Right leg pain after a fall in a patient with a prosthesis

, May 23, 2012

A 28-year-old female with a history of juvenile rheumatoid arthritis and knee and hip arthroplasty experiences pain after accidentally twisting her right leg.
 

Gradual onset of left-sided temporal headache and ptosis

, Dakshinamurty Gullapalli, MD; Chintan Shah, MD; Eric McGraw, MD April 12, 2012

Glaucoma limited this patient's vision, but new symptoms limited to his left side had more to do with his ocular muscles.
 

A neck mass in a patient with fever and sore throat

March 15, 2012

The initial diagnosis was viral illness, but blood cultures that came back positive for Fusobacterium necrophorum mandated further evaluation.
 

An acute elbow injury after 
a fall at the playground

February 16, 2012

A common childhood accident can lead to a limb-threatening injury that requires prompt assessment and treatment followed by regular monitoring.
 

A different kind of headache in a patient with migraines

, January 19, 2012

Magnetic resonance venography is the definitive imaging modality for this unusual condition, but MRI is also performed to identify other abnormalities in the brain.
 

Atypical manifestations of a 
potentially fatal infection

, , Joseph M. Candelario, FNP-BC December 21, 2011

Four clinicians agreed on the diagnosis of left inguinal hernia, but CT scans proved all of them wrong.
 

Sudden onset of confusion and visual disturbances

, , Urvi R. Shah, MD November 22, 2011

An advanced MRI technique clinches the diagnosis after it detects cerebral lesions not seen on conventional MRI.
 

Impaired vision along with a headache in an elderly man

, Taral R. Sharma, MD, MBA; Dennis G. Duncan; Urvi R. Shah, MD October 28, 2011

An otherwise healthy man with a history of otitis media presents with a worsening headache and visual disturbances for the past week.
 

A case of confabulation and abnormal eye movements

, Bush Kavuru, MD; Joseph W. Iskandar, DO; Ashley Coffman; Kelly Johnson September 23, 2011

An emergency department team works to determine the cause of this patient's recurrent nausea, vomiting, and failure to thrive.
 

Pain and chronic diarrhea 
in an elderly cancer patient

, John E. Poulos, MD; Thomas H. Daignault, PA-C; Leroy Roberts, MD August 19, 2011

A patient with a history significant for chronic obstructive pulmonary disease among other conditions presents with increased bowel movements, diarrhea, and severe abdominal pain.
 

Acute left elbow deformity following a fall on the hand

July 22, 2011

Following a fall on an outstretched hand, an elderly patient presents with obvious deformity and limited range of motion caused by guarding.
 

Pain in a patient's pelvis and hip following a car accident

, Jason Kim, MD; Denise Rizzolo, PA-C, PHD June 21, 2011

After being struck by a car 2 days earlier, the patient could still walk but had pain in the pelvis and hip.
 

What caused this massive abdominal and pelvic cyst?

, Michael H. Stella, MD; Ali S. Raja, MD, MBA, MPH May 20, 2011

A 27-year-old woman presented to the ED for evaluation of abdominal pain that was present for the past 12 hours and progressively worsening abdominal distention that had persisted for 3 months.
 

Sudden cramps and vaginal bleeding during pregnancy

April 22, 2011

A female patient with sudden onset vaginal bleeding and cramps and a positive pregnancy test presented to the emergency department for evaluation.
 

Tingling and swelling on the left side of a patient's neck

, Urvi R. Shah, MD; Sandeep K. Puri March 22, 2011

In this unusual case, a patient with a history significant for trauma to the neck and upper extremities presents with progressive swelling of the neck and tingling in the left upper limb.
 

Cyanosis and difficulty with 
breathing in a newborn

, Urvi R. Shah, MD; Gary Seth Barrett; Sandeep K. Puri February 22, 2011

A newborn cries after delivery but then develops deep cyanosis, increased respiratory effort, and a falling heart rate.
 

Pain in a 2-year-old girl who 
refuses to bear weight

January 25, 2011

After a toddler catches her leg behind her while going down a slide, she presents with her mother to the clinic with pain and refusal to bear weight.
 

Sensory loss and complex joint pain in an adult male

, Dakshinamurty Gullapali, MD December 21, 2010

This patient's imaging test results and symptoms, including complicated pain throughout multiple joints and numbness below nipple level, led to a diagnosis.
 

