**Figure 1.** Still images from point of care echocardiography of patient noting a dilated aortic root, early RV diastolic collapse in the context of a pericardial effusion, and an aortic dissection flap. Left: aortic root measuring 5.3cm; Right: early RV diastolic collapse with dissection flap

Cool County Cases - Aortic Dissection with Hemopericardium and Cardiac Tamponade

September 15, 2023

The Case:

A 40-year-old man with no known past medical history presented for evaluation of chest pain. According to the patient’s fiancée, the patient was experiencing chest pain one day prior to presentation. He continued to have chest pain and was seen at an urgent care clinic, where he was referred to the Emergency Department for an abnormal EKG and chest radiograph. While in the waiting room, the patient had a syncopal episode and was brought back to a station. The patient has no significant surgical or family history. He is a lifelong nonsmoker and occasional social drinker.

Vladimir Bernstein MD

**Figure 1.** CXR with thoracic metallic foreign bodies clinically consistent with an intravascular foreign body in both the SVC and IVC crossing the right atria.

Cool County Cases - You Found What Where?: A Discussion of Intravascular Foreign Bodies

September 8, 2023

The Case:

The patient was a 27-year-old male with a past medical history of insulin-dependent type 1 diabetes and prior ICU hospitalization in 2006, presenting with one day of isolated right lower quadrant pain. He endorsed compliance with his insulin. The patient was afebrile with isolated tachycardia to 120 bpm without hypotension or other vital sign abnormalities. His exam was notable for McBurney’s point tenderness and left lower extremity varicose veins. The patient’s blood work was notable for hyperglycemia without ketosis or acidosis in addition to mild leukocytosis. A CT abdomen-pelvis was notable for uncomplicated appendicitis and was incidentally positive for intravascular foreign bodies within the inferior vena cava.

Jose Reyes, MD

MS4 Infographic - Congestive Heart Failure

August 28, 2023

Here is a quick recap of the management of decompensated heart failure. Remember to always look for a reason for decompensation given the cause can be more deadly than the effect.

Morgan Kemerling, MS4

the County Consult