Diabetic Myonecrosis of the Axilla: A Novel Case With Severe Clinical Features.

Diabetic myonecrosis is a rare and poorly understood complication of long-standing, inadequately controlled diabetes mellitus. Theoretical mechanisms contributing to the pathophysiology of diabetic myonecrosis include microvascular complications due to advanced glycation end-products, ischemia-reperfusion injuries, and dysregulated coagulation-fibrinolysis activity. Case reports of diabetic myonecrosis most commonly describe diabetic patients with chronically poor glycemic control who experience isolated swelling and severe pain in a unilateral lower limb with no signs of infection or systemic toxicity. Due to the rarity of this condition, there are currently no treatment guidelines. This case describes a 58-year-old male with a history of uncontrolled diabetes who presented with diabetic ketoacidosis with mixed hypovolemic and septic shock. Diabetic myonecrosis was incidentally discovered in the patient's right latissimus dorsi with CT imaging and subsequent surgical exploration. Spontaneous diabetic myonecrosis may mimic several other serious conditions and elicit suboptimal management strategies, particularly in the context of atypical presentations.

Bochdalek Hernia in an Adult Causing Intraoperative Complication.

Bochdalek hernias are rarely diagnosed in adults and account for 0.17-6% of all diaphragmatic hernias. It is a congenital diaphragmatic hernia caused by a defect in the posterior attachment of the diaphragm due to a failure of the pleuroperitoneal membrane closure in utero. This may rarely cause chest pain, respiratory symptoms, or gastrointestinal symptoms. In this study, we present a case of a laparoscopic paraesophageal repair via Nissen fundoplication. The incidental finding and subsequent repair of a Bochdalek hernia during this case may have resulted in complications of the surgery including pneumothorax due to the defect in the pleuroperitoneal membrane.

Superior Mesenteric Artery Syndrome: Could it Involve a Potential Familial Pattern?

Superior mesenteric artery (SMA) syndrome often presents with small bowel obstruction due to acute angulation of the SMA, thereby compressing the duodenum. This syndrome is a rare, sporadic disease, which is often caused by rapid weight loss. However, there may be a genetic predisposition to SMA syndrome, due to a congenitally shortened ligament of Treitz or a more distal origination of the SMA on the abdominal aorta. In this study, we present a patient who was diagnosed with SMA syndrome despite not exhibiting the classic weight-loss clinical picture. Interestingly, the patient reported a family history of SMA syndrome in her mother who had experienced a similar presentation.

POTS and Antiphospholipid Syndrome: An Unlikely Association.

Antiphospholipid syndrome is a rare complication of postural orthostatic tachycardia syndrome. Clinically, the presentation has overlapping symptoms of both diseases, with lightheadedness or syncope when moving from a supine to a standing position as well as blood clots, headache, or pregnancy complications in women. This case presentation involves a 39-year-old patient identified as female who has been diagnosed with POTS and elevated anticardiolipin antibodies.