搜索结果：Clinical practice and cases in emergency medicine

Foreign bodies in the external auditory canal are an uncommon presentation in emergency settings. Among adults, insects represent a frequent organic foreign body, often causing symptoms such as otalgia, tinnitus, vertigo, and anxiety. Prehospital management of such cases is rarely addressed in the medical literature, with minimal guidance available for emergency medical services (EMS) personnel. In this report we discuss their role in stabilizing patients and reducing discomfort through appropriate interventions. A 40-year-old male called EMS after a live insect entered his left ear, causing severe otalgia and distress. Prehospital medical personnel clinically confirmed the presence of the insect and assessed for signs of tympanic membrane perforation. A medical command physician authorized the use of 2% lidocaine to euthanize the insect, which alleviated movement-related discomfort within 20 seconds. Despite initial symptom relief, the patient experienced persistent fullness in the ear and was transported to a tertiary-care hospital. In the emergency department multiple removal attempts were made, with successful extraction using thin dressing forceps. No tympanic membrane perforation was noted, although minor trauma to the external auditory canal was present. The patient was discharged with ciprofloxacin-dexamethasone otic drops and return precautions. Prehospital use of lidocaine for a live insect in the auditory canal may provide significant symptom relief while reducing the risk of further auditory canal trauma. This case underscores the importance of command-based support for EMS personnel to provide safe, evidence-based approaches for managing intra-aural insects in the field.

Evaluating patients with acute neurologic deficits is a regular occurrence in the emergency department (ED), but some presentations warrant increased concern. This case highlights the importance of repeat evaluations and how resolution of symptoms does not rule out a more ominous underlying pathology. A 59-year-old male with a past medical history of coronary artery disease and Human immunodeficiency viruses (HIV) presented to a Level II trauma and comprehensive stroke center for left-sided facial droop and left-sided hemiparesis. Computed tomography of the brain including angiography and perfusion was performed revealing no hemorrhage or large vessel occlusion. Given his National Institutes of Health Stroke Scale score of 11, he received alteplase and subsequently experienced several episodes of resolution and recurrence of his symptoms while in the ED. Magnetic resonance imaging revealed an acute ischemic infarct in the right basal ganglia and insular region, which along with his clinical presentation was consistent with capsular warning syndrome. Capsular warning syndrome is a rare clinical entity with an incidence ranging from 1.5-5% in stroke patients. Its recognition is crucial when making decisions concerning management, as resolution of symptoms should still garner a high level of attention given that the the increased risk of stroke with permanent neurological disability is highest within the first 48 hours. The role of thrombolysis continues to be an area of focus as its benefit has not yet been determined but continues to be the mainstay therapy in the correct clinical setting. This is especially true in the cases of recurrent episodes post thrombolysis, which does not preclude the diagnosis of capsular warning syndrome but should heighten the need for acute management of these patients and close monitoring. This case illustrates its unique presentation and the need for increased recognition and understanding within the field of emergency medicine.

Chalk-stick fractures are transverse spinal injuries seen in patients with ankylosing spondylitis due to chronic inflammation and spinal rigidity. These fractures may result from minor trauma and are associated with potentially fatal complications. While spinal fractures in ankylosing spondylitis are well recognized, thoracic chalk-stick fractures complicated by hemothorax from vascular injury remain exceedingly rare. We present a case of an elderly male with ankylosing spondylitis who sustained a thoracic chalk-stick fracture following a ground-level fall, complicated by hemothorax and hemorrhagic shock. This case highlights a rarely reported but life-threatening complication and emphasizes the importance of early imaging and high clinical suspicion in this high-risk population-even after minor trauma. A 90-year-old male with known history of ankylosing spondylitis presented to the emergency department after a ground-level fall associated with syncope. He had thoracic back pain, dyspnea, and hypotension. Computed tomography revealed a thoracic vertebra 11 chalk-stick fracture with interspinous vascular injury and a large, right-sided hemothorax. The patient underwent emergent chest tube placement, blood transfusion, and vasopressor support, which initially stabilized his condition. However, his hospital course was complicated by multiple comorbidities, and he ultimately died after prolonged critical care. This case illustrates the potential for catastrophic vascular complications from minor trauma in patients with ankylosing spondylitis. Thoracic chalk-stick fractures may result in life-threatening hemothorax and hemorrhagic shock. Emergency physicians should maintain a high index of suspicion and obtain early radiographic imaging to facilitate timely diagnosis and intervention in this high-risk population.

