Residency Program - Case of the Month
Each month, the housestaff and faculty in the Department of Pathology and Laboratory Medicine highlight a challenging diagnostic case from all subspecialty areas. Written in a multiple choice format with a discussion to follow, these educational cases represent diagnostic dilemmas due to interesting or unusual clinical presentations, microscopic or gross or other testing characteristics, or demonstrate rare diseases or conditions. We hope you’ll enjoy these cases.
Disclaimer: Review of the Case of the Month is intended for educational purposes ONLY, NOT for research.
The patient is a 54-year-old right-hand dominant man with a history of epilepsy and obstructive sleep apnea who has been experiencing recurrent refractory seizures.
A 70-year-old male with a medical history significant for myelodysplastic syndrome presented with over 4 weeks of lower back pain, “bruising”, and axillary lymphadenopathy.
A 75-year-old male presented to the hospital with early satiety and melena. An upper endoscopy was performed and revealed a large proximal gastric cancer.
The patient is a 49-year-old male with a history of untreated HIV complicated by previous pneumocystis jiroveci pneumonia, recent histoplasmosis and blastomycosis, CMV infection, oropharyngeal candidiasis, syphilis, and delusional disorder.
A male in his early thirties with no significant past medical history presented with perineal pain several weeks after a ground level fall and was found to have a large peritoneal hematoma requiring drainage.
76-year-old patient with diffuse pelvic pain and with history of BCG refractory high-grade urothelial carcinoma status post neoadjuvant chemotherapy with 2 cycles of gem/carbo.
A 65-year-old female with splenomegaly, hepatomegaly, and adenopathy presents for a lymph node biopsy to rule out lymphoma.
A female in her mid-50s presented with a gradually increasing painful vulvar mass for last 8 months.
A 67-year-old man with worsening bilateral otalgia, dry cough, hemoptysis, fatigue and hoarseness for the past 2 months.
A 70-year-old female with a past medical history of primary biliary cholangitis who developed liver failure at the age of 43 and underwent liver transplantation two years later at the age of 45 presented with progressive abdominal distension, early satiety, weight loss, and fatigue.
The patient is a 55-year-old man with chest pain and dyspnea after a ground-level fall.
The patient is a 50-year-old male who presented with facial swelling near the region of the right parotid gland for several months.
A 77-year-old male presented to the hospital with gross hematuria. The patient has a history of benign prostatic hyperplasia (BPH) with outflow obstruction and had an elevated prostate specific antigen (PSA) in September of 2013 of 20.2 ng/mL (H).
A middle-aged patient with a history of HIV and poor adherence to antiretroviral therapy (HAART) presented to an outside institution with 1-week history of abdominal pain, nausea, and constipation.
This is a 69-year-old South Asian female who presented with a rash of one month’s duration, long-standing neuropathy in a stocking glove distribution, polyarthritis, and fever. The cutaneous eruption consisted of violaceous to erythematous patches and plaques with associated edema, starting on the bilateral hands and feet and gradually spreading to the proximal limbs and trunk.
A 24 year old Caucasian female with chronic kidney disease stage V had been on peritoneal dialysis for two years. Last year, she was evaluated for kidney transplantation by our adult transplant nephrology clinic.
The patient is an 85-year-old man with intermittent gross hematuria for the past few months. He reports intermittent symptoms of hesitancy and frequency.
A 44-year-old male presents with a two-year history of swelling in the right jaw, which was previously treated with hot compresses and antibiotics with some immediate improvement. For two months prior to presentation, the right jaw mass/swelling grew noticeably larger.
A 22-year-old woman with a history of chronic abdominal pain, nausea, and gastroesophageal reflux disease underwent esophagogastroduodenoscopy to reveal diffuse white patches of esophageal epithelium with associated epithelial sloughing.
A 65-year-old man presented with one week of non-radiating right lower quadrant abdominal pain associated with nausea, vomiting, and anorexia.
Presentation: 25 yo previously healthy male presented with fever, sore throat, night sweats and weight loss found to have leukocytosis.
Patient is a 71-year-old woman with persistent lower left quadrant pain and a CT scan that showed a solid 4 cm right ovarian mass. No extraovarian masses, ascites, or pleural effusion were noted. Family history was concerning for multiple relatives with breast cancer and a daughter who died in her early 30s from metastatic colon cancer.
