2) Recognize intravenous leiomyomatosis as a rare cause of intracardiac tumors. CASE INFORMATION: A 56 year-old postmenopausal woman with a history of uterine fibroids presented with two days of exertional shortness of breath and constant retrosternal chest pressure, worse with exertion and lying flat. She denied orthopnea, paroxysmal nocturnal dyspnea or cough. Physical exam revealed normal vital signs, elevated JVD, clear lungs, regular rhythm with II/VI holosystolic murmur at the left lower sternal border, no extremity edema, and an enlarged uterus palpable 4 cm below the umbilicus. Basic labs, cardiac enzymes, and EKG were normal. Chest x-ray showed cardiomegaly and vascular prominence. An echocardiogram revealed normal left ventricular ejection fraction, dilated right atrium (RA) and right ventricle (RV), and tricuspid regurgitation. There were two linear mobile echodensities in the inferior vena cava (IVC) protruding into the right atrium and ventricle. Cardiac and abdominopelvic MRI showed multiple uterine leiomyomas, with a lobulated mass arising from the uterine fundus and extending up the right gonadal vein into the IVC, RA, and RV. The patient underwent total hysterectomy and total excision of the mass through the infrarenal IVC. Pathology of the mass showed intravenous leiomyomatosis. IMPLICATIONS/DISCUSSION: The differential diagnosis of an enlarged non-pregnant uterus includes endometrial and myometrial processes. Advanced endometrial carcinoma is the main endometrial cause. Myometrial causes are divided into benign and malignant. Benign conditions include leiomyomas (i.e. fibroids), adenomyosis, and stromal adenomyosis. Malignant causes include leiomyosarcoma and endometrial stromal sarcoma. Uterine conditions capable of extending into the IVC and heart are endometrial stromal sarcoma and intravenous leiomyomatosis. Intravenous leiomyomatosis is a rare benign condition in which nodules of benign smooth muscle tissue grow within the veins of the myometrium and may extend into the uterine and hypogastric veins. Rarely, these tumors extend up the IVC into the heart. Only 43 cases of intravenous leiomyomatosis with cardiac extension have been reported in the English literature. Symptoms of cardiac extension include venous obstruction, right-sided heart failure, and rarely, sudden death. Successful therapy entails total excision of the tumor, as residual tumor could result in recurrence. 3) Identify Salmonella as a rare infectious cause of spondylodiscitis. CASE INFORMATION: A 65-year-old woman presented with four days of low back pain and fever. The pain radiated down her left leg and was aggravated by movement. She denied trauma, weakness or numbness. She had a temperature of 104, blood pressure of 154/76, and heart rate of 115. Physical exam showed lumbar paraspinal spasm with no focal tenderness. Neurological exam was normal, including straight leg test. White cell count was 14000 with 90% neutrophils. ESR was 64. Blood and urine cultures were negative. Lumbar x-rays were normal. An indium scan done as part of the workup for fever and leucocytosis showed increased uptake at L4-L5. MRI of the spine revealed disc herniation at L4-L5, but no spondylodiscitis. Even though the source of fever was uncertain, the patient was treated empirically with vancomycin with resolution of fever. However, the pain persisted and she underwent discectomy. Pathological exam showed acute discitis, but cultures were not done. Despite the surgery, her back pain worsened, and repeat imaging showed destruction of L4 and L5 vertebral end plates, with prevertebral, epidural and paraspinal abscess. A CT-guided biopsy was done, and Salmonella javiana grew from the drained fluid. The patient had hemoglobin C trait but no immunocompromising conditions. She was treated with fluoroquinolones and slowly improved. IMPLICATIONS/DISCUSSION: Most cases of back pain are due to simple benign etiologies. However, certain red flags prompt the search for more serious causes. These include advanced age, malignancy, signs of infection, and progressive neurological symptoms. Spondylodiscitis is the simultaneous infection of the vertebral body and disc space. MRI is the most sensitive and specific imaging modality, with a sensitivity of 91% during the first two weeks of symptoms. Radionuclide scanning is done when MRI cannot be performed. It is very sensitive but not as specific. CT-guided biopsy should be pursued in cases of suspected spondylodiscitis, even with a normal MRI. Most cases of spondylodiscitis are due to Staphylococcus aureus. Other organisms include Streptococcus, E. coli and Salmonella, with the most frequent serotypes being Salmonella typhimurium and S. choleraesuis. Predisposing factors for salmonellosis include sickle cell disease, HIV, immunosuppressive therapies and previous trauma. Spondylodiscitis due to S. javiana has not been previously reported. Hemoglobin C disorders have not been associated with Salmonella osteomyelitis.