Absent Left circumflex (LCX) artery is a rare coronary artery anomaly usually detected incidentally on angiographic studies. We present a case of absent LCX diagnosed with Computed Tomography Coronary Angiogram (CTCA) in an 80 year old female presenting with atypical chest pain and normal cardiac parameters.

Hepatocellular carcinoma is a primary liver malignancy caused by chronic inflammation and persistent cytokine release. Although rare, they may present as large, pedunculated hepatocellular neoplasms. We present a case report on a 66-year-old male with such a mass requiring thorough pre-operative planning to complete a challenging surgical resection.

Pituitary hyperplasia due to endemic hypothyroidism is very rare and should be considered in the differential diagnosis of pituitary neoplasm, especially if the patient hails from endemic iodine deficient regions such as the Himalayas. Establishing correct diagnosis may save the patient of any unnecessary neurosurgical intervention.

Radiotherapy and chemotherapy in patients with testicular cancer often cause infertility. We describe congenital single testis patient with testicular cancer and azoospermia who was underwent ipsilateral Onco-TESE during radical orchiectomy and succeeded in sperm collection, followed by having a healthy child after ICSI.

Ultrasound-guided Erector spinae planae block was practiced after induction of general anesthesia on a male heart patient to perform a nephrectomy, with the aim of an opioid-sparing approach. We founded an important hemodynamic instability 15 minutes after the execution of the block and we want to investigate the possible causes.

Opioids are often ineffective for managing chronic non-malignant pain. If prescribed, this should be as part of an opioid trial with clear aims of therapy, tapering/stopping if it is ineffective, or if it is causing adverse effects. Clinical guidance is available but there are many gaps in the evidence.

We present a case of obstructive jaundice without biliary stones. This was due to a sclerotrophic gallbladder causing compression (Mirizzi’s syndrome) or adhesions to the extrahepatic biliary tree, pain and recurrent cholecystitis. The jaundice resolved following cholecystectomy. Mirizzi’s syndrome should be suspected in a patient with cholecystitis and obstructive jaundice after a thorough clinical assessment have excluded the usual causes of these symptoms.

Unicornuate uterus with pregnancy in the non-communicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment.

Here, we report a case of PNH with gastroduodenal lesions likely caused by transient mucosal ischemia due to thrombosis. When patients with PNH present with abdominal symptoms, thrombosis-induced gastrointestinal injury should be considered. Recognition of gastric patchy redness on esophagogastroduodenoscopy may help make the diagnosis of this potentially serious complication.

Cytomegalovirus (CMV) infection exists in 50-80% of the world’s population in clinically undetected form due to their immunocompetent status. Here we report a case of a 42-year-old COVID-19 patient with no past medical history, who received tocilizumab, which led to a massive lower gastrointestinal bleeding not responded to medical management.

Patient in sinus rhythm with dilated cardiomyopathy and low ejection fraction < 35% have a 4% risk of embolic event (1). This is a soft indication for therapeutic anti-coagulation(controversial) (2). Presence of excess Intra-cardiac Smoke-like Echoes increase risk of embolic event and switch the soft indication to strong one

Ultra-small superparamagnetic iron oxide (USPIO) compounds are used to detect nodal metastases in various types of cancer. A benign mixed tumor was evaluated with MRI including USPIO and prior to surgery. USPIO were significantly concentrated in the lesion.

The objective of this case report is to describe the operation and use of awake ECMO without anticoagulation in a patient with a nearly completely obstructive squamous cell carcinoma of the trachea. A retrospective chart and literature review was performed in a private hospital in a large municipal area.

Medullary thyroid carcinoma (MTC) typically manifests as a solitary thyroid nodule, and a miliary pattern on conventional chest imaging is not commonly observed. Here, we report a 58-year-old woman with constitutional symptoms, and innumerable small nodules on chest imaging, mimicking miliary tuberculosis. Pathologic findings confirmed a diagnosis of metastatic MTC.

Gliosis with haemorrhagic transformation is a late reported complication of stroke (1-2), Sometimes there is a big discrepancy between clinical and radiological diagnosis, Clinical decision must be multi-aspects decision and does not depend on a single unusual investigation.

Here, an 8-year-old girl is reported with bilateral horizontal gaze palsy, ataxia and drowsiness. Brain MRI demonstrated dorsal midbrain, bilateral putamen nuclei and cerebellar dentate nucleus involvement. MRS revealed an elevated lactate peak which suggested a mitochondrial disease. Finally, the molecular genetic test reported NDUFS4 gene mutation

Management of idiopathic ventricular fibrillation (IVF) is challenging because an arrhythmic substrate may be missed at initial diagnosis; therefore, careful follow-up and reassessment are necessary. Three-dimensional mapping would be useful for reassessment of IVF because it revealed an arrhythmic substrate in a patient, 12 years after his initial IVF diagnosis. .

We present a novel case of an urticaria multiforme-type drug reaction to the new cystic fibrosis medication Trikafta (elexacaftor + tezacaftor + ivacaftor). Equipped with this information, clinicians may be more prepared to counsel and treat patients if they experience similar symptoms after beginning Trikafta.