant (LLQ) abdominal pain, worsening in the prior 24 hours, associated with nausea and vomiting at the time of presentation.Her last normal menstrual period was approximately 17 weeks prior to presentation, but she reported some vaginal spotting nine weeks ago.Abdominal exam revealed diffuse tenderness to palpation, worse in the LLQ, without peritoneal signs.A point-of-care ultrasound (POCUS) showed an intrauterine pregnancy (IUP).However, the patient's persistent unilateral pain was concerning.Therefore, a formal pelvic ultrasound was performed, which revealed an IUP at seven weeks gestation, including an anechoic region with free fluid in the pelvis (Image 1), and a left adnexal

Neuroretinitis from neurosyphilis is an uncommon finding in previously healthy young individuals. A 37-year-old presented with three days of painless, unilateral vision loss with an associated diffuse erythematous non-pruritic truncal rash. Physical exam demonstrated vision loss in the left eye. Fundoscopic exam showed unilateral peripapillary hemorrhage, papilledema and venous engorgement. Labs showed positive syphilis antibody qualitative. Magnetic resonance imaging demonstrated 12 millimeters of high right frontal lobe cerebrospinal fluid density. The patient was treated with benzylpenicillin and within 18 hours had improvement of his vision.

Due to the recent increase in endovascular procedures, retained foreign bodies such as stents and catheters in vasculature have become a common and serious complication. Treatments for these complications vary depending on the acuity and stability of the foreign body in the vessel. We discuss a rare case of an adult found to have an incidental retained umbilical artery catheter in the aorta.

Diaphragmatic hernias are an uncommon occurrence in the pediatric population; however, they can cause significant morbidity and mortality if the diagnosis is missed or delayed. This case discusses the radiographic and clinical exam findings of a one-year-old patient with this pathology.

A paraspinal abscess is an uncommon condition frequently diagnosed late due to equivocal symptoms, which can lead to increased morbidity and mortality. Commonly associated risk factors include prior invasive spinal procedures, diabetes mellitus, trauma, chronic steroid use, malnutrition, intravenous drug use and an immunocompromised state. Pediatric paraspinal abscesses are not well documented in the literature. We report a case of a two-year-old female presenting with fevers, lower back pain, and decreased oral intake ultimately diagnosed with isolated lumbar paraspinal abscess. The patient underwent an ultrasound-guided percutaneous drainage of the abscess, subsequently improving, and was discharged within 48 hours of presentation.

CASE PRESENTATIONA 50-year-old Hispanic male with a history of diabetes presented to the emergency department with a painful maxillary mass for 12 days.He had been previously treated with antibiotics without improvement.Review of systems was significant for fever, diaphoresis, weight loss, and malodorous breath.Physical exam revealed poor dentition, mild tenderness to palpation of the maxillary sinuses and a 2.5 x 4 cm yellow, rubbery lesion on the hard palate (Image 1).The mass was pliable and adherent.Computed tomography of the face revealed irregularities of the hard palate, subcutaneous emphysema, and chronic sinusitis (Images 2 and 3). DIAGNOSISRhinocerebral mucormycosis, an infection of the nasal and paranasal sinuses, is the most common presentation of the mucormycosis spectrum. 1Five hundred cases are reported in the United States each year. 2 The fungi are found in dead and

Since 2014, Academic Life in Emergency Medicine (ALiEM) has used the Approved Instructional Resources (AIR) score to critically appraise online content. The primary goals of this study are to determine the interrater reliability (IRR) of the ALiEM AIR rating score and determine its correlation with expert educator gestalt. We also determine the minimum number of educator-raters needed to achieve acceptable reliability.Eight educators each rated 83 online educational posts with the ALiEM AIR scale. Items include accuracy, usage of evidence-based medicine, referencing, utility, and the Best Evidence in Emergency Medicine rating score. A generalizability study was conducted to determine IRR and rating variance contributions of facets such as rater, blogs, posts, and topic. A randomized selection of 40 blog posts previously rated through ALiEM AIR was then rated again by a blinded group of expert medical educators according to their gestalt. Their gestalt impression was subsequently correlated with the ALiEM AIR score.The IRR for the ALiEM AIR rating scale was 0.81 during the 6-month pilot period. Decision studies showed that at least 9 raters were required to achieve this reliability. Spearman correlations between mean AIR score and the mean expert gestalt ratings were 0.40 for recommendation for learners and 0.35 for their colleagues.The ALiEM AIR scale is a moderately to highly reliable, 5-question tool when used by medical educators for rating online resources. The score displays a fair correlation with expert educator gestalt in regard to the quality of the resources. The score displays a fair correlation with educator gestalt.