JEM reports最新文献

{"title":"Expedited evaluation of atypical aortic dissection with point of care ultrasound: A case report","authors":"Reginald J. Myles ,&nbsp;Addison B. Smartt ,&nbsp;Patrick Kishi ,&nbsp;Lauren B. Querin ,&nbsp;Douglas Rappaport ,&nbsp;Cody Petrie","doi":"10.1016/j.jemrpt.2025.100189","DOIUrl":"10.1016/j.jemrpt.2025.100189","url":null,"abstract":"<div><h3>Background</h3><div>Aortic dissection (AD) is a vascular emergency with substantial morbidity and mortality. Aortic dissections have been classically categorized into two subtypes: Stanford Type A aortic dissections involve the ascending aorta and/or aortic arch and require emergent surgical intervention. Stanford Type B aortic dissections involve the aortic arch distal to the left subclavian artery and descending aorta and can be managed medically. Despite its dire consequences, Type A dissections remain challenging to diagnose due to highly variable clinical presentations. While imaging modalities such as magnetic resonance imaging (MRI), computed tomography angiography (CTA), and transesophageal echocardiography (TEE) have high diagnostic sensitivity, they are time-intensive and may delay treatment initiation.</div></div><div><h3>Case report</h3><div>This case report describes the rapid diagnosis and management of a 47-year-old male patient presenting with atypical symptoms of aortic dissection, including vague chest tightness and progressive global encephalopathy. Bedside point-of-care ultrasound (POCUS) played a pivotal role in initiating timely diagnosis, intervention, and improving the clinical outcome of this patient with a Stanford Type A aortic dissection.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>POCUS can provide valuable early diagnostic insights and expedite further evaluation of Stanford Type A aortic dissection. Especially in cases of atypical presentation, POCUS is a rapid and inexpensive diagnostic tool for this highly emergent and morbid condition, accelerating further definitive imaging and treatment.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated lung cancer screening needs among emergency department patients","authors":"Beau Abar,&nbsp;George Ashji,&nbsp;David Adler","doi":"10.1016/j.jemrpt.2025.100188","DOIUrl":"10.1016/j.jemrpt.2025.100188","url":null,"abstract":"<div><h3>Background</h3><div>More than 10 % of Emergency Department (ED) cancer-related visits are for lung cancer<strong>.</strong> Timely lung cancer screening is an effective mechanism to decrease lung cancer morbidity and mortality, but only 16 % of eligible patients in the general population are up-to-date with lung cancer screening recommendations. Furthermore, many characteristics found predictive of non-adherence with screening are over-represented within the ED patient population.</div></div><div><h3>Objective</h3><div>The goal of this study is to determine risk for non-adherence with USPSTF lung cancer screening guidelines among the ED patient population.</div></div><div><h3>Methods</h3><div>Data on smoking history and lung cancer screening were abstracted from the medical charts of patients 50–80 years old presenting to the University of Rochester Medical Center ED during 2023. Adherence with guidelines among eligible patients was determined by documentation of lung cancer screening in the year prior to ED presentation. We also evaluated any screening that occurred within 120 days of their ED visit.</div></div><div><h3>Results</h3><div>A total of 559 patient charts were reviewed, with 354 having a documented history of tobacco use (63 %). Pack year estimates were available for 252 patients, and 116 patients had a 20+ pack year smoking history documented (e.g., eligible for lung cancer screening). Among those, 14 individuals received LCS in the past year, representing a screening adherence rate of 12 % at presentation. By 120 days post-visit, the rate declined to 9 %.</div></div><div><h3>Conclusion</h3><div>ED patients are at elevated risk for non-adherence with LCS guidelines, supporting previous work that demonstrates the potential value of ED-based intervention efforts.