Background: Epipericardial fat necrosis (EFN) presents as acute chest pain with the potential to mimic life-threatening conditions. It is unclear whether this is truly a rare condition, or simply underdiagnosed by low threshold of suspicion. The literature suggests an estimated prevalence of 2% of EFN as the cause of chest pain in all patients presenting [...]

Background: Coronary Computed Tomography Angiography (CCTA) is a common anatomic modality for detection of cardiac ischemia in the setting of chest pain hospitalizations. However, invasive coronary angiography (ICA) is the gold standard for diagnosing ischemic coronary artery disease. Research showed that CCTA has a high sensitivity but lacks the specificity and accuracy component of Fractional [...]

Case Presentation: 19-Year-old ,African American, female with significant medical history of hypertension, Uncontrolled Diabetes Mellitus, presents with chest pain for 24 hr. Pain was sub-sternal, pressure like,7/10,radiating to right arm and in between the shoulder blades, persistent ,precipitated by drinking alcohol the night before ,associated with Shortness of breath and palpitations. Patient had a history [...]

Case Presentation: Acquired hemophilia A is a rare disorder related to autoantibodies against factor VIII (Fc VIII) and reduced Fc VIII/VIII inhibitors causing bleeding. The incidence is 1 to 1.5 per million a year with 78 years as a median. Diagnosis is crucial due to the mortality can include spontaneous hemorrhages into skin, muscles, soft [...]

Case Presentation: An 18-year-old female with no medical history was evaluated at an outside hospital for erythematous rash on her forearms, abdominal pain, chest pain, and leukocytosis. Chest Computed Tomography revealed hilar adenopathy. Transthoracic echocardiography showed right atrial and right ventricular (RV) dilation with low ejection fraction (EF). She was then transferred to our institution. [...]

Case Presentation: A 67-year-old male with a history of Graves’ disease, paroxysmal atrial fibrillation status post cardiac ablation not on anticoagulation, and chronic ibuprofen use presented to the emergency department with progressive dizziness, fatigue. He noted 10 days of black stools. Additionally, patient’s wife reported he had confusion that started yesterday. Patient presented stable on [...]

Case Presentation: The World Health Organization designates a rare disease as one affecting under 6.5-10 per 10,000 people (1). We present a case of disparate findings, ultimately diagnosing Erdheim-Chester Disease (ECD), a rare non-Langerhans histiocytic multisystem disorder with fewer than 1000 reported cases (2,3).A 63-year-old man presented with months of progressively worsening anasarca, acute on [...]

Case Presentation: A 23-year-old male with no past medical history presented with neck pain and bilateral arm paresthesia of four-week duration. The patient was prescribed ibuprofen, and an MRI cervical spine was ordered. The MRI showed multilevel degenerative disc disease, and the patient was referred to physical medicine and rehabilitation. In the weeks prior to [...]

Case Presentation: A 46-year-old female with history of rheumatoid arthritis and asthma presented with chest and back pain to an outside facility and was evaluated for acute coronary syndrome and cholecystitis. Patient’s absolute eosinophil count (AEC) was 1.76 at that time. Patient was re-admitted with altered mental status and vomiting. Her AEC was 41. Strongyloides [...]

Case Presentation: A 21-year-old male with no past medical history presented to the emergency room with sudden onset chest pain, bradycardia, and hypotension. He described feeling chest “pressure” that led to shallow breaths. His pain was substernal, pleuritic, non-radiating, and associated with palpitations. He had mild relief when sitting up. Symptoms started that morning and [...]