A 72-year-old female had history of a thyroid mass discovered by her PCP on routine exam. Thyroid ultrasound performed at outside hospital showed bilateral thyroid nodules: a right lobe heterogeneous predominantly hypoechoic solid 3.2 x 2.3 x 2.0 cm nodule (considered suspicious), and a left lobe upper pole 2.5 x 1.9 x 1.6 cm nodule (considered mildly suspicious).
The patient is a 32-year-old woman with a nine-month history of constitutional symptoms of ‘just not feeling good.’ She describes symptoms of abdominal malaise, epigastric discomfort that abruptly began without any triggers. She denies any vomiting, diarrhea, or melena. Her past medical history is significant for obesity. She does not drink, smoke, or use any illicit substances.
The patient is an 80-year old woman who presented with sudden onset of sharp, constant pain in her epigastrium that radiates to her chest. An abdominal ultrasound performed a few months prior was notable for multiple calculi, diffuse wall thickening, and a 0.5 cm polyp in the gallbladder.
A 43-year-old female presented to the emergency department with a seizure. She has history of alcoholism and seizures attributed to alcohol withdrawal. She reported that she had been binge drinking for the past two days.
A 29-year-old G5P2022 presented for repeat cesarean section at 38 weeks gestation. The pregnancy was a twin gestation complicated by intrauterine fetal demise of one twin at 11 weeks gestation. Subsequent chorionic villous sampling of both twins showed a normal 46 XX karyotype in the living twin and a 69 XXX genotype in the demised twin.
A 72-year-old man presented to the emergency department with a chief complaint of abdominal pain, vomiting, poor appetite and weight loss. CT demonstrated thickening of the duodenum and a right adrenal mass. He underwent endoscopy with biopsy showing duodenal adenocarcinoma. For his adrenal mass, he was noted to have mildly elevated urine catecholamines and metanephrines.
A 66-year-old male presented at our institution for the evaluation of his right neck mass. After one month of the mass appearance, he started developing symptoms that included difficulty swallowing solids and change in voice. Ultrasound of his neck revealed an 18 mm slightly irregular hypoechoic mass in the submandibular gland.
A 34-year-old woman presented to our institution with a history of acute abdominal pain, nausea, and non-bilious, non-bloody vomiting. She had a history of lupus nephritis for which she was treated with peritoneal dialysis as an outpatient.
Patient is a 37-year-old G5P2032 with no significant past medical history who presents with severe abdominal pain. CT abdominal and pelvis reveal bilateral ovarian masses with central necrosis in addition to moderate ascites and nodularity suspicious for ovarian malignancy.
A previously healthy adolescent male presents with one week of jaundice and abdominal pain. Liver enzymes are elevated, and a CBC is normal. Radiology imaging reveals an obstructing mass at the pancreatic head.
A 24 year old homeless man presented to the UCD Medical Center with five months of progressive diarrhea which worsened in the past 2 months. According to the patient there was no inciting agent which has precipitated his diarrhea.
A 17-year-old female presented with right femur fracture and underwent intermedullary nailing and open reduction internal fixation. She complained right hip pain again 9 months after the surgery. X-ray revealed hardwire failure and non-union of the fracture.
A fully vaccinated 14-year-old girl with no significant medical history presented to our institution with a history of progressive decline. Ten days prior to admission, she experienced vague abdominal pain, followed by a sore throat. She developed chest pain, and after experiencing a fall, was found to have altered mental status with speech difficulties.
A 69-year-old female with a history of cecal tubular adenoma and tubulovillous adenomas and a family history of colon cancer presented for a repeat colonoscopy. A 2 cm sessile polyp at the base of the cecum was removed by hot snare and cold forceps.
The patient is a 69-year old woman who presented with a longstanding, recently enlarging left thyroid nodule. The patient initially elected for observation after having the nodule first evaluated in 2006. Serial ultrasounds over the years showed that the nodule had remained stable.
The patient is a 64-year-old woman who presented to an outside gastroenterologist for evaluation of dysphagia. During esophagogastroduodenoscopy, the patient was noted to have an submucosal mass in the duodenum, possibly representing a prominent papilla.
A 78-year-old man with a history of biliary colic admitted to outside hospital in for gallstone pancreatitis. He underwent laparoscopy for gallbladder removal but the procedure was aborted due intraoperative findings of a cirrhotic liver. The follow up CT scan showed a hypodense lesion in the pancreas and a follow up EUS with biopsy demonstrated a mass in the uncinate process.
