Jennifer C. Kam

Foreign Body Aspiration Presenting with Asthma-Like Symptoms

Aspiration of a foreign body into the tracheobronchial tree is rare in adults. In the majority of these cases there is an underlying condition such as mental retardation, depressed mental status, impairment in the swallowing reflex, neurological impairment, alcohol or sedative abuse, or complications from dental manipulations that contributed to the aspiration. These patients are commonly misdiagnosed with asthma and typically do not respond to mainstay anti-inflammatory and/or bronchodilator therapy. We describe the case of a patient with a foreign body aspiration in the upper trachea not recognized by radiographic studies that presented with asthma-type symptoms.

Pleural Empyema due to Group D Salmonella

Non-typhi Salmonella normally presents as a bacteremia, enterocolitis, and endovascular infection but rarely manifests as pleuropulmonary disease. We present a case of a 66-year-old female with underlying pulmonary pathology, secondary to an extensive smoking history, who presented with a left-sided pleural effusion. The causative agent was identified as being group D Salmonella. Decortication of the lung was performed and the patient was discharged on antibiotics with resolution of her symptoms. This case helps to support the inclusion of Salmonella group D as a possible etiological agent of infection in the differential causes of exudative pleural effusions.

A Rare Case Presentation of a Perforated Giant Sigmoid Diverticulum

Giant sigmoid diverticulum (GSD) is a rare complication of diverticulosis. These lesions arise from herniations of the mucosa through the muscle wall which progressively enlarge with colonic gas to become large air-filled cysts evident on plain X-ray and CT scans. We present a rare case of a 72-year-old female presenting with abdominal distention, abdominal tenderness, and fever who developed a type 1 giant sigmoid diverticulum (pseudodiverticulum) that subsequently formed an intra-abdominal abscess and an accompanying type 2 diverticulum as well. The patient was treated with surgical resection of the diverticulum with a primary anastomosis and abscess drainage. The patients postoperative course was uneventful. This case helps to support the need for the consideration of GSD in patients aged 60 and older with a history of diverticulosis and presenting with abdominal discomfort and distension.

Hepatic Hydrothorax without Any Evidence of Ascites

Hepatic hydrothorax usually presents in association with ascites, but there are rare cases when it does not. This case helps to support the differential of hepatic hydrothorax in patients who have a history of liver cirrhosis, portal hypertension, and recurrent pleural effusions without ascites. We hope to support the conclusion that a patient with recurrent pleural effusions, without ascites, does not exclude gastrointestinal involvement in its etiology.

Postpneumonectomy-like syndrome presenting in a patient with treated pulmonary tuberculosis: a case report

IntroductionPostpneumonectomy syndrome is a rare condition that is characterized by dyspnea resulting from an extreme mediastinal shift and bronchial compression of the residual lung following surgical pneumonectomy. It is even rarer for this syndrome to present in patients without a history of prior lung surgery but induced by autopneumonectomy due to parenchymal disease, an entity termed ‘postpneumonectomy-like syndrome’.Case presentationWe present a rare case of a 91-year-old Puerto Rican man presenting with progressively worsening dyspnea with a history of pulmonary tuberculosis diagnosed 40 years earlier who developed severe unilateral lung fibrosis. Plain X-ray and computed tomography scans confirmed the presence of postpneumonectomy-like syndrome secondary to his parenchymal lung destruction. The patient developed cor pulmonale due to his extensive lung disease and as a consequence was not a suitable candidate for surgical intervention. The patient was otherwise stable until he developed acute respiratory distress from an acute upper gastrointestinal bleed and died four days into his hospital course.ConclusionWe present a rare case of postpneumonectomy-like syndrome as sequelae of severe pulmonary parenchymal tuberculosis infection along with a review of literature, in the hopes of aiding clinicians to include the differential of postpneumonectomy-like syndrome in patients presenting with worsening dyspnea without a history of surgical lung resection.

False elevation of cardiac markers: importance of recognition

The availability of troponins as cardiac markers in the diagnosis of acute coronary syndrome is invaluable. However, their elevation can sometimes lead the physician astray. We report a rare case of an 86-year-old Hispanic female with a past medical history significant for asthma, hypertension, atrial fibrillation, and dyslipidemia, who presented to the emergency room complaining of a two-day history of shortness of breath associated with wheezing. She denied any chest pain. The patients wheezing ameliorated with bronchodilator treatment. However, her admission laboratory investigations were positive for elevated troponin I, with normal creatine kinase (CK) and CK-myoglobin (MB). The first set of cardiac enzymes revealed a troponin I of 29.16 ng/mL (normal �0.05 ng/mL), CK 234 IU/L, and CK-MB 3.9 IU/L. The electrocardiogram showed rate-controlled atrial fibrillation with nonspecific ST changes. Subsequent cardiac enzymes failed to show any increase in CK or CK-MB. However, the troponin I was, as on admission, persistently elevated at 20.87-29.16 ng/mL. Subsequent cardiac catheterization revealed mild nonobstructive coronary artery disease. Other laboratory tests showed normal creatinine, alkaline phosphatase, and bilirubin, and a negative rheumatoid factor, with absence of hemolysis. A blood sample was subsequently drawn and sent to Beckman Coulter laboratories for heterophile antibody testing. The results confirmed our suspicion of a falsely elevated troponin I caused by the presence of a heterophile antibody. The addition of blocking agents yielded troponin I levels in the normal range. Consistent with current guidelines, we conclude that cardiac markers should be used in conjunction with the clinical picture and the electrocardiogram. This case is unique in that the troponin elevation was incidentally found and led to an array of tests which were all negative.

Follicular Lymphoma Presenting as an Isolated Colonic Polyp

Follicular lymphoma (FL) is the most common form of indolent lymphoma and accounts for 20–25 % of all lymphomas [1]. The gastrointestinal (GI) tract is the predominant site for primary extranodal non-Hodgkin lymphomas (NHL) and is 5–10 % of all extranodal diseases. Primary gastrointestinal NHL is found in the colon and is 6–20 % of all cases with 1–3.6 % being follicular lymphomas [2]. There has been only one other reported case of a follicular lymphoma presenting as an isolated polyp. We present another case of this same occurrence and include a brief review of this rare event. Case Presentation