A saddle pulmonary embolism is defined as a large thromboembolus lodged at the bifurcation of the pulmonary artery. It would be expected for a patient with a saddle pulmonary embolism to present with symptoms such as dyspnea or pleuritic pain. However, more often than not, saddle pulmonary embolisms may present asymptomatically and are not associated with the typical symptoms. We present a case of an incidental finding of saddle pulmonary embolism in an 89-year-old patient with a past medical history significant of gastrointestinal adenocarcinoma that was treated with capecitabine. The saddle pulmonary embolism was found incidentally on computer tomography (CT) with the contrast of the abdomen and subsequently confirmed with CT of the chest with contrast. It is crucial to be mindful of a possible pulmonary embolism in a patient with similar past medical history.
Mycobacterium tuberculosis is primarily known to affect the lungs with cavitary lesions and enlarged lymph nodes as the first telltale sign. However, if the bacteria spread to extrapulmonary areas such as the bones, and lack lymphadenopathy, then the differential diagnosis may become misleading. We present a case of a 68-year-old male patient with a chief complaint of chronic left hip pain upon which computer tomography identified lytic lesions on the left hip. Given the mildly elevated prostate-specific antigen with a family history of prostate cancer, a bone biopsy was warranted. The biopsy revealed non-caseating granulomas and the DNA probe identified the Mycobacterium tuberculosis complex. This case signifies that atypical presentations of Mycobacterium tuberculosis may mimic other diagnoses and more invasive techniques such as a biopsy may be necessary.
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