Ruptured splenic abscess presenting as pneumoperitoneum.

Spontaneous pneumoperitoneum follows perforation of hollow viscus; rarely, it may arise from pulmonary interstitial emphysema or intestinal inflammatory disease. We report a 30-year-old man with ruptured splenic abscess who presented with acute abdomen and had pneumoperitoneum. He was treated with splenectomy and is asymptomatic 2 months later.     

Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion.

The case of a 33-year-old woman who presented with abdominal pain referable to the lower abdomen is discussed. She had had an uncomplicated intrauterine abortive procedure two weeks earlier. It was determined that a ruptured ectopic pregnancy was the etiology of her abdominal pain. The rare phenomenon of combined intrauterine and extrauterine pregnancy is discussed.     

Ruptured thoracic aneurysm presenting as dyspnea and hypotension

A 65-year-old woman with a two-day history of progressive back pain presented with acute dyspnea, tachypnea, hypotension, and tachycardia. The patient was being treated for chronic obstructive lung disease and long-standing hypertension. She evidenced unilateral diminished breath sounds and wheezing. A portable chest radiograph in the emergency department revealed a large left pleural effusion. A hemothorax was confirmed by thoracentesis, and a 7-cm descending thoracic aortic aneurysm was demonstrated by angiography. The patient underwent successful surgical resection and Dacron graft repair of the aneurysm. This case emphasizes the need for maintaining a high index of suspicion for atypical presentations of ruptured thoracic aneurysms and for using diagnostic thoracentesis in pleural effusions of unknown etiology.     

Lymphocytic interstitial pneumonitis presenting as recurrent pneumothoraces

A 34-year-old woman seronegative for the human immunodeficiency virus presented with recurrent, bilateral pneumothoraces. She also had bibasilar interstitial and alveolar infiltrates, and histologic examination was consistent with lymphocytic interstitial pneumonitis. To our knowledge, this is the first documented case of lymphocytic interstitial pneumonitis presenting with recurrent pneumothoraces.     

Mesalazine interstitial nephritis presenting as colitis ulcerosa exacerbation

Mesalazine is the first line treatment in paediatric inflammatory bowel disease (IBD). There are several reports in the literature about nephrotoxicity (1/150 treated patients), from renal insufficiency to reversible nephritis. It is currently advised to follow creatinine in patients treated with mesalazine during the first 5 years of treatment; however this may reveal the problem too late. As demonstrated in this paediatric case, a high degree of clinical suspicion is needed to diagnose the side effects before irreversible kidney damage occurs. Since the treatment of IBD exacerbation and mesalazine induced interstitial nephritis is based upon steroids, delayed diagnosis of the latter is at risk.     

Ruptured saphenous venous graft pseudoaneurysm presenting as a pulsatile chest mass

A 72‐year‐old man with prior history of coronary artery bypass grafting and sternal wire infection presented with non‐ST‐segment elevation myocardial infarction. His coronary angiogram revealed stenosis of the distal left main coronary artery (LMCA) and a pseudoaneurysm of saphenous venous graft (SVG) to right posterior descending artery. Patient developed ventricular fibrillation during admission, and postcardiopulmonary resuscitation, a pulsatile chest mass was observed which was diagnosed with computed tomography as a chest wall collection resulting from rupture of the pseudo‐aneurysm. He underwent percutaneous coronary intervention of the LMCA with drug‐eluting stents followed by successful coil embolization of the SVG pseudoaneurysm. Patient had an uneventful recovery postprocedure.     

Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance

We report a case of heterotopic pregnancy in a woman who had not undergone in vitro fertilization or any other reproductive assistance. The patient failed to mount a tachycardic response to hemorrhagic shock. Bradycardia is a well-established phenomenon in the setting of hemoperitoneum and particularly with ruptured ectopic pregnancy. This is a case of heterotopic pregnancy with relative bradycardia in a woman without predisposing factors for heterotopic pregnancy. We make suggestions on avoiding common pitfalls in the emergency department diagnosis of heterotopic pregnancy. We also address the similar clinical presentations of heterotopic pregnancy and intrauterine pregnancy with ruptured corpus luteum cyst.     

Carcinoma of the prostate presenting as interstitial lung disease

Two patients were hospitalized because of fever, cough and dyspnea and an interstitial infiltrate of both lungs that was shown to be a lymphangitic spread of prostate carcinoma. The presentation of prostatic carcinoma as interstitial lung disease is rare, and emphasizes the importance of rectal examination and determination of acid phosphatase in the context of interstitial lung disease.     

Ruptured hemorrhagic corpus luteum as a presenting symptom of systemic lupus erythematous

Clinical Rheumatology - A young female presented to the emergency room with ruptured hemorrhagic corpus luteum (RHCL). Her workup revealed a new diagnosis of SLE with nephritis and positive lupus...     

