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JAMA Surgery Clinical Challenge
May 2016

Headache and Facial Swelling

Author Affiliations
  • 1Hofstra North Shore–LIJ School of Medicine, Hempstead, New York
  • 2Department of Urology, Smith Institute for Urology, North Shore–LIJ Health System, New Hyde Park, New York
  • 3Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
JAMA Surg. 2016;151(5):483-484. doi:10.1001/jamasurg.2015.4722

A 49-year-old woman with no relevant medical history presented with a 2-day history of headache and facial swelling. She was found to have severely elevated blood pressure at an urgent care center, prompting her transfer to the hospital. On review of systems, she endorsed anorexia and malaise for the past several days. She was in no acute distress but appeared languid. Her blood pressure was 210/110 mm Hg. Physical examination demonstrated periorbital and 1+ bipedal pitting edema. She had mild tenderness to percussion of both flanks.

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