Case Reports in Emergency Medicine https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Exercise-Induced Acute Bilateral Upper-Arm Compartment Syndrome Wed, 20 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/9454782/ We present a rare case of acute exercise-induced bilateral upper-arm compartment syndrome in a patient who, after a year-long hiatus from exercise, subjected his upper-extremities to the stress of over 100 pushups. The patient presented with severe pain of the bilateral biceps and triceps and complaints of dark urine. Decompressive fasciotomy was performed followed by an intensive care unit (ICU) stay for associated myoglobinuria secondary to rhabdomyolysis. The patient suffered no long-term sequelae as a result of his conditions and recovered full function of the bilateral upper-extremities. Albeit rare, acute exercise-induced compartment syndrome should be considered as a diagnosis following unaccustomed bouts of exercise. Brian C. Traub, Mark K. Lane, and Jeff A. Traub Copyright © 2017 Brian C. Traub et al. All rights reserved. Physician Beware: Severe Cyanide Toxicity from Amygdalin Tablets Ingestion Thu, 24 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/4289527/ Despite the risk of cyanide toxicity and lack of efficacy, amygdalin is still used as alternative cancer treatment. Due to the highly lethal nature of cyanide toxicity, many patients die before getting medical care. Herein, we describe the case of a 73-year-old female with metastatic pancreatic cancer who developed cyanide toxicity from taking amygdalin. Detailed history and physical examination prompted rapid clinical recognition and treatment with hydroxocobalamin, leading to resolution of her cyanide toxicity. Rapid clinical diagnosis and treatment of cyanide toxicity can rapidly improve patients’ clinical outcome and survival. Inquiries for any forms of ingestion should be attempted in patients with clinical signs and symptoms suggestive of poisoning. Tam Dang, Cham Nguyen, and Phu N. Tran Copyright © 2017 Tam Dang et al. All rights reserved. A Case of Female Acute Urinary Retention Presenting to the ED Wed, 16 Aug 2017 06:11:03 +0000 http://www.hindawi.com/journals/criem/2017/4598314/ Introduction. Acute urinary retention is a rare occurrence in women necessitating further investigation. Potential underlying causes may be broadly classified into obstructive, neurological, pharmacological, and psychogenic categories. Case. A 36-year-old nulliparous female presented to the Emergency Department with a two-day history of acute urinary retention. Point-of-care ultrasonography and CT scan imaging confirmed the presence of a large uterine mass causing compression of the bladder. The acute retention was relieved with urethral catheterization. A Uterine leiomyoma was confirmed on histology after hysterectomy. Discussion. Once the acute urinary retention has been relieved by insertion of a urethral catheter, the underlying cause of the obstruction must be determined. Although uterine leiomyoma is a fairly common finding in the general population, it is an extremely rare cause of acute urinary retention in women with just a handful of reported cases in the literature. Kylen Swartzberg, Ahmed Adam, Feroza Motara, and Abdullah E. Laher Copyright © 2017 Kylen Swartzberg et al. All rights reserved. Combined Dorsal and Ulnarward Carpometacarpal Dislocation Associated with Open Fracture of the Base of First Metacarpal and Severe Degloving Injury Tue, 15 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/7524563/ We report a rare case of dislocation of second to fourth carpometacarpal (CMC) joints of the right hand with combined dorsal and ulnarward displacement of the second to fourth digits and fracture of the shaft of the first metacarpal associated with degloving injury. These injuries were diagnosed early and treated successfully with closed reduction and internal fixation using Kirschner wires. The functional outcome was good at follow-up at 5 years. A high index of suspicion is required to successfully diagnose and treat this condition. Ali J. Electricwala and Jaffer T. Electricwala Copyright © 2017 Ali J. Electricwala and Jaffer T. Electricwala. All rights reserved. Cigarette Lighter Fluid Induced Gastric Ulcer: A Severe Complication of Delayed Foreign Body Removal Tue, 15 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/4041087/ The majority of foreign bodies ingested pass uneventfully through the