A Case of Necrotizing Pneumonia Complicated by Hydropneumothorax.

We present a case of a 58-year-old man who had asthma and developed necrotizing pneumonia (NP). The Computed Tomography (CT) scan of his chest showed cavitating consolidation with hydropneumothorax. Despite chest tube insertion and antibiotics, the patient did not improve. Therefore, surgical intervention was considered, and he underwent a right posterior-lateral thoracotomy, with middle lobe lobectomy, and decortication. As a result, the patient's condition started to improve, and he was discharged in good health.

Atypical Presentation and Diagnostic Challenges of Appendicitis in an 85-Year-Old Male: A Case Report.

Acute appendicitis in elderly individuals is uncommon and poses a significant challenge due to atypical symptomatology. An 85-year-old male presented to the emergency department (ED) with abdominal pain associated with nausea and reduced oral intake. Physical examination revealed diffuse abdominal tenderness. He was initially treated for constipation with an enema and discharged. Two days later, the patient returned with worsened pain and a new onset of fever. Examination revealed guarding. Lab results showed significant elevation in C-reactive protein (CRP) and white blood count (WBC). A contrast-enhanced computed tomography (CT) scan showed evidence of a perforated appendix. He was admitted into the surgical ward and improved on conservative treatment. This case describes an atypical presentation of acute appendicitis in an elderly patient, emphasizing the importance of recognizing unusual presentations in this population. Early use of contrast-enhanced CT scans is crucial for accurate diagnosis and improving patients outcomes.

Spontaneous Cerebrospinal Fluid Rhinorrhea Secondary to Idiopathic Intracranial Hypertension.

The cerebrospinal fluid (CSF) is a physiological fluid that functions to protect the brain tissue and maintain intracranial pressure. Defects between the subarachnoid spaces and other spaces can cause CSF leaks. We report the case of a 37-year-old female with no known past medical history who presented to the emergency department with a history of headaches for two months, nasal drip for 1.5 months, and recurrent fevers. Idiopathic intracranial hypertension was confirmed by cranial magnetic resonance imaging (MRI) and transnasal endoscopic repair of a CSF leak defect, and an abdomen fat graft was performed followed by an Axium navigation-guided right ventriculoperitoneal shunt (VPS).

Broken Heart: A Clear Case of Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TC) is a recognized clinical syndrome characterized by reversible cardiomyopathy with a distinctive left ventricular apical ballooning appearance. TC is associated with risk factors such as estrogen deficiency, emotional and physical stress, and genetic factors. The clinical presentation of TC can be like that of a myocardial infarction. While catecholamine-induced myocardial stunning is suggested by current evidence, the exact pathophysiological mechanisms remain uncertain. Diagnostic criteria, including the InterTAK Diagnostic Criteria, have been established by the Takotsubo International Registry. Supportive and symptomatic medication constitutes the mainstay of treatment, with a focus on improving left ventricle (LV) function over several days, leading to full recovery within three to four weeks. Given its resemblance to myocardial infarction, cautious diagnosis and management are essential for optimal outcomes. We present the case of a previously healthy 35-year-old female who presented with chest pain and dyspnea after discovering her father's death. On examination, she exhibited hypotension, bradycardia, and a new-onset left bundle branch block (LBBB) in her electrocardiogram. Her left ventricular ejection fraction (LVEF) on presentation was 22%, and troponin T (TnT) levels were notably elevated at 430 (normal ranges < 14). After two days of treatment and monitoring at the cardiac intensive care unit (CICU), she improved clinically, and her LVEF improved to 52%.

Bilateral Elbow Dislocation After Trauma in a Healthy Adult Female.

Bilateral elbow dislocation is a rare injury. We report a rare case of a simultaneous bilateral traumatic elbow dislocation in a 28-year-old previously healthy Kenyan female. Initial clinical assessment and plain radiographs showed the possibility of an associated fracture at the right capitulum. CT scan demonstrated bilateral fractures at the capitulum simultaneously. This case was managed conservatively through a closed reduction under procedural sedation as a joint effort of orthopedics and the emergency department. Three days later, the left above elbow backslap was removed and the patient was discharged on analgesics and referred to the outpatient clinic for regular follow-up and physiotherapy. At seven weeks, the patient reported improvement of pain bilaterally and mild stiffness at the right elbow that is continuing to improve with physiotherapy.

Transient Left Bundle Branch Block in the Setting of Cardiogenic Pulmonary Edema.

Cardiogenic pulmonary edema complicated by transient left bundle branch block (LBBB) is a relatively rare finding. We report a case of a 52-year-old woman with underlying heart failure but no structural heart disease who was referred for evaluation due to severe shortness of breath and documented LBBB on a 12-lead EKG. She was diagnosed with cardiogenic pulmonary edema due to medication noncompliance. With the resolution of her symptoms by treating her pulmonary edema with bisoprolol and furosemide, repeated EKG showed resolution of LBBB. A review of her medical records showed similar presentations of pulmonary edema associated with transient LBBB. In conclusion, to the best of our knowledge, transient LBBB associated with cardiogenic pulmonary edema is very uncommon. The etiology of transient LBBB remains unclear, however, the most likely theory that explains our patient's transient LBBB is a consequence of ventricular enlargement from fluid overload and cardiac muscle strain with dilatation, causing bundle conduction interruption. Our patient's cardiogenic pulmonary edema was complicated with transient LBBB in multiple previous presentations with a resolution of the LBBB after treating the underlying pulmonary edema.