A boy's ankle injury reveals a more serious condition

, November 23, 2010

Imaging studies obtained from a 2-year-old who presents with a sprained right ankle and head injury reveal something unexpected.
 

Abdominal mass and pain in a patient with pancreatitis

Robin L. Peacock; Urvi Shah, MD; Andres C. Marte-Grau, MD; Rathnakar Sherigar, MD October 26, 2010

A male patient with a history significant for pancreatitis, alcohol dependence, and smoking presents with left-sided abdominal pain and vomiting.
 

A cracking sensation is the onset of severe ankle pain

September 21, 2010

Persistent ankle pain leads to a stress fracture diagnosis, but the patient's history suggests that something else is going on.
 

Left flank pain following cardiac catheterization

R. Steve Andrews, RRT; Andres C. Marte-Grau, MD; Rathnakar Sherigar, MD; Jennifer Pitts Hanopole; Urvi R. Shah, MD August 24, 2010

This patient's condition highlights the importance of paying close attention to history and not ruling out a rare complication of a procedure.
 

Imaging and biopsy hold the key to knee pain diagnosis

July 27, 2010

The patient's complaints suggested injury to the meniscus, but radiography, MRI, and biopsy revealed a different cause.
 

Nonhealing wound following trauma

June 22, 2010

Continuing symptoms raise suspicions of a serious complication after a young man catches his finger in a car door.
 

Foot pain following a skateboarder's fall

, William Min, MD, MS, MBA May 19, 2010

Will this injury heal spontaneously? Or does it need aggressive treatment? Injury location holds the key to prognosis and treatment.
 

A 50-year-old female with dyspnea and pleural effusion

Danielle North; Ellen D. Mandel, DMH, PA-C April 21, 2010

This condition represents an uncommon complication that can develop in patients with any form of cirrhosis and is considered a manifestation of decompensation.
 

Imaging helps to diagnose an uncommon disease in a man with painless hematuria

Jennifer Pitts Hanopole, Andres Marte-Grau, MD; Rathnakar Sherigar, MD March 16, 2010

This patient's condition is rarely diagnosed by history and physical examination alone; CT with and without contrast is essential to detection.
 

Bowing of the right lower leg in an infant

, Richard Davidson, MD February 16, 2010

The baby's tibia exhibited a lytic lesion and medial cortical disruption, and the fibula showed mild cortical thickening.
 

Classic adolescent injury mimics a twisted ankle

, William Min, MD, MS, MBA January 19, 2010

An ankle injury in a skeletally immature boy turns out to be much more serious than initial radiographs suggest to the casual observer.
 

An immigrant with fever, chills, and pleural effusion

, December 15, 2009

This disease is uncommon in persons born in United States, but those caring for immigrants should consider its different manifestations.
 

Foot pain for 5 years, and an abnormal radiograph

Captain Amelia Duran-Stanton PA-C, PhD, MPAS November 17, 2009

Learn to recognize the clinical manifestations and radiographic appearance of a condition you may never have heard of.
 

A 17-year-old male with leg weakness and low back pain

October 28, 2009

These cysts, named for their radiographic appearance and common in younger patients, comprise approximately 1% of bone tumors.
 

Anatomical variant found during catheter insertion

Gina Luckianow, PA-C; Deborah Cole, PA-C, MMSC; Lewis J. Kaplan, MD, FACS, FCCM, FCCP September 28, 2009

Catheter placement to address bleeding following repair of a duodenal ulcer leads to the discovery of a congenital cardiac anomaly in a 62-year-old woman.
 

An unresponsive airline passenger with miosis

, August 25, 2009

A middle-aged man is found unconscious in the international terminal of the airport with pinpoint pupils and a white powdery substance around his nose and mouth.
 

A common ankle injury with a not-so-common twist

Joseph M. Ehrhard, MPAS, PA-C, ATC July 29, 2009

A basketball player completes his jump shot by landing on another player's foot. A squeeze test positive for pain and inability to bear weight on the affected leg suggest more than an ankle injury.
 

Unusual vascular structures in the chest cavity

June 18, 2009

Shortness of breath and occasional chest pain signal a vascular anomaly in a middle-aged woman.
 

