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The authors report a case of sudden death in a 23-year-old woman in whom autopsy by the medical examiner revealed hypothalamic sarcoidosis. The decedent had experienced 6 months of amenorrhea and a 50-pound weight gain. She sought medical attention when she experienced headache, and after imaging and laboratory studies, she was suspected of having neurosarcoidosis. She appeared to respond well to corticosteroid therapy. However, 6 weeks after the beginning of therapy, she was found dead on the floor of her residence. Autopsy showed extensive granulomatous inflammation of the hypothalamus and adjacent structures. Previously reported cases of hypothalamic sarcoidosis are reviewed. A hypothesis for the mechanism of sudden death is presented.

While inguinal hernia is common in the primary care office, the differential diagnosis is extensive and includes infectious, inflammatory and neoplastic processes. Varicocele is another frequent, generally benign condition which occasionally reflects serious disease entities. Left-sided or bilateral varicoceles account for the overwhelming majority of varicoceles because the left gonadal vein drains into the left renal vein in contrast to the right gonadal vein, which drains directly into the inferior vena cava, thus making left-sided or bilateral venous congestion more likely. Presence of an uncommon unilateral right-sided varicocele thus warrants further radiological workup, in particular CT abdomen and pelvis, to evaluate for retroperitoneal pathology. We describe a case in which appropriate use of a variety of imaging modalities including testicular ultrasound and CT led to an important diagnosis of a large, well-differentiated liposarcoma in the right retroperitoneum of a patient with a right-sided groin mass.

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