A previously healthy 43-year-old male presented two weeks after head trauma. He complained of worsening headache with swelling of the forehead and the left periorbital area, purulent discharge from the left eye, and rhinorrhea that began a few days prior to presentation. CT of the head and maxillofacial bones are shown below. He underwent incision and drainage of his abscesses. Operative cultures grew streptococcus intermedius and coagulase-negative staphylococcus. He was sent home on a six-week course of oral clindamycin and intravenous ceftriaxone, based on sensitivities.
Introduction:Deep Venous Thrombosis (DVT) always has been linked reciprocally to malignancy. It even can be the first manifestation of malignancy. However, current guidelines recommend only age-appropriate cancer screening for patients with new unprovoked DVT, due to cost-effectiveness. Case Presentation:A 49-year-old gentleman presented to the hospital for node ablation for his refractory atrial fibrillation. He had a history of mitral regurgitation status/post mitral valve replacement on warfarin with therapeutic INR. Other than palpitations, he denied other symptoms except for some discomfort in his calves and mild abdominal bloating. His physical exam and routine labs were unremarkable. Doppler of his lower extremities showed bilateral occlusive posterior tibial vein thrombosis. A comprehensive thrombophilia workup was negative.Although not indicated by current guidelines, CT scan of chest/abdomen showed a pancreatic head mass, with metastases to the liver. Biopsy showed a poorly differentiated pancreatic adenocarcinoma. The patient was started on therapeutic anticoagulation with enoxaparin. He refused chemotherapy. One week after discharge, he developed hypoxemia, along with progression of his thromboses, and passed away two weeks after discharge.
A 74-year-old Caucasian male presented with recurrent pre-syncopal episodes. He reported having diaphoresis as a prodrome, then feeling "about to lose consciousness" without actual loss of consciousness. These symptoms occurred more frequently in the past three weeks. He reported no visual disturbances, and the duration of each episode was only a few minutes. He denied any history of recent head trauma. He denied chest pain, palpitations, shortness of air, or orthopnea. His physical examination revealed normal heart sounds with no murmurs. Bradycardia (55 bpm) was present. Otherwise, the physical exam was unremarkable, including normal orthostatic vitals. Labs showed a normal complete blood count and comprehensive metabolic panel. His thyroid-stimulating hormone level was 9.3 µIU/ml and his free thyroxine and free triiodothyronine levels were normal.
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