J Emerg Med
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Review Case Reports
Destructive cervical spine osteoblastoma at C5 in a young patient initially presenting with quadriparesis: case report and review of the literature.
Osteoblastomas are rare benign bone tumors that are mostly found in the posterior spinal elements; about 20% are located in the cervical spine. ⋯ Neuroimaging should be performed with either conventional plain X-ray study, which seems to be sufficient in patients presenting with non-specific symptomatology related to cervical spine damage, or with advanced techniques in the case of patients with persistent neck pain or neurological deficit.
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Wandering spleen is a rare and unusual entity, characterized by excessive mobility and displacement of the organ from its normal position. This happens due to congenital or acquired anomalies leading to the lack of the spleen's suspensory ligaments. Clinical presentation is variable; acute abdominal pain may occur when persistent torsion of the splenic pedicle results in splenic infarction. Ultrasonography, computed tomography, and magnetic resonance imaging are modalities that may be used in diagnosis. The treatment of choice is surgery, with splenectomy or splenopexy, the latter being preferred. ⋯ Wandering spleen should be considered in cases of acute abdominal pain, and surgery is the treatment of choice, with the goal of preservation of the organ whenever possible.
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Case Reports
Complete atrioventricular block associated with non-penetrating cardiac trauma in a 40-year-old man.
Myocardial contusion is a rare complication of blunt chest trauma. Transient conduction and rhythm problems, right ventricular dysfunction, or pulmonary embolism may occur after chest trauma, but these complications almost always occur early in the post-operative period. ⋯ Even with an injury that does not seem to be caused by direct penetrating trauma to the heart, maybe every trauma patient needs an electrocardiographic evaluation. It is important to note that myocardial healing is a continuous process after trauma, and additional pathology may be revealed later in the course of healing from myocardial contusion.
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Neurological abnormalities in melioidosis are rare but may manifest as an acute stroke, and in the emergency department (ED), an inappropriate stroke treatment may threaten a patient's life. ⋯ In light of this case, patients with identifiable risk factors, especially underlying diabetes, a history of positive soil contact, and those who lived in an endemic area or ever traveled to an endemic area, and who present themselves with fever and neurologic deficit or multi-organ involvement, should have melioidosis considered in the differential diagnosis.