The delayed appearance of multi-organ manifestations from the precipitating factors may lead to difficulties in diagnosing CES.Complicated acalculous cholecystitis can be one of the infrequent hepatobiliary manifestations of CES.

Cholesterol embolization syndrome (CES) is an atherosclerotic complication that usually develops after a vascular procedure/surgery or thrombolytic therapy or, rarely, spontaneously, and results in nonspecific cutaneous, renal, central nervous system and, less often, gastrointestinal manifestations that may mimic other systemic diseases.The delayed appearance of multi-organ manifestations from the precipitating factors may lead to difficulties in diagnosing CES.Complicated acalculous cholecystitis can be one of the infrequent hepatobiliary manifestations of CES.Patent foramen ovale is a risk factor for systemic embolic events such as cryptogenic stroke. Far less commonly, patent foramen ovale is associated with non-cerebral systemic embolic events. Paradoxical coronary artery embolism is a rare and underdiagnosed cause of acute myocardial infarction. It should be considered in patients presenting with myocardial infarction and an otherwise low-risk profile for atherosclerotic coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST elevation myocardial infarction. Echocardiography demonstrated patent foramen ovale with a significant shunt. In addition to the treatment of the acute coronary event, patent foramen ovale closure was performed to prevent recurrent paradoxical embolic events.

Coronary artery embolism is an established cause of acute coronary syndrome, but paradoxical coronary artery embolism causing myocardial infarction is rare and requires a high degree of clinical suspicion for diagnosis.Recognition of this condition is important as it has an influence on management and prognosis. A search for venous thrombosis and underlying prothrombotic conditions should be undertaken.Percutaneous device closure of the patent foramen ovale should be considered to prevent future embolic events.

Coronary artery embolism is an established cause of acute coronary syndrome, but paradoxical coronary artery embolism causing myocardial infarction is rare and requires a high degree of clinical suspicion for diagnosis.Recognition of this condition is important as it has an influence on management and prognosis. A search for venous thrombosis and underlying prothrombotic conditions should be undertaken.Percutaneous device closure of the patent foramen ovale should be considered to prevent future embolic events.Acromegaly is characterized by excess skin and soft tissue growth due to increased growth hormone (GH) levels. Patients with similar physical findings but without somatotroph axis abnormalities are considered to have pseudoacromegaly. The list of pseudoacromegaly differential diagnoses is long. It may be caused by several congenital and acquired conditions and diagnosis can be challenging due to its rarity and occasional overlapping of some of these conditions. The presence of a pituitary tumour in such cases may lead to a misdiagnosis of acromegaly, and thus, biochemical evaluation is key. Here, we present a case of pseudoacromegaly with an acromegaloid phenotype, normal IGF levels, a supressed GH response to an oral glucose tolerance test, moderate insulin resistance and non-functioning pituitary microadenoma.

There are several conditions that present with clinical aspects of acromegaly or gigantism but without growth hormone (GH) excess. Such cases are described as “pseudoacromegaly” or “acromegaloidism”.In cases of excessive soft tissue growth with normal GH levels, other growth promotors (for example, thyroid hormone, sex hormones, insulin and others) should be taken into consideration.Biochemical confirmation of GH excess in patients presenting with clinical features of acromegaly and pituitary adenoma should always be considered to avoid unnecessary surgeries.

There are several conditions that present with clinical aspects of acromegaly or gigantism but without growth hormone (GH) excess. Such cases are described as “pseudoacromegaly” or “acromegaloidism”.In cases of excessive soft tissue growth with normal GH levels, other growth promotors (for example, thyroid hormone, sex hormones, insulin and others) should be taken into consideration.Biochemical confirmation of GH excess in patients presenting with clinical features of acromegaly and pituitary adenoma should always be considered to avoid unnecessary surgeries.Cutaneous angiosarcoma is a rare, highly malignant tumour of vascular endothelial origin. It usually arises in the skin and superficial soft tissue, mostly on the head and neck. It presents as a variety of lesions, and so is considered a great mimicker, leading to a delay in diagnosis and evidencing the importance of biopsy with immunohistochemistry confirmation. CHR2797 chemical structure There are few reports of extremity involvement in patients with pre-existing chronic lymphoedema, or exposure to radiation therapy. We report the case of an 82-year-old woman with lower limb extensive cutaneous involvement, distant metastatic disease, and poor therapy response. Its rare location without predisposing factors highlights the need to raise awareness about this disease.

Extremity involvement of cutaneous angiosarcoma has been rarely described. The marked heterogeneity in presentation leads to a delay in diagnosis and poor prognosis, so the index of suspicion should be high.The cases reported in the literature describe a well-known relationship between cutaneous angiosarcoma and predisposing factors, but its absence should not exclude the diagnosis.This case highlights the importance of recognizing and biopsy suspected skin lesions for immunohistochemistry diagnostic confirmation.

Extremity involvement of cutaneous angiosarcoma has been rarely described. The marked heterogeneity in presentation leads to a delay in diagnosis and poor prognosis, so the index of suspicion should be high.The cases reported in the literature describe a well-known relationship between cutaneous angiosarcoma and predisposing factors, but its absence should not exclude the diagnosis.This case highlights the importance of recognizing and biopsy suspected skin lesions for immunohistochemistry diagnostic confirmation.