Clinical Cases & Journal Review

Olivia Yale, Colleen Campbell A 40-year-old male with no pertinent past medical history apart from significant cigarette use presented to the emergency department, referred from urgent care, for SOB and outside CXR concerning for a large right pleural effusion. The patient stated that over the past two months, he has had increasing SOB, coughing fits, and a 20-lb weight loss. The patient was born in Costa Rica but has lived in the United States for most of his life and is fully vaccinated. He denied any recent viral illness, recent travel, sick contacts, fever, abdominal pain, rashes, or ch...

A. Elashmawy, B. Merte, and A. J. Medak Chief Complaint: Left knee pain and swellingHistory of Present IllnessA 63-year-old male with a past medical history of hypertension and diabetes presented with five days of progressive left knee swelling, redness, and discomfort. Symptoms were localized to the midline area inferior to the patella. The patient described worsening swelling, warmth, and tenderness to palpation in the area. He denied fever, recent trauma, or prior similar episodes. The patient had recently been prescribed trimethoprim-sulfamethoxazole, but he had not started taking the m...

Maya Ibelaidene, Rachna Subramony A 45 year old male with a past medical history of gastric sleeve presented to the Emergency Department with two days of progressively worsening right upper quadrant (RUQ) abdominal pain. The pain was constant, dull in character, and radiated intermittently to the back. It was associated with nausea, vomiting, fever, chills, but no chest pain, or changes in bowel habits. He denied prior similar episodes, alcohol misuse, or known gallstone disease. There was no history of liver disease. Vital Signs: BP 130/83 mmHg | HR 56 | T 98.7°F | RR 18 | SpO₂ 100% ...

Sabrina Straus, Rachna Subramony A 68-year-old female with no past medical history on file presented to the emergency department for evaluation of a painless red left eye and visual disturbance. She reported noticing a horizontal line across her vision in the left eye for approximately one month. She described the visual phenomenon as a wave-like, ribbon-shaped distortion that appeared suddenly while she was at rest and had remained unchanged in severity since onset. She denied eye pain, headache, diplopia, vertigo, focal weakness, sensory deficits, or other neurologic symptoms. She also...

Sargis Manukyan, Akash Desai Point-of-care ultrasound (POCUS) is an important tool for today’s practitioners. Studies have supported the use of POCUS in many clinical decision-making scenarios compared solely to standard examinations and other imaging modalities1. Its integration in the emergency medicine (EM) setting has been pivotal and is now gaining momentum for implementation in internal medicine (IM).1 POCUS differs from formal radiological US assessments in that it is a fast, dynamic bedside tool that both performed and interpreted by the sonographer-physician.2 A recent systema...

Hannah Oelschlager MD, Aarish Shahab MD, Rachna Subramony MD, Bryan Merte MD A 63-year-old man with bladder cancer and type 2 diabetes mellitus presented on postoperative day 8 after robotic-assisted laparoscopic radical cystoprostatectomy with orthotopic neobladder creation. He had been discharged three days earlier with a transurethral Foley catheter in the neobladder and externalized ureteral stents draining into an abdominal collection appliance. His postoperative course had otherwise been uncomplicated, with adequate urinary drainage before discharge.  D...

Liam DiZio, Elaine Yu A 43-year-old female with a history of hepatic adenoma status post embolization and microwave ablation presented to the emergency department with one week of constant right flank and right lower chest wall pain. She denied fever, nausea, vomiting, dysuria, hematuria, chest pain, dyspnea, or recent trauma. An outpatient ultrasound performed two days prior demonstrated an 8 mm nonobstructing right renal calculus. Given her history, recurrent hepatobiliary pathology, nephrolithiasis, and musculoskeletal pain were at the top of her differential. Vital Signs: BP 121/89 |...

Letitia Mueller, Bryan Merte, Anthony Medak A 73-year-old female presented from family health center for "unbearable" chronic back pain. She has a complex surgical history, including a T11-sacral posterior spinal fusion and an L3 corpectomy performed at a local outside hospital. She is chronically wheelchair-bound. The patient reported the pain is "stable" but reached a breaking point. She described "notches" forming on her thoracic spine. She denied acute lower extremity numbness, weakness, saddle anesthesia, or bowel/bladder incontinence. She denied fevers or recent trauma. PMH: COPD o...

Natalie Sarafian, Elaine Yu A 62-year-old male with a history notable for HFrEF (on Lasix), HIV, cirrhosis with varices, ulcerative colitis, methamphetamine use, and Hodgkin’s lymphoma (in remission) presents to the emergency department with acute onset shortness of breath and chest pain. His exertional dyspnea and exertional chest pain are also accompanied with lower extremity edema and orthopnea. Cardiac history is significant for CHF diagnosed in 2020, with a hospitalization in September 2025 for ADHF, and multiple recurrent admissions after being unable to take GDMT medications. Curre...

Julia Kelly, Cameron Smyres A 62-year-old man who was recently diagnosed with colon cancer presents to the ED after being diagnosed with a pulmonary embolism on outside CT imaging. The patient had a CT scan of his chest for cancer staging and an incidental PE was found. He was told to seek care at the ED. The patient is asymptomatic, and specifically denies chest pain, dyspnea, acute leg swelling and otherwise feels at his baseline. He denies any recent travel and has no history of blood clots in the past. Vitals: BP 106/70 | Pulse 55 | Temp 98 °F (36.7 °C) | Resp 19 | Wt 79.8 kg (176 ...