Tag Archives: diagnostic dilemma

Provoked Dizziness from Bow Hunter’s Syndrome

  A 62-year-old man was experiencing debilitating bouts of dizziness provoked by head rotation until ultimately finding relief with cervical spine fixation. He had a history of coronary artery disease, human immunodeficiency virus, tobacco use disorder, and generalized anxiety, and initially presented to a routine primary care visit with 3 weeks of episodic dizziness. During […]

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An Unusual Presentation of Thrombotic Thrombocytopenic Purpura

  We describe a patient with sudden and severe postoperative thrombocytopenia whose diagnosis was delayed. The patient was a 58-year-old black man with diabetes mellitus type 2, hypertension, and chronic kidney disease, who presented to our institution with 4 days of abdominal pain. He had a history of remote exploratory laparotomy for an abdominal gunshot […]

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Double the Trouble: Acute Coronary Syndrome and Ischemic Stroke in Polycythemia Vera

Vague symptoms turned out to be life-threatening conditions. A 50-year-old man with a history of polycythemia vera presented to the hospital with epigastric discomfort and clumsiness of the right hand for 5 days. Polycythemia vera was diagnosed 1 year prior, with good control of hematocrit by intermittent phlebotomy. He did not have any other medical […]

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What’s in a Mass?: Large Native Mitral Valve Mass

After an elective cystectomy, a 77-year-old man developed postoperative atrial fibrillation, resulting in a surprising new finding and a challenging diagnosis. He had no cardiovascular symptoms or cardiac history. The preoperative electrocardiogram was normal. Transthoracic echocardiogram identified a mass on the mitral valve (Figure 1A), new 3+ aortic valve regurgitation, and 2+ mitral valve regurgitation. Left ventricular […]

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Curious Case of Wheezing: Carcinoid Heart Disease

  A 58-year-old African American woman with a history of well-controlled hypertension (on amlodipine and lisinopril) presented with a 2-month history of anorexia, early satiety, dysgeusia, and intermittent loose stools, symptoms that had progressed to the point that she had experienced a 20-pound weight loss. These abdominal symptoms also were accompanied by progressive exertional dyspnea […]

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