A Rapidly Progressing Carotid Body Tumor: A Case Report.

Carotid body tumors (CBTs) are a rare form of paragangliomas that often arise near the carotid bifurcation. They are typically slow growing and often asymptomatic. We report a case of a CBT in a 70-year-old man, who presented with a firm, painless, pulsatile neck mass that rapidly increased in size over the course of two months. The diagnosis was suspected based on the patient's clinical history and physical examination. The diagnosis was confirmed with CT angiography (CTA). The tumor was nonfunctioning based on normal urinary-free catecholamines, vanillylmandelic acid (VMA), and metanephrines levels. The patient then underwent a CT scan of his thorax, abdomen, and pelvis which did not detect any metastatic spread. The patient was referred to a tertiary vascular surgery center for definitive treatment. Our aim in presenting this case is to increase awareness of this rare type of paraganglioma with the hope of increasing early intervention and improving outcomes.

Intraoperative Complications During Orthopaedic Spinal Surgery in a Polypharmacy Patient With Multiple Comorbidities.

Orthopedic spinal surgeries, such as laminectomies or decompressions, have the potential to significantly increase quality of life for patients suffering from a spectrum of health issues ranging from neuropathy to chronic pain. Patients suffering from neurological symptoms such as weakness or neuropathy may lose significant function and become unable to perform the activities of daily living, however these delicate surgical interventions also come with significant risks to the health and well-being of those same patients. This is especially true with patients who have predisposing health conditions. Here, we discuss the effects of surgery on a patient with severe obesity, multiple confounding pre-existing conditions, and significant polypharmacy. An initially unremarkable spinal laminectomy and decompression surgery resulted in severe intraoperative complications that necessitated direct admission to the intensive care unit for significant post-operative management before he was able to be discharged safely. Although not a case of incredible rarity, we hope it can contribute to the growing body of data about the role of predisposing health conditions and polypharmacy in calculating and understanding the risks of orthopaedic surgery.

Myocardial Bridging as a Differential Diagnosis for Myocardial Infarction: A Case Report.

We present a case of a 55-year-old male who presented to the emergency department with complaints of acute onset of chest pain. As part of the workup, an electrocardiogram (ECG) revealed ST-segment elevation in leads V1-V5. Upon cardiac catheterization, myocardial bridging of the left anterior descending (LAD) artery was discovered without evidence of any obstructive coronary artery disease. The purpose of this report is to add to the existing literature that myocardial bridging, although traditionally thought to be a benign pathology, can also present risks for ischemia and infarction.

The Incidental Discovery of an Ileal Conduit Calculus: A Case Report.

In patients who have undergone radical cystectomy, urinary diversion procedures such as ileal conduits may pose a considerable problem for urologists when they result in stone formation. While an ileal conduit stone is only one of many potential complications of this procedure, its management may be particularly challenging; symptoms and treatments vary depending on factors such as stone location, composition, and the patient's BMI. We present a unique case of a 91-year-old male with a history of prostate and bladder cancer status post-radical prostatectomy, cystectomy, and ileal conduit who presented to the emergency department complaining of abdominal pain, nausea, vomiting, and disorientation for the last 24 hours. The patient was diagnosed with a complete bowel obstruction secondary to gallstone ileus. Consequently, an exploratory laparotomy was performed, which revealed that his small bowel obstruction was not caused by gallstone ileus but rather secondary to an internal hernia and volvulus associated with a previous bowel resection and anastomosis. The stone that was originally thought to be causing the small bowel obstruction turned out to be a 3.3 cm stone in his ileal conduit, which ultimately had no part in causing the patient's small bowel obstruction. Calculus formation is an infrequent complication of ileal conduit placement. Our aim in presenting this case is to increase awareness of this rare complication that can arise without symptoms with the hopes of increasing early intervention and improving outcomes.

Rheumatoid Arthritis-Linked Artificial Joint Infections Leading to Amputations.