gastrointestinal tract without endoscopic intervention. Nevertheless, certain ingested objects pose a greater risk for complications and are more challenging to remove than others. This case report describes a 49-year-old male who swallowed a cigarette lighter causing a gastric ulcer. The lighter was successfully removed by flexible endoscopy using a polypectomy snare. Urgent removal is required due to the shape of the object and its hazardous contents. This is the first case report published in the United States describing cigarette lighter ingestion and management. Ciel Harris, Lauren Stemboroski, and Asim Shuja Copyright © 2017 Ciel Harris et al. All rights reserved. A Case of Lionfish Envenomation Presenting to an Inland Emergency Department Sun, 13 Aug 2017 06:44:26 +0000 http://www.hindawi.com/journals/criem/2017/5893563/ Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures. Rachel F. Schult, Nicole M. Acquisto, Crystal K. Stair, and Timothy J. Wiegand Copyright © 2017 Rachel F. Schult et al. All rights reserved. Second Report of Accidental Intestinal Myiasis due to Eristalis tenax (Diptera: Syrphidae) in Iran, 2015 Tue, 11 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/3754180/ We have described a new case of accidental intestinal myiasis that had occurred due to Eristalis tenax in Iran. A 4-year-old girl living in rural area near Bajestan city located in the south of Khorasan Razavi province visited the hospital lab with complaints of one live larva in feces and did not have other symptoms, except anal itching. This case had a history of consuming subterranean village water and did not have a history of traveling outside the city or contact with other patients. Conclusion. Based on the morphology characteristic, the larva was identified as “rat-tailed maggot” or larvae fly E. tenax. Ramezani Awal Riabi Hamed, Ramezani Awal Riabi Hamid, and Naghizade Hamid Copyright © 2017 Ramezani Awal Riabi Hamed et al. All rights reserved. Treatment of Community-Acquired Pneumonia: A Case Report and Current Treatment Dilemmas Thu, 15 Jun 2017 07:39:03 +0000 http://www.hindawi.com/journals/criem/2017/5045087/ Resistance to macrolides is rising in the USA and warrants careful consideration when confronted with a patient with suspected pneumonia in the urgent care clinic. This case study exemplifies the potentially serious consequences of treatment failure following prescription of a macrolide for community-acquired bacterial pneumonia. Furthermore, the consequential treatment dilemmas currently faced by physicians are briefly discussed. Glenn Harnett Copyright © 2017 Glenn Harnett. All rights reserved. The Semantics of Priapism and the First Sign of Chronic Myeloid Leukemia Tue, 30 May 2017 06:58:29 +0000 http://www.hindawi.com/journals/criem/2017/2656203/ Priapism is defined as an erection that persists beyond four hours, lasting beyond or unrelated to sexual stimulation (Salonia et al., 2014). Because the risk of ischemic damage and impotence is high with priapism (35%), management guidelines are directed towards rapid treatment of this condition (Salonia et al., 2014). This report describes the rare case of an 18-year-old male who presented to the Emergency Department (ED) three times with recurrent and worsening episodes of sustained penile erections. On the patient’s third visit, he presented with priapism of greater than six-hour duration that was found to be the result of chronic myeloid leukemia. Clinician awareness of the diagnostic semantics and differential diagnosis surrounding priapism is pivotal in its urgent management. Michael R. Minckler, Ellie Conser, Javier J. Figueroa, Aaron J. Scott, Joshua Gaither, and Richard Amini Copyright © 2017 Michael R. Minckler et al. All rights reserved. Lead Poisoning Can Be Easily Misdiagnosed as Acute Porphyria and Nonspecific Abdominal Pain Mon, 29 May 2017 09:13:00 +0000 http://www.hindawi.com/journals/criem/2017/9050713/ Lead poisoning (LP) is less commonly encountered in emergency departments (ED). However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria. The final definitive diagnosis of lead toxicity was confirmed based on high blood lead levels after detailed medical history taking. The lead poisoning was caused by traditional Chinese herbal pills. The abdominal pain disappeared after a course of chelating treatment. The triad for the diagnosis of lead poisoning should be a history of medicine intake, anemia with basophilic stippling, and