Aortic Dissection Case Report Bunce, Chelsea; Bryczkowski, Christopher; Rometti, Mary
Journal of education & teaching in emergency medicine,
01/2023, Volume:
8, Issue:
1
Journal Article
Peer reviewed
Open access
Although uncommon, acute aortic dissections are a life-threatening, cannot miss diagnosis for the emergency medicine clinician. Point of care ultrasound can play an integral role in the initial work ...up of the undifferentiated patient. While not initially utilized to make the diagnosis of aortic dissection, the ultrasound images obtained in this case describe key findings on ultrasound vital for an emergency clinician to recognize. It is essential for emergency medicine clinicians to differentiate an aortic dissection from other causes of chest pain and abdominal pain because the quick mobilization of resources plays a key role in the management and outcome of such patients. TopicsAortic dissection, vascular, dissection flap, back pain, point of care ultrasound, POCUS.
Neurocysticercosis is one of the most common causes of acquired epilepsy worldwide. This diagnosis is rarely considered in patients presenting to the emergency department (ED) with recurrent seizures ...in the United States (U.S.). This is the case of a young adult male presenting with post-ictal confusion and recurrent seizures requiring intubation for agitation and airway protection. It illustrates the need to maintain a broad differential when considering etiology of seizures in a globalized patient population. TopicsSeizure, neurocysticercosis, epilepsy, parasitic infection.
Infant tuberculosis (TB) is a rare but potentially deadly infection and difficult to diagnose, especially in infants who may present with non-specific symptoms. Here, we report a case of an United ...States-born term infant with community-acquired miliary TB and no confirmed TB exposure history. The patient initially presented with respiratory distress at seven weeks of life with chest radiograph showing a right lower lobe (RLL) infiltrate. After failing multiple courses of treatment for community-acquired pneumonia and developing growth faltering, the patient had imaging findings suggestive of TB infection with CNS involvement. The diagnosis of TB was confirmed by QuantiFERON and purified protein derivative (PPD). In infants who fail conventional treatment for bacterial pneumonia, the differential should be broadened to consider alternative etiologies. Additionally, brain imaging should be performed in cases of disseminated TB despite negative cerebrospinal fluid (CSF) studies since these patients are at high risk of central nervous system (CNS) involvement. TopicsTuberculosis, pneumonia, pediatrics, growth faltering.
Small bowel diverticulitis is an uncommon subset of acute diverticulitis and can mimic many other intra-abdominal processes. As a result, imaging modalities such as ultrasound and computed tomography ...(CT) scan are especially important for timely recognition of diverticulitis and can expedite diagnosis and treatment and reduce complications. In the case described in this report, an 81-year-old male with history of esophageal cancer and recurrent diverticulitis with history of multiple bowel resections presented to the emergency department (ED) with right lower quadrant abdominal pain and constipation. Findings on ultrasound were suggestive of diverticulitis, and findings on CT of the abdomen and pelvis showed ileitis with phlegmon and micro-abscess suspicious for small bowel diverticulitis. ED providers should familiarize themselves with ultrasound findings of diverticulitis and be aware that diverticulitis can also present in the small bowel. Treatment of small bowel diverticulitis is similar to colonic diverticulitis. TopicsIleitis, small bowel diverticulitis, abdominal ultrasound.
Electronic cigarette (e-cigarette) or vaping associated lung injury (EVALI) cases have increased with the popularity of e-cigarettes in the mostly young, healthy population. Some common symptoms ...associated with EVALI include shortness of breath and chest pain, and the most common diagnostic imaging findings are organizing pneumonia and diffuse alveolar damage seen on computed tomography (CT). Pneumomediastinum is a known sequela of EVALI.1 In the setting of pneumomediastinum in EVALI, EVALI is a diagnosis of exclusion, so other sources of pneumomediastinum need to be evaluated. EVALI has diverse presentations, and this case is a unique representation of a disease process that is becoming more commonplace with the increase in popularity of vaping. It is important to be aware of the clinical symptoms of EVALI, which can be nonspecific and can include gastrointestinal symptoms along with respiratory symptoms. It is equally important to recognize the diverse image findings of EVALI, which can include subcutaneous emphysema and pneumomediastinum. In this case, pneumomediastinum is seen in EVALI, and the patient was successfully treated with empiric antibiotic coverage, steroids, and conservative measures- making sure to limit any coughing or increases in intrathoracic pressure that can cause worsening of pneumomediastinum. TopicsEVALI, vaping, pneumomediastinum, E-cigarette, ground-glass opacity.
