Lymphocytic myocarditis presenting as acute myocardial infarction: a case report and review of the literature

We report a case that presented as acute myocardial infarction (AMI) caused by lymphocytic myocarditis (LM), and explore the relationship between AMI and LM. We also performed a literature search to identify publications that previously reported LM-associated myocardial infarction. Coronary angiography of our patient revealed normal coronary arteries. However, a perfusion–metabolism mismatch in the apex and mid-inferior walls supported the diagnosis of AMI, and right ventricular septal endomyocardial biopsy showed LM. Extensive viral serological tests were negative for an infectious etiology. Immunosuppressive therapy may be beneficial in patients with high-risk myocarditis who are pathologically confirmed to be virus-negative.     

Myocarditis presenting as typical acute myocardial infarction: A case report and review of the literature

BACKGROUND Myocarditis refers to a variety of myocardial inflammatory lesions. A variety of factors such as infection and physical and chemical factors can cause myocarditis.Depending on the severity of myocardial damage, myocarditis patients can manifest heart failure, cardiogenic shock, and even sudden death. Here we present a case of viral myocarditis that mimicked acute coronary syndrome.CASE SUMMARY A middle-aged male patient presented with chest pain and elevated troponin I after a flu-like infection. This patient had a history of hypertension and a habit of alcohol and tobacco use. Electrocardiography showed typical changes in acute myocardial infarction, with the T-wave increasing. Coronary angiogram revealed no stenosis. Cardiac magnetic resonance imaging revealed edema of the middle and apical septal and apical anterior walls on T2-weighted images and the T1 mapping. Late gadolinium enhancement of the middle and apical septal and apical anterior walls could be found. Rubella virus immunoglobulin G and immunoglobulin M antibodies were abnormally elevated. The patient was given antiviral and antibiotic treatments, and serum biomarkers and electrocardiograph returned to normal after 5 d of treatment. After one-year follow-up, the patient showed no symptoms, and cardiac magnetic resonance showed that myocardial thickness was significantly thinner than before, and fibrosis was less than before.CONCLUSIONThis case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal.     

Functional airway obstruction presenting as stridor: a case report and literature review

We report the case of a young man who presented to 3 emergency departments with apparent upper airway obstruction and was intubated each time before being diagnosed with paradoxical vocal cord motion. His previous discharge diagnoses were laryngeal edema secondary to anaphylaxis, even though he had no other objective findings of IgE-mediated disease. Flexible fiberoptic laryngoscopy demonstrated tight apposition of the vocal cords during inspiration while symptomatic, but normal movement when asymptomatic. Psychiatric evaluation revealed severe posttraumatic stress disorder. Of the approximately 41 reported cases of functional airway obstruction in the medical literature, only two have been adult males and none have been associated with posttraumatic stress disorder. The current literature is reviewed, and an approach to evaluation and management of such patients is provided.     

Traumatic tricuspid insufficiency: a case report with a review of the literature.

Traumatic tricuspid insufficiency, a rare complication of blunt chest trauma, has been reported with increasing frequency during the last 40 years. Automobile accidents are the leading cause of traumatic tricuspid valve regurgitation. The most frequently reported injury is chordal rupture, followed by rupture of the anterior papillary muscle and leaflet tear, primarily of the anterior leaflet. In the acute phase of the injury, the traumatic lesion may go undetected. In the chronic phase many patients remain asymptomatic and others exhibit symptoms and signs of moderate to severe right heart failure. Clinically overt right heart failure has been the traditional indication for surgery, which usually consisted of tricuspid valve replacement. More recently, a more aggressive strategy, with surgical repair of the valve performed before deterioration of the right ventricular function occurs, has been advocated.     

Mesenteric lymphangioma presenting as adnexal torsion: case report and literature review

We report the case of a patient with a mesenteric chylous lymphangioma who presented with acute pelvic symptoms mimicking adnexal torsion. The cyst contents had no specific sonographic or CT characteristics, such as a fluid-fluid level, to aid the preoperative diagnosis; definitive diagnosis was made only upon histopathologic examination of the cyst, which was resected intact.     

Unusual diagnoses presenting as incarcerated inguinal hernia: a case report and review of the literature

Many different pathological processes can present as an incarcerated inguinal hernia. We present an unusual case of sigmoid diverticular abscess presenting as a left incarcerated inguinal hernia and review the literature on this subject. This was treated with open drainage of the abscess cavity and laparotomy with segmental sigmoid resection and primary anastomosis.     

Femoral neck stress fracture presenting as gluteal pain in a marathon runner: case report

A case is described of a 50-year-old man with a femoral neck stress fracture presenting as gluteal pain. An operative pinning procedure of the femoral neck was performed for stabilization. Femoral neck stress fractures are often misdiagnosed early in their presentation. The signs and symptoms can mimic those of more commonly seen disorders. Appropriate physiatric history and physical examination, along with indicated studies, will help prevent misdiagnosis and potentially serious complications associated with musculoskeletal pathology.     

Intrapelvic malignant nerve sheath tumors presenting as acute urinary retention: A case report and literature review

Malignant nerve sheath tumors (MPNSTs) are rare sarcomas tumors which rarely present as intrapelvic mass and are hard to diagnose clinically. We present a 29‐year‐old male patient presented with acute urinary retention and was diagnosed with large intrapelvic mass. After complete surgical resection, the histopathology confirmed the diagnosis of low MPNST.     

