Occipital Condyle Syndrome As the Initial Presentation of Recurrence of Metastatic Breast Cancer: A Case Report.

Skull-base metastasis is extremely rare. Various syndromes have been identified based on the anatomical involvement of the metastatic tumor. Occipital condyle syndrome (OCS) occurs with involvement of occipital bone and compression of the hypoglossal canal. OCS is very rare and usually has an underlying widely disseminated metastatic cancer. We present a 66-year-old female who initially presented with tongue deviation and occipital headache. MRI revealed a mass compressing the occipital bone and hypoglossal canal. Further work-up revealed metastatic breast cancer.

Tainted Love: A Case of Gonococcal Endocarditis.

Gonococcal endocarditis (GE) is a rare complication of disseminated gonococcal infection with significant morbidity and increasing mortality despite early diagnosis and surgical intervention. The discovery and use of antibiotics in the treatment of gonococcal infections has made this once relatively common entity a rarity. Notably, over the recent years, GE has shown an alarming resurgence for unclear reasons. The upward trend in the incidence of gonococcal infections coupled with observed antibiotic resistance may in part explain the rise in cases. GE mostly affects sexually active young people without a history of valvular heart disease. Prompt diagnosis and surgical intervention are important in the bid to mitigate poor outcomes. Management is therefore multidisciplinary; primary care clinicians who usually are the first to see this patient population should be able to make an early diagnosis and facilitate early referral for surgical intervention as indicated. Despite appropriate and timely therapy, devastating consequences of this condition are not uncommon.

Large Spontaneous Right Catamenial Pneumothorax with Diaphragmatic Defect and Liver Herniation.

Catamenial pneumothorax is a spontaneous pneumothorax that occurs predominantly women of child bearing age. We describe a case of a 40-year-old nulliparous woman with medical history significant for endometriosis who presented with severe chest tightness of one-day duration. Chest radiography (CXR) showed a large right spontaneous pneumothorax, what was thought to be a 5.6 cm pleural mass at the right lung base. Following pneumothorax diagnosis, the patient underwent emergent right thoracostomy with pigtail catheter placement. A repeat CXR revealed marked re-expansion of the lung but persistence of a right pleural mass. Follow up computed tomography scan of the chest showed a 33 mm diaphragmatic defect with 5.8 x 4.6 x 3.9 cm area of herniated liver corresponding to the presumed pleural mass. Following complete thoracic imaging, patient underwent video-assisted thoracoscopic surgery, mechanical pleurodesis, and open repair of the right diaphragmatic defect. Intraoperatively, an endometrial implant was noted on the chest wall. On postoperative day three, she began her menstrual cycle and was evaluated by gynecologist who recommended hormonal therapy to reduce risk of recurrent pneumothorax. Due to a persistent air leak, the chest tube was transitioned to a Heimlich valve to facilitate home discharge. The patient was discharged on postoperative day eight, seen as outpatient with resolution of air leak and removal of chest tube.