Imaging focused on a tooth reveals an unusual mass

, Andrea Medel; Thomas Chiodo, DDS May 19, 2009

Facial pain and swelling attributed to an impacted wisdom tooth turn out to be signs of a life-threatening diagnosis.
 

A man with an unusual sequela of alcoholism

May 16, 2009

A 55-year-old male presented to the emergency department with history of vomiting. He appeared acutely ill and complained of experiencing excruciating lower left chest pain. He had a history of coronary artery disease and was an alcoholic. He had undergone prior surgical procedures that included cholecystectomy and coronary artery bypass graft surgery. The ECG demonstrated tachycardia but no signs of acute MI. His pulse was 120 beats per minute; BP was 130/70 mm Hg; and his respiratory rate was 28 breaths per minute.
 

Severe pain in the shoulder with no history of trauma

Jeffrey L. Spivey, MPAS, PA-C; Thomas M. Carrell, MD April 28, 2009

This patient's left shoulder was tender to palpation over the greater tubercle of the humerus and supraspinous fossa. Range of motion was limited by pain to approximately 20° forward flexion and abduction.
 

Eclampsia causes a reversible condition in a young woman

March 18, 2009

A 19-year-old woman presented to the emergency department with a history of seizures. At presentation, she had an elevated BP and was noted to be about 34 weeks' pregnant.
 

Knee pain and an abnormal radiograph in a skier

Brian Downie, ATC, PA-C, MS February 20, 2009

The patient is a 20-year-old male who fell while downhill skiing. After returning home, he presented to our orthopedic clinic with continued complaints of lateral knee pain, swelling, and a sense of weakness.
 

MRI helps to identify this increasingly common disease

Lucy Rochetti, PA-C January 01, 2009

A 5-year-old Indian female presented to her primary care provider (PCP) with complaints of fever (100ºF - 101ºF), headache, vomiting, decrease in appetite, and fatigue for 1 day. Additionally, the mother reported two episodes of "muscle twitching" in the patient's right cheek and lip lasting approximately 2 to 5 minutes; these had occurred about 1 week before presentation.
 

Pleural disease manifests years after asbestos exposure

Alex Shalshin, MD, RPA-C December 01, 2008

An 82-year-old African-American male presented to the emergency department (ED) with a complaint of fever for 3 days and a history of previous abnormal findings on chest radiograph. As part of the patient's evaluation, a CBC, electrolytes, and coagulation panel were ordered and a plain chest radiograph was obtained.
 

A common cause of knee pain in athletic children

, Hilary Sugar; Stanley C. Parman, MD November 01, 2008

A 13-year-old female presented with a 4-day history of left knee pain. The pain had come on suddenly. The patient stated that after she walked home from school, she had some moderate knee discomfort; then, after dinner, she noticed increased pain and swelling just below her patella.
 

An unusual cause of low back pain in an adolescent

Jason R. Smith, PA-C; Amer F. Samdani, MD October 01, 2008

A 14-year-old male presented to our institution with back pain that had persisted for the past month. He denied trauma, recent strenuous activity, night pain, lower extremity dysesthesias, or bowel/bladder dysfunction. The physical examination revealed an apparent spinal asymmetry, a limitation in forward flexion of about 50%, tenderness over the thoracolumbar region, and intact motor and sensory function in the bilateral lower extremities
 

These characteristic findings reveal a rare disease

Julie Vajnar, PA-C, RT September 01, 2008

 

A rare disease of children appears in a young man

Pamela Phelan, MPAS, PA-C August 01, 2008

The patient reported to the surgeon that he had had right hip pain since he was a young child. Lately, he had experienced increased leg weakness, nocturnal pain, grinding, stiffening, and overall instability of his right leg.
 

Chest pain and an abnormal ECG in a young woman

Julie Vajnar, PA-C, RT July 01, 2008

A 34-year-old female was discovered to have an abnormal ECG. She denied chest pain, weakness, palpitations, syncope, and shortness of breath, but she did state that she experienced occasional atypical chest pain when she was stressed and had a history of mitral valve prolapse.
 