A 77-year-old G4P4004 female presented for evaluation of post menopausal bleeding. She had complaints of daily vaginal spotting for the past one month.
A 33-year-old woman presented with heavy vaginal bleeding with large clots lasting for more than two weeks. Her signs and symptoms are also significant for abdominal pain and with the presence of a large 6 cm ecchymosis over the center of her abdomen without any known trauma.
The patient is a 68 years old female, presented with shortness of breath and lower extremity swelling. She reports a significant abdominal distension, early satiety and small caliber bowel movements for the past 2 weeks. She also reports significant pain diffusely throughout the abdomen.
The patient is a 76-year-old male with a history of diabetes mellitus and bullous pemphigoid. He presented with diffused erythema, edema and slight fissuring in both palms without active blisters.
A 5-week-old female presented with blood in her diaper. On examination, she was unremarkable without any evidence of pain, fever, or rash. However, placing a Foley catheter revealed gross hematuria.
The patient is a newborn baby boy delivered at 37 weeks with a large 9 cm multicystic mass overlying his neck that significantly impaired his respiratory efforts. The mass was removed by ENT and at the time of surgery, frozen sections demonstrated tissue consistent with thyroid.
This patient is a 21-year-old female who initially presented with epistaxis, severe back pain and fatigue. She was found to be neutropenic with increased blasts and subsequently diagnosed with BALL with t(9;22)(q34;q11) BCR/ABL1.
Patient is 10-year-old female with profound iron deficiency anemia. Labs show hemoglobin of 3.6 g/dL, mean corpuscular volume of 54, serum iron of less than 5 ng/dL, serum ferritin of 1 ng/dL, and thrombocytosis with platelet count of 840/uL. Celiac serology was negative.
The patient was a 21-month-old, previously healthy girl who presented with abdominal distension, emesis, and irritability to an outside hospital. She was found to have a liver mass.
A 74-year-old man has a 1.5 year history of a right inferior pole renal mass seen incidentally on CT scan. He has been asymptomatic and under observation with imaging studies. Surveillance CT revealed a slight increase in mass size from 1.8 cm to 2.2 cm. PET/CT scan demonstrated a FDG avid lesion.
A 13-year-old female with past medical history of Sickle cell disease (Hb SS disease) had multiple transfusions, iron overload, abnormal transcranial doppler (TCD), status post hematopoietic stem cell transplant (HSCT) complicated with GVHD in skin and lungs during transplant course, HHV6 reactivation, Oral/labial HSV infection.
A 52-year-old man presented with progressive eosinophilia for two years. His initial eosinophilia was mild, with absolute eosinophils of 2,400/mm3, but the absolute eosinophil count increased to 13,300/mm3 two years later.
The patient was a 66-year-old woman with a past medical history of chronic hepatitis B infection (for more than 30 years – asymptomatic), hypothyroidism, hyperlipidemia, and degenerative joint disease. She also had a family history of Hodgkin lymphoma (mother). She underwent an ultrasound (due to a low GFR) that identified several hypodense lesions in both kidneys.
A 75-year-old man presented with a 2-year history of a lesion on the left temple. A shave excision was performed on a 1.1 cm well-demarcated, ulcerated, brown pigmented plaque.
The patient is a 70 year old Caucasian male, who is transferred from an outside institution with complains of increasing black stools, fatigue, nausea and vomiting and vague upper abdominal pain. He states that his symptoms have been present for the past two months and he has been having fatigue, light headedness and weight loss.
An 18-year old female with a history of asthma presented to the clinic with the primary complaint of bilateral knee pain (4-5/10) that is mostly associated with running. She reports easy bruising and superficial hematomas in the past which resolve with difficulty.
The patient is a 44-year-old Asian man with a three month history of worsening cough and painful deep inspiration. The cough is occasionally productive of yellow/green sputum and, one week prior to presentation, he began noticing streaks of bright red blood in the sputum.
The patient is a young adult with a history of systemic lupus erythematosus (SLE) complicated by class IV-V lupus nephritis requiring prolonged immunosuppression on a multi-drug regimen. New onset headaches, confusion, and behavioral changes prompted evaluation by neurology.
