Rumpel-Leede Phenomenon | Annals of Internal Medicine: Clinical Cases

We report a case of Rumpel-Leede phenomenon in an 80-year-old man presenting in the context of lightheadedness, dizziness, and elevated at-home blood pressure readings. In this case, the finding was found quite incidentally, by a routine blood pressure measurement, and was characterized by a purpuric rash on both upper extremities, which was nonpalpable and nonblanching with pressure. The pathophysiology of this rare clinical entity involves acute rupture of dermal capillaries from capillary fragility, resulting in a self-limiting nonpurpuric rash that resolves spontaneously without intervention.

Gradenigo Syndrome: Retro-orbital Pain, Abducens Palsy, and Petrous Apicitis | Annals of Internal Medicine: Clinical Cases

Gradenigo's syndrome is a rarely encountered triad of otitis media, retro-orbital pain, and abducens nerve palsy. Originally described in the early 1900s by Giuseppe Gradenigo, it is the physical manifestation of a lesion involving the petrous apex of the temporal bone, oftentimes in the setting of a pneumatized petrous apex/temporal bone; a noted normal anatomical variant that may predispose to infection. Local irritation of the ipsilateral trigeminal and abducens nerves leads to retro-orbital pain and abducens palsy, respectively.

An Interesting Case of Hypercalcemia: Intrathyroidal Parathyroid Adenoma | Annals of Internal Medicine: Clinical Cases

Hyperparathyroidism is the most common cause of hypercalcemia in the general population, with most patients presenting with mild to moderate hypercalcemia on routine bloodwork. Serum parathyroid hormone levels, followed by neck imaging studies, are helpful in diagnosing and localizing parathyroid adenomas. Ectopic parathyroid adenoma causes diagnostic challenges. Here, we present the patient case of a 65-year-old man with severe and symptomatic hypercalcemia who was found to have an intrathyroidal parathyroid adenoma, confirmed only after thyroid resection. Although imaging and laboratory results were helpful in our evaluation, pathology was the key to establishing the final diagnosis.

Culture Negative Endocarditis With Tropheryma whipplei | Annals of Internal Medicine: Clinical Cases

Tropheryma whipplei endocarditis is an increasingly recognized cause of culture negative endocarditis but is challenging to diagnose and often not accompanied by typical symptoms of Whipple disease. In this report, we describe a case of T. whipplei endocarditis and share echocardiographic images from the patient case.

Pediatric COVID-19–Associated Cavernous Sinus Thrombosis | Annals of Internal Medicine: Clinical Cases

This report details the physical and imaging findings associated with a pediatric case of cavernous sinus thrombosis (CST) that developed in the setting of COVID-19 infection, sinusitis, and orbital cellulitis. COVID-19 is rarely associated with CST but may contribute to the development by inducing hypercoagulability.

Acute Localized Abdominal Pain From Primary Epiploic Appendagitis | Annals of Internal Medicine: Clinical Cases

This report describes primary epiploic appendagitis in a 40-year-old man. He had the classic physical finding of highly localized abdominal pain and the classic computed tomography findings of a hyperattenuating ring sign and a central dot sign.

Deep Vein Thrombosis in a Patient With an Absent Infrarenal IVC | Annals of Internal Medicine: Clinical Cases

Absence of an infrarenal inferior vena cava is a rare anomaly that can be associated with deep venous thrombosis in young patients with no other provoking factors. Here, we present a patient case of a young man having groin pain and found to have gonadal vein and pampiniform plexus thromboses with an absent infrarenal inferior vena cava.

Large Free-Floating Right Atrial Thrombus | Annals of Internal Medicine: Clinical Cases

We present the images of a 67-year-old man who came to the emergency department with bilateral lower extremity pain and shortness of breath. Our images include an intraoperative transesophageal echocardiogram that shows a large, continuous free-floating right atrial mass and a large 31 cm × 1 cm thrombus that was successfully extracted. The thrombus likely could not embolize because of the patient's severe heart failure.

Correction: Diffuse Necrosis: A Rare Case of Idiopathic Black Esophagus, Duodenum, and Jejunum | Annals of Internal Medicine: Clinical Cases

Pleural and Pericardial Plaques in Asbestos Exposure | Annals of Internal Medicine: Clinical Cases

Asbestos is a generic term for a group of naturally occurring fibers composed of hydrated magnesium silicate minerals. Transported worldwide to shipyards and factories, it is a material that was widely used in construction, mining, and manufacturing. Exposure to asbestos can cause significant benign and malignant lung, pleural, and pericardial disease. Usually asymptomatic, pleural plaques are the most common radiologic manifestation of asbestos exposure. We report a case of a man who presented with heart failure exacerbation and was incidentally found to have pleural and pericardial plaques from asbestos exposure.