recurrent abdominal pain. Ming-Ta Tsai, Shi-Yu Huang, and Shih-Yu Cheng Copyright © 2017 Ming-Ta Tsai et al. All rights reserved. Unilateral Dilated Pupil and Spontaneous Cardiac Arrest with Successful Bystander Resuscitation Wed, 17 May 2017 06:27:01 +0000 http://www.hindawi.com/journals/criem/2017/4071531/ A 75-year-old man collapsed on a golf course and received cardiopulmonary resuscitation from a bystander, including the use of a public automated external defibrillator (AED). The AED was discharged once, with return of spontaneous circulation. An air ambulance crew found the patient haemodynamically stable, with no acute abnormalities on a 12-lead ECG. He had reduced consciousness and a dilated left pupil. On contacting the patient’s wife by telephone, she said that he had fallen and hit his head earlier that day. The crew decided to convey the patient to a Major Trauma Centre that had both neurosurgical and cardiology specialist services (rather than the nearest hospital) so that both traumatic brain injury and cardiac pathologies could be addressed if required. A head CT was normal, but coronary angiography demonstrated occlusion of two coronary arteries. These were successfully treated with stenting, and the patient went home two weeks later. He informed medical staff that his left pupil has been permanently dilated since he was a boy following a traumatic ocular injury. This case illustrates the utility of early deployment of an AED as well as the importance of an accurate history and emergency decision-making by prehospital personnel. James M. Hancox, Julian Spiers, Nicholas Crombie, and David N. Naumann Copyright © 2017 James M. Hancox et al. All rights reserved. Clomiphene Associated Inferior STEMI in a Young Female due to Right Coronary Artery Dissection Tue, 16 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/4747831/ Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is an uncommon cause of myocardial infarction. It most commonly affects females in the perimenopausal age. NA-SCAD has been associated with many predisposing factors including pregnancy and hormonal therapy for both contraception and ovulation induction. The presented case is a previously healthy 41-year-old woman diagnosed with inferior ST-elevation myocardial infarction due to right descending coronary artery dissection associated with recent use of clomiphene monotherapy for ovulation induction (a previously fertile woman), which was not previously reported. Learning Objectives. Emergency physicians (EPs) should be aware about NA-SCAD as a cause of acute coronary syndrome (ACS) especially in perimenopausal women even with no risk factors. NA-SCAD occurs more commonly in the postpartum period and in females following hormonal therapy. Here, clomiphene monotherapy was reported as a possible contributing factor to NA-SCAD. Guidelines for NA-SCAD management are not up to date, and EPs should avoid some interference before the final diagnosis of the cause of myocardial infarction. Feras Husain Abuzeyad, Eltigani Seedahmed Ibnaouf, and Mudhaffar Al Farras Copyright © 2017 Feras Husain Abuzeyad et al. All rights reserved. Tissue Hypoperfusion, Hypercoagulopathy, and Kidney and Liver Dysfunction after Ingestion of a Naphazoline-Containing Antiseptic Sun, 07 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/3968045/ Naphazoline is a peripheral -adrenergic receptor agonist commonly used as a topical decongestant. In Japan, over-the-counter antiseptics often contain naphazoline to effect local hemostasis. We present the first case involving the development of hypercoagulopathy, with kidney and liver dysfunction, following a naphazoline overdose. A 22-year-old Japanese woman with a history of depression ingested 160 mL of a commercially available antiseptic containing 0.1% naphazoline. Three days later, she was brought to the emergency department because of general fatigue, nausea, and vomiting. Physical examination revealed cool, pale extremities. Laboratory data showed evidence of severe kidney and liver dysfunction (creatinine, 9.2 mg/dL; alanine aminotransferase, 2948 IU/L), hypercoagulation (D-dimers, 58.3 μg/mL), and thrombocytopenia (platelet count, 90,000/μL). After infusion of normal saline, intravenous administration of alprostadil, and hemodiafiltration, her organ function completely recovered. Because both the kidney and liver express -adrenergic receptors, their failure was likely associated with