Venous Thromboembolism (VTE) in May-Thurner Syndrome: Decision-Making Related to Long-Term Anticoagulation.

May-Thurner syndrome (MTS) involves the compression of the left iliac vein between the right iliac artery anteriorly and the lumbar vertebrae posteriorly. Patients may remain asymptomatic throughout their lives or experience unilateral lower limb swelling and symptoms of deep vein thrombosis (DVT), such as redness and pain in the limb, or features of its complication (pulmonary embolism) such as chest pain or shortness of breath. We present the case of a 34-year-old female exhibiting acute pain and tightness in her left leg, due to DVT of the left common femoral vein, extending up to the pelvic veins, which, on further diagnostic imaging, was found to be due to MTS. The patient was initiated on lifelong anticoagulation to prevent further complications. The rising incidence of MTS, coupled with frequent delays in its diagnosis, highlights the need to raise awareness among healthcare providers, especially acute medics (who are often the first point of contact for the patient) to expand their diagnostic umbrella of differentials to include MTS as a potential cause of such presentations and to look and think beyond DVT of the lower limb. This is especially important in females presenting with non-specific DVT symptoms, as early suspicion and referral to the respective medical teams including vascular medicine, can improve diagnostic accuracy and provide more management options, thereby improving long-term outcomes.

Dissecting the Diagnosis - An Unusual Case of Pericarditis.

Chest pain is an extremely common presenting complaint on the acute medical unit. It is important to distinguish between patients who have serious pathology and those without. Often, the focus is on ruling out an acute coronary syndrome and inadequate consideration is given to other possible causes. This case highlights the importance of performing relevant investigations in a timely manner, in order to ensure that a correct diagnosis is made.

Posterior reversible encephalopathy syndrome: 'a headache' on the AMU.

Headache and seizures are common presentations to the acute medical unit. We report a case of posterior reversible encephalopathy syndrome (PRES) in a 73-yr-old woman with a history of uncontrolled hypertension who had recently discontinued one of her antihypertensive drugs; such cases are rare but pose a diagnostic challenge given the nonspecific nature of the clinical presentation. However, early diagnosis and treatment leads to full recovery in the majority of patients.

Acute fulminant necrotizing amoebic colitis: a potentially fatal cause of diarrhoea on the Acute Medical Unit.

Diarrhoea is a common presenting complaint to the Acute Medical Unit. We report a case of acute fulminant necrotizing amebic colitis in a 73 year old man with no recent travel history preceding his admission. Such cases are often difficult to diagnose and hence associated with a high mortality, unless treated promptly and appropriately. This case report highlights the importance of early diagnosis and prompt initiation of treatment.