Chest imaging of hypersensitivity pneumonitis induced by heroin abuse.

Long-term abuse of nasally inhaled substances such as heroin can result in life-threatening hypersensitivity pneumonitis and respiratory distress. In the setting of hypoxia, a chest CTA is often necessary to see the extent of the lung involvement and to rule out pulmonary emboli.

Two pulmonary emboli in a psych pod.

BACKGROUND: A female patient known to have schizoaffective disorder self-presented to an emergency department in a state of acute agitation and paranoia shortly after a 35-day inpatient stay at a psychiatric facility. CASE REPORT: The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain. CONCLUSION: Psychiatric hospitalizations, medications, diagnoses and relevant sequelae increase venous thromboembolism risk more than many realize.

An odontoid fracture and vertebral artery injury in fast-track.

While CT scans without IV contrast are obtained commonly to evaluate vertebral injuries, CT angiography scans should be considered whenever a fracture site approaches known vasculature.

A Diagnosis of Adult-Onset Still's Disease after Multiple Urgent Care Visits.

A 34-year-old man with recent treatment and resolution of community-acquired pneumonia presents to the emergency department with protracted fever, rash, and sore throat. Sustained fever and greater than two-fold increase in leukocytosis despite appropriate antibiotic therapy prompted hospital admission for infectious disease and rheumatologic evaluations which ultimately revealed adult-onset Still's disease, a rare autoinflammatory disorder with potentially life-threatening complications.

A smartphone, a slit lamp, and an ophthalmology consult.

Clinicians should always consider capturing images with their phone when possible so that key clinical findings seen in the real-time physical examination can be memorialized in the electronic medical record.

Spontaneous Intracranial and Lumbar Subdural Hematoma Presenting as Vaginal Pain.

BACKGROUND: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT: A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.

Rolando fracture.

Rolando fractures are associated with poor prognosis and when they occur on the dominant hand potential for disability is even greater. Timely imaging, placement into a thumb spica splint, and orthopedic surgery evaluation are integral to ensuring the best possible outcome for the patient.