An unusual case of penetrating injury to the heart is reported. This presented late, after an initial silent period. A high index of suspicion must be maintained when chest injuries are managed conservatively. If there is doubt, a subxiphoid pericardial window may allow cardiac injury to be excluded.

Inadvertent spillage of gall stones is a rare yet important cause of delayed postcholecystectomy complications. Varied presentations and difficulty in diagnosis are the hallmarks, making it crucial to have a high index of suspicion to detect and intervene appropriately. Peritoneo-cutaneous fistulae from the retained stone can be completely excised in toto.

Mycoplasma pneumoniae infection usually presents with upper and lower respiratory tract infection. Extrapulmonary involvement is not uncommon, however. We report two cases of predominantly extrapulmonary manifestations of Mycoplasma pneumoniae infection without significant pulmonary involvement. Both cases were diagnosed by serology. These cases illustrate the diversity of clinical presentation...

The diagnosis of pulmonary hypertension requires a high index of suspicion and careful attention to assessing the severity and classification of disease. Proper evaluation and understanding of determinants of severity in pulmonary arterial hypertension are necessary to guide appropriate therapy. This article discusses the diagnosis and treatment of this complex and multifactorial disease.

Ill or immunosuppressed hospital patients are at increased risk for herpes simplex and herpes zoster virus infections, with high potential morbidity and mortality. Here, we present two cases of reactivation of herpes virus infections with delay in diagnosis, with ultimately fatal results. Since these infections are treatable, it is important to keep a high index of suspicion to facilitate early...

Blastomycosis is a fungal infection of immunocompetent hosts. We present a case of cutaneous blastomycosis acquired in New Brunswick, which provides evidence that this disease is endemic in Atlantic Canada. This case also demonstrates that the diagnosis of blastomycosis may be elusive. Perseverance, a high index of clinical suspicion and close cooperation with the microbiology laboratory may be...

We present the case history of a patient who was severely immunocompromised due to infection with the human immunodeficiency virus (HIV), and who subsequently developed acute mastoiditis due to Aspergillus fumigatus. Fungal otomastoiditis is a rarely reported complication of HIV infection. A high index of suspicion is required in these patients to facilitate early diagnosis and appropriate ther...

Organophosphorus poisoning in neonates is extremely rare and needs high index of suspicion to diagnose it. The clinical presentation is often confused with the features of sepsis like apnea, copious oral secretions, diarrhea, letharginess, seizures. There may be recurrence of manifestations due to chronic exposure. We report a classic case admitted in the intensive care unit of our hospital.

The varied clinical presentation of osteoarticular tuberculosis makes the diagnosis an enigma. This report underlines the fact that osteoarticular tuberculosis can present in the most atypical pattern. It also emphasises the need for a high index of clinical suspicion and the low threshold for tissue biopsy for establishing the diagnosis.

We present here a 45-year-old male with no past medical problem who presented with palpitations. He was found to have supraventricular tachycardia intractable to medical therapy. Later his rhythm converted to junctional tachycardia. Further workup revealed hemochromatosis to be primary etiology causing the arrhythmia. The low index of suspicion for additional workup is key to diagnosis and succ...