A 46-year-old G2P2 female presented with bleeding and cramping pelvic pain that had gradually gotten worse. She complained of spotting in between her periods with clotting every six months. She had been experiencing dizziness for about a month.
A 62-year-old female with a remote past medical history of hairy cell leukemia (HCL) presented to an outside hospital with progressively worsening headaches accompanied by short term memory loss, expressive aphasia, and lethargy.
The patient is a 55-year-old woman with a history of alcoholic cirrhosis, currently being treated for breast cancer, who noticed a slowly-growing left cheek mass one year ago.
The patient is a 65-year-old woman with a history of hypothyroidism, colonic tubular adenomas, and new onset hematochezia. She underwent a colonoscopy two months prior to presentation as part of her hematochezia workup, which revealed a 1 cm. firm and rubbery rectal mass, in addition to other adenomatous polyps.
The patient is a 37-year-old man with a month-long history of gradual left testicular enlargement and painful swelling. Ultrasound revealed a 7.9 cm heterogeneously hypoechoic mass replacing the majority of the left testicle.
A 38-year-old man was transferred from outside facility for evaluation and management of an intra-abdominal mass. Pertinent history begins in 2008 when the patient underwent an excision of a skin lesion on his back. He states that the mass was 1 x 1.5 inches. Pathology showed melanoma (he could not specify the type) and he was told that no further treatment would be required.
A 69-year-old female returns for follow up regarding her lobular carcinoma in situ (LCIS). She has a long history of LCIS and has been on long-term follow up since 1997. Her annual mammogram of April 2015 was negative with a heterogeneously dense parenchyma, which may limit the sensitivity of mammography. A subsequent breast MRI revealed a linear non-mass enhancement.
A 20-year-old man presented with a 1 year history of slowly progressive left sided proptosis. He denied any visual changes or associated pain.
The patient is a 6-year-old boy who presented with 4 days of vomiting and bloody diarrhea. Significant exposures included recent consumption of unpasteurized apple cider. Despite receiving IV fluids he became oliguric and developed mild edema in the face and extremities.
The patient is a 2.5 year old male, who presented with a slow growing papule on the right anterior thigh; first noticed around one year of age. The papule had occasional bleeding but no ulcer noticed at the time of examination.
A 20-year-old female with history of Systemic Lupus Erythematosus (SLE) and lupus nephritis causing renal failure for which she is on hemodialysis. She was on chronic immunosuppression and subsequently developed a left thigh nodule and numerous lung nodules. Incisional biopsy of the left anterior thigh mass showed suppurative granulomatous dermatitis containing fungi consistent with chromomycosis and the patient was started on Itraconazole.
A 74-year-old woman underwent living donor kidney transplantation for chronic kidney disease on 5/15/2012. The patient developed fatigue, fever, cough, diarrhea and small bowel obstruction 30 months after the transplantation and was found to have bilateral pleural effusion.
The patient is a 64-year-old female with an unremarkable past medical history who presented for evaluation of a slow growing swelling on the floor of her mouth. Physical examination revealed a firm mass (2.7 x 1.1 cm) that appeared confined to the right side with normal overlying mucosa.
An 82-year-old man who presented with fever, diaphoresis, fatigue, and dysphagia. On exam, he was noted to have prominent lymphadenopathy including enlarged tonsils as well as splenomegaly.
A 17-year-old female with past medical history of Anomalous Pulmonary Venus Connection (Left to right shunt) and Biphasic thoracolumbar Scoliosis with Restrictive Lung Disease. She present with proximal muscle weakness since last year.
A 66-year-old female with a past medical history of peptic ulcer disease presents to the Emergency Department with 5 weeks of vague epigastric abdominal pain with non-bloody non-bilious emesis. She does not report any weight loss, fever, chills or lymphadenopathy.
A 53-year-old male with history of neurofibromatosis type 1 (NF-1) presented to the ED with a 3-week history of abdominal pain. On physical examination, multiple plexiform neurofibromas and cafe-au-lait spots were noted.
A 30-year-old male with a history of Hodgkin lymphoma which was diagnosed 5 years ago. He received chemotherapy followed by an allogenic stem cell transplant in 2013. He subsequently developed poikiloderma, keratoconjunctivitis sicca, chronic diarrhea and lost 20% of his weight over a period of 4 months.