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound stratified by the wells score for the diagnosis of proximal deep vein thrombosis: A prospective study","authors":"Nicolás Rojas Muñoz ,&nbsp;Hans Clausdorff Fiedler ,&nbsp;Felipe Riquelme Morales ,&nbsp;Victor Vidal Zamorano ,&nbsp;Francisca Seydewitz Osses ,&nbsp;Sofía Rivera Gonzalez ,&nbsp;Carlos Basaure Verdejo","doi":"10.1016/j.jemrpt.2025.100187","DOIUrl":"10.1016/j.jemrpt.2025.100187","url":null,"abstract":"<div><h3>Background</h3><div>Deep vein thrombosis (DVT) affects 1 in 1000 people, with complications associated both in under and over diagnosis. Duplex ultrasound is the gold standard but its use in emergency settings is limited. Two-point Point-of-Care ultrasound protocol performed by emergency physicians can foster its diagnosis. However, 6 % of cases can be missed and its performance stratified by clinical pre-test probability is unknown.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic performance of an extended compression ultrasound (ECUS) protocol performed by emergency physicians when stratified by Wells score.</div></div><div><h3>Methods</h3><div>We conducted a prospective diagnostic accuracy study. Adult patients (≥18 years) with suspected DVT were stratified by Wells score (low, intermediate, high risk) and underwent ECUS by trained emergency physicians or residents. Results were compared to complete duplex ultrasound (CDUS) performed by radiologists within 24 h.</div></div><div><h3>Results</h3><div>Among 194 patients analyzed (54 % female, mean age 61 ± 18 years), the overall prevalence of proximal DVT was 17 %. The ECUS protocol demonstrated a global sensitivity of 97 % (95 % CI: 84.2–99.9), specificity of 94.4 % (95 % CI: 89.7–97.4), positive predictive value of 78.6 % (95 % CI: 63.2–89.4), and negative predictive value of 99.3 % (95 % CI: 96.4–100). In the low-risk group, sensitivity was 100 % (95 % CI: 29.2–100) with a negative predictive value of 100 % (95 % CI: 90.7–100).</div></div><div><h3>Conclusion</h3><div>The combined use of Wells score stratification and ECUS can reliably exclude proximal DVT in low and intermediate-risk patients, potentially optimizing emergency department resources and facilitating timely clinical decisions. In low-risk patients, this strategy may yield results comparable to comprehensive Doppler ultrasound.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare complication of thoracotomy: thoracodorsal artery pseudoaneurysm","authors":"Mustafa Koyun ,&nbsp;Bahadir Reis","doi":"10.1016/j.jemrpt.2025.100186","DOIUrl":"10.1016/j.jemrpt.2025.100186","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoaneurysms are pathological formations that can develop after trauma, inflammation, or surgery, with symptoms sometimes emerging following a latent period.</div></div><div><h3>Case report</h3><div>This paper examines a 66-year-old female patient with a history of thoracotomy for descending aortic aneurysm repair who presented to the emergency department with swelling and loco-regional pain in the left lateral chest wall. The patient was referred to the radiology unit with suspected abscess in the left chest wall. Ultrasonography (US) and color Doppler US (CDUS) revealed a thoracodorsal artery pseudoaneurysm in the area thought to be an abscess. This paper presents the radiological findings of this previously undocumented late complication of thoracotomy and emphasizes the importance of considering vascular complications in patients presenting with chest wall swelling.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Emergency physicians must recognize that post-thoracotomy chest wall swellings could be pseudoaneurysms rather than abscesses or hematomas. Careful physical examination detecting pulsation or bruit should prompt vascular imaging. Familiarity with characteristic ultrasonographic findings (\"yin-yang\" sign, \"to-and-fro\" flow pattern) facilitates accurate diagnosis. Mismanagement, such as incision of a misdiagnosed pseudoaneurysm, may cause catastrophic hemorrhage. Maintaining high suspicion in patients with thoracic surgical history ensures appropriate vascular surgery referral.