Emphysematous aortitis is a rare but lethal form of infectious vasculitis. This condition was found incidentally on computed tomography of the chest during the evaluation of a patient presenting with pneumonia coincident with adynamic ileus. The patient did not have a history of malignancy. While colon cancer could not be ruled out, it is possible that ileus may have contributed to or resulted in bacterial translocation in this case. Appropriate investigations and empirical therapy against Clostridium septicum should be initiated in the presence of clinical and radiological findings suggestive of emphysematous aortitis.
A saddle pulmonary embolism is defined as a large thromboembolus lodged at the bifurcation of the pulmonary artery. It would be expected for a patient with a saddle pulmonary embolism to present with symptoms such as dyspnea or pleuritic pain. However, more often than not, saddle pulmonary embolisms may present asymptomatically and are not associated with the typical symptoms. We present a case of an incidental finding of saddle pulmonary embolism in an 89-year-old patient with a past medical history significant of gastrointestinal adenocarcinoma that was treated with capecitabine. The saddle pulmonary embolism was found incidentally on computer tomography (CT) with the contrast of the abdomen and subsequently confirmed with CT of the chest with contrast. It is crucial to be mindful of a possible pulmonary embolism in a patient with similar past medical history.
Non-mucinous lepidic adenocarcinoma with pneumonic presentation is a rare form of lung cancer. Its ability to mimic infectious and inflammatory diseases in both patient presentation and diagnostic imaging can result in a delayed diagnosis. This case follows the workup of a 60-year-old non-smoker female who immigrated from Ecuador twenty years prior and worked at a shore repair shop for the past two years who presented with worsening shortness of breath and 15lbs weight loss over a two-month period. A unique aspect of this patient's presentation was that the typical imaging and bronchoscopy findings often seen to distinguish this type of lung adenocarcinoma from other disease processes were absent. No nodular masses were observed on Computed Tomography (CT), and no lesions or airway abnormalities were seen on bronchoscopy. It was not until biopsy and bronchoalveolar lavage (BAL) that the diagnosis of adenocarcinoma was recognized. Our case aims to increase awareness among clinicians of the unpredictable presentation of nonmucinous lepidic adenocarcinoma. Furthermore, we want to highlight the relevance of including adenocarcinoma of the lung in the differential diagnosis even when infectious or occupational etiologies appear more likely.
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