naphazoline overdose-induced hypoperfusion. The most plausible causes of hypercoagulation are peripheral low perfusion and subsequent microthrombus formation. This case illustrates that severe organ dysfunction can occur following over-the-counter antiseptic ingestion and serves as a caution for both drug manufacturers and healthcare professionals. Yuko Ono, Nozomi Ono, and Kazuaki Shinohara Copyright © 2017 Yuko Ono et al. All rights reserved. Anti-MuSK-Positive Myasthenic Crisis in a 7-Year-Old Female Sun, 30 Apr 2017 06:29:40 +0000 http://www.hindawi.com/journals/criem/2017/8762302/ A seven-year-old African American female with anti-MuSK-positive Juvenile Myasthenia Gravis collapsed while at school from progressively worsening weakness and dyspnea. On initial emergency department presentation, she required 15 liters per minute of supplemental oxygen to maintain oxygen saturation above 92%. Initial pulmonary function tests and venous blood gas led to the decision to place her on noninvasive positive pressure ventilation (NPPV) with BiPAP in the emergency department. Due to worsening hypercarbia, she later required mechanical intubation in the PICU and underwent IVIG therapy followed by plasmapheresis in order to achieve a stable discharge from the hospital. A respiratory virus panel PCR was positive for influenza A, influenza B, and rhinovirus, likely precipitating the respiratory failure and myasthenic crisis in this seven-year-old patient. Given the rarity of this condition, this case report is to provide further education to the clinician managing severe, prepubertal Juvenile Myasthenia Gravis and myasthenic crisis. Harrison J. Matthews, Apisadaporn Thambundit, and Brandon R. Allen Copyright © 2017 Harrison J. Matthews et al. All rights reserved. Vertebral Arteriovenous Fistula: An Unwelcome Thrill Wed, 05 Apr 2017 08:57:19 +0000 http://www.hindawi.com/journals/criem/2017/8386459/ Cervical vertebral AV fistulae are uncommon vascular lesions involving abnormal communication between the extradural vertebral artery and surrounding venous structures. We examine the case of a female evaluated in the emergency department with a vertebral AV fistula presenting classically as pulsatile tinnitus and later successfully treated with standard endovascular techniques. A discussion on the etiology, pathophysiology, and management of vertebral AV fistulae follows. Matthew K. Edwards, Erica N. Christenson, Brian M. Corliss, Adam J. Polifka, and Brandon R. Allen Copyright © 2017 Matthew K. Edwards et al. All rights reserved. Bilateral Pulmonary Embolism after a Short-Haul Flight in a Man with Multiple Risk Factors including Sickle Cell Trait Wed, 29 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/4316928/ We report a case of pulmonary embolism (PE) in an Afro-Caribbean man following a short commercial flight of less than 5,000 kilometers (Km) in economy class with a 1-month interval between journeys. He had an elevated body mass index (BMI) and sickle cell trait (SCT) with hyperhomocysteinemia. No other preexisting source of venous thrombosis was found. We posit that venous thromboembolism (VTE) and/or PE may have been a complication of SCT in an individual with other multiple risk factors. We discuss the possible interaction of these risk factors for VTE and/or PE and the implications for travelers at risk. The need for a PE risk score and guidelines for the prophylaxis of thromboembolism among travelers exists. Kamille Abdool, Kanterpersad Ramcharan, Antonio J. Reyes, Nadiene Lutchman, and Adrian Alexander Copyright © 2017 Kamille Abdool et al. All rights reserved. An Exceptional Case of Diabetic Ketoacidosis Sun, 26 Mar 2017 07:20:54 +0000 http://www.hindawi.com/journals/criem/2017/4351620/ We present a case of diabetic ketoacidosis, known as one of the most serious metabolic complications of diabetes. We were confronted with rapid neurological deterioration and unseen glycaemic values, which reached almost 110 mmol/L, subsequently resulting in hyperkalaemia and life-threatening dysrhythmias. This is the first reported live case with such high values of blood glucose and a favourable outcome. Celine Van de Vyver, Jorn Damen, Carl Haentjens, Dominique Ballaux, and Benoit Bouts Copyright © 2017 Celine Van de Vyver et al. All rights reserved. Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma Tue, 14 Mar 2017 08:34:36 +0000 http://www.hindawi.com/journals/criem/2017/7589057/ Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT) revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT) demonstrated right-sided costal fractures (ribs 7 to 9), with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment. Maximilian Andreas Storz, Eric P. Heymann, and Aristomenis K. Exadaktylos Copyright © 2017 Maximilian Andreas Storz et al. All rights reserved. Seat Belt Compression Appendicitis following Motor Vehicle Collision Wed, 01 Mar 2017 07:35:06 +0000 http://www.hindawi.com/journals/criem/2017/8245046/ Appendicitis and trauma both present in emergency department commonly but their presentation together in the same patient is unusual. We present a case of a middle-aged man brought by emergency medical services (EMS) to the emergency department with complaints of abdominal pain after he was involved in motor vehicle collision. He was perfectly fine before the accident. His primary survey was normal. Secondary survey revealed tenderness in right iliac fossa with seat belt mark overlying it. Computerized tomography (CT) of the abdomen and pelvis was performed which showed 8 mm thickening of appendix with minimal adjacent fat stranding. There is also subcutaneous fat stranding of anterior lower abdominal wall possibly due to bruising. Impression of posttraumatic seat belt compression appendicitis was made. Laparoscopic appendectomy was done and patient recovered uneventfully. Histopathology showed inflamed appendix, proving it to be a case of seat belt compression appendicitis. Muhammad Faisal Khilji and Qazi Zia Ullah Copyright © 2017 Muhammad Faisal Khilji and Qazi Zia Ullah. All rights reserved. Knee Dislocation: A Case Report, Diagnostic Vascular Work-Up, and Literature Review Wed, 22 Feb 2017 09:53:15 +0000 http://www.hindawi.com/journals/criem/2017/9745025/ Knee dislocation is an uncommon, potentially limb-threatening, knee injury. Most often caused by high-velocity trauma, it can also result from low- or even ultra-low-velocity trauma. Rapid identification of the injury, reduction, and definitive management are necessary to minimize neurovascular damage. We present a case of rotatory anterolateral knee dislocation sustained during a twisting sports-related event. Special emphasis is placed on diagnosing vascular injuries associated with knee dislocations. Matthijs R. Douma, Michael D. Burg, and Björn L. Dijkstra Copyright © 2017 Matthijs R. Douma et al. All rights reserved. Atypical Neuroleptic Malignant Syndrome Associated with Use of Clozapine Mon, 20 Feb 2017 07:45:28 +0000 http://www.hindawi.com/journals/criem/2017/2174379/ The Neuroleptic Malignant Syndrome (NMS) is a medical emergency of infrequent presentation in the emergency department, which is associated with the use of psychiatric drugs, such as typical and atypical antipsychotics. Our case addresses a 55-year-old patient diagnosed with undifferentiated schizophrenia for 10 years, who had been receiving clozapine and clonazepam as part of their treatment. This patient presents the symptoms of Neuroleptic Malignant Syndrome without fever, which improves with treatment especially with the withdrawal of clozapine. In the absence of fever and clinical improvement, the patient is considered to have an atypical presentation of this disease. Quevedo-Florez Leonardo, Granada-Romero Juliana, and Camargo-Arenas Juan Fernando Copyright © 2017 Quevedo-Florez Leonardo et al. All rights reserved. Epistaxis as a Common Presenting Symptom of Glanzmann’s Thrombasthenia, a Rare Qualitative Platelet Disorder: Illustrative Case Examples Sun, 19 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/8796425/ Children often present to emergency departments (EDs) with uncontrollable nose bleeding. Although usually due to benign etiologies, epistaxis may be the presenting symptom of an inherited bleeding disorder. Whereas most bleeding disorders are detected through standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. Here we present two case reports and review diagnostic and management challenges of platelet function disorders with a focus on Glanzmann’s thrombasthenia (GT). Patient 1 was a 4-year-old boy with uncontrolled epistaxis. His medical history included frequent and easy bruising. Previous laboratory evaluation revealed only mild microcytic anemia. An otolaryngologist stopped the bleeding, and referral to a pediatric hematologist led to the definitive diagnosis of GT. Patient 2 was a 2.5-year-old girl with severe epistaxis and a history of milder