Sternoclavicular joint injuries are rare and potentially life-threatening injuries due to their proximity to vital mediastinal structures. In adolescents, skeletal immaturity can add complexity to the injury due to potential involvement of the physis. A physeal fracture with displacement can appear as a dislocation on imaging, also known as pseudo-dislocation. Additionally, this anatomic area is difficult to visualize with plain radiographs, which can result in misdiagnosis and delayed treatment. We present a case of a 15-year-old male athlete who presented to the emergency department with severe right clavicular pain four hours after sustaining a football injury. Plain radiographs obtained at an outside facility as well as repeat plain radiographs at our facility showed no evidence of fracture or dislocation. The patient's degree of pain and physical exam findings prompted further imaging with computed tomography (CT), ultimately revealing a physeal fracture of the medial right clavicle with posterior and superior displacement. Sternoclavicular joint injuries in skeletally immature patients are complex and require immediate diagnosis and intervention. Plain radiographs are often unreliable in recognizing these injuries and, in our case, the physeal fracture with displacement was not radiographically apparent on two separate occasions. Advanced imaging with CT revealed the diagnosis, highlighting the importance of a detailed physical exam and for physicians to maintain a high index of clinical suspicion when evaluating adolescents with high-impact trauma, even in the setting of negative plain radiographs.

Purple urine bag syndrome (PUBS) is an uncommon yet visually striking condition observed in patients with long-term urinary catheters. It is associated with urinary tract infections caused by bacteria that metabolize tryptophan into indigo and indirubin pigments. Although typically benign, PUBS can signal underlying medical and social vulnerability. We describe a 78-year-old woman with multiple sclerosis and chronic suprapubic catheterization who presented with failure to thrive and concerns for caregiver fatigue. A striking finding on arrival was the deep purple discoloration of her urine in the Foley bag, consistent with PUBS. Additionally, she was tachycardic and had extensive, unstageable pressure ulcers. Laboratory studies revealed leukocytosis, lactic acidosis, and acute kidney injury. Imaging suggested sacral osteomyelitis, stercoral colitis, and aspiration pneumonia. Blood cultures grew Streptococcus dysgalactiae, and she was treated empirically with broad-spectrum antibiotics. After goals-of-care discussions, she was transitioned to hospice and died shortly after discharge. While purple urine bag syndrome is often benign, its presence should prompt clinicians to evaluate for serious underlying disease, particularly in debilitated or high-risk patients. It is classically associated with chronic catheterization, alkaline urine, and infections involving organisms such as Providencia stuartii, Klebsiella pneumoniae, and Proteus mirabilis. This case highlights PUBS as a visible marker of potentially severe, multisystem pathology requiring timely and comprehensive assessment. Moreover, it underscores the role of social determinants of health such as inadequate home support, caregiver strain, and fragmented post-discharge care in exacerbating clinical decline. Recognition of these factors is essential for holistic care planning in frail older adults.

Dense deposit disease, also known as C3 glomerulopathy, is a rare renal disorder caused by abnormal complement deposition in the glomerular basement membrane. Patients often require long-term immunosuppressive therapy and, in some cases, complement inhibitors such as ravulizumab. While effective at limiting renal damage, complement blockade significantly increases susceptibility to invasive infections from encapsulated bacteria, particularly Neisseria meningitidis. Despite immunization and antimicrobial prophylaxis, these patients remain incompletely protected. We describe a case of meningococcemia in a fully vaccinated adolescent with dense deposit disease on ravulizumab therapy. A 17-year-old male with a history of dense deposit disease on mycophenolate mofetil and ravulizumab presented to the pediatric emergency department with fever, vomiting, altered mental status, and a rapidly evolving petechial-purpuric rash. He was fully immunized with both meningococcal conjugate and serogroup B vaccines. Initial evaluation revealed fever, hypotension, and altered level of consciousness. Laboratory studies showed leukocytosis, elevated inflammatory markers, and blood cultures subsequently confirmed N. meningitidis. Empiric ceftriaxone and vancomycin were initiated, later narrowed to ceftriaxone. Supportive management included intravenous (IV) fluids, vasopressors, IV immunoglobulin, and dexamethasone. The patient demonstrated rapid improvement, with resolution of hemodynamic instability and normalization of kidney function. He was discharged on hospital day eight with prophylactic penicillin and close outpatient follow-up. This case underscores the risk associated with complement inhibition, even in fully vaccinated individuals. Clinicians must maintain high vigilance for meningococcal disease in immunocompromised patients and initiate early aggressive therapy to optimize outcomes.

