Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer that enables the en bloc resection of large lesions. However, it is associated with a significant risk of delayed bleeding, particularly in patients receiving antithrombotic therapy. Delayed bleeding after ESD causes anemia and serious systemic complications, including cardiovascular events. Here, we report a rare case of Takotsubo syndrome triggered by delayed bleeding after gastric ESD that culminated in cardiac arrest. A man in his 70s who underwent gastric ESD experienced delayed bleeding six days after the treatment, requiring emergency endoscopic hemostasis. The following day, the patient developed sudden ventricular fibrillation without prior chest symptoms. After resuscitation with electrical defibrillation, left ventriculography revealed apical ballooning consistent with Takotsubo syndrome. With intensive care, cardiac function recovered, and the patient was discharged ambulatory. Takotsubo syndrome is typically induced by stress, and often triggers psychological and physical stimuli. Although most patients present with chest pain or discomfort, our patient showed no preceding symptoms and developed sudden arrhythmia and cardiac arrest. This case highlights the need for aggressive bleeding prevention and enhanced post-ESD cardiac surveillance to mitigate rare but potentially fatal complications.

Avascular necrosis of the femoral head (ANFH) results from compromised vascular supply, leading to osteonecrosis and progressive structural weakening that may culminate in articular collapse and functional disability. We report a case of a 33-year-old woman who developed avascular necrosis of the right femoral head six weeks after a three-hour hysteroscopic myomectomy. Initial non-contrast magnetic resonance imaging (MRI) demonstrated early-stage osteonecrosis. Two weeks later, a sudden increase in hip pain raised concern for femoral head collapse, prompting a non-contrast computed tomography (CT) scan. CT revealed intraosseous gas within the necrotic region, with subtle evidence of articular collapse at the superior aspect of the femoral head. A contrast-enhanced MRI was subsequently performed to exclude a possible superimposed anaerobic infection and included dynamic contrast-enhanced (DCE-MRI) and intravoxel incoherent motion (IVIM) sequences. Functional MRI techniques allowed in vivo evaluation of perfusion and microvascular diffusion within the affected femoral head, providing valuable insight into areas likely corresponding to necrotic bone, reparative tissue, and preserved marrow. Multimodal imaging integrating morphological and functional findings enabled detailed interpretation of distinct zones representing different stages or characteristics of tissue response to ischemic injury. This case report highlights the potential of functional MRI techniques to enhance understanding of perfusion alterations in avascular necrosis of the femoral head.

Spontaneous pneumomediastinum (SPM) is a rare condition characterized by the presence of free air within the mediastinum without trauma or invasive procedures. Although it is usually benign and self-limiting, it can cause acute chest pain in children. We present a 12-year-old female patient with exercise-related spontaneous pneumomediastinum whose symptoms began 3 hours after taking a ballet class focused primarily on stretching and posture. Physical examination was normal, vital signs were stable, and there was no subcutaneous crepitus. The patient was treated with analgesics and rest on an outpatient basis; complete radiographic resolution was achieved within 1 week, and symptoms completely regressed. This case report highlights that activities such as ballet can be a rare trigger for SPM, the diagnostic value of lateral radiography, and the safety of conservative management in clinically stable pediatric patients.

Oesophageal cellulitis caused by Klebsiella pneumoniae infection is extremely rare and is often missed because of its atypical symptoms and endoscopic presentation. In this article, a case of a 56-year-old male with poorly controlled diabetes mellitus who presented with chest pain, acid reflux, nausea, vomiting, and weight loss is reported. Imaging revealed progressive, diffuse oedema and thickening of the oesophageal wall, followed by submucosal stratification, fistula formation, and extraluminal gas bubbles. Endoscopic examination revealed progression from erosions in the upper oesophagus to multiple ulcers, fistulae, and intramural abscess formation in the middle and lower oesophagus. Both secretions and tissue cultures confirmed K. pneumoniae infection. Following comprehensive treatment, including acid suppression, the administration of effective antibiotics, mucosal repair, nutritional support, and appropriate endoscopic debridement to facilitate drainage, the patient's symptoms and endoscopic findings significantly improved, and the development of severe complications, such as oesophagotracheal or oesophagomediastinal fistulae, was avoided. This case highlights the need to consider bacterial infection in the differential diagnosis of atypical oesophageal lesions in immunocompromised hosts and emphasises the importance of pathogen-directed, precise anti-infective therapy.

We present a 19-year-old female, eight weeks postpartum, with a seven-week history of migratory arthralgias followed by progressive dyspnea and pleuritic chest pain. A large mass in her right lower lobe was discovered on computed tomography. Laboratory evaluation demonstrated elevated anti-proteinase 3 (PR3) antibody, along with elevated inflammatory markers. The bronchoalveolar lavage culture grew Cryptococcus neoformans, and serum cryptococcal antigen was positive. The patient was diagnosed with pulmonary cryptococcosis and treated with amphotericin and flucytosine, given the severity of her illness. Granulomatosis with polyangiitis was a part of the initial differential but was not diagnosed until she later developed transient hemoptysis, recurrent epistaxis, skin rash, and significant proteinuria. The skin biopsy was consistent with cutaneous vasculitis, and the kidney biopsy was positive for glomerulonephritis, confirming postpartum systemic vasculitis masked by a concurrent pulmonary cryptococcal infection.