JEM reports最新文献

{"title":"Systemic sclerosis with associated endometrial squamous metaplasia, liver mass, adrenal lesion and bilateral breast masses: Case report","authors":"Ariella Gartenberg ,&nbsp;Capwell Taylor ,&nbsp;Arvind Haran ,&nbsp;Alexander Petrie","doi":"10.1016/j.jemrpt.2025.100165","DOIUrl":"10.1016/j.jemrpt.2025.100165","url":null,"abstract":"<div><h3>Background</h3><div>Systemic sclerosis is a rare and chronic autoimmune connective tissue disease that involves widespread vascular dysfunction, as well as fibrosis of the skin and internal organs. With the development of organ-based treatment, including ACE-inhibitors for renal crisis and goal directed therapy for heart failure, the mortality associated with renal and cardiac involvement has decreased significantly. Consequently, the increased risk of malignancy in patients with systemic sclerosis has become a topic of concern. Once the diagnosis of systemic sclerosis is made, various associated disease processes, including malignancy, must be screened for.</div></div><div><h3>Case report</h3><div>This case report details a 44 year old female presenting to the Emergency Department with abdominal pain, vaginal bleeding, pruritic rash, and two syncopal episodes. The patient was ultimately diagnosed with systemic sclerosis with extensive “salt and pepper” skin pigmentation and tightening over the arms, chest, and back, with associated bilateral breast masses, an adrenal lesion, liver mass, and endometrial squamous metaplasia.</div><div><strong>Why should an emergency physician be aware of this?</strong> A chief complaint as common as “syncope” can be an atypical presentation of less common, difficult to diagnose conditions in the emergency department, such as systemic sclerosis. While systemic sclerosis is not a diagnosis readily made in the emergency department, prompt recognition and appropriate consulting services or referrals can prevent long-term devastating complications and associated morbidity and mortality.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When itching signals more: A case of chronic pruritus leading to cancer diagnosis","authors":"Christine E. Maloney,&nbsp;William B. Prince","doi":"10.1016/j.jemrpt.2025.100163","DOIUrl":"10.1016/j.jemrpt.2025.100163","url":null,"abstract":"<div><h3>Background</h3><div>Pruritus is a common complaint seen by emergency medicine physicians and carries a broad differential encompassing dermatologic, systemic, neurologic, and psychogenic etiologies.</div></div><div><h3>Case report</h3><div>A 16-year-old girl presented to the emergency department with two months of pruritus and rash. Prior diagnoses for her symptoms included atopic dermatitis, medication-induced tactile hallucinations, and scabies. Physical examination in the emergency department was notable for a firm supraclavicular lymph node and laboratory studies were notable for systemic inflammation. Biopsy revealed a new diagnosis of classical Hodgkin lymphoma.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Recognition of refractory chronic pruritus by frontline providers as a presenting symptom of Hodgkin lymphoma can prevent diagnostic delay.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous peroneal pseudoaneurysm in the young athlete","authors":"Nina C. Lund,&nbsp;Jennifer L. Hemberg","doi":"10.1016/j.jemrpt.2025.100162","DOIUrl":"10.1016/j.jemrpt.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoaneurysm represents an unusual cause of unilateral extremity pain in the acute care setting. However, a growing body of literature supports its inclusion in the standard differential for acute-onset extremity pain. Consideration for pseudoaneurysm is particularly justified in management of pediatric patients, who may bear undiagnosed syndromes conferring increased risk of vascular injury.</div></div><div><h3>Case report</h3><div>We present an unusual case of acute onset unilateral extremity pain in an otherwise healthy 17-year-old male resulting from spontaneous peroneal artery rupture with pseudoaneurysm identified on emergent angiography. In this case, pseudoaneurysm was complicated by compartment syndrome necessitating four compartment fasciotomy and washout with delayed closure.