Ectopic pregnancy is a serious pregnancy complication that occurs when a gestational sac implants outside the uterus, most commonly in the fallopian tubes. However, a rare form of ectopic pregnancy, the cesarean scar ectopic pregnancy, occurs within a prior cesarean section scar and is becoming more common as cesarean delivery rates continue to rise. Cesarean scar ectopic pregnancies are challenging to diagnose and pose significant risks, including rupture and hemorrhage, which can lead to maternal death. A 27-year-old woman presented to the emergency department with a 16-day history of abdominal pain and vaginal bleeding, initially believed to be her menstrual period. She had a history of one previous lower uterine segment cesarean section. On examination, her beta-human chorionic gonadotropin (β-hCG) levels were elevated, and transvaginal ultrasound revealed an empty uterus with a gestational sac within a cystic area of the cesarean scar. The patient was diagnosed with a cesarean scar ectopic pregnancy. Given the high rupture risk, she underwent laparoscopic surgery with dilation and curettage. Postoperative management included methotrexate, antibiotics, and analgesics. A follow-up β-hCG test showed a significant decline, confirming resolution of the ectopic pregnancy. At her two-week follow-up, the patient remained asymptomatic with no bleeding, and ultrasound confirmed no retained products of conception. Cesarean scar ectopic pregnancies are a rare and life-threatening complication of pregnancy that require timely diagnosis and intervention. Early detection through transvaginal ultrasound and appropriate multidisciplinary management are critical to prevent adverse outcomes. This case highlights the importance of early recognition, classification, surgical decision-making, and standardized diagnostic protocols to improve outcomes and save lives.

Ewing sarcoma is a relatively common neoplasm occurring in pediatric patients 10-20 years of age, commonly presenting with bone fracture, fever, and pain and swelling at the site of the primary tumor. Here we present an unusual case of Ewing sarcoma in the cervical spine leading to neurological symptoms including left lower extremity hemiparesis and left upper extremity hemiplegia. A 19-year-old Bengali-speaking male presented to the emergency department with a three-week history of left lower extremity hemiparesis and left upper extremity hemiplegia. Due to concern for spinal cord compression, a computed tomography of the cervical spine without contrast was obtained, which revealed a lucent lesion in the left fifth cervical (C5) vertebral body. Magnetic resonance imaging of the cervical spine revealed a left cervical extradural mass present from C3-C7. The patient subsequently underwent C3-C7 laminectomy with tumor decompression and fusion one week later. Surgical pathology revealed Ewing sarcoma. Following chemotherapy two months later the patient regained complete recovery of motor and sensory function in the left lower and left upper extremities. It is important for emergency physicians to broaden their differential diagnosis when the physical examination reveals neurological deficits as exhibited in this case. A broader workup must be obtained that does not solely consist of head imaging but also includes imaging of the spine to prevent missing the diagnosis.

In this report we highlight the emerging role of pediatric cardiac point-of-care ultrasound (POCUS) in rapidly diagnosing infective endocarditis, using a clinical case as illustration. A six-year-old girl with a known ventricular septal defect presented with worsening respiratory symptoms, fevers, abdominal pain, and decreased oral intake. Initial POCUS, performed by an emergency physician, indicated a suspicious echogenic mass in the right atrium, prompting formal echocardiography. Further imaging and cultures confirmed infective endocarditis due to methicillin-sensitive Staphylococcus aureus. This case underscores the utility of pediatric cardiac POCUS as a rapid bedside diagnostic tool for infective endocarditis in emergency settings, leading to early diagnosis and management. Although POCUS cannot replace comprehensive echocardiography, its immediate availability significantly accelerates diagnosis and management initiation, particularly in pediatric patients with congenital heart conditions who are at increased risk for the condition. Ongoing training and standardized protocols will enhance its efficacy. Clinicians should recognize the strengths and limitations of POCUS, integrating it into broader diagnostic workflows for pediatric infective endocarditis.

