A Rare Case of a Chylous Pleural Effusion as the Initial Manifestation of Synchronous Tumors.

Multiple primary malignancies (MPMs) are defined as two or more histopathologically distinct malignancies in the same individual. MPMs are classified as synchronous when tumors are diagnosed within six months of each other. The most common malignancies in MPMs are melanoma, breast, lung, and prostate cancer. Synchronous lymphoma and solid tumors are relatively rare. In these cases, a multi-disciplinary approach to treatment is essential. The early detection of additional primary malignancies such as myeloid and lymphatic tumors will enable prompt management with curative intent. The authors present a case of diffuse B-cell non-Hodgkin lymphoma and invasive lobular breast carcinoma presented as a chylous pleural effusion.

Racemose neurocysticercosis presenting with thalamic stroke: A case report and literature review.

Racemose neurocysticercosis is an uncommon type of neurocysticercosis that represents a particularly aggressive infection. It is characterized by the presence of multiple confluent cysts within the subarachnoid space and it carries unique diagnostic challenges. Clinical manifestations include headache, cerebrovascular events, and life-threatening hydrocephalus. A 56-year-old female presented with sudden onset headache and right-sided hemisensory loss. Brain MRI revealed multiple cystic lesions in the subarachnoid space consistent with racemose neurocysticercosis and left thalamus acute lacunar infarct. This case report emphasizes the clinical importance, unique characteristics, and imaging features of racemose neurocysticercosis and its complications.

Diagnostic Point-of-Care Ultrasound (POCUS) for Abdominal Pain: A Case of Tumefactive Sludge.

Biliary sludge is an extremely viscous sediment, consisting essentially of calcium bilirubinate granules and cholesterol crystals, which, due to its high viscosity, has poor and slow movement, leading to a mass-like configuration called tumefactive biliary sludge. Tumefactive sludge was first described with the advent of ultrasonography in the 1970s and is an uncommon intraluminal lesion of the gallbladder (GB). The differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. Ultrasonography is the election method for the screening of GB diseases, with diagnostic accuracy exceeding 90%. The point-of-care ultrasound (POCUS) has shown a major improvement in the evaluation of hepatobiliary diseases. POCUS allows the detection of GB wall thickness, pericholestatic fluid, sonographic Murphy's sign, and dilatation of the common bile duct. The authors present a case of abdominal pain caused by the presence of tumefactive sludge in the GB, in which POCUS helped establish the diagnosis and therapeutic guidance.

Diastolic Function and Left Atrial Strain in Young Patients with History of Aortic Coarctation Repair.

Aortic coarctation (AoCo) leads to long-term sequelae that may impair heart function. Data regarding new echocardiographic function parameters such as atrial strain, in affected patients, are scarce. This study aims to describe these parameters in AoCo patients and define their association with severity measures. 53 AoCo patients and 31 healthy controls, aged 12-40 years, were evaluated. Effectively corrected AoCo (cAoCo) was defined as aortic trans-isthmic corrected Doppler gradient (Dgrad) ≤ 20 mmHg (n = 36), and recoarctation (rAoCo) as Dgrad > 20 mmHg (n = 17). Dependent variables were: E/E'; atrial reservoir strain (Ares); and atrial conduit strain (Acd). T-tests/Mann-Whitney U tests were used to compare these among groups. Multivariable regression was used to test correlation with systolic blood pressure (SBP), indexed LV mass (ILVM), Dgrad, and the ratio between the narrowest diameter of aortic arch and aorta at diaphragm level (Aoratio). In cAoCo and rAoCo patients, E/E' was higher (p < 0.001), Ares, and Acd were lower (p < 0.001 for both) comparing with controls. Acd was higher in cAoCo than rAoCo (p = 0.045). Higher Ares was associated with higher Aoratio (p = 0.002), and lower Acd with higher Dgrad (0.014). EF and GLS were not different among groups. Young patients with effectively corrected aortic coarctation have persistent changes in diastolic function parameters (E/E' and atrial strain), and these are affected by anatomical sequelae. These patients' physiology is closer to patients with recoarctation, than to healthy individuals. This provides rationale for a stronger prevention, and treatment, of arterial dysfunction and high left ventricular afterload in these patients.

Eosinophilic Ascites: An Infrequent Presentation of Eosinophilic Gastroenteritis.

Eosinophilic gastroenteritis (EGE) is an unusual and benign inflammatory disorder that mainly affects the digestive tract. Its main symptoms are cramp-like abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding, and weight loss. Laboratory results show peripheral eosinophilia. This disease generally affects patients with a personal history of atopy and drug or food intolerance. The etiology remains unknown, the diagnosis is challenging, and the treatment depends on the severity of the disease and can range from supportive therapy to corticosteroid therapy. We report a case of a 24-year-old female known to have a history of iron deficiency anemia who was brought to the emergency department with an intense colicky abdominal pain, fatigue, diarrhea, and vomit right after a mild coronavirus disease 2019 (COVID-19) infection. The clinical investigation revealed moderate ascites identified in abdominal computed tomography (CT) scan, peripheral blood eosinophil count, and elevation of inflammatory parameters. An ultrasound-guided diagnostic paracentesis was performed, showing ascitic fluid with a clear predominance of eosinophils (57%). To confirm the diagnosis of EGE, an upper digestive endoscopy (UDE) was performed. The biopsies of the esophagus and gastric body revealed polymorphonuclear eosinophils and colonic mucosal biopsies revealed eosinophils (20 eosinophils per 10 fields). After reviewing the clinical history, we concluded that the patient was taking iron supplements due to her iron deficiency anemia, whose onset coincided with the symptoms presented. Exploring the clinical history a little more, the patient mentioned that in the past, she already had some intolerance to oral iron supplements, manifested by gastrointestinal symptoms, although milder. Approximately three weeks after suspending the supplements, we have seen an analytical improvement that was accompanied by clinical improvement. The patient was discharged with the resolution of abdominal pain.