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Our discussion reviews current evidence for emergent vascular imaging in the pediatric population. If there is a high suspicion for pseudoaneurysm or other vascular emergency, providers should prioritize computed tomography with angiography over magnetic resonance. Prompt diagnosis is critical to avert progression to compartment syndrome and/or disability. We also discuss the known causes of pseudoaneurysm and conclude that the finding of spontaneous pseudoaneurysm should trigger evaluation for related genetic and rheumatologic disorders with the aim of mitigating morbidity and mortality related to the underlying disease process.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided interscalene block for the reduction of luxatio erecta in a high-risk patient: A case report","authors":"Alexandra Over,&nbsp;Tyler Nghiem,&nbsp;Pamela Santivanez,&nbsp;Amin Mohamadi,&nbsp;Josh Greenstein,&nbsp;Barry Hahn,&nbsp;William Caputo","doi":"10.1016/j.jemrpt.2025.100161","DOIUrl":"10.1016/j.jemrpt.2025.100161","url":null,"abstract":"<div><h3>Background</h3><div>Inferior glenohumeral dislocation (IGD), or luxatio erecta humeri, is a rare shoulder dislocation, accounting for 0.5 % of all cases. It often results from hyperabduction of the arm, causing the humeral head to dislocate inferiorly. IGD is associated with neurovascular complications, particularly in elderly patients with comorbidities. Traditional management involves procedural sedation, which may be risky in high-risk patients. Ultrasound-guided interscalene nerve blocks offer a safer alternative by providing localized pain control without sedation.</div></div><div><h3>Case report</h3><div>We report the case of an 85-year-old male with multiple comorbidities who presented with IGD after a fall. Given the patient's risks, an ultrasound-guided interscalene block was used for reduction. Reduction was achieved using the traction-countertraction method, confirmed by post-reduction radiographs. The patient experienced no immediate complications, and at follow-up, showed no signs of re-dislocation or neurological deficits.<strong>Why should an emergency physician be aware of this?</strong> Ultrasound-guided interscalene nerve blocks provide a safe and effective alternative to procedural sedation for IGD reduction, especially in high-risk patients. This approach minimizes opioid use, improves outcomes, and reduces emergency department resource utilization. Future guidelines should consider incorporating this technique for similar cases, with further studies needed to evaluate long-term outcomes.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric ultrasound-guided noninvasive ventilation for altered hypertensive cardiogenic pulmonary edema: A case report","authors":"Sasikumar Mahalingam ,&nbsp;Gunaseelan Rajendran ,&nbsp;Anitha Ramkumar ,&nbsp;Kumaresh Pillur Tamilarasu ,&nbsp;Aswin Kumaran ,&nbsp;Surendar Ravipragasam ,&nbsp;Tharun kumar Ganesan ,&nbsp;Shivakumar Somannavar ,&nbsp;Vijayalakshmi Padmanaban ,&nbsp;Vinay Yareshimi ,&nbsp;Nedurumalli Naga Vaishnavi ,&nbsp;Nirmala Subbamanda Dinesh","doi":"10.1016/j.jemrpt.2025.100157","DOIUrl":"10.1016/j.jemrpt.2025.100157","url":null,"abstract":"<div><h3>Background</h3><div>Gastric ultrasound is mainly used in the preoperative evaluation of patients for aspiration risk assessment. This is accomplished by assessing the gastric antrum, which can be used to calculate the total gastric volume (TGV). We extrapolated this concept to our emergency department to manage cardiogenic pulmonary edema.</div></div><div><h3>Case report</h3><div>Here, we report a case of a 65-year-old man with comorbidities, namely, hypertension and coronary artery disease, who presented to the emergency department with acute cardiogenic pulmonary edema (ACPE) and had a drop in sensorium after a few minutes of hospital arrival, for whom we resorted to gastric ultrasound-guided noninvasive ventilation (G-NIV) under a sedation cover rather than intubation. We achieved excellent outcomes, and the patient was discharged healthy.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Although noninvasive ventilation (NIV) is a class 1 indication for ACPE, its role may be limited in altered sensorium or irritable patients. Ideally, these patients should be intubated and mechanically ventilated. However, in resource-limited settings where ventilators are not available, G-NIVs can be used. However, another advantage of G-NIV is that intubation-related complications can be avoided, resulting in early discharge and less morbidity.