Temporal lobe epilepsy is a form of focal epilepsy that originates in the temporal lobes, often presenting with a variety of symptoms including altered consciousness, automatisms, and focal seizures with or without impaired awareness. Given such a diversity of manifesting symptoms, recognizing temporal lobe epilepsy in the emergency department (ED) can be challenging. Early identification is crucial for appropriate management, including timely initiation of antiepileptic therapy and differentiation from other neurological emergencies. A 50-year-old male with no prior history of seizures or neurological conditions presented to the ED after experiencing unusual sensations that had begun three days earlier. The patient described an intermittent sensation of warmth rising from his pelvis to his head, accompanied by an experiential déjà vu-like feeling he described as "dream reenactment." His episodes had become progressively more frequent, occurring approximately once every 90 minutes within the first 24 hours, with two instances of brief loss of consciousness. Diagnostic workup, including neurology consultation and an electroencephalogram in the ED, revealed a 19-second, non-motor focal seizure originating from the left anterior temporal region, consistent with temporal lobe epilepsy. Magnetic resonance imaging showed no acute structural abnormalities. The patient was diagnosed with temporal lobe epilepsy, started on lacosamide, and discharged from the ED. This case underscores the importance of recognizing temporal lobe epilepsy in the ED, particularly in patients with recurrent episodes of altered consciousness or unusual sensory experiences. Prompt diagnosis and treatment are critical to preventing further seizures and improving quality of life.

Spontaneous splenic vein rupture is a rare condition associated with a high risk of mortality. Only a few cases have been documented, all of which have been linked to underlying predisposing conditions. In this case, however, we present a previously healthy patient with no identifiable risk factors. A 64-year-old male presented to the emergency department with acute-onset abdominal pain and nausea. Physical exam revealed a rigid abdomen with diffuse tenderness and guarding. Serial labs revealed a progressively decreasing hemoglobin and red blood cell count. Computed tomography demonstrated a ruptured splenic vein with a large volume of retroperitoneal hemorrhage. Laparotomy identified a large retroperitoneal hematoma with hemoperitoneum, and embolization was performed by interventional radiology. The patient recovered after one week in the surgical intensive care unit and was subsequently discharged home with no complications to date. This case underscores the importance of maintaining a high clinical suspicion in patients with acute, unexplained abdominal pain, and emphasizes the crucial role of emergency physicians in the timely recognition and management of such conditions. Given the scarcity of existing literature, this case provides valuable insight into the presentation and management of spontaneous splenic vein rupture in previously healthy individuals, thereby enhancing clinical awareness of this rare and life-threatening condition.

Takotsubo cardiomyopathy is characterized by stress-induced left ventricular dysfunction. The reverse form accounts for < 25% of all cases. We present a case of reverse Takotsubo cardiomyopathy in a young, otherwise healthy, woman following illicit drug use CASE REPORT: A 19-year-old female patient presented to the emergency department (ED) complaining of insomnia, left-sided chest pain, palpitations, and heightened energy levels after ingesting a significant quantity of small, rounded chocolate chips containing unidentified pills at a rave party the previous night. Her electrocardiogram revealed sinus tachycardia with ST-segment elevation in leads I and aVL. At the ED she developed respiratory distress and required oxygen supplementation. Her troponin level was 1.048 nanograms per milliliter (ng/mL) (reference range < 0.03 ng/mL), and her urine drug screen was positive for methamphetamines. Point-of-care transthoracic echocardiography showed moderately impaired left ventricular systolic function (ejection fraction approximately 35-39%) and hypokinesia of basal and mid-left ventricular segments accompanied by hyperkinesia of the apical segments, indicative of reverse Takotsubo cardiomyopathy. The patient was admitted to the cardiac care unit and showed clinical improvement after supportive treatment. However, 30 hours after discharge she presented back to the ED with epigastric pain and was found to have left renal artery thrombosis and an occlusive thrombus at the right internal iliac artery on computed tomography angiography. Amphetamine intoxication is associated with the development of reverse Takotsubo cardiomyopathy, along with multiple vascular thromboses.

Metformin, a first-line type two diabetes medication, is generally considered safe and effective. However, it is rarely associated with life-threatening lactic acidosis. This generally presents in patients with gastrointestinal upset as a primary complaint. It is most common in patients with underlying chronic kidney disease. Prevention of associated mortality requires early diagnosis and intervention with fluids, bicarbonate, vasopressors, and hemodialysis. This is a notable presentation of metformin toxicity, as the 68-year-old male patient presented with an atypical chief complaint of dyspnea and no history of kidney disease. Physical exam was notable for tachypnea and clear breath sounds. Labs revealed anion gap metabolic acidosis from an accumulation of lactic acid and acute renal failure. Other causes of lactic acid metabolic acidosis were considered and ruled out. Nephrology was consulted and pharmacological therapies started as the patient transitioned to the intensive care unit for emergent hemodialysis. He eventually regained renal function and was discharged. His metformin level returned several weeks later significantly elevated. Emergency physicians should maintain metformin toxicity on the differential for patients on metformin presenting with dyspnea and anion gap metabolic acidosis with elevated serum lactic acid concentrations. Other sources of lactic acidosis should be ruled out, and corrective therapies, including renal replacement therapies, should be started immediately. Additionally, it is essential to determine a patient's kidney function before being prescribed metformin and to have the patient serially monitored as an outpatient.

