Gastric emphysema (GE) in association with hepatic portal vein gas (HPVG) is a rare, benign medical condition that is very seldom caused by noninvasive positive pressure ventilation (NIPPV). This report describes a patient who developed GE along with gastric vein gas and HPVG, most likely due to multiple episodes of vomiting in combination of using bilevel positive airway pressure (BiPAP), a form of NIPPV. The patient responded to conservative treatment with intravenous fluids, pantoprazole, and the urgent cessation of BiPAP and oral intake.
With the popularity of synthetic cannabinoid street drugs such as “K2 and Spice,” a number of serious neurologic adverse events are coming to light. This case is a 36-year-old African American man, with no significant medical history, who presented with extensive left cervical and intracranial internal carotid artery occlusion and subsequent ischemic stroke. The patient endorsed smoking K2—a synthetic cannabinoid (SC) with structural similarity to cannabis. The mechanism by which SC abuse induces a prothrombotic state leading to ischemic neurovascular sequelae is currently unclear, although a temporal association in the absence of other stroke risk factors suggests a causal relationship. Our case highlights the need for emergent neuroimaging upon suspected SC overdose. Practitioners should be vigilant in recognizing that ischemic stroke and unexplained neurologic deficit can arise after SC abuse, especially in younger populations with few stroke risk factors and who are prone to chronic cannabis use.
Dolichocolon has been described as a developmental variant and is characterized by redundancy of the colon. Diagnosis is based off clinical symptoms and barium enema or CT-colonography. This redundancy is often seen in the adult and elderly population, with pediatric prevalence limited to case reports. Information regarding radiologic evaluation is limited, as most cases are documented outside of the radiology literature. This case report demonstrates a complex course of transient symptoms of constipation, obstruction, and suspected volvulus in a 1-month-old with dolichocolon. A retrospective review of the images offers insight into gaining suspicion of this variant in radiographs and fluoroscopic exams.
West Nile virus (WNV) is an arthropod-borne flavivirus belonging taxonomically to the Japanese encephalitis subgroup. Usually, it is transmitted by Culex pipiens mosquitoes. Consequently, an increase in WNV-positive mosquitoes presents a rise of the number of patients, as it has been seen in NYC. We present a 65-year-old patient with WNV infection who presented with Guillain–Barré syndrome (GBS). She had a rapidly progressing ascending paralysis, a common feature in GBS patients but an uncommon presentation in WNV. Realizing WNV as an emerging pathogen along with its uncommon presentation of GBS can be potentially lifesaving if caught at an early stage.
Normal development of the patella typically involves fusion of secondary ossification centers into a single bone during adolescence, with failure of fusion resulting in bipartite and tripartite patellae. In such variants, injury to incomplete ossification center fusion, though uncommon, has been reported to occur in the setting of traumatic quadriceps tendon rupture. The authors present a rare and complex case of traumatic bipartite fragment separation, patellar avulsion, and a complex partial quadriceps tendon tear confirmed surgically in a 36-year-old male. In this case, a tear in the lateral aspect of the quadriceps tendon attached to the nonfused patellar ossification center resulted in retraction of the band containing the bipartite fragment and separation of the patellar fragments, with superior displacement of the smaller bony avulsion likely due to complex attachments from the medial aspect of the quadriceps tendon. Knowledge of the classical locations of a bipartite and tripartite patella can aid in the differentiation of the anatomic variant versus patellar avulsion. Additionally, knowledge of the variable and complex nature of the quadriceps tendon aids in understanding the process of patellar avulsions and various tears, leading to the appropriate orthopedic management.
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