Medial calcaneal nerve entrapment as a cause for chronic heel pain

Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes.     

Medial calcaneal nerve entrapment as a cause for chronic heel pain

Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes.     

Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases

Medial superior cluneal nerve entrapment neuropathy causes pain radiating from the low back down to the posterior thigh. It tends to be misdiagnosed as a lumbar spine disorder. Patients in previous reports were in the middle or old age at the onset. Proposing simultaneous full flexion of the ipsilateral hip and knee joints as a provocation test, we present two cases of teenager females who spent long before diagnosis of their condition. Both of them had engaged in vigorous sports activities and completely recovered from the disability following local anaesthetic and corticosteroid injection at the trigger point.     

Saphenous nerve entrapment caused by pes anserine bursitis mimicking stress fracture of the tibia

Numerous studies have addressed saphenous nerve entrapment at the level of the adductor canal. In this case, we report an entrapment syndrome located further distally occurring as part of an athletic overuse injury. Distal tibial pain, initially managed as a stress fracture, resolved when a pes anserine bursitis was treated. This was associated with return of saphenous nerve potentials along the tibia.     

Electrocardiographic manifestations: acute inferior wall myocardial infarction

The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction with clinical findings often provide the necessary information for the Emergency Physician (EP) to predict complications, morbidity and mortality. IWMI patients may have associated right ventricular infarction (RVI) or lateral and posterior wall extension. Each of these entities is associated with specific hemodynamic abnormalities and increased mortality. In addition, various atrioventricular (AV) blocks are commonly associated with IWMI. This article presents several cases of IWMI with EKGs and a discussion of EKG interpretation in the setting of IWMI.     

Vertical rectus abdominis musculocutaneous flap for chest wall reconstruction after irradiation

We have used a contralateral vertical rectus abdominis musculocutaneous flap based upon the superior epigastric vessels in six patients to provide coverage after resection of locally recurrent breast carcinoma in irradiated tissues. Primary healing of defects as large as 16 cm X 35 cm has been obtained using this technique. Although there is no evidence to suggest that such a procedure significantly lengthens survival, it was clearly beneficial to the quality of life in these patients. Our results suggest that older patients with relatively indolent disease receive the greatest benefit from this procedure.     

Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery: A case report

BACKGROUNDAnterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves. This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block. The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.CASE SUMMARYThe patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair. Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1% lidocaine 20 mL. The pain was relieved after the block. The diagnosis was anterior cutaneous nerve entrapment syndrome. Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.CONCLUSIONUltrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.     

Medial thigh abscess mimicking septic arthritis of the knee: a report of two cases

Background

Septic arthritis of the knee joint requires prompt diagnosis and treatment for optimal outcomes. Pyomyositis with abscess formation is uncommon but may present with similar symptoms in the vicinity of a joint.

Objective

This report describes two cases of medial thigh abscess initially diagnosed and treated as septic arthritis, and highlights the need to make an accurate diagnosis.

Case Report

Two patients presenting with knee pain secondary to pyomyositis and abscess formation in the medial thigh were investigated with aspiration and treated subsequently with knee surgery, resulting in contamination of the knee joint in one case and delayed diagnosis with significant morbidity in both.

Conclusion

Failure to identify a soft tissue infection may lead to delayed diagnosis, misdirected treatment, and contamination of a normal joint. Diagnosis is best confirmed with thorough physical examination and specific imaging where available.     

Thrombosed interrupted inferior vena cava and retroaortic left renal vein mimicking retroperitoneal neoplasm

Anomalies of the inferior vena cava (IVC) have been recognized as one of the predisposing factors for deep vein thrombosis. Rarely, thrombosis of an anomalous retroperitoneal vein may resemble a soft tissue mass. Awareness of this fact helps preventing unnecessary interventions. We report a case of thrombosis of retroaortic left renal vein and interrupted IVC that mimicked a retroperitoneal neoplasm.     

Acute inferior wall myocardial infarction induced by aortic dissection in a young adult with Marfan syndrome: A case report

BACKGROUNDAortic dissection (AD) is an emergent and life-threatening disorder, and its in-hospital mortality was reported to be as high as 24.4%-27.4%. AD can mimic other more common disorders, especially acute myocardial infarction (AMI), in terms of both symptoms and electrocardiogram changes. Reperfusion for patients with AD may result in catastrophic outcomes. Increased awareness of AD can be helpful for early diagnosis, especially among younger patients.CASE SUMMARYWe report a 28-year-old man with acute left side chest pain without cardiovascular risk factors. He was diagnosed with acute inferior ST-segment elevation myocardial infarction (STEMI), which, based on illness history, physical examination, and intraoperative findings, was eventually determined to be type A AD caused by Marfan syndrome. Emergent coronary angiography revealed the anomalous origin of the right coronary artery as well as eccentric stenosis of the proximal segment. Subsequently, computed tomography angiography (CTA) showed intramural thrombosis of the ascending aorta. Finally, the patient was transferred to the cardiovascular surgery department for a Bentall operation. He was discharged 13 d after the operation, and aortic CTA proved a full recovery at the 2-year follow-up.CONCLUSIONIt is essential and challenging to differentiate AD from AMI. Type A AD should be the primary consideration in younger STEMI patients without cardiovascular risk factors but with outstanding features of Marfan syndrome.     

Acute pancreatitis presenting as acute inferior wall ST-segment elevations on electrocardiography

Over recent years, much attention has been directed toward the optimal way to rule out acute coronary syndromes and myocardial infarction in patients presenting with chest pain. The electrocardiogram (ECG) is one of the single most important tools in this process. Acute pancreatitis has been shown to be associated with ECG changes that can mimic acute myocardial ischemia. These ECG changes, in association with the epigastric pain and the occasional hemodynamic instability found in acute pancreatitis, have frequently prompted invasive coronary evaluation and even thrombolytic therapy. We present a case of a man with multiple risk factors for coronary artery disease who presented with chest pressure and ECG changes suggesting an acute inferior wall myocardial infarction. He had an angiogram that revealed normal coronary arteries and, subsequently, was diagnosed with acute pancreatitis based on suggestive pancreatic enzymes and computed tomography of the abdomen.     

Right ventricle free wall longitudinal strain for diagnosis of right ventricular infarction in inferior wall myocardial infarction

The International Journal of Cardiovascular Imaging -