Neurotoxic envenomation often presents with non-specific neurological symptoms and minimal local signs, which can delay appropriate diagnosis and treatment. This is the first reported case of a neurotoxic snakebite presenting with an atypical symptom of unilateral neck pain. A 12-year-old girl was referred to our emergency centre with neck weakness progressing to quadriplegia, attributed to a fall while playing. A diagnosis of acute flaccid paralysis secondary to cervical trauma was made and treated at the first hospital; however, she developed respiratory distress and was transferred to our centre. Clinical examination and computed tomography ruled out cervical cord injury. A diagnosis of neurotoxic envenomation was considered, given our centre's high snakebite burden and the symptom of descending flaccid paralysis. Despite initiating antivenom and supportive treatment, the patient died. As the death was sudden and unexplained, medicolegal autopsy was done. Meticulous examination revealed a suspicious mark over the right foot. Chemical analysis on a skin sample from the site tested positive for snake venom, confirming envenomation. This case highlights the diagnostic challenge posed by atypical presentations of neurotoxic snakebite, especially in the absence of a clear history. In endemic areas, flaccid paralysis should prompt clinical suspicion of snakebite. Early recognition and timely administration of antivenom are crucial to prevent fatal outcomes. This case also underscores the need for strengthening diagnostic tools and forensic confirmation to avoid missed or delayed diagnoses, which carry serious medicolegal and public health implications.

Physician-in-triage (PIT) models have become increasingly common in emergency medicine. The goal is to facilitate rapid patient evaluation and improve key operational emergency department (ED) metrics. However, there is limited time for the PIT encounter, which often involves an abbreviated patient evaluation. Point-of-care ultrasound (POCUS) has been shown to improve patient care and speed diagnosis in a variety of scenarios. Although physicians working within a PIT model must remain mindful of time constraints, POCUS can help identify time-sensitive diagnoses and guide appropriate initial testing during certain encounters. Ocular POCUS can be particularly impactful on timely diagnosis and appropriate deployment of ED resources. We present three cases of acute monocular vision loss wherein the PIT physician used ocular POCUS to arrive at the correct initial diagnosis. This led to the appropriate deployment of ED stroke and neurology resources in the case of acute central retinal artery occlusion, while avoiding this unnecessary use of these resources in two cases where it was not indicated. Use of point-of-care ultrasound in PIT models should be thoughtfully employed in cases where immediate diagnosis is required, as well as when POCUS results will likely alter subsequent diagnostic testing pathways. Ocular POCUS in PIT can rapidly differentiate neurologic causes of monocular vision loss from primary ophthalmic conditions.

Kawasaki disease is a vasculitis most commonly affecting children under five years of age but can also occur in older children and adults. When not sufficiently treated, Kawasaki disease can lead to cardiac complications such as myocarditis and coronary artery aneurysms, with aneurysms being the most serious long-term complication as it poses a risk for acute coronary syndrome. A 19-year-old with remote history of Kawasaki disease presented to the emergency department with chest pain, diaphoresis, and emesis after being struck in the chest by another player during a basketball game. Despite his young age and reported mild musculoskeletal trauma, an electrocardiogram and troponin were ordered. Electrocardiogram findings were concerning for ischemia, and troponin was elevated, confirming myocardial infarction and prompting a cardiology consult. Urgent percutaneous coronary intervention of the occluded aneurysm with balloon angioplasty resulted in significantly improved distal blood flow. Kawasaki disease is widely recognized as a cause of cardiac complications in childhood, but the risk does not end there. Adults with a history of childhood Kawasaki disease remain at risk for complications of coronary artery aneurysm, even when they received appropriate medical treatment. Thrombosis or dissection of a coronary artery aneurysm can lead to acute coronary syndrome in otherwise healthy individuals. Therefore, emergency physicians must maintain a high level of suspicion for cardiac complications in both children and adults with a history of Kawasaki disease. In this case, prompt diagnosis and intervention were essential to achieving the best possible outcome.