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound for Pupillary Assessment - A Systematic Review","authors":"Gunaseelan Rajendran ,&nbsp;Sasikumar Mahalingam ,&nbsp;Anitha Ramkumar ,&nbsp;Yuvaraj Krishnamoorthy ,&nbsp;P.T. Kumaresh ,&nbsp;Vijayanthi Vijayan ,&nbsp;Rajkumar Elanjaeran ,&nbsp;Rahini Kannan ,&nbsp;Sathya Prakasam ,&nbsp;Anas Salih","doi":"10.1016/j.jemrpt.2025.100158","DOIUrl":"10.1016/j.jemrpt.2025.100158","url":null,"abstract":"<div><h3>Background</h3><div>The conventional clinical assessment of pupils &amp; pupillometers has shown very poor interrater reliability. As a promising alternative, bedside ultrasound has emerged for pupillary assessment.</div></div><div><h3>Objectives</h3><div>Thus, we conducted a systematic review to assess ultrasound's utility and comparative effectiveness in pupillary assessment.</div></div><div><h3>Methods</h3><div>This systematic review involved searching three major databases—PubMed, Embase, and Scopus—from inception to April 2024, using predefined search terms. Inclusion criteria comprised adult patients over 18 years undergoing ultrasound for pupillary assessment, with comparison against standard methods such as pupillometry or clinical examination. Screening and data extraction were independently conducted by two investigators (GR, SM), with data appraisal utilizing the QUADAS-2 Risk of Bias assessment tool (CRD42024540402).</div></div><div><h3>Results</h3><div>Among 556 identified studies, seven met inclusion criteria, encompassing 865 patients and 1141 ultrasonographic pupillary assessments. Six of these studies reported a favourable correlation or association between ultrasound and pupillometer or clinical examination. Significant findings included a substantial correlation between ultrasound and infrared video pupillometry by Farina et al. (R = 0.831, p &lt; 0.01), by Fu et al. (Bland-Altman agreement −0.069) &amp; Modi et al. (Interclass Correlation Coefficient = 0.93). Diagnostic accuracy for identifying Relative Afferent Pupillary Defect (RAPD) had high sensitivity and specificity reported by Ramamoorthy et al. and Schmidt et al.</div></div><div><h3>Conclusion</h3><div>Our systematic review demonstrates a significant correlation/association between ultrasound and pupillometer or clinical examination for pupillary assessment. However, current evidence remains limited, and further high-quality research is needed before recommending routine use or claiming superiority over pupillometry or standard clinical assessments.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between enroller demographics and participant enrollment into an emergency department-based cancer prevention trial","authors":"Ivana-Re Baldie,&nbsp;Beau Abar,&nbsp;Brenda Hernandez-Romero,&nbsp;Nancy Wood,&nbsp;Adrienne Morgan,&nbsp;David Adler","doi":"10.1016/j.jemrpt.2025.100159","DOIUrl":"10.1016/j.jemrpt.2025.100159","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate diversity among clinical trial participants threatens external validity. Potential explanations for disparities in participation include staff bias, lack of access to studies, and racial discordance between staff and patients.</div></div><div><h3>Objectives</h3><div>We examined associations between patient and enroller demographics and enrollment into a randomized controlled trial (RCT) on cancer screening among Emergency Department (ED) patients. Enrollment through the ED ensures access to trials across a diverse patient population, and the dataset analyzed is of sufficient magnitude and diversity (both in enrollers and patients) to provide novel evaluation.</div></div><div><h3>Methods</h3><div>Research enrollers identified potentially eligible ED patients for enrollment using the electronic health record, approached patients and described the RCT, and attempted to enroll them into the study.</div></div><div><h3>Results</h3><div>A total of 4419 patient-enroller encounters were documented. Enrollment rates were similar across enroller gender (47 % when enroller was a woman; 48 % when enroller was a man), though there was mild variability across enroller race (50 % when enroller was White; 45 % when enroller was Asian; 44 % when enroller was Black). Concordance between patient and enroller race was not tied to enrollment.</div></div><div><h3>Conclusions</h3><div>Conducting research in diverse settings like the ED can mitigate access barriers, as can enroller cultural competency training.