Progressive systemic sclerosis sine scleroderma presenting as pulmonary interstitial fibrosis

PURPOSE: The purpose of this work was to report the clinical features of 10 patients with systemic sclerosis presenting with lung disease in the absence of cutaneous involvement (systemic sclerosis sine scleroderma). PATIENTS AND METHODS: The study involved a retrospective review of patients with systemic sclerosis at a tertiary care facility presenting with clinical and/or radiographic evidence of interstitial lung disease in the absence of cutaneous manifestations of scleroderma, and a MEDLINE, computer search for patients who presented with lung disease and later developed taut skin (scleroderma). RESULTS: Ten patients with systemic sclerosis sine scleroderma presenting with pulmonary signs or symptoms were discovered. A positive antinuclear antibody (seven of eight), esophageal dysmotility (eight of nine), restrictive lung disease (six of eight), Raynaud's phenomenon (five of eight), and abnormal nailfold capillaries (six of six) were present in these patients. Six of these 10 patients developed typical scleroderma from four months to seven years after presentation. Lung pathology was examined in six patients and all had changes consistent with interstitial pneumonitis and fibrosis. Four of the 10 patients had occupations that could have exposed them to potential pulmonary toxins. In contrast to patients with typical scleroderma, all 10 patients we discovered were men. conclusions: Systemic sclerosis should be considered in patients with idiopathic interstitial lung disease even in the absence of classic sclerodermatous cutaneous involvement. An esophagram, antinuclear antibody, and widefield nailfold examination may facilitate the diagnosis.     

Retroperitoneal schwannoma presenting as an adrenal tumor.

A retroperitoneal tumor in the region of the adrenal gland was diagnosed in a 56-year-old woman. The patient had been suffering from a dull abdominal pain for nearly four weeks before consulting her family physician. Ultrasound, CT and MRI scans revealed a giant tumor of the right adrenal gland. Endocrine activity could not be demonstrated. The size of the tumor was suggestive of an adrenal carcinoma. The patient was referred for adrenalectomy and complete exstirpation of the retroperitoneal mass. The histological examination revealed characteristical findings of a benign schwannoma.     

Giant-cell arteritis presenting as an orbital pseudotumor.

In this report a woman with giant-cell arteritis presenting as an orbital pseudotumor is described. Other causes of orbital pseudotumor were excluded in this patient. The pathogenesis of orbital pseudotumor caused by giant-cell arteritis is discussed. The concurrent arteritis of the superficial temporal artery and the rapid resolution of signs and symptoms after prednisone therapy supports the causal relationship between orbital pseudotumor and giant-cell arteritis in this patient.     

A case of Hodgkin's disease presenting as lymphocytic interstitial pneumonitis

Lymphoproliferative disorders of lung have a broad clinical and pathologic spectrum. The clinical and radiographic features are non-specific. Accurate diagnosis is required to initiate appropriate therapeutic intervention. We report a case of Hodgkin's disease mimicking lymphocytic interstitial pneumonitis in a 21-year-young male.     

Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device.

Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Asymptomatic colonization of the cervix with this organism has been noted in users of an intrauterine device (IUD), and its prevalence ranges between 1.6% and 36%. Rarely, symptomatic infection may occur, with the potential for extensive morbidity and even death. Herein we report a patient who survived severe disseminated actinomycosis yet presented with the clinical picture of a metastasized malignancy. This is the first report of disseminated pelvic actinomycosis presenting as an external lesion of the abdominal wall and in which a Progestasert IUD (Alza, Palo Alto, CA) was present. The common difficulty, and thus delay, in diagnosing this disease led to considerable morbidity due to an infection considered curable with penicillin. We recommend that all patients with an IUD or a history of IUD use have such information made known to those responsible for interpreting the Papanicolaou smear. Such knowledge may heighten suspicion and focus attention on the identification of these organisms before onset of clinical disease. It is important to consider this disease when caring for patients with an IUD or when counseling those contemplating its use as a contraceptive.     

Retroperitoneal hemorrhage presenting as a ruptured ectopic pregnancy

A young woman presented with acute abdominal pain, anemia, and a positive pregnancy test. At surgery a large retroperitoneal hematoma secondary to a ruptured right kidney was found. Pathological examination revealed a hematogenic necrosis of a choriocarcinoma of the kidney. The patient tolerated subsequent chemotherapy with no evidence of recurrent disease after ten months of follow-up care. The diagnosis of choriocarcinoma must always be entertained when a patient presents with a positive pregnancy test and normal pelvic examination.     

Richter's transformation presenting as an obstructing endobronchial lesion.

A 60-year-old man with chronic lymphocytic leukemia presented to our institution with a recurring lingular pneumonia. On fiberoptic bronchoscopy, the patient was found to have an endobronchial mass obstructing the lingula and left upper lobe. Biopsy specimens of the mass demonstrated anaplastic large cell lymphoma consistent with Richter's transformation. Only one case of endobronchial Richter's transformation has been previously reported in the literature. This was described as peribronchial and endobronchial leukemic infiltrates within the bronchial mucosa. We report the first case of an obstructive endobronchial mass secondary to Richter's transformation. The endobronchial mass was treated with a Nd-YAG laser to maintain airway patency while the patient underwent chemotherapy, resulting in complete resolution of the mass within the airway.