A new method forthe synthesis of Single-Bit Re-configurable Passive Electromagnetic Skins ( 1RP-EMSs ) featuring advanced beam shaping capabilities is proposed. By using single-bit unit cells, the ...multi-scale problem of controlling 1RP-EMSs is formulated as a two-phase process. First, the macro-scale synthesis of the discrete surface current that radiates the electromagnetic ( EM ) field fitting the user-designed requirements is performed by means of an innovative quantized version of the iterative projection method ( QIPM ). Subsequently, the meta-atom states of the 1RP-EMS are optimized with a customized implementation of the System-by-Design paradigm to yield a 1RP-EMS that supports such a feasible reference current. A representative set of numerical results is reported to assess the effectiveness of the proposed approach in designing and controlling single-bit meta-atom RP-EMSs that enable complex wave manipulations.
Diffraction (X‐ray, neutron and electron) and electron cryo‐microscopy are powerful methods to determine three‐dimensional macromolecular structures, which are required to understand biological ...processes and to develop new therapeutics against diseases. The overall structure‐solution workflow is similar for these techniques, but nuances exist because the properties of the reduced experimental data are different. Software tools for structure determination should therefore be tailored for each method. Phenix is a comprehensive software package for macromolecular structure determination that handles data from any of these techniques. Tasks performed with Phenix include data‐quality assessment, map improvement, model building, the validation/rebuilding/refinement cycle and deposition. Each tool caters to the type of experimental data. The design of Phenix emphasizes the automation of procedures, where possible, to minimize repetitive and time‐consuming manual tasks, while default parameters are chosen to encourage best practice. A graphical user interface provides access to many command‐line features of Phenix and streamlines the transition between programs, project tracking and re‐running of previous tasks.
Recent developments in the Phenix software package are described in the context of macromolecular structure determination using X‐rays, neutrons and electrons.
Transverse myelitis (TM) is a rare inflammatory myelopathy presenting as bilateral neurologic deficit localized to the spinal cord. A critical management step in the emergency department (ED) is ...evaluating for and treating acute reversible causes such as mass lesion or reversible ischemia when present. Described in this case report is TM presenting after a respiratory arrest in suspected opioid overdose. Magnetic resonance imaging (MRI), ideally with contrast, and lumbar puncture are essential diagnostic studies to confirm inflammation. Finally, further diagnostic efforts are aimed at evaluation and treatment for other concurrent illnesses. TopicsTransverse myelitis, transverse myelopathy, hypoxia, opioid overdose, hypoxic spinal cord injury.
Thigh Mass Case Report Rometti, Mary; Bryczkowski, Christopher
Journal of education & teaching in emergency medicine,
10/2022, Volume:
7, Issue:
4
Journal Article
Peer reviewed
Open access
Patients commonly present to the Emergency Department for the evaluation of soft tissues masses of various etiology. Point-of-care ultrasound (POCUS) can aid in the initial evaluation of these masses ...to begin narrowing a given differential. Soft tissue sarcomas are a malignant neoplasm that frequently present in an extremity, and require close follow-up for the evaluation of metastasis and possible resection, among other treatment options. Being able to effectively differentiate between infectious, inflammatory, benign, or potentially malignant pathology for undifferentiated soft tissue masses is critical for Emergency Medicine clinicians to ensure patients receive appropriate treatment and referrals for definitive care. TopicsThigh mass, soft tissue mass, sarcoma, point-of-care ultrasound.
This is a case of a 35-year-old postpartum female presenting to the emergency department (ED) with acute onset chest pain and dyspnea with initial concern for acute ST-segment elevation myocardial ...infarct (STEMI). Her electrocardiogram (ECG) showed ST segment elevations in the lateral leads and inferior leads with depressions in the high lateral and septal leads. Given her post-partum status, spontaneous coronary artery dissection (SCAD) was part of the differential as well as other emergent processes. Upon cardiac catheterization, the patient was found to have 50% vasospasm in the left circumflex coronary artery. Her post-catheterization echocardiogram showed a normal ejection fraction (EF) without regional wall abnormalities. This is an interesting case of chest pain in a younger patient, without typical acute coronary syndrome (ACS) risk factors, presenting with a concerning ECG likely due to coronary vasospasm. We will discuss other atypical causes of STEMI patterns that should be considered in the differential and management of such patients. TopicsSickle cell trait, STEMI, postpartum, vasospasm, ECG, cardiology.
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