Introduction: Emergency departments (ED) are unpredictable and prone to diagnostic errors. In addition, non-emergency specialists often provide emergency care in Japan due to a lack of certified emergency specialists, making diagnostic errors and associated medical malpractice more likely. While several studies have investigated the medical malpractice related to diagnostic errors in EDs, only a few have focused on the conditions in Japan. This study examines diagnostic error-related medical malpractice lawsuits in Japanese EDs to understand how various factors contribute to diagnostic errors. Methods: We retrospectively examined data on medical lawsuits from 1961-2017 to identify types of diagnostic errors and initial and final diagnoses from non-trauma and trauma cases. Results: We evaluated 108 cases, of which 74 (68.5%) were diagnostic error cases. Twenty-eight of the diagnostic errors were trauma-related (37.8%). In 86.5% of these diagnostic error cases, the relevant errors were categorized as either missed or diagnosed incorrectly; the others were attributable to diagnostic delay. Cognitive factors (including faulty perception, cognitive biases, and failed heuristics) were associated with 91.7% of errors. Intracranial hemorrhage was the most common final diagnosis of trauma-related errors (42.9%), and the most common initial diagnoses of non-trauma-related errors were upper respiratory tract infection (21.7%), non-bleeding digestive tract disease (15.2%), and primary headache (10.9%). Conclusion: In this study, the first to examine medical malpractice errors in Japanese EDs, we found that such claims are often developed from initial diagnoses of common diseases, such as upper respiratory tract infection, non-hemorrhagic gastrointestinal diseases, and headaches.

Cyclospora cayetanensis is a coccidian protozoa that was newly recognized in 1979 in Papua New Guinea. We report the case of a 42-year-old French man who had visited Vietnam and presented with fever and watery diarrhea that had lasted for more than 2 weeks. The patient was diagnosed with C. cayetanensis infection by examination of a stool smear using UV fluorescence microscopy. Based on this rare case, we recommend that Cyclospora infection might be considered in the differential diagnosis of traveler's diarrhea in immunocompetent patients.

Background Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure derived from forceful vomiting, and subsequent presentation of chest pain, dyspnea, and shock. Case presentation: We present two cases of Boerhaave syndrome that were both triggered by excessive alcohol consumption and quickly detected in the emergency room. The first patient complained of severe chest pain, nausea, and vomited on his arrival: he was diagnosed with Boerhaave syndrome complicated with mediastinitis from the computed tomography (CT) and esophagogram findings. An emergency operation was successfully performed, where a 3-cm tear was found on the left-posterior wall of the distal esophagus. The patient subsequently suffered from anastomotic leakage but was discharged 41 days later. The second patient reported severe chest pain, nausea, vomiting, and hematemesis on his arrival: he was suspected of having Boerhaave syndrome without mediastinitis based on the CT findings. The symptoms gradually disappeared after a conservative treatment. Upper gastrointestinal endoscopy performed on the 9th day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the second patient was also differently diagnosed with Mallory-Weiss syndrome. Conclusion Emergency clinicians must accurately distinguish Boerhaave syndrome from Mallory-Weiss syndrome as they both have similar history and symptoms. CT can be a valuable and useful modality to detect any severity of Boerhaave syndrome.

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The file provides a rare audio-recording of typical sound of infective endocarditis (IE) in an adult with patent ductus arteriosus (PDA). It is important to consider PDA-associated IE if pan-systolic murmur is heard in the 2nd intercostal space along the left sternal border, radiating to the left subclavian region.