Impact of Healthcare Access Disparities on Initial Diagnosis of Breast Cancer in the Emergency Department.

Breast cancer continues to be the second leading cause of cancer deaths in women in the United States. This is more noticeable in communities with pronounced healthcare disparities. The aim of this study was to investigate the different demographics that might play a role in the detection of breast cancer in a county hospital emergency department (ED). A retrospective study was conducted of female patients diagnosed with breast cancer over a five-year period (1/1/2015 to 12/31/2018). Patients with breast cancer as the primary or secondary diagnosis were identified. This study shows that 66 (73.3%) women diagnosed in the ED were Hispanic or African American. There was a significant delay (a median of 461 days) in the time between the diagnosis of suspected breast cancer in the ED to their follow-up visit with definitive diagnosis in a primary care clinic. These findings suggest that women with a suspected breast cancer diagnosis who are seen in a safety net hospital and have Medicaid funding may have significant delays before final diagnosis is made. Patient demographics could have an impact on the patients' access to screening and regular healthcare visits, hindering an early breast cancer diagnosis by a primary care provider.

Management of Traumatic Spigelian Hernia: A Case Report and Literature Review.

Traumatic abdominal wall hernias comprise less than 1% of all abdominal wall hernias. We present a 22-year-old male sustaining a traumatic Spigelian hernia resulting from striking a guardrail while snowboarding. In addition, the patient was found to have injuries to the serosa of the small bowel and mesentery, which were repaired during emergent surgery. A hybrid surgical approach was used to repair the defect using both laparoscopy and an incision over the abdominal wall defect.

Point of Care Ultrasound Diagnosis of a Massive Thoracoabdominal Aortic Aneurysm.

This report highlights an atypical presentation of extensive thoracoabdominal aortic aneurysm with intramural hematoma and transient paralysis of the lower extremities. Clinical suspicion for aortic pathology prompted a point of care ultrasound of the heart and aorta, which demonstrated a thoracic and abdominal aortic aneurysm with intraluminal pathology. Consultation and transfer to a tertiary care facility was based solely on the emergency physician's ultrasound. Subsequent computed tomography (CT) imaging confirmed the ultrasound findings and discovered a left common iliac artery thrombosis consistent with the patient's presentation. Point of care ultrasound can help clinicians diagnose aortic pathology and direct patient care efficiently and effectively.