Faraz Siddiqui

Phrenic nerve injury and diaphragmatic paralysis following pacemaker pulse generator replacement

Diaphragmatic paralysis (DP) is a common condition. It can be unilateral or bilateral and the diagnosis is usually based on a clinical and radiological findings. Bilateral diaphragmatic paralysis is usually symptomatic with dyspnea and acute respiratory failure while unilateral diaphragmatic paralysis is typically asymptomatic and when present, symptoms usually depend on the presence of underlying pulmonary or neurologic disease. DP can be the result of various chest conditions that affect the phrenic nerve such as tumors, vascular abnormalities or traumatic incidents during surgery as well as blunt or penetrating chest or neck injuries. We report a unique case of phrenic nerve injury and unilateral diaphragmatic paralysis secondary to pacemaker pulse generator replacement that was successfully treated with diaphragmatic plication.

Delayed Pneumothorax: A Potential Complication Of Transbronchial Lung Biopsy

The purpose of this article is to report a case of secondary tension pneumothorax presenting seven weeks post Transbronchial Lung biopsy. A 62 year old male with a known history of germ cell tumor was found to have a left-sided pneumothorax which later complicated to a tension pneumothorax.To the best of our knowledge this is the second case being reported for a delayed pneumothorax post a Transbronchial Lung Biopsy .The purpose of this case report is to create awareness among physicians to consider this diagnosis even at a later stage and the importance of patient education regarding the signs and symptoms of pneumothorax. Our case adds to the medical literature, a new presentation of a rare complication of delayed pneumothorax post TBB.

Actinomyces viscosus causing disseminated disease in a patient on methotrexate

Actinomycosis is an uncommon infectious disease caused predominantly by Actinomyces israelii. Actinomycosis usually involves the cervicofacial, thoracic, abdominal, and pelvic region, dissemination is uncommon. Actinomyces viscosus are commensal organisms that make up the normal flora of the oropharynx of humans and has rarely been reported to cause disease. Here, we report a unique case of disseminated actinomycosis with lung and brain lesions caused by Actinomyces viscosus resembling lung cancer with metastasis in a 74 year old male. Cultures from skin lesions confirmed A. viscosus. Although the patient was immunocompromised, antibiotic treatment with a penicillin-based regimen was effective.

Internal Carotid Artery Dissection with Lidocaine Nerve Block Injection Trauma: A Rare Case Report

Internal carotid artery dissection (ICAD) accounts for 25% of cerebrovascular accidents in young and middle-aged patients. Dissection occurs when the intimal wall of an artery is damaged as a result of trauma or defect. ICAD development after dental work is a relatively uncommon phenomenon. Our study highlights a rare presentation of ICAD that resulted from a direct lidocaine nerve block injection in a patient undergoing pulpotomy for a right maxillary second premolar tooth. We have described the case and reviewed the literature on this rare but potentially life-threatening phenomenon.

Cracking the Crack Dance: A Case Report on Cocaine-induced Choreoathetosis

Movement disorders represent one of the less common presentations of cocaine toxicity observed in clinical practice. Given the magnitude of crack cocaine use, it is vital to understand the underlying pathogenesis. We present a case of a patient who clinically exhibited cocaine-induced choreoathetosis. The diagnosis was confirmed after ruling out all other organic causes of de novo choreoathetoid movement. This case highlights the association of cocaine with choreoathetoid movements. We propose a preliminary understanding of the underlying pathogenesis, which may help intensivists better recognize this uncommon phenomenon.

Vanishing Lung Syndrome: Compound Effect of Tobacco and Marijuana Use on the Development of Bullous Lung Disease – A Joint Effort

Marijuana use has been increasing across the United States due to its legalization as both a medicinal and recreational product. A small number of case reports have described a pathological entity called vanishing lung syndrome (VLS), which is a rare bullous lung disease usually caused by tobacco smoking. Recent case reports have implicated marijuana in the development of VLS. We present a case of a 47-year-old man, who presented to our hospital with shortness of breath, fevers and a productive cough. On physical exam, he was tachypneic with audible stridor and absent right sided breath sounds. Laryngoscopy showed a retropharyngeal abscess, and chest radiography showed a possible right pneumothorax. Chest computed tomography (CT) showed bilateral bullous emphysematous lung disease with a giant bulla occupying most of his right lung field. He was placed on mechanical ventilation and treated with broad spectrum antibiotics in the intensive care unit, where he developed acute respiratory distress syndrome (ARDS). He continued to decline, and developed disseminated intravascular coagulation, after which he succumbed to his disease.