Atypical Presentation of a Right Atrial Myxoma.

Primary cardiac tumors are exceptionally rare and predominantly located in the left atrium with occasional involvement on the right side of the heart. We present the case of a 52-year-old man who presented with chest pain, leading to suspicion of acute coronary syndrome. However, further investigation revealed a right atrial tumor measuring 6.3 cm. After surgical removal, the pathology analysis of the mass confirmed the histology of myxoma. Differential diagnoses for atrial myxomas include thrombus and other tumors, such as rhabdomyomas. More than half of these tumors arise in the left atrium and may be complicated by neurologic symptoms secondary to embolization. Right atrial myxomas are rare and described in the literature with a myriad of symptoms (signs of right heart failure [i.e., fatigue, peripheral edema, hepatomegaly, ascites], a diastolic murmur, and symptoms of pulmonary emboli). In other cases, they may be asymptomatic. Due to the low incidence and variety in their clinical picture, careful documentation of these cases is suggested for early recognition and directed management.

Cryptococcal Meningitis in an Apparent Immunocompetent Host.

Cryptococcal meningitis is a severe fungal infection that primarily affects individuals with compromised immune systems, such as those with the human immunodeficiency virus (HIV) or those undergoing immunosuppressive therapies after organ transplantation. In rare cases, immunocompetent individuals may also be affected by this life-threatening condition. We present the case of a 64-year-old male patient with no known underlying immune deficiency diagnosed with cryptococcal meningitis, who presented with persistent headaches and subjective fevers. Due to the absence of apparent immunosuppressive conditions or identifiable risk factors during evaluation, our suspicion for fungal meningitis was low. However, the diagnosis was confirmed through CSF fluid analysis, leading to the immediate initiation of guideline-directed treatment with amphotericin and fluconazole. This case highlights the importance of considering cryptococcal meningitis in the differential diagnosis of persistent headaches, even in patients without known immune compromise. Early recognition and appropriate management are essential to preventing complications and delays in management and guaranteeing optimal outcomes for all our patients.

Cardiogenic Pneumonia: Unilateral Pulmonary Edema Secondary to Severe Eccentric Mitral Regurgitation.

Mitral regurgitation (MR), whether primary or secondary, stems from functional or anatomical impairment of components of the mitral apparatus resulting in abnormal blood flow to the left atrium during systole. A common complication is bilateral pulmonary edema (PE), which, in rare instances, may be unilateral and easily misdiagnosed. This case presents an elderly male with unilateral lung infiltrates and progressive exertional dyspnea with the failed treatment of pneumonia. Additional workup, including a transesophageal echocardiogram (TEE), showed severe eccentric MR. He underwent mitral valve (MV) replacement with significant improvement in symptoms.

Cardiac Amyloidosis Disguised as Atrial Flutter: A Case Report.

Cardiac amyloidosis (CA) is a rare form of infiltrative cardiomyopathy (IC) that frequently leads to heart failure (HF). Its symptoms can range from minimal to significant shortness of breath, palpitations, leg swelling, and chest discomfort. Early diagnosis and treatment are crucial in preventing the further progression of the disease and improving outcomes. This case report describes a 63-year-old male with no prior medical history who presented with severe dyspnea, palpitations, and chest heaviness. Initially diagnosed with atrial flutter, he was later confirmed to have cardiac amyloidosis through a thorough workup with multimodality imaging. The patient was started on guideline-directed medical therapy (GDMT) and discharged home with a follow-up from a heart failure specialist. An outpatient workup confirmed the diagnosis of amyloidosis with a positive pyrophosphate scan. At a seven-month follow-up, the workup for extra-cardiac involvement was negative, and the ejection fraction (EF) had improved. This case highlights the importance of a high index of suspicion and a thorough workup in cases of suspected cardiac amyloidosis to achieve early diagnosis and prevent disease progression.

Pneumomediastinum as a Complication of Cocaine Insufflation.

A 25-year-old man presents to the ED for unresponsiveness after consuming cocaine and other unknown substances. Chest imaging from the presentation was unremarkable, but after developing fever and leukocytosis, he underwent extensive work-up in search of infectious foci. A CT scan of the chest showed a small pneumomediastinum and the possibility of an esophageal tear. After recovering consciousness and the ability to recount events, the patient admitted to the concomitant use of cocaine and opiates via insufflation.

Hemophagocytic Lymphohistiocytosis Following COVID-19 Infection.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with multiple inflammatory symptoms involving several organ systems, including hematologic manifestations. Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome caused by excessive inflammation in the absence of immune regulation. We present the case of a patient with HLH secondary to dysregulated inflammatory response following COVID-19; we also describe the diagnostic and management challenges associated with the condition.

An Uncommon Case of Acute Coronary Stent Thrombosis.

Coronary stent thrombosis is an uncommon complication of percutaneous coronary intervention, which can result in myocardial infarction and often death. We present a case of acute stent thrombosis in a patient with newly diagnosed triple vessel coronary artery disease occurring within less than an hour of stent placement along with a review of the literature.

Altered behavior with an organic cause: a case report.

BACKGROUND: Insulinomas are pancreatic endocrine tumors of rare incidence worldwide, the vast majority are of single occurrence and benign. These may not always present with the clear symptoms described in the literature and may be overlooked because their neuroglycopenic characteristics present in a fashion similar to some psychiatric conditions. CASE REPORT: A 50-year-old Hispanic man referred severe psychomotor symptoms, described as anxiety, aggressiveness, agitation, weakness, diaphoresis, and decreased visual acuity. Laboratory testing performed during his last episode revealed increased insulin levels and C-peptide among other findings. Imaging, biopsy, and histopathologic analysis confirmed an insulinoma was the cause of the symptoms, proving the importance of ruling out organic causes of altered mental status prior to consideration of psychiatric disorders. CONCLUSION: It is of critical importance to rule out organic causes of altered mental status prior to consideration of psychiatric disorders, as unusual diseases may be overlooked by physicians and be detrimental to the patient's progress.