Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms.

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Left ventricle non-compaction cardiomyopathy (LVNC) is an uncommon disorder characterized by the persistence of fetal myocardium of prominent trabecular meshwork, deep intertrabecular recesses, systolic dysfunction and left ventricular dilatation. It is thought to be caused by the arrest of normal endomyocardial morphogenesis. Here we present a case of a 27-year-old Caucasian female without past medical history who was presented to the emergency department because of syncope while she was working out. On further questioning, she relates that she has been having recurrent syncope for the last 9 years but she did not seek medical attention. Echocardiography and cardiac magnetic resonance imaging confirmed the diagnosis of LVNC and also showed a preserved ejection fraction. Implantable loop recorder showed recurrent non-sustained ventricular tachycardia. Although data were limited, an implantable cardioverter-defibrillator was prophylactically implanted because of the individual's high sudden cardiac death risk.

The current report is the case of a 30-year-old male patient who presented with symptomatology suggestive of appendicitis. However, careful history-taking and laboratory tests led to the diagnosis of Clostridium difficile colitis, resulting in successful nonsurgical management of this patient. Although both appendicitis and C. difficile colitis are common conditions, they are rarely diagnosed concurrently. This is reflected by paucity of literature describing this manifestation. Given this current presentation, the authors contend that the manifestation of extracolonic colitis within the appendix is possibly underdiagnosed or misdiagnosed as an acute appendicitis and thus potentially results in unnecessary surgical intervention. This report reminds physicians to consider the medical approach to managing acute appendicitis given the possibility of underlying C. difficile colitis as the causative factor.

Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly with incidence of 0.008-0.033%. The most common complication of QAV is aortic regurgitation (75%). Other complications include aortic stenosis, left ventricular hypertrophy, bundle branch blocks, and abnormal displacement of the ostium in the right coronary artery. It is vital that patients with QAV who present with progressive aortic regurgitation undergo valve replacement or repair within an appropriate amount of time. This case report focuses on the presentation of a 20-year-old man who was easily overlooked with transthoracic echocardiography (TTE) during childhood when he was diagnosed with aortic stenosis secondary to bicuspid aortic valve. The patient presented to our cardiology clinic for evaluation of a new diastolic murmur. TTE revealed QAV, moderate aorticinsufficiency, and mild aortic stenosis.