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dermal filler for penile augmentation Masquerading as abscesses on ultrasound: A case report","authors":"Mary E. Velagapudi,&nbsp;Adrienne Malik,&nbsp;Bradley S. Jackson","doi":"10.1016/j.jemrpt.2025.100160","DOIUrl":"10.1016/j.jemrpt.2025.100160","url":null,"abstract":"<div><h3>Introduction</h3><div>Dermal fillers have gained popularity over the years for cosmetic procedures including penile augmentation. With the increasing use of cosmetic enhancement dermal fillers, it is important to understand how they appear when imaged with ultrasound.</div></div><div><h3>Case report</h3><div>A 32-year-old male presented for penile pain, swelling, and erythema with a fever and leukocytosis after receiving a polymethyl-methacrylate (PMMA) filler 10 days prior in Mexico. Soft tissue point of care ultrasound was concerning for cellulitis versus abscess.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Penile dermal fillers can present with post-procedure complications including infections such as cellulitis or abscess. However, we found that particulate debris and coarse-grain heterogenous echogenicity of PMMA fillers are an abscess mimic.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple cranial nerve palsies as a rare manifestation of Lyme disease: A case report","authors":"Spencer Prete ,&nbsp;Calvin S. Jackson ,&nbsp;Erin L. Simon","doi":"10.1016/j.jemrpt.2025.100155","DOIUrl":"10.1016/j.jemrpt.2025.100155","url":null,"abstract":"<div><h3>Background</h3><div>Lyme disease is a common illness transmitted by ticks and caused by <em>Borrelia</em> bacteria. It can lead to a range of neurological symptoms known collectively as neuroborreliosis. Facial nerve palsy (CN VII) is the most common cranial nerve deficit in Lyme disease, and involvement of multiple cranial nerves is rare.</div></div><div><h3>Case report</h3><div>A 74-year-old male with no significant past medical history presented to the emergency department (ED) with symptoms of nausea, vomiting, headache, right-sided facial droop, and diplopia. The patient denied fever, rash, neck rigidity, or extremity deficits. On examination, he exhibited right-sided facial paralysis involving the nasolabial fold, lip, eyebrow, forehead, and eyelid, alongside abducens nerve palsy (CN VI). A CT scan of the head and neck did not reveal any acute processes. The patient's differential diagnosis included posterior fossa lesion, vertebral artery dissection, stroke, multiple sclerosis, and Guillain-Barré syndrome. Given the lack a of clear etiology and the patient's presentation in an endemic area, a Lyme disease panel was ordered, which returned positive. The patient was diagnosed with neuroborreliosis and treated with intravenous ceftriaxone.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>An emergency physician should consider Lyme disease in their differential diagnosis for patients presenting with cranial nerve palsies after normal imaging studies. Ordering Lyme laboratory testing and initiating treatment in the ED can decrease morbidity and mortality. It is essential to distinguish between Lyme disease and Bell's palsy in patients presenting with a facial cranial nerve palsy as treatment for Lyme disease facial palsies includes antibiotics and avoidance of steroids.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated obturator hip dislocation: A case report and literature review","authors":"Yassine Batou ,&nbsp;Amine El Farhaoui ,&nbsp;Kamal Benalia ,&nbsp;Hamza Margoum ,&nbsp;Adnane Lachkar ,&nbsp;Najib abdeljaouad ,&nbsp;Hicham Yacoubi","doi":"10.1016/j.jemrpt.2025.100154","DOIUrl":"10.1016/j.jemrpt.2025.100154","url":null,"abstract":"<div><h3>Background</h3><div>Obturator dislocation of the hip is an uncommon condition, rarely isolated because it is often associated with a fracture of the acetabulum or the femoral head. It is easy to diagnose because of the abnormal limb positioning it causes, and radiography confirms the diagnosis. The increased risk of complications, particularly avascular necrosis of the femoral head, makes it an emergency for reduction, but the time frame for reduction remains open to debate.</div></div><div><h3>Case Report</h3><div>We report the case of an isolated post-traumatic anteroinferior (obturator) dislocation of the hip in a young man and its clinical, radiological and follow up aspects.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>Understanding the clinical, radiological, and therapeutic aspects of an obturator hip dislocation is crucial for an emergency physician, as this condition, although rare, can be serious. It typically results from a violent trauma that may conceal life-threatening injuries and can lead to long-term disabling; complications.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}