A previously-healthy thirty-year old man presented to the Emergency Department at Hawke’s Bay Hospital with central chest pain, following blunt chest trauma whilst SCUBA diving. He was at a depth of approximately five metres, during his ascent, when he was dumped onto a rock by a wave, hitting the left side of his chest. Several hours later, he developed central chest tightness and mild dyspnoea. He had no dysphagia or abdominal pain. Examination findings showed normal vital signs, reduced air entry over left chest wall, and a “crunchy” systolic murmur.

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A 41 year-old woman case with nonproductive cough, dyspnea, weight loss and fever is described. Laboratories were remarkable for hypoxemia, leukocytosis, anemia and elevated hepatic enzymes. Chest X-ray demonstrated bilateral interstitial opacities. She was hospitalized with diagnosis of suspected pneumonia. Patient’s condition progressed to multiple organ failure and unfortunately, death. The diagnostic of gastric adenocarcinoma with lymphangitic spread was established at autopsy.

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A 67-year-old gentleman with a prior history of coronary artery disease and a four-vessel coronary artery bypass graft five years prior to admission, presented to the hospital complaining of a 12-day history of midsternal chest pain. A chest radiograph performed 18 months prior to this presentation revealed a normal cardiovascular silhouette and normal mediastinum. Upon presentation, a new chest radiograph revealed a wide mediastinum. A computed tomography done emergently revealed an aortic thrombus starting at superior mediastinum and large (6 cm) pseudoaneurysm in anterior mediastinum.

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A 30-year-old Hispanic gentleman with past medical history of hypertension and dyslipidemia, presented to the emergency department with complaints of a blunt, constant, epigastric pain radiating to his back for 24 hours. Physical examination revealed a man in severe distress, tachypneic and tachycardic. Laboratory data, as well as the physical exam, were consistent with acute severe pancreatitis. The patient was admitted to the intensive care unit (ICU) and a computed tomography (CT) of his abdomen was obtained revealing a large thrombus in the portal vein (Figure 1).

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A 59-year-old Hispanic lady with history of rheumatic fever and chronic atrial fi brillation presented to the emergency department with severe dyspnea. Seventeen years prior to this presentation, she had undergone re-do mitral valve replacement, and tricuspid annuloplasty. The patient’s chest radiograph revealed massively dilated right chambers of the heart (Figure 1). An electrocardiogram showed right axis deviation, atrial fi brillation with a controlled heart rate of 70 beats per minute.

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A 54 year-old Caucasian gentleman with history of diabetes presented to emergency department with complaints of facial swelling for one week and left orbital pain of one day duration. The patient underwent computed tomography (CT) scan of head with intravenous contrast which revealed infl ammation of left medial rectus muscle and cellulites of medial left orbital coronal space deep to and surrounding the medial rectus muscle with some lateral deviation of the left eye. In addition, left maxillary sinus disease was noted.

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