recurrent epistaxis. She had a bruise on her abdomen with a palpable hematoma and many scattered petechiae. Previous assessments revealed no demonstrable hemostatic anomalies. Platelet aggregation studies were performed following referral to a pediatric hematologist, leading to the diagnosis of GT. As evidenced by these cases, the ED physician may often be the first to evaluate severe or recurrent epistaxis and should recognize indications for coagulation testing and hematology consultation/referral for advanced hematologic assessments. Michael Recht, Meera Chitlur, Derek Lam, Syana Sarnaik, Madhvi Rajpurkar, David L. Cooper, and Sriya Gunawardena Copyright © 2017 Michael Recht et al. All rights reserved. Delayed Stroke following Blunt Neck Trauma: A Case Illustration with Recommendations for Diagnosis and Treatment Thu, 09 Feb 2017 06:37:41 +0000 http://www.hindawi.com/journals/criem/2017/3931985/ Blunt cerebrovascular injury (BCVI) to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of BCVI. In an effort to highlight this issue, we report the case of a 31-year-old male patient who presented with left-sided weakness consistent with transient ischemic attack (TIA) and concussion. The patient’s symptoms occurred within 24 hours of a blunt neck injury sustained by a knee strike during a basketball game. An initial computerized tomography (CT) scan of the brain was normal; a CT angiogram (CTA) of the neck and carotids did not reveal obstruction, dissection, stenosis, or abnormalities of the carotid or vertebral vessels and the patient was subsequently discharged. A magnetic resonance imaging (MRI) of the brain obtained four days after the initial injury demonstrated an acute infarct in the right middle cerebral artery (MCA) territory. Thus, despite initial negative imaging, neurological deficits must be aggressively pursued in order to prevent stroke in BCVI cases. Best Anyama, Daniela Treitl, Jeffery Wessell, Rachele Solomon, and Andrew A. Rosenthal Copyright © 2017 Best Anyama et al. All rights reserved. Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis Wed, 01 Feb 2017 13:00:13 +0000 http://www.hindawi.com/journals/criem/2017/8512147/ The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes. M. Kirsch, C. Rimpau, C. H. Nickel, and P. Baier Copyright © 2017 M. Kirsch et al. All rights reserved. Ultrasound Utility in the Diagnosis of a Morel-Lavallée Lesion Wed, 01 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/criem/2017/3967587/ Morel-Lavallée lesions are uncommon injuries that can be associated with significant comorbidities if not detected early. Rapid diagnosis in the Emergency Department could significantly improve patient outcomes. We describe the diagnosis of such a lesion through the use of ultrasound imaging in the Emergency Department to utilize a fast, cost-effective imaging technique that does not subject the patient to radiation exposure. Our patient received surgical consultation but improved with conservative management. Ultrasound findings associated with this lesion do not require specialized equipment and should be considered when evaluating soft tissue lesions using point of care ultrasound. Scott LaTulip, Rameshwar R. Rao, Alan Sielaff, Nik Theyyunni, and John Burkhardt Copyright © 2017 Scott LaTulip et al. All rights reserved. Pseudoaneurysm of the Profunda Femoris Artery following Blunt Trauma Treated by Endovascular Coil Embolization: Review of Two Cases and Relevant Literature Thu, 26 Jan 2017 13:34:58 +0000 http://www.hindawi.com/journals/criem/2017/8079674/ Profunda femoris artery (PFA) pseudoaneurysm after blunt trauma without associated femur fracture is a rare occurrence. Most of the reported cases of PFA pseudoaneurysm in the English literature developed after penetrating trauma, surgical procedures, and femur fractures. We present two such cases following blunt trauma and without any associated long bone injury. After initial imaging failed to show any long bone fracture, CT angiography confirmed pseudoaneurysm of the branch of the PFA. Both patients were then treated with emergent coil embolization of the bleeding vessel. Pseudoaneurysms typically present late and signs of persistent hip pain, thigh swelling, presence of a pulsatile mass, and even unexplained anemia all may suggest the diagnosis. Recognition of PFA pseudoaneurysm requires high index of suspicion and is often difficult to diagnose clinically because of its location. Saptarshi