ABSTRACT
"Hemoptysis" refers to the expectoration of blood from the respiratory tract. However, "life-threatening hemoptysis" includes any volume that leads to features such as airway obstruction, hypoxia, or hemodynamic instability. We present a case of life-threatening hemoptysis in a 65-year-old male with a history of benign prostatic hyperplasia and uncontrolled hypertension. Radiological investigations revealed a pseudo-aneurysm at the site of a prior thoracic aortic coarctation repair more than 50 years prior in childhood. He required vascular surgical intervention, during which there was evidence of an aorta-bronchial fistula as the likely cause of bleeding. Following the repair and optimal blood pressure control, the patient had no further episodes of hemoptysis and was discharged from the hospital. His case not only adds to the growing body of medical literature reporting hemoptysis as a complication of coarctation repair but also highlights the aorto-bronchial fistula as a possible and potentially catastrophic mechanism for bleeding in these patients.
ABSTRACT
Epidural abscesses are rare suppurative abscesses of the central nervous system that can expand and lead to severe neurologic complications and even death. Here we describe the case of a 68-year-old female who developed a spinal epidural abscess one month following cervical spinal decompression and fusion. The patient presented with decreased grip strength, flaccid paralysis of the lower extremities with hyporeflexia, urinary incontinence, and decreased sensation in the bilateral lower extremities. A cervical spine MRI revealed a large cervical spinal epidural abscess causing multilevel spinal cord compression that was treated with surgical evacuation and antibiotics. Due to the complications of epidural abscess, we as clinicians must have high clinical suspicion to initiate the correct treatment. In addition, patients without neurological symptoms or symptoms lasting less than 36 hours have the best recovery rate. Our case highlights the importance of timely diagnosis, management, and intervention, which can lead to restored functionality and the prevention of permanent neurologic sequelae.
ABSTRACT
Transient ischemic attack (TIA) shakes can present as epilepsy which could lead to misdiagnosis. When a patient present with neurological findings we must ensure our differentials remain broad. As a physician, we must ensure our role in analyzing the full clinical picture of our patients. We present the case of a 75-year-old man with multiple comorbidities who presented with limb shaking and seizure-like symptoms and who was found to have bilateral carotid stenosis. After finding bilateral carotid stenosis, it ultimately led to the diagnosis of "TIA Shakes." Overall, this case re-emphasizes the importance of diagnosis and correctly managing our patients.
ABSTRACT
Fibroepithelial stromal polyps (FEPs) are benign tumors of the integumentary system with mesodermal origin. They are commonly found over the skin. Rarely, they can be found in the nipple. We report a case in a 62-year-old female with a large FEP emerging from the left breast nipple. It started as a "mole" 10 years ago and slowly progressed in size. The patient did not complain of pain but did report occasional bloody discharge. She has no family history of breast cancer. On physical exam, a pedunculated large polyp, with rubbery consistency, emerging from the left nipple was noted. The lesion consisted of hyper-pigmentation with scattered ulcerations and cauliflower-like growth. Surgical excision was performed and histopathologic analysis showed extensive fibrovascular tissue with dense collagen fibers deposition consistent with FEP. Surgical treatment is curative with minimal skin deformity. In order to make the diagnosis and exclude malignancy, histopathology is mandatory.