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the scan tells a different story","authors":"Matthew S. Berniard,&nbsp;Monika Krzak,&nbsp;Richard Slama,&nbsp;Charles Dalton Hardesty,&nbsp;Carlo Zamora,&nbsp;Christina Cartwright","doi":"10.1016/j.jemrpt.2025.100185","DOIUrl":"10.1016/j.jemrpt.2025.100185","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care ultrasound (POCUS) has become a standard in emergency care for its rapid, accurate bedside diagnostics and procedural guidance. Our institution developed a tailored, comprehensive POCUS course aligned with American Board of Emergency Medicine guidelines. Unlike many physician-only programs, our course also trains Advanced Practice Providers (APPs) alongside their supervising physicians. Two weeks after completing the course, an APP applied this training in a rare case, directly contributing to a life-saving intervention. While not a substitute for residency-based ultrasound training, this experience highlights the powerful impact of structured ultrasound education for all emergency providers.</div></div><div><h3>Case report</h3><div>A 33-year-old male presented to the emergency department (ED) with progressively worsening, atraumatic, right knee and calf pain over a two-week period leading to difficulty ambulating. Initially evaluated by an APP in the low-acuity area, a supervising physician was consulted to proctor and perform a proximal lower extremity POCUS for suspected deep vein thrombosis (DVT). While no DVT was identified, the scan revealed a 3.8 cm arterial structure consistent with a massive popliteal artery aneurysm. Computed Tomography Angiography confirmed the diagnosis and raised concern for rupture. The patient was taken emergently for bypass surgery. Investigation revealed the aneurysm was secondary to tertiary syphilis in the setting of undiagnosed human immunodeficiency virus (HIV).</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Emergency Medicine physicians should embrace the broad utility of ultrasound as a rapid, accurate, and cost-effective diagnostic tool that enhances patient care, especially in resource-limited settings. This case underscores ultrasound's role in the timely diagnosis and treatment of vascular emergencies, while highlighting the need for comprehensive ultrasound training programs inclusive of all provider types.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune checkpoint inhibitor-associated polyneuropathy in malignant pleural mesothelioma: A case report","authors":"Mehdi Kashani ,&nbsp;Colleen Leu-Turner ,&nbsp;Douglas E. Rappaport ,&nbsp;James Kelley (Senior Author)","doi":"10.1016/j.jemrpt.2025.100184","DOIUrl":"10.1016/j.jemrpt.2025.100184","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs), such as nivolumab and ipilimumab, have revolutionized treatment for malignant pleural mesothelioma (MPM) but may cause rare, immune-related neurological adverse events.</div></div><div><h3>Case presentation</h3><div>A 71-year-old man with recurrent MPM developed rapidly progressive weakness, sensory loss, and neuropathic pain following his second cycle of nivolumab/ipilimumab. Workup ultimately revealed inflammatory demyelinating and axonal polyradiculoneuropathy. Cerebrospinal fluid analysis supported an autoimmune process. High-dose corticosteroids and intravenous immunoglobulin (IVIG) were initiated, resulting in functional improvement. He was discharged on a steroid taper with outpatient follow-up.</div><div>Why should an emergency physician be aware of this?</div><div>This case highlights the importance of recognizing immune-mediated polyneuropathy as a potential complication of ICI therapy. Timely diagnosis, multidisciplinary care, and early immunosuppressive treatment can lead to meaningful recovery.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All choked up; male with foreign body sensation","authors":"Harrison Barnhart,&nbsp;Gordon Tse,&nbsp;Norman Ng,&nbsp;Amin Mohamadi,&nbsp;Barry Hahn","doi":"10.1016/j.jemrpt.2025.100183","DOIUrl":"10.1016/j.jemrpt.2025.100183","url":null,"abstract":"","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leech infestation-a rare cause of upper gastrointestinal bleeding: A case report","authors":"Mengesha Akale ,&nbsp;Dawit Zena ,&nbsp;Fitsum Mesfin ,&nbsp;Nahom Addisu","doi":"10.1016/j.jemrpt.2025.100182","DOIUrl":"10.1016/j.jemrpt.2025.100182","url":null,"abstract":"<div><h3>Background</h3><div>Leeches are rare blood-sucking endoparasites found in fresh water and can cause potentially life-threatening complications. Leech infestations are an uncommon cause of upper gastrointestinal bleeding, often presenting diagnostic challenges and rarely considered in the differential diagnosis. The available literature on leech infestation is limited.