A young boy presented with history of abdominal trauma. History and initial clinical findings suggested a soft tissue injury. Due to increasing abdominal pain and fever, we proceeded with an exploratory laparotomy with a diagnosis of intra-abdominal injury, at which we found a perforated appendix. Appendicitis following blunt abdominal trauma needs high index of suspicion.

BACKGROUND Lobular carcinoma in accessory breast tissue is a rare occurrence. We present such a case in a 61-year-old woman. CASE PRESENTATION A skin nodule in the axillary skin on excision biopsy revealed invasive lobular carcinoma. CONCLUSIONS Carcinoma in accessory breast tissue is uncommon especially invasive lobular type. A high index of suspicion may avoid late diagnosis.

In this case report, we present a case of young male with left sided acute appendicitis who presented with left upper quadrant abdominal pain. The purpose of this report is to increase awareness in the emergency physicians and young surgeons of this rare presentation, with high suspicion of index could lead to facilitate early recognition and decrease morbidity and mortality.

Necrotizing fasciitis is a serious soft tissue infection rarely occurring in children after blunt trauma. Due to its high morbidity and mortality rates, a high index of suspicion is necessary for prompt diagnosis and treatment. We describe a 6-year-old Costa Rican girl who died secondary to multiple complications following a posttraumatic necrotizing fasciitis.

Wegeners granulomatosis is a necrotizing granulomatous vasculitis with multisystemic involvement. We present two cases of Wegener's presenting with otological manifestations as the first symptom. These symptoms are subtle and diagnosis may be easily overlooked. Hence a high index of suspicion is required. Early diagnosis and treatment goes a long way in improving the outcomes and in preventing ...

Prosthetic valve endocarditis occurs in 2-4% of patients with prosthetic valves and carries a mortality of around 50%. A low index of suspicion should enable early diagnosis. The empirical use of antibiotics in patients with a prosthetic valve who develop an unexplained fever is inappropriate. Careful liaison between cardiologist, microbiologist and cardiac surgeon is essential for optimal mana...

A high index of suspicion is needed when a patient presents with thyroid mass in the settings of an advanced CRC. Secondary thyroid malignancy should be considered unless proven otherwise. reatment should be determined considering extent of CRC metastasis, patient's general condition, and presence of local symptoms.

Wilson's disease is most common disorder of cooper metabolism. It has varied clinical presentations. We report a 12 years old female child presenting with genu valgum progressed over 6 months. Careful examination, high index of suspicion and investigations confirmed Wilson's disease.

Mesenteric artery embolism is a rare and an acute abdominal emergency with a very high mortality rate which requires a high index of suspicion for its diagnosis. We hereby report a 55 years old male with rheumatic heart disease in atrial fibrillation with thromboembolic superior mesenteric artery occlusion with a fatal outcome.

thickness penetration involving the rectal mucosa, as seen in this patient, is even more unusual but critical to recognize as these findings on endoscopy and CT can easily be mistaken for a primary rectal carcinoma [2] . Given that treatment of these two entities is completely different, a high index of suspicion and histologic confirmation are essential in order to avoid inappropriate radical ...