The Morel-Lavallée lesionLavalleeLavelle.

BACKGROUND: Trauma patients present to the emergency department with various injuries. Few injuries can be easily missed during the evaluation of polytrauma patients. We report one such rare injury in a trauma patient. CASE REPORT: We report the case of a 67-year-old man who presented to the emergency department with an alleged history of trauma. He reported severe pain in the lower abdomen, right hip, and right thigh. An x-ray study did not reveal any bony injury, and an extended focused assessment with sonography in trauma was also negative. Point-of-care ultrasound of his right thigh revealed the presence of a Morel-Lavallée lesion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Morel-Lavallée lesions are post-traumatic, closed, degloving injuries that go unnoticed in many polytrauma patients. Emergency physicians should be mindful of this lesion because delay in diagnosis can result in significant complications.

An Unusual Cause of Bulbar Palsy in the Emergency Department.

BACKGROUND: Osmotic demyelination syndrome commonly occurs after rapid correction of hyponatremia. But it has also been reported after graded correction of hyponatremia in the presence of other risk factors like chronic alcoholism, malnutrition, liver disease, and hypokalemia. CASE REPORT: We report a case of a 67-year-old man who presented with dysphagia and nasal regurgitation and had features suggestive of bulbar palsy on neurological examination. He had spontaneous rapid correction of hyponatremia from a serum sodium level of 122 mEq/L to 132 mEq/L after discharge from our hospital. Neuroimaging was suggestive of extrapontine myelinolysis involving the basal ganglia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: An emergency physician should be aware of this because osmotic demyelination syndrome should also be considered in the differential diagnosis of patients presenting with bulbar palsy to the emergency department.