Hematometra presenting as acute appendicitis: a case report

A case of intrauterine blood passing into the abdominal cavity and resulting in a clinical picture similar to acute appendicitis is presented. To our knowledge, hematometra presenting in this manner has not been reported in the medical literature. Some disease processes which more commonly mimic acute appendicitis include nonspecific mesenteric adenitis, gynecologic disorders, diverticulitis, and urinary tract infection. Unusual diseases presenting in this manner include splenic torsion, infarcted omentum, ileocecal tuberculosis, and duodenal hematoma.     

鞍区黄色肉芽肿一例并文献复习

正患者男,6岁,于6月前无明显诱因出现左眼视物模糊,无头晕、头痛、恶心呕吐、吞咽困难等,外院行相应治疗后症状未见明显缓解。入院专科查体未见明显异常,实验室检查提示三碘甲状腺原氨酸(triiodothyronine,T3)、四碘甲状腺原氨酸(thyroxine,T4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离四碘甲状腺原氨酸(free thyroxine,FT4)、黄体生成素(luteinizing     

Ampullary carcinoid tumor presenting as acute pancreatitis in a patient with von Recklinghausen's disease: case report and review of the literature

A patient with von Recklinghausen syndrome presented with multiple attacks of pancreatitis. Evaluation using computed tomography, endoscopic retrograde cholangiopancreatography, and endosonography revealed an ampullary carcinoid. The patient underwent a pylorus-sparing Whipple resection, and is doing well after 30 months of follow-up. This is the second reported case of ampullary carcinoid presenting with pancreatitis in a patient with von Recklinghausen syndrome.     

Mediastinal tuberculous lymphadenitis presenting with insidious back pain in a male adult: a case report and review of the literature

Mediastinal tuberculous lymphadenitis (MTL) is mostly observed in primary tuberculosis in infants, children and adolescents, and is not found commonly in adults. Mediastinal tuberculous lymphadenitis cases may present with an insidious progression of tuberculous symptoms, including gradual deterioration in the lungs and a variety of clinical characteristics; however, initial symptoms are rarely only chronic back pain. We present the case of a 33-year-old man with mediastinal tuberculous lymphadenitis misdiagnosed as myofascitis. Since such individuals do not develop respiratory symptoms in the initial stages, they often go undiagnosed and can potentially spread tuberculosis.     

Postpartum sacral fracture presenting as lumbar radiculopathy: a case report

Although rare, sacral stress fractures may occur in pregnant women, and osteoporosis of pregnancy is a poorly understood entity. We present the case of a young, postpartum, recreational runner who developed low back pain (LBP) and radicular symptoms suggestive of L5 radiculopathy found to be secondary to sacral stress fracture. The patient had a good clinical outcome after several months and was able to resume her normal activities. This case illustrates that clinicians should have a high index of suspicion for sacral stress fracture in athletic pregnant or postpartum women presenting with LBP and/or lumbar radiculopathy. Also included are a brief review of osteoporosis in pregnancy and guidelines on the diagnosis and management of sacral stress fractures.     

Intestinal pseudo-obstruction as a presenting manifestation of systemic lupus erythematosus: case report and review of the literature

A case of intestinal pseudo-obstruction as a presenting manifestation of systemic lupus erythematosus is presented. Systemic lupus erythematosus is an autoimmune disease with a wide spectrum of unpredictable multisystemic presentations. A case of systemic lupus erythematosus that was diagnosed in a patient whose initial presentation for the disease was acute renal failure, hydronephrosis, intestinal pseudo-obstruction, and false-positive syphilis serologies is presented. There have been 18 other cases of intestinal pseudo-obstruction associated with systemic lupus erythematosus to date in the English literature. A variety of gastrointestinal syndromes have been increasingly recognized as possible manifestations of systemic lupus erythematosus, and this case illustrates in particular that intestinal pseudo-obstruction may be a presenting manifestation of this disorder.     

Delayed splenic rupture presenting as unstable angina pectoris: case report and review of the literature

The diagnosis of delayed rupture of the spleen can be challenging if the history of trauma is remote, or initially missed. Delayed rupture of the spleen can occur in approximately 1% of blunt force injuries to the spleen. We present a difficult case of delayed rupture of the spleen from remote, minor trauma and discuss the literature associated with this injury.     

Cauda equina syndrome presenting as abdominal pain: a case report

Cauda equina syndrome (CES) is an uncommon entity. Symptoms include bowel and bladder dysfunction, saddle anesthesia, and varying degrees of lower limb motor and sensory disturbances. The consequences of delayed diagnosis can be devastating, resulting in bowel and bladder incontinence and lower limb paralysis. There is little in literature regarding abdominal pain as a significant feature of the initial presentation of CES. We present the case of a 32-year-old woman with CES who presented to the emergency department with gradually worsening lower abdominal pain.     

Amyloidosis of the colon presenting as ischemic colitis: A case report and review of the literature

Review of the English literature revealed 21 cases describing abnormalities on barium enema secondary to amyloidosis of the colon. These cases were categorized as to frequency of specific barium enema findings and distribution within the colon. The most common radiologic findings were luminal narrowing (11 of 21), loss of haustrations (10 of 21), thickened mucosal folds (8 of 21), mucosal nodularity (8 of 21), and ulceration (6 of 21). The most frequent locations of disease within the colon were the descending and rectosigmoid portions (13 of 21). We present a case of primary amyloidosis that demonstrates the findings of bowel wall thickening and luminal narrowing on doublecontrast barium enema and computed tomography (CT). Pathologic examination in our case, in addition to similar observations from the literature, suggests that at least a part of the radiologic changes of colonic amyloid can be attributed to bowel ischemia.