</div></div><div><h3>Case presentation</h3><div>A 20-year-old woman from rural Ethiopia presented with bloody vomiting and spitting of saliva mixed with blood of 6 days duration. There was bright red blood over the posterior part of the tongue, palate, and oropharynx. An endoscopy revealed a motile dark brown worm in the hypopharynx, specifically in the pyriform sinus, along with active bleeding. Under conscious sedation, a 5 cm long leech was removed gently using nontoothed forceps. Bleeding was stopped immediately and patient discharged in stable condition.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When booming in the ears is more than benign tinnitus","authors":"Bryan Kharbanda,&nbsp;Nicholas San Roman","doi":"10.1016/j.jemrpt.2025.100181","DOIUrl":"10.1016/j.jemrpt.2025.100181","url":null,"abstract":"<div><h3>Background</h3><div>Patients commonly present to the emergency department (ED) after initial outpatient evaluations fail to achieve timely diagnosis or symptom control. Many subjective-seeming neurologic symptoms affect a large portion of the US population at least once in a patient's lifetime (tinnitus 15 %, dizziness 30 %, and vertigo 40 %) but remain a diagnostic and treatment challenge for physicians. The ED in the United States plays a major role in risk stratifying these complex patients.</div></div><div><h3>Case presentation</h3><div>A 49-year-old woman with history of hypertension presents to the ED complaining of hearing a “booming” sensation synchronous with her pulse in her right ear for weeks. She was initially evaluated by her primary care physician and diagnosed “possible tinnitus” and referred to ENT. There, she received an audiogram deemed “normal.” Weeks after her initial evaluation, she mentioned new and progressing symptoms of dizziness to her primary care physician who thus referred her to the ED. In the ED, the patient was found to be hypertensive, anxious, and with slight ataxia. CT angiography of the head and neck found complete occlusion of the left internal carotid throughout the entire left cervical region. The patient was started on heparin, anti-hypertensive medications, and transferred to a comprehensive stroke center after discussion with their neuro-interventionalist.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Pulsatile tinnitus (PT) is rare but the causative differential diagnosis is vast and may be complex. PT should be considered an otologic symptom rather than its own diagnosis. Recent data suggests that an underlying cause can be identified in about 70 % of PT cases through proper diagnostic work-up (6). Failure to recognize the need for further work-up and diagnostics could lead to significant morbidity and mortality. Early recognition is crucial as treatment options are available to mitigate permanent neurologic deficits or death for dangerous causes. The treatment options vary markedly, however, depending on the ultimate etiology for PT. Accurate and timely diagnosis entirely drive effective management of pulsatile tinnitus.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small bowel obstruction caused by hiatal hernia","authors":"Jacob Cabrejas,&nbsp;Kara Zweerink,&nbsp;Wesley Eilbert","doi":"10.1016/j.jemrpt.2025.100180","DOIUrl":"10.1016/j.jemrpt.2025.100180","url":null,"abstract":"<div><h3>Background</h3><div>A hiatal hernia is caused by herniation of a portion of the stomach or other abdominal viscera into the thorax through the esophageal hiatus of the diaphragm. It is a common condition and asymptomatic in most cases.</div></div><div><h3>Case report</h3><div>We present the case of a 52-year-old male with a past medical history of previous hiatal hernia repair who presented to the emergency department with one day of diffuse abdominal pain and multiple episodes of emesis. Bowel sounds were heard on auscultation of his left chest. Computed tomography of the abdomen and pelvis demonstrated multiple abdominal contents herniating through the esophageal hiatus. Multiple dilated loops of small bowel were seen in the left hemithorax with decompressed small bowel seen more distally, indicating a small bowel obstruction with a transition point in the thoracic cavity.</div><div><em>Why should an emergency physician be aware of this?</em> Hiatal hernia is a common condition. While rare, large hiatal hernias may result in herniation of small bowel with the potential complication of bowel obstruction.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 3","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}