We report an interesting case of ileal diverticulitis which posed a diagnostic challenge. A 75-year-old female presented to the emergency department with severe right lower quadrant pain for 3 days. The clinical history, examination and imaging suggested a diagnosis of acute appendicitis. The patient was taken to the operating room for an open appendectomy. The intra-operative findings demonstrated a large mass at the ileocecal junction involving the appendix as well as multiple nodular masses in the ileum and cecum. The patient underwent a right hemicolectomy with ileocecal anastomosis. The pathology result revealed Ileal diverticulitis. Ileal diverticulitis is a rare form of diverticulitis. It can often mimic other processes such as acute appendicitis. Once ileal diverticulitis is diagnosed, it should be treated with the same principles as for sigmoid diverticulitis. Though rare, ileal diverticulitis should be considered in the differential diagnosis of a patient who presents with right lower quadrant pain, and a computed tomography scan that shows an inflammatory process in the right lower quadrant, in the setting of a normal appendix.

The anti-granulocyte activity of serum from patients with B-cell chronic lymphocytic leukaemia (CLL) and other lymphoproliferative disorders was investigated. Granulocyte-binding IgG was measured in 34 patients with CLL, 13 patients with hairy cell leukaemia, one patient with prolymphocytic leukaemia, two patients with Sézary cell leukaemia, and seven patients with chronic T-cell lymphocytosis who had a predominance of circulating large granular lymphocytes. Anti-granulocyte activity was absent in CLL and its variants, but present in the majority of granulocytopenic patients with chronic T-cell lymphocytosis. In one of these patients, granulocytopenia was associated with complement-activating IgG granulocyte antibody. Thus, antibody-mediated granulocyte injury appears to be an unusual occurrence in chronic lymphocytic leukaemia, but is a frequent complication of chronic T-cell lymphocytosis.

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MD NY Methodist Hospital, Brooklyn, NY INTRODUCTION: Dysphagia is a very common complaint in the outpatient setting. We present a rare cause of dysphagia; dysphagia lusoria. CASE PRESENTATION:A 24 year old female presented with complaints of one year of dysphagia, weakness, cramping abdominal pain and fatigue. Since age twelve, she suffered from intermittent dysphagia to solids, neck stiffness and right sided pressure-like headaches. She previously had not sought medical attention for her symptoms due to their intermittent nature. At twenty-three, she was started on famotidine without significant relief. One year later she presented to the office where a bilateral blood pressure measurement revealed a discrepancy. Right radial pulsation was slightly diminished as compared to the left; otherwise, her exam was unremarkable. A CT chest angiogram revealed her right subclavian artery arising from the aortic arch distal to the left subclavian artery, crossing posterior to the esophagus with no proximal esophageal dilatation. She is scheduled for an open thoracotomy and surgical repair of the aberrant vessel.DISCUSSION: Dysphagia is one of the top complaints in family practice offices with prevalence rates ranging from 6 to 27% in adults. When the initial work up for dysphagia is unrevealing, rare pathologies should be considered. 1 An aberrant right subclavian artery (ARSA) occurs in 0.2 to 2% of the population. In ARSA, the right subclavian artery arises distal to the left subclavian artery and usually passes behind the esophagus and trachea. The artery can create a partial or full ring around either of these structures. Ninety percent of adult patients with ARSA remain asymptomatic and most are found incidentally postmortem. 2 Of those with symptoms, 10% usually complain of shortness of breath and dysphagia. An ARSA causing dysphagia was first described by Dr. David Bayford who coined the term Dysphagia Lusoria. If left unrepaired, an ARSA can remain asymptomatic but an aneurysm, aortitis, or ARSA-esophageal fistula can develop. 2 CONCLUSIONS: Although dysphagia is a common complaint, clinicians should consider other rare etiologies when initial work up is unrevealing and symptoms are persistent. Dysphagia lusoria is uncommon but may have life-threatening consequences if undiagnosed.