The patient is a 43-year-old woman and navy veteran who was brought to the attention of the Mather Veterans Affairs otolaryngology service after a CT scan conducted as part of a routine trauma survey following a motor vehicle accident revealed a nodular thyroid.
The decedent is a 55-year-old Caucasian male with a past medical history of diffusely metastatic carcinoma, severe chronic obstructive pulmonary disease (on 4 L home oxygen therapy), extensive smoking history, and asbestos exposure history. He had symptomatic lesions and pathologic fractures at the lumbosacral spine, the left pelvis, the left femur and the left upper extremity. He was not a candidate for systemic treatment or surgery but was considering possible radiation therapy.
The patient is a 24-year-old O RhD positive G2P1 female at full term in her pregnancy. Her history includes HbSC disease and she has had sickle cell pain crises episodically requiring transfusions. Fetal monitoring has been stable.
The patient is a 57-year-old male with a history of atrial fibrillation on coumadin, chronic obstructive pulmonary disease, hypertension, gout, and alcohol abuse who presented with a three day history of melena. His INR was 7.
The patient is a 35-year-old female with a medical history significant for hypothyroidism, depression, and asthma. She presented to her primary care physician in January 2014 with four days of fever and cough after having returned from a trip to Egypt and Israel for which she was placed on antibiotics.
An 83-year-old female G2P2 with a past medical history of hypertension, hyperlipidemia, hypothyroidism and enterococcus endocarditis in 2013 presented in February 2014 with mid-abdominal pains. She was primarily diagnosed with gallstones. In March 2014, she returned to the hospital with abdominal pains. A CT scan showed a large cystic pelvic mass.
A 2-year-old female with no significant past medical history presented to her primary care physician six months prior with complaint of dysuria, she was placed on empiric antibiotics, urine cultures were found to be negative and she was sent home with resolution. She had two more distinct episodes of dysuria with negative urine cultures which resolved after one week. She presented again five months later with similar complaints in addition to a rash and a fever.
The patient is a 47-year-old male with no significant past medical history who presented with a palpable mass of several years in the anterior and lateral aspects of the left lower leg. The mass was first attributed to a musculoskeletal injury and no further evaluation was obtained. However, the lesion continued to progress in size with severe pain.
The patient, a 91 year old female, presented with a 6 month history of vaginal bleeding and mild abdominal discomfort.
The decedent is a 57-year-old female with a history of papillary serous ovarian cancer (stage IIIc) who underwent a radical hysterectomy and debulking of her primary tumor followed by six cycles of intraperitoneal chemotherapy.
A 50-year-old female with a past medical history of fibromyalgia, chronic pain, and 25 pack year smoking history, who presented to the ED at an outside hospital one year ago with severe left upper quadrant pain without fever, chills, anorexia, nausea, vomiting, diarrhea, constipation, or back pain. She additionally had a 40 lb weight loss (unintentional) over the prior 8 months.
A 70-year-old woman with malaise, hot flashes, and 5-10 pound weight loss was found to have an elevated hematocrit of 46. She was referred to UC Davis Urology for further evaluation.
A 28-year-old woman with no significant past medical history presented with a palpable left neck mass which had been slowly increasing in size for approximately one year and was not associated with pain or other symptoms.
The patient is a healthy 80-year-old male with a large, right, painless scrotal swelling that has progressed in size slowly for many years.
A 22-year-old G1P0 female with an uncomplicated pregnancy history was at 31 weeks 6/7 days gestational age by last menstrual cycle when she presented to her OB clinic for routine screening. There was imaging concern for congenital anomalies, so she was transferred to our institution for management.
A 3-year-old boy presented with an enlarging mass in front of his ear. There was no bleeding or bruising, change in visual acuity, fever, pain, or drainage from the ear.
The patient is a 55 year old male with a past medical history significant for hypertension and osteoarthritis who presented with a 3 to 4 month history of alternating diarrhea with steatorrhea and constipation. He also noted fevers and an unintentional 40 lbs weight loss.
The decedent was a 33 year old male with a prior history of illicit drug use who complained of vague abdominal pain 1 week prior to death.
75 year old male who presented with dysphagia and epigastric discomfort.
A newborn female infant born at 37 weeks gestation with a left –sided multicystic lung mass discovered at 25 weeks on ultrasound.
63-year-old female with a past medical history of gastrointestinal bleeding from a gastric ulcer and H. pylori infection presented with new complaints of melena, progressive weakness, fatigue and shortness of breath.
