Background: As the outbreak of coronavirus disease 2019 (COVID-19) has progressed, computed tomography has emerged as an integral part of the diagnosis alongside reverse transcriptase-polymerase chain reaction assays. Frequently encountered imaging findings include peripheral airspace consolidations; bilateral ground-glass opacities; and, less commonly, cavitation. Hilar lymphadenopathy is a rarely reported finding in the setting of COVID-19. Case presentation: A 73-year-old Caucasian woman presented to our hospital with fever and fatigue. She had a maximum body temperature of 102.3°F with lymphopenia and thrombocytopenia. She was diagnosed with severe acute respiratory syndrome coronavirus 2 infection on the basis of a positive result from a reverse transcriptasepolymerase chain reaction of a nasopharyngeal swab sample. Contrast-enhanced chest computed tomography revealed multifocal, subpleural ground-glass opacities with nodular consolidations bilaterally. Computed tomography also demonstrated atypical bilateral hilar lymphadenopathy, a rarely reported imaging feature of COVID-19. Chest computed tomography 1 month before the presentation did not show focal consolidations or lymphadenopathy. This indicated that the findings were due to the patient's severe acute respiratory syndrome coronavirus 2 infection. She received 5 days of oral hydroxychloroquine and experienced resolution of her symptoms. Conclusion: Chest computed tomography has been used extensively to diagnose and characterize the distinguishing radiological findings associated with viral pneumonia. It has emerged as an integral part of the diagnosis of COVID-19 alongside reverse transcriptase-polymerase chain reaction assays. Clinicians must be aware of uncommon clinical and radiological findings in order to diagnose this entity. Hilar lymphadenopathy is commonly seen with fungal infections, mycobacterial infections, and sarcoidosis. An extensive literature review found that bilateral hilar lymphadenopathy has not been reported in the setting of COVID-19. More data are needed to establish the clinical impact of this novel finding.
The way in which bones are affected in cases of sickle-cell anemia is well known. Nevertheless, advances in treatment and in methods of transfusion mean that we are increasingly seeing cases of older patients with this disease. A retrospective analysis of 222 cases of sickle-cell anemia demonstrates the radiological appearance of the skeleton in the disease and reveals the various bone segments which are particularly vulnerable at certain periods of life. Correlation of X-rays permits the discovery of lesions which are not clinically apparent. The frequency and characteristics of epiphyseal osteonecrosis and osteitis are studied. Aggravation of the bone lesions when corticoids are administered poses the problem of differential diagnosis of the disease, especially in comparison with rheumatic fever.
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Gastroparesis in a patient with diabetic ketoacidosis A 40-year-old man with type 1 diabetes mellitus and recurrent renal calculi presented to the emergency department with nausea, vomiting, and abdominal pain for the past day. He had been checking his blood glucose level regularly, and it had usually been within the normal range until 2 or 3 days previously, THE CLINICAL PICTURE
Background Schistosomiasis is considered one of the neglected tropical diseases which is rarely seen in USA. We are reporting herein a case of intestinal schistosomiasis presented as bloody diarrhea and hypovolemic shock at Monmouth Medical Center, New Jersey. Methods: Case Report A 79 year old female presented with bleeding into her colostomy bag and associated left lower abdominal pain for one day duration. She has a history of colon cancer diagnosed 25years ago, which was treated with chemotherapy and a left hemicolectomy with colostomy formation. On admission, her blood pressure was 78/51 mm Hg. She looked pale and her abdominal examination revealed tenderness in left lower quadrant. Laboratory findings showed hemoglobin of 5.3 g/dl. CT abdomen showed extensive colitis. She was resuscitated and treated with Piperacillin-Tazobactum for 6 days with minimal improvement. Stool for ova and parasites were negative. EGD was unremarkable with no evidence of acute bleeding. Colonoscopy showed severe ulcerative colitis in the distal 30cm of colon. Pathology revealed ischemic and necrotic tissue with numerous calcified schistosoma eggs in the colon (Figure 1). After furthering questioning, the patient mentioned that she travelled to South China 8months prior to presentation. Patient was then treated with Praziquental for one day for possible Schistosomiasis Japonicum, given the regional distribution. The patient showed marked clinical improvement and was discharged home later. Figure 1: Histopathology image showing calcified schistosoma eggs in colon Results Intestinal Schistosomiasis is a parasitic disease which peaks at age 15-20yrs, older patients usually have less parasitic burden. Symptoms include diarrhea, abdominal pain, dyspepsia and malnutrition. Heavily infected patients can have hemorrhagic diarrhea, obstruction and ischemic colitis. Definitive diagnosis requires egg identification. Treatment is relatively safe and effective, especially in the developed countries where the resistance to Praziquantel (PZQ) has not been reported yet. Conclusion Even though the worms that cause the disease are not found in USA, this case highlights the importance of recognizing Schistosomiasis especially in New Jersey, due to the high traveling immigrant population, as early recognition and treatment reduces morbidity and mortality. Disclosures All Authors: No reported disclosures
To identify if a change from an open to a closed model of ICU operation system resulted in a change in the length of stay or mortality of the patients admitted to ICU with a diagnosis of Sepsis.
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