A relatively common cause of pain in the hand

June 01, 2008

A 22-year-old teacher presented to our clinic with a complaint of right hand pain while pulling a zipper attached to her boots. She stated that while trying to zip her boot, she experienced pain along the top of her right hand below her first finger. She denied any traumatic injury to her hand. However, while zipping her boot, she felt a "pop" and heard a "snap" along her hand that produced significant pain and discomfort.
 

An ice hockey player with an unusual elbow injury

May 01, 2008

A 16-year-old right-hand-dominant male presented to the clinic with a complaint of left elbow pain. The patient, who played goalkeeper for his hockey team, stated that while tending goal, he caught the puck in his gloved left hand with his elbow flexed and his arm abducted.
 

Appendicitis: What helps to make the diagnosis?

April 01, 2008

A 73-year-old female presented to the emergency department with nontraumatic abdominal pain in the right lower quadrant (RLQ).
 

A 50-year-old man with a serious pain in the neck

March 01, 2008

A 50-year-old male presented with neck pain, which he described as beginning at the base of the skull and radiating downward. Three weeks previously, he had had a four-wheeler accident but never sought medical attention.
 

A 13-year-old boy with a common athletic injury

February 01, 2008

A 13-year-old boy presented to the clinic for the evaluation of right hip pain. He stated that he was playing soccer and felt a "pop" after kicking the ball. On physical examination, his vital signs were normal. He was able to stand but experienced mild right hip pain with walking; no swelling or bruising was visible. There was tenderness with palpation about the right hip. Internal and external rotation of the hip was normal, but therewas mild pain.
 

A telltale sign of fracture in a 74-year-old woman

Christopher Davis, MPAS, PA-C, RT; William Jacoby, MD; Asim Khwaja, MD January 01, 2008

A 74-year-old woman presented to the emergency department with a 3- to 4- day history of intractable lower back pain. The pain had intensified until the patient could no longer walk pain-free. Eventually, any movement of her lower extremities or lower back produced excruciating pain.
 

Mechanical thrombolysis for deep vein thrombosis

Christopher Davis, MPAS, PA-C, RT; Asim Khwaja, MD December 01, 2007

A 58-year-old Hispanic female presented to the emergency department (ED) with left lower extremity pain and edema that had been present for the previous 4 days. The pain had had an acute onset. The patient had no history of travel, immobilization, or other risk factors for hypercoagulation. She denied chest pain, shortness of breath, and cough. Physical examination in the ED revealed that her left lower extremity was swollen up to the proximal thigh; her calf was tender, and her skin was warm.
 

Shortness of breath in a 27-year-old man

November 01, 2007

A 27-year-old man presented to the emergency department with complaints of shortness of breath that had worsened over several weeks and a dry cough that was sometimes severe. His symptoms increased when lying flat. He denied having any chest pain. The patient had been healthy until 3 months previously, when he ruptured an Achilles tendon, which was surgically repaired. He subsequently developed postoperative deep vein thrombosis and pulmonary embolism (PE). After warfarin (Coumadin) therapy, follow-up chest CT showed resolution of the PE.
 

Abdominal pain in a man with hepatitis C

October 01, 2007

An 80-year-old man presented with right upper quadrant abdominal pain. He denied nausea, vomiting, diarrhea, or constipation. Urinalysis results were negative and the WBC count was normal, but liver function values were elevated. The patient had no history of alcohol abuse but did have chronic hepatitis C. A physical examination revealed tenderness over the right upper quadrant and hepatomegaly. The patient did not appear jaundiced.
 

Compression fractures in a man with osteoporosis

September 01, 2007

An 83-year-old male with an osteoporotic compression fracture of the second lumbar vertebra (L2), sustained in a fall, complained of continuing pain despite conservative treatment for the past 3 weeks.
 

What caused this UTI in a 3-year-old girl?

August 01, 2007

The patient is a 3-year-old girl whose mother was worried because the child was eating poorly and seemed irritable. The mother also noticed strong-smelling urine in the diaper over the past few days. A urine sample demonstrated positive leukocyte esterase and nitrites compatible with a urinary tract infection (UTI).
 

Symptoms of a stroke in a 41-year-old woman

June 01, 2007

A 41-year-old woman presented with complaints of severe headaches and left arm weakness that had occurred off and on for 2 months. In a visit to the emergency department 2 days previously, she underwent CT of the head. The results were negative. The patient took no medications, smoked half a pack of cigarettes daily, and had an otherwise unremarkable history. On physical examination, her left upper extremity was slightly weaker than the right. Otherwise, the neurologic examination was negative.
 

