Patient: Male, 71Final Diagnosis: SIADHSymptoms: Cachexia • confusionMedication: —Clinical Procedure: Percutaneous liver biopsySpecialty: OncologyObjective:Rare diseaseBackground:The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is usually seen in pulmonary malignancies, central nervous system disorders, and secondary to medications. SIADH has very rarely been encountered in primary hepatocellular carcinoma. Two cases were reported in Japan and 1 case in Spain after extensive investigation of the medical records.Case Report:We report a case of a 71-year-old man who presented with confusion, cachexia, and abdominal symptoms in the form of vomiting and abdominal discomfort. On the initial work-up, SIADH diagnosis was made. After an extensive work-up, the reason for SIADH turned out to be a newly diagnosed hepatocellular carcinoma. The precipitating factor for the cancer was not identified by history or by work-up. No metastasis was identified. Liver functions were preserved but patient was severely malnourished.Conclusions:SIADH can occur as a para-malignant feature of the malignancy. In our case, it was related to the hepatocellular carcinoma, which is a malignancy very rare to cause SIADH.

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Background: The fat embolism syndrome (FES) has been considered a diagnostic enigma since its first description over a century ago. Varying degree of presentation along with absence of specific diagnostic criteria or a scoring system makes it difficult to be diagnosed. Simple fat embolism may be a pathologic finding with variable clinical significance; patients with the FES have fat emboli in multiple organs, causing extensive organ dysfunction. While most patients with FES fully recover, there is an estimated 5to15percent mortality rate. There is no wide accepted specific treatment beyond aggressive supportive care.Case Report: A 72 year old Caucasian female presented with dyspnea, hypoxia and altered mental status within 24 hours of admission for an inferior pubic rami fracture secondary to fall. Patient required intubation and mechanical ventilation for respiratory failure. An Echocardiogram revealed Right Ventricular strain and MRI of the brain showed multiple acute/subacute infarcts, which supported a diagnosis of FES, especially as pulmonary embolism was deemed less likely with a negative CT Chest Angiogram and US Doppler of Legs. The patient gradually recovered with supportive care, successfully extubated with eventually discharged after thirty days of hospitalization. Conclusion:Fat emboli syndrome has a variable degree of presentation, ranging from mild symptoms to severe multi organ involvement that can ultimately be fatal. It can also be associated with long term morbidity which emphasizes the need for rapid precise diagnosis and management.

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