Air in the Wrong Place at the Wrong Time: A Case of Pneumomediastinum and Pneumopericardium in the Setting of COVID-19 Disease.

Infection with SARS-CoV-2, commonly referred to as COVID-19 disease, has been noted to involve a systemic inflammatory reaction affecting multiple organ systems. Patients present with a spectrum of symptoms from mild to severe respiratory distress requiring supplemental oxygen and, at times, intubation and mechanical intubation. Pulmonary involvement causes diffuse alveolar wall damage leading to destruction and collapse of the alveolar walls causing air leakage and introduction of the air into the mediastinum, pericardium, and interstitial spaces. We present a case of a 71-year-old patient who presented with respiratory distress requiring supplemental oxygen with subsequent rapid decline and decompensation requiring intubation and mechanical ventilation who was found to have pneumomediastinum and pneumopericardium.

Case of Junctional Rhythm in the Setting of Acute Adrenal Insufficiency.

Primary adrenal insufficiency occurs when the production of glucocorticoid and mineralocorticoid hormones from the adrenal cortex decreases. Cardiovascular manifestations, although a rare sequela in acute adrenal insufficiency, include arrhythmias, heart failure and ischemia. Rapid identification and treatment are crucial as mortality can occur rapidly. We present a patient with no underlying adrenal dysfunction who presented with worsening renal function and subsequent development of acute adrenal insufficiency manifesting with hypothermia, hypotension, and junctional rhythm requiring vasopressor support along with hydrocortisone therapy.

Nonbacterial Thrombotic Endocarditis With Leptomeningeal Carcinomatosis: A Rare Presentation of Advanced Rectal Adenocarcinoma.

Nonbacterial thrombotic endocarditis (NBTE) is a rare condition characterized by the formation of sterile vegetations on valvular structures. Commonly asymptomatic in early stages resulting in systemic emboli as its initial manifestation. NBTE is found to be associated with diseases, which induce hypercoagulability, and, most commonly, is associated with malignancy. Rectal signet ring cell adenocarcinoma is an uncommon histological type of rectal cancer with a poor prognosis and aggressive nature. We present a rare manifestation of advanced rectal signet cell adenocarcinoma discovered due to manifestations of NBTE and leptomeningeal carcinomatosis.

Catheter-Directed Vegetation Aspiration in Tricuspid Valve Bacterial Endocarditis: A Potential Treatment for Poor Surgical Candidates.

Infective endocarditis is a condition that has the potential to cause significant morbidity and mortality. Potential complications include sepsis, heart failure, atrioventricular block, embolic stroke, septic emboli, and intracardiac abscess formation. The backbone of treatment is intravenous antibiotics; however, in certain clinical scenarios, surgical management is also indicated to reduce complications and mortality. There exists a challenging subset of patients who require surgery but carry a high perioperative mortality risk. Percutaneous management of endocarditis is emerging as a potential treatment for this high-risk group of patients: it allows for an attempt at source control while avoiding the high risks of surgery. Herein, we present the case of a 35-year-old male presenting with hemoptysis secondary to pulmonary septic emboli in the setting of Enterococcus faecalis tricuspid endocarditis. He was determined to be a poor surgical candidate and underwent catheter-directed debulking of the tricuspid vegetation with excellent results.