Pulmonary artery angiomatoid fibrous histiocytoma mimicking pulmonary embolism.

A young man presented to the emergency department with pleuritic chest pain and shortness of breath. Of note, he recently went on a long-distance flight of about 9 hours. Given his recent long-distance travel and clinical symptoms, a pulmonary embolism was suspected. However, pathological examination of the excised pulmonary artery intraluminal mass demonstrated an angiomatoid fibrous histiocytoma. This case describes the clinicopathological and immunohistochemical features and molecular profile of a rare type of pulmonary artery tumour, a pulmonary artery angiomatoid fibrous histiocytoma.

Too young to break? A rare case of premenopausal osteoporosis.

We present a case of a 29-year-old female with fragility fracture of the ninth thoracic vertebrae with a z-score of -3.3 of the lumbosacral spine. She was worked up for secondary causes of osteoporosis, all of which was unrevealing except for a low vitamin D level which was repleted. She had genetic profile done, which revealed low-density lipoprotein receptor-related 5 mutation which was thought to the cause of premature osteoporosis. This report highlights a rare case of osteoporosis in a premenopausal female and challenges associated with premenopausal osteoporosis.

An Interesting Case of Critical Spontaneous Ureteral Rupture.

Spontaneous rupture of the ureter in an uncommon presentation. We present a case of an 85-year-old female patient with a past medical history significant for hypertension and hyperlipidemia who presented to the emergency room (ER) due to abdominal pain and nausea. Computed tomography (CT) of abdomen and pelvis revealed proximal ureteral and ureteropelvic junction rupture with fluid within the left retroperitoneum and pelvis. No clear etiology was identified. The patient had a left percutaneous nephroureteral catheter tube (PNCT) placed in addition to being given broad-spectrum antibiotics for possible infection. She was noted to improve and was discharged with outpatient follow-up for tube removal. Our patient presented with a rupture of the ureter; however, the source remained elusive. CT scan assisted with the diagnosis but there is no evidence of hydronephrosis or mass. There are no clear treatment guidelines for spontaneous ureteral rupture as the presentation is rare. Treatment may involve percutaneous drainage and possibly antibiotics for concurrent infection. Surgical intervention may be required in cases where severe complications arise. Early diagnosis and management may prevent long-term morbidity and mortality.

Pancoast-Tobias Syndrome: A Unique Presentation of Lung Cancer.

A 65-year-old man with 50 pack-year smoking history presented to the emergency department for evaluation of upper back and right shoulder pain secondary to a fall. Physical examination was notable for anisocoria with a constricted left pupil (miosis), mild ptosis of the left eyelid, and bilateral shoulder pain, right more than left, with both passive and active movements. Chest computed tomography identified a soft tissue mass at the left lung apex with extension into the pleural surface, associated with destructive osseous changes of the right scapula, adjacent ribs, and thoracic vertebral bodies. Imaging of the brain revealed multiple masses suspicious of metastatic brain lesions. Biopsy of the right supraclavicular lymph node revealed lung tissue adenocarcinoma and negative Kirsten rat sarcoma viral oncogene homolog (K-Ras), epidermal growth factor receptor (EGFR), B-raf proto-oncogene (BRAF), C-ros oncogene 1 (ROS1), and anaplastic lymphoma kinase (ALK) rearrangement. Recognizing Pancoast syndrome in patients with significant smoking history, anisocoria, and shoulder pain is crucial for identifying the underlying etiology and expediting the treatment.

Brain Natriuretic Peptide and Troponin T in Patients With Acute Pulmonary Embolism and Grade 3 Obesity: A Retrospective Analysis.

Introduction The interpretation of brain natriuretic peptide (BNP) and Troponin T (TnT) in patients with obesity is very challenging. The applicability of these biomarkers as prognostic indicators of increased mortality in pulmonary embolism (PE) in patients with Grade 3 obesity has yet to be determined. Methods To investigate whether the combination of BNP and TnT may help to identify patients at low risk for short-term mortality, we assessed 92 patients admitted with the diagnosis of PE and Grade 3 obesity. The study endpoint was all-cause mortality at 30 days. Results The negative predictive value (NPV) of these tests combined is 98.8%; however, we were not able to detect a statistically significant difference between the patients who had a BNP < 100 pg/mL and TnT < 0.03 ng/mL and the other individuals who had either BNP ≥ 100 pg/mL or TnT ≥ 0.03 or both. The mortality rate was 5.43% within 30 days of the diagnosis. The logistic regression analysis using BNP and troponin as continuous variables identified BNP (p < 0.005) as an independent predictor for 30 days mortality. Receiver operating characteristic (ROC) analysis determined that a BNP level of 684 pg/mL was the cutoff level to predict mortality in the population studied. Conclusions Our results support that BNP and TnT levels retain an excellent NPV among patients with PE and Grade 3 obesity. BNP testing could be an independent predictor of high-risk patients in this population. The low incidence of all-cause mortality in this study (5.43%) is primarily explained by the more frequent use (9.75%) of systemic or catheter-based thrombolysis associated with a lower rate of major bleeding compared to the general population.