Patients with psychiatric concerns often present to an emergency department (ED) for medical evaluation prior to inpatient psychiatry placement. One diagnosis to consider prior to disposition is autoimmune encephalitis (AIE). This report describes a pediatric patient who presented with psychiatric symptoms that required inpatient admission and workup to diagnose a rare form of AIE. A 16-year-old female with no known past medical history presented as a transfer from an outside hospital for medical evaluation of two days of auditory and visual hallucinations. Initial labs and imaging were unremarkable. Due to the acuity of her symptoms and abnormal vital signs, she was admitted to the hospital for further medical workup. After almost three weeks inpatient and multiple specialist consultations, she was diagnosed with anti-heavy chain neuronal intermediate filament AIE. The next month of admission included treatment with immunomodulators, antibiotics for associated infections, and malignancy evaluation. Symptoms resolved, and the patient was discharged. The patient remained asymptomatic on immunotherapies, and without psychiatric medications, the following year. During evaluation of psychiatric concerns in the ED, it is essential to consider organic causes of behavioral changes, which can be difficult to discern. Autoimmune encephalitis can be subtle. Features such as autonomic dysregulation, acute or subacute symptom onset, recent infection, autoimmune or malignancy history, cognitive deficits, or focal neurologic findings should raise clinical suspicion. For patients with psychiatric symptoms, the role of an emergency physician is not to diagnose autoimmune encephalitis, but to recognize nuances in patient presentations to best direct proper workup, treatment, and disposition.

Hyperkalemic emergencies can present with weakness, paralysis, sensorimotor deficits, and potentially fatal cardiac conduction abnormalities even in the absence of an elevated serum potassium. Common antihypertensive medications, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, are associated with serum potassium elevations and can exacerbate hyperkalemia, especially in patients with renal impairment. We report a 49-year-old patient who presented to the emergency department six hours following an intentional ingestion of potassium supplements totaling 600 milliequivalents (mEq). The patient also reported chronic use of ibuprofen and losartan 50 mg. Symptoms on presentation included weakness, chest pain, and shortness of breath. Initial labs revealed a potassium > 10 mEq/L which was beyond the upper limit of assay detection for metabolic testing. Calcium gluconate, insulin with dextrose, albuterol, sodium bicarbonate, calcium chloride, fluids, and furosemide were sequentially administered. Initial electrocardiogram (ECG) showed tachycardia, a widened QRS complex without discernible P waves, and non-specific ST-segment changes. Following treatment, a repeat ECG demonstrated decreased heart rate, normal axis, and a decreased QT interval. Creatinine at presentation was 1.67 mg per deciliter (patient's baseline) with repeat labs revealing a potassium of 9.6 mEq/L. Definitive treatment with placement of a central venous catheter for emergent dialysis was initiated. This case illustrates how a patient's regularly prescribed medication may complicate the management of an acute overdose. Prompt identification of a patient's medications and supplements may expedite potentially life-saving interventions in a hyperkalemic emergency.

Pectus excavatum (PEX) is the most common congenital chest wall deformity, characterized by posterior depression of the sternum and lower costal margin. While often asymptomatic, severe PEX can lead to compression of the heart and great vessels, potentially causing right ventricular dysfunction, syncope, and other cardiovascular symptoms. Syncope due to right ventricle compression in PEX is rare but can significantly impact quality of life and may require surgical intervention. An 18-year-old female presented to the emergency department after an unwitnessed syncopal episode. The patient reported feeling lightheaded while showering, followed by collapse and brief loss of consciousness. Diagnostic testing revealed normal neurological and metabolic parameters including point-of-care glucose, electrocardiogram, serum troponin, electrolytes, and head computed tomography. Chest imaging showed severe PEX with concerns of right ventricular compression. Transthoracic echocardiography demonstrated normal cardiac function, and exercise stress testing showed no ischemic changes. Additional laboratory studies revealed iron deficiency anemia. This case underscores the potential for PEX to cause distorted cardiac morphology, including right ventricular compression, which can lead to syncope in severe cases. The absence of cardiac ischemia, arrhythmias, or metabolic derangement suggests postural changes compounded by undiagnosed anemia and underlying PEX as the most likely cause of this patient's syncope. Given the patient's symptoms and anatomical findings, referral for surgical evaluation was made to discuss definitive management options. This case highlights the importance of considering structural chest wall abnormalities in the differential diagnosis of syncopal events, particularly when standard causes are excluded.