Biswas, Patrick McNerney, and Paul Kiproff Copyright © 2017 Saptarshi Biswas et al. All rights reserved. Idiopathic Renal Infarction Mimicking Appendicitis Sun, 22 Jan 2017 09:45:04 +0000 http://www.hindawi.com/journals/criem/2017/8087315/ Renal infarction is a rare cause of referral to the emergency department, with very low estimated incidence (0.004%–0.007%). Usually, it manifests in patients aged 60–70 with risk factors for thromboembolism, mostly related to heart disease, atrial fibrillation in particular. We report a case of idiopathic segmental renal infarction in a 38-year-old patient, presenting with acute abdominal pain with no previous known history or risk factors for thromboembolic diseases. Because of its aspecific clinical presentation, this condition can mimic more frequent pathologies including pyelonephritis, nephrolithiasis, or as in our case appendicitis. Here we highlight the extremely ambiguous presentation of renal infarct and the importance for clinicians to be aware of this condition, particularly in patients without clear risk factors, as it usually has a good prognosis after appropriate anticoagulant therapy. Marco Di Serafino, Rosa Severino, Chiara Gullotto, Francesco Lisanti, and Enrico Scarano Copyright © 2017 Marco Di Serafino et al. All rights reserved. Cerebral Salt-Wasting Syndrome Caused by Minor Head Injury Tue, 17 Jan 2017 12:45:55 +0000 http://www.hindawi.com/journals/criem/2017/8692017/ A 34-year-old woman was admitted to hospital after sustaining a head injury in a motor vehicle accident (day 1). No signs of neurological deficit, skull fracture, brain contusion, or intracranial bleeding were evident. She was discharged without symptoms on day 4. However, headache and nausea worsened on day 8, at which time serum sodium level was noted to be 121 mEq/L. Treatment with sodium chloride was initiated, but serum sodium decreased to 116 mEq/L on day 9. Body weight decreased in proportion to the decrease in serum sodium. Cerebral salt-wasting syndrome was diagnosed. This case represents the first illustration of severe hyponatremia related to cerebral salt-wasting syndrome caused by a minor head injury. Toshiki Fukuoka, Yuko Tsurumi, and Arihito Tsurumi Copyright © 2017 Toshiki Fukuoka et al. All rights reserved. Evaluating Complications of Chronic Sinusitis Mon, 09 Jan 2017 12:32:28 +0000 http://www.hindawi.com/journals/criem/2017/8743828/ Chronic sinusitis is a relatively common diagnosis throughout the US. In patients with an otherwise unremarkable medical history the treatment is typically supportive, requiring only clinical evaluation. We present the case of a 25-year-old male with a history of chronic sinusitis that was brought to our emergency department with new-onset seizure. Three days before he had presented to his usual care facility with two days of headache and fever and was discharged stating headache, subjective fever, and neck stiffness. After further investigation he was diagnosed with a mixed anaerobic epidural abscess. The evaluation and management of chronic sinusitis are based on the presence of symptoms concerning for complication. Prompt investigation of complicated sinusitis is essential in preventing debilitating and fatal sequelae. Our case study underscores the importance of early diagnosis and appropriate management. Phillip Hong, Charles A. Pereyra, Uta Guo, Adam Breslin, and Laura Melville Copyright © 2017 Phillip Hong et al. All rights reserved. Congenital Diaphragmatic Hernia Presenting in a 7-Day-Old Infant Wed, 04 Jan 2017 11:38:09 +0000 http://www.hindawi.com/journals/criem/2017/9175710/ A 7-day-old male infant presented to the emergency room after respiratory distress was noted at an outpatient well child check. On exam, he was observed to have tachypnea, increased work of breathing, and decreased breath sounds on the left side of the chest. On chest X-ray, he was found to have a left-sided congenital diaphragmatic hernia. The infant was transported to a tertiary care facility where the defect was repaired without complication. Interestingly, the mother had a history of a normal antenatal ultrasound, completed at 19 + 2 weeks of gestational age. This case report summarizes the challenges of diagnosing late-presenting congenital diaphragmatic hernia, associated malformations, possible etiologies, and prognosis. Christopher Rouse, Luke Schmidt, Lee Brock, and Angela Fagiana Copyright © 2017 Christopher Rouse et al. All rights reserved.