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.

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%.

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).

Intracranial hemorrhage with concurrent aortic dissection.

Aortic dissection is a rare yet lethal condition that is often missed. Presenting symptoms often include chest pain, abdominal pain, or loss of consciousness. Rarely is it asymptomatic, and the concurring symptoms may draw attention away from the dissection. We present a case of a 51-year-old male who presented to the emergency department with sudden onset of slurred speech and right-sided weakness. The CT scan showed a basal ganglia hemorrhage. However, during the scan, the radiologist incidentally found some aortic changes and recommended an ECG-gated CT scan of the thorax, which revealed a Stanford type B aortic dissection. We aim to shed light on patients presenting with neurological findings and conclude to have aortic dissection to increase awareness and facilitate rapid diagnosis and treatment.

Rare triad of fractures in the upper limb. Simultaneous fractures of the distal radius, with the radial head and the ulna styloid.

We're reporting a 35-year-old gentleman that presented with a rare combination of ipsilateral fracture of both proximal and distal ends of the radius associated with ulna styloid fracture due to a fall with outstretched hands. Thorough clinical examination of 2 adjacent joints (elbow and wrist) is critical in identifying such an unusual or rare combination of injuries. Appropriate management for such cases depends on the characteristics of the injury, such as fracture patterns, job, hand dominance, and age of the patient. The treatment should aim to preserve the radial head to avoid the possibility of proximal radial migration, particularly in young patients. Such a combination of injury implies complex injury and needs special consideration in deciding management plan. In this case, the proximal end of the radius and the ulna styloid fractures were treated conservatively. In contrast, the distal end of the radius was treated with open reduction internal fixation.

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.