55-year-old para 1 female who presented with abdominal pain and a palpable mass.
27 year-old male with a recent history of recurrent pneumonia (5 times over the past two years).
37 year-old nulligravida female with a history of abnormal menstruation and more recently, episodes of severe lower abdominal cramping and copious vaginal bleeding.
44 year-old pravida 2, para 2 woman with a seven-year history of a pedunculated vulvar mass.
11-year-old girl with no significant past medical history who presented with a headache located behind the right eye, with radiation to bilateral temples.
64 year-old female with a past medical history of cervical cancer s/p vaginal hysterectomy, hemorrhagic cyst s/p right oopherectomy, hypertension, and recurrent pulmonary emboli. She presented with abdominal pain for two weeks. Computed tomography (CT) showed a multi-cystic pelvic mass.
86 year old male with a past medical history significant for diabetes mellitus and hypertension who was incidentally found to have a left lung mass discovered on chest radiographs (during work-up for dull chest pain).
40-year-old Asian female status post right ovarian cystectomy and left salpingo-oophorectomy for seromucinous cystadenoma of the right ovary and mixed endometrioid and mucinous tumor of low malignant potential of the left ovary.
63-year-old female presents with worsening abdominal pain, distention, nausea and progressively fewer and smaller bowel movements.
16-year-old girl with no significant past medical history presented with a tender right breast lump.
53-year-old Caucasian male with a past medical history significant for hypertension.
64-year-old female, with a past medical history significant for chronic obstructive pulmonary disease, diabetes mellitus, and hypertension, who was found to have a right adrenal mass on chest CT (during work-up for pneumonia).
62-year-old male, with no significant past medical history, who presented with a chief complaint of a lump in his right testicle causing mild discomfort.
65-year-old female who presented with increasing abdominal distention and pain.
2-year-old boy with a soft tissue mass in the thenar eminence of the hand. MRI showed an amorphous area of enhancing soft tissue in the thenar eminence and a suggestion of increased soft tissue between the radial metacarpals.
39 year-old female with a 5-month history of persistent abdominal pain and cramping. A colonoscopy was performed and found no abnormalities.
54 year-old woman with a history of melanoma of the right leg and a left adnexal mass that was found on CT when the patient presented to the ED with abdominal pain.
38 year-old male, with a past medical history significant only for gastroesophageal reflux disease, who presented with burning epigastric pain.
38 year-old male with a history of a left testicular varicocele and a chief complaint of infertility for four years.
30 year-old female from Sudan with no significant past medical history who presents with an incidental finding of persistent mildly elevated liver function tests and microcytic anemia.
66 year-old female with a past medical history of hypertension, atrial fibrillation and congestive heart failure who underwent a computed tomography (CT) scan of the abdomen to evaluate for an existing abdominal aneurysm.
22 year-old woman with a 10 year history of menorrhagia.
15-month-old female with a 1-week history of fever, fatigue, and maculopapular rash which had recently resolved.
9-year-old boy with no past medical history who had a right flank mass which had been growing over several months.
31-year-old female with a prior history of a myelomeningocele who was noted to have a new cystic structure within the pelvis/sacrum region at the time of a C-section.
68 year-old man who initially presented with pancreatitis and was incidentally found to have hypercalcemia due to hyperparathyroidism.
34-year-old male with no significant past medical history who presented with right painful lump, behind right ear for 2.5 months.
56-year-old female with no significant past medical history who presented to her PMD with on going non-specific microscopic hematuria.
33-year-old Caucasian female with no significant past medical history who presented with a chief complaint of progressive shortness of breath over a course of 3 months.
79-year-old man with a history of Barrett’s esophagus.
37-year-old female with a two to three month history of abdominal pain, burning on urination, occasional fevers, weight loss of 10 lbs. and amenorrhea for a period of 6 months.
The patient is a nulligravida 47-year-old female with Turner’s Syndrome who presented with a 10 month history of irregular vaginal bleeding.
80 year-old woman who presented with a three month history of multiple urinary tract infections and one day of gross hematuria.
51-year-old female with a right upper eyelid swelling present for at least nine months.
57-year-old male who noted a “pop” in his right thigh while doing heavy labor activities.
63-year-old male who presented to the emergency room because of sharp chest pain radiating to the scapula.