Enterovirus-human-rhinovirus (EV-HRV) is best known to cause the "common cold" and asthma exacerbations. Simple bronchitis and community-acquired pneumonia related to EV-HRV are also well documented. Scattered reports of rhinovirus causing acute respiratory distress syndrome (ARDS) have been published, yet the causality between recent SARS-CoV-2 pneumonia and severe ARDS secondary to EV-HRV has not been well defined. This case presents a 67-year-old male who was unvaccinated against SARS-CoV-2 with a past medical history of chronic obstructive pulmonary disease, who recently experienced a mild-tomoderate case of SARS-CoV-2 pneumonia, which was treated with dexamethasone and remdesivir. He was discharged to an inpatient psychiatric facility on as-needed oxygen via nasal cannula. Three weeks later, he experienced an episode of presyncope and was readmitted to the hospital. He then began to require increasing levels of supplemental oxygen via a high-flow nasal cannula. A real-time polymerase chain reaction respiratory pathogen panel was positive for EV-HRV. Computed tomography of the chest revealed extensive ground-glass opacities. Further workup for bacterial and fungal pneumonia was negative. Repeat SARS-CoV-2 testing was also negative. He required several days of supplemental oxygen via a high-flow nasal cannula. He received a short course of broad-spectrum antibiotics and a 10-day course of high-dose dexamethasone. Ultimately, he fully recovered, did not require further supplemental oxygen, and was discharged on room air.

Radiofrequency ablation (RFA) may be used to treat either benign or malignant tumors of the liver. Complications are relatively rare, with the most common being pyogenic liver abscess formation. Risk factors for pyogenic liver abscess formation include Child-Pugh class B or C cirrhosis, biliary tract disease, diabetes mellitus, and preexisting biliary diversion. Differentiating sterile post-ablative necrosis from abscess formation may be difficult on imaging as air may be considered a normal post-ablation finding. Treatment of pyogenic liver abscesses includes drainage and antibiotics targeting the most common organisms. This case presents a 71-year-old female with none of the above risk factors who developed a pyogenic liver abscess after undergoing RFA for a solitary liver metastasis secondary to biopsy-proven colonic adenocarcinoma. She was successfully treated with antibiotics and an indwelling percutaneous drain.

Type A aortic dissection (AD) is a devastating cardiovascular emergency requiring emergent surgical intervention. Most patients with AD have several risk factors for the disease including longstanding hypertension, smoking history, atherosclerosis, and old age. Younger patients may also present with AD if a genetic disorder affecting the integrity of the aorta is present. This case presents an otherwise healthy 36year-old male with no known significant family history who presented with an atypical presentation of aortic dissection. He described a five-day history of chest pressure made worse with exertion followed by progressive dyspnea which prompted him to seek medical attention. His initial laboratory workup revealed an elevated troponin I level which prompted a cardiology consultation in the emergency department. Transthoracic echocardiography revealed dilatation of the aortic root and aortic regurgitation. CT angiography of the chest was performed revealing a type A dissection beginning at the aortic root and terminating proximal to the right brachiocephalic artery. Involvement of the coronary arteries was suspected due to the elevated troponin I. He was taken to the operating room and underwent aortic grafting, right coronary artery bypass, and repair of the left main artery. Unfortunately, at the end of the operation, the patient went into refractory ventricular fibrillation, which progressed to asystole. He was unable to be revived.

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Portal vein thrombosis (PVT) is a heterogeneous entity often described as either an acute or chronic occlusion of the portal vein or its tributaries. The clinical presentation is highly variable, and it often mimics other more common causes of abdominal pain. In most patients, imaging studies such as doppler ultrasound, computed tomography, or magnetic resonance imaging are adequate for diagnosis. Occasionally imaging studies may be inadequate, and the diagnosis may not be made until complications such as bowel necrosis and perforation have occurred. We present a case of a morbidly obese 45-year-old female who was initially treated for suspected small bowel enteritis and discharged home on several occasions after nonspecific findings on abdominal imaging were seen and interval improvement in symptoms occurred with intravenous fluids and antibiotics. She then presented with worsening symptoms and was found on abdominal imaging to have a large fluid collection in the peritoneal cavity requiring exploratory laparotomy with peritoneal washout and partial small bowel resection due to perforation. She was diagnosed with PVT with mesenteric extension after samples of the resected mesentery were evaluated in the pathology laboratory. Her treatment included a prolonged course of antibiotics, total parenteral nutrition, and anticoagulation.