Primary central nervous system melanoma is rare, accounting for approximately 1% of total melanoma cases (1-3). Primary central nervous system melanoma localized to the spinal cord is even rarer. The cervical and thoracic levels are most frequently involved. There are no pathognomonic imaging characteristics and diagnosis must be confirmed immunohistologically. The preferred treatment is gross total resection. Utilization of adjuvant radiotherapy and chemotherapy may improve disease-free survival. The prognosis for primary central nervous system melanoma is generally better than that of metastatic and cutaneous melanoma, although there are relatively few cases from which to draw conclusions. We report a case of a 64-year-old woman diagnosed with primary spinal melanoma of the thoracic spine treated with subtotal surgical resection followed by adjuvant radiation therapy.

Sickle cell trait, a trait known to be protective against falciparum malaria, is prevalent in the African American community. Unlike true sickle cell disease, sickle cell trait is currently not a disqualifying condition for military service. In the case below, we describe an occurrence, from Logar Provence, Afghanistan (2,072 m above mean sea level), of exertional acute rhabdomyolysis in an American service member known to be a sickle cell trait carrier. The case serves to educate Military Medical providers and Commanders alike, to the increased risk certain training and work environments have on sickle cell trait Service members; it raises the question of what duty limitations, if any, sickle cell carriers should have.

Delayed hypersensitivity disorders and food allergies are often challenging for the clinician and patient alike. A recent discovery of an IgE antibody specific to galactose-α-1,3-galactose, which is a carbohydrate abundantly expressed on cells and tissues of beef, pork, and lamb, adds one more tool to aid the clinician in making the appropriate diagnosis. A link has been discovered between the bite of the Lone Star Tick (Amblyomma americanum) and the development of sensitivity to galactose-α-1,3-galactose. With a high prevalence of Lone Star Tick populations inhabiting major U.S. Army Installations, and the type of duty required by our Service members, it could potentially affect susceptible individuals. We describe a case of an active duty soldier who went 4 years searching for this elusive diagnosis and connection and discuss why it should remain in the differential diagnosis when treating military health care beneficiaries.

Uterine artery pseudoaneurysms (UAP) are a rare cause of post-partum hemorrhage. Conservative management is discouraged due to the risk of spontaneous hemorrhage. Intra-arterial embolization is highly successful (>90%) and offers definitive treatment. We present the case of a 27-year-old woman with significant delayed post-partum hemorrhage after cesarean section who was found to have a UAP on imaging. Her tortuous vascular anatomy and spasmodic aneurysmal neck presented technical challenges to embolization with traditional material, such as gel foam and coils. Intra-arterial thrombin was then employed with good technical and clinical outcome. To our knowledge, this is the first case describing the use of intra-arterial thrombin in the treatment of UAP. Given its success in this case, we argue that intra-arterial thrombin should be considered a viable alternative for embolization of UAP when more traditional techniques fail.

Chronic recurrent multifocal osteomyelitis (CRMO) is an uncommon idiopathic inflammatory disorder. The diagnosis is often delayed because a variable clinical presentation and limited awareness among care providers. We present an 11-year-old female diagnosed with CRMO and her imaging workup. In particular, this case highlights the role of whole-body magnetic resonance imaging to enhance detection and diagnosis of CRMO.

A 74-year-old woman requiring lifetime anticoagulation for antiphospholipid syndrome was noted to develop a pseudoaneurysm (PA) of the breast following core needle biopsy. She was successfully treated via thrombin injection and suffered no complications. In patients requiring anticoagulation, definitive management of PA may be desired. In appropriately selected patients, ultrasound (US)-guided thrombin injection offers superior outcomes to alternative conservative management and obviates the need for surgical intervention.

Tarsometatarsal osseous coalition is extremely rare. Herein, we present a case of osseous coalition between the base of the third metatarsal and the lateral cuneiform. The patient is a 38-year-old male who presented with an acute episode of foot pain following strenuous activity. Radiographs of the left foot demonstrated an osseous coalition between the third metatarsal base and the lateral cuneiform. Tarsal coalition is a congenital defect that results when adjacent tarsals fail to separate during embryonic development. According to the literature, total osseous coalition is less common than cartilaginous coalition. This case serves as only the second known documented case of osseous coalition between the third metatarsal and the lateral cuneiform, with the first case published in an orthopedic journal. To our knowledge, no case of third metatarsal-lateral cuneiform coalition has been published in the literature otherwise. The intent of this publication is to add to the database of tarsometatarsal coalition cases with a specific emphasis on bony coalition between the third metatarsal and lateral cuneiform.

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