Rheumatoid arthritis (RA) is a common autoimmune condition that can rarely cause more serious complications, such as permanent joint damage or infection, and may pose a significant additional risk during certain routine procedures. One major consequence of RA is that it can lead to serious and permanent joint damage requiring arthroplasty. Additionally, RA is a known cause of infection, with orthopedic prosthetic joint infections (PJIs) being documented. We explore one such serious case of a patient with long-term RA and a left knee joint replacement who presented to the emergency room with a serious PJI. History revealed that he repeatedly was affected by infections and had an extensive and severe clinical course, including nine revision surgeries. After a physical examination, imaging was performed, which further supported the diagnosis of joint infection. Considering the extensive number of attempts to salvage the joint, clinicians decided an above-knee amputation was necessary. This case highlights the fact that RA both increases the need for orthopedic arthroplasties and the risk of complications from these procedures, complicating clinical decision-making for physicians. Additionally, this patient had other underlying medical conditions and social habits that may have contributed to his severe clinical course, and we hope to explore these, discuss possible methods of modifying them, and assist clinicians in not only better treating similar patients but also emphasizing the importance of further developing standardized predictive algorithms and scoring tools.

Lipschütz Ulcers: Classic Presentation of an Uncommon Condition.

We describe the case of a 17-year-old female who presented with the acute onset of painful genital ulcers after experiencing a week of flu-like symptoms. A physical exam revealed two 1 cm necrotic ulcers on the right vulva with an erythematous margin and overlying exudate. A diagnosis of Lipschütz ulcers was made based on the classic signs and symptoms, in addition to ruling out relevant infectious and inflammatory diseases. Our goal in presenting this case is to add to the literature and increase awareness regarding this uncommon condition. The differential diagnosis and workup for genital ulcers can be extensive, but when diagnosed correctly, treatment and reassurance can provide great comfort for the patient.

Evaluating Acute Bilateral Foot Drop: A Case Report.

We illustrate the case of an 84-year-old Caucasian female who presented with complaints of bilateral lower extremity weakness and ambulation difficulties complicated by a unilateral deep venous thrombosis. Physical examination on hospital admission revealed an acute onset of bilateral foot drop with pes cavus deformity. Bilateral foot drop has been associated with a more chronic presentation due to metabolic, neurologic, and musculoskeletal etiologies. Acute onset of bilateral foot drop has been poorly defined in the literature and is considered a rare pathologic phenomenon, requiring additional investigation into the underlying cause of the presentation. We hypothesize that a spinal cord compression at the T12-L1 level resulted in L5 nerve root compression, resulting in our patient's presentation. Definitive treatment has not been established for this condition; however, studies have been completed to evaluate surgical versus conservative approaches to help restore patients' ambulatory function. Our aim is to incorporate this case report into the limited current literature on acute bilateral foot drop as well as outline possible treatment methods to restore impaired functionality.

Variability of Steroid Response Time in Polymyalgia Rheumatica: A Case Report.

We present a unique case of a 75-year-old Caucasian female who presented with a two-month history of unrelenting proximal muscle pain and stiffness in the neck, shoulders, and pelvic girdle that lasted for 45 minutes each morning upon waking. Due to clinical suspicion of polymyalgia rheumatica (PMR), the patient was started on the standard therapy of low-dose glucocorticoid therapy and was noted to have a dramatic improvement in terms of pain, strength, mobility, and range of motion. Current literature shows high variability in the standard response time to treatment. Typical resolution of symptoms occurs within a span of one day to months. The case presented in our study shows symptom resolution as well as marked improvement in muscle strength and mobility within 12 hours. The purpose of this case report is to provide additional information for physicians when considering symptom-resolution time related to low-dose glucocorticoid therapy and PMR. Additionally, we briefly explore the literature on the correlation between giant cell arteritis (GCA) and glucocorticoid therapy for PMR as well as the data associated with adjuvant therapy using immunomodulatory treatment.