A young man with acute onset of testicular pain

May 01, 2007

A 23-year-old male presented to the emergency department with complaints of testicular pain on the right side. He said he did not seek treatment earlier because he was embarrassed and hoped the pain would resolve without medical help.
 

Pelvic pain, vaginal spotting, and a right adnexal mass

March 01, 2007

A 36-year-old woman presents to the emergency department with complaints of lower abdominal and pelvic cramps that began the previous day. She denies nausea, vomiting, diarrhea, and fever. She reports vaginal spotting and states that it is not like her normal menses. Her last period was more than 2 months ago. She is sexually active and uses no contraception.
 

A common cause of vomiting in infancy

January 01, 2007

A worried mother brings her 7-week-old infant to your office. She states that the infant is not gaining weight, that he seems to "spit up" everything given to him, and that he still seems hungry after vomiting. On physical examination, he appears thin but not jaundiced. There is a firm, mobile mass in the right upper quadrant (RUQ) of the abdomen. His mucous membranes appear dry.
 

A swollen, painful leg in a 4-year-old girl

December 01, 2006

The patient is a 4-year-old girl who presents with worsening swelling and pain in the left lower leg. There is no history of trauma, but there are focal areas of swelling. No bruising or evidence of an insect bite is noted, but the areas are red and warm. A few inguinal lymph nodes are palpable on the ipsilateral side.
 

Plain films show the most common hip problem of adolescence

November 01, 2006

The patient is a 13-year-old boy with pain in the left thigh and no history of trauma. His symptoms started about 2 months ago and have gradually worsened.
 

Using CT to diagnose pulmonary embolism

October 01, 2006

The patient is a 60-year-old man who presents to the emergency department with shortness of breath and tachycardia. He underwent a total hip replacement 2 weeks ago. You notice he has tachypnea. You hear a prominent second heart sound on auscultation and bibasilar rales over the lungs. The chest radiography findings are normal.
 

MRI confirms cause of facial numbness

August 01, 2006

The patient is a 34-year-old black female who presents with intermittent right facial numbness. She has no other complaints. She states the numbness has been present "off and on" for 12 months. She has no pain or pruritus. She reports that she had an episode of weakness in her left leg several months ago but that it has since resolved.
 

Difficult-to-diagnose pelvic pain

June 01, 2006

The patient is a 34-year-old woman who has been seeing you about chronic pelvic pain for some time now. You have performed a thorough workup. You have ruled out fibroids, endometriosis, and inflammation, but you cannot seem to find a source for the patient's pain. There is no evidence of bowel disease, such as Crohn's disease, or of appendicitis.
 

GI symptoms in a 34-year-old woman

April 01, 2006

Diagnostic Imaging Review
 

A common—and correctable—cause of infertility in women

Julie Vajnar, PA-C, RT February 01, 2006

The patient is a 36-year-old Hispanic woman who has been infertile for several years and who desires pregnancy.
 

A long-term smoker with right-sided weakness and “heaviness” in one leg

December 01, 2005

A 47-year-old African-American woman presented to the emergency department (ED) with right-sided weakness and what she described as feelings of "heaviness" in the right leg. She also complained of mild abdominal discomfort. These symptoms had been present for a few days. Her history was significant for smoking one pack of cigarettes per day for 25 years, and she also had a history of gastroesophageal reflux disease and arthritis. She denied shortness of breath or chest pain.
 

Knee pain and a limp after a fall

October 01, 2005

A 39-year-old woman presented in the emergency department (ED) with complaints of a fall and consequent knee pain. She stated that she had landed on her right knee and had only mild discomfort. She had no previous history of trauma or surgery. She walked into the ED with a limp but was able to bear weight.
 

Diffuse joint pain in a man with an obstructed bronchus

August 01, 2005

A 46-year-old man went to the emergency department (ED) of a local hospital complaining of joint pain, low-grade fever, and occasional chills. He received a diagnosis of arthritis and was treated and discharged. Two weeks later, he presented in the ED of our hospital with a nonproductive cough, fever, and chills.
 

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