Isolated pericardial cystic Echinococcosis: A rare clinical presentation

Isolated pericardial Hydatid cyst without involvement of other viscera is a rare condition with reported incidence of 0.5-2% of all cases of cystic echinococcosis even in the countries endemic for the disease. Hydatid disease is a major public health concern in the animal raising regions worldwide. Pericardial hydatid disease can be asymptomatic or present with varying symptoms from atypical chest pain, arrhythmias, rupture and tamponade to anaphylaxis. Early diagnosis and surgical treatment is necessary to prevent fatal complications. Here we report a case of symptomatic isolated pericardial hydatid cyst who presented with epigastric pain. doi: https://doi.org/10.12669/pjms.38.3.4965 How to cite this:Thapaliya P, Ali TA, Bhutta MM. Isolated pericardial cystic Echinococcosis: A rare clinical presentation. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4965 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Urological Involvement in the Multidisciplinary Management of Placenta Accreta Spectrum in a Centralised, High-Volume Centre: A Retrospective Analysis

Objectives Placenta accreta spectrum (PAS) significantly increases the complexity of childbirth and frequently involves urologic organs. Multidisciplinary team (MDT) care is paramount to ensure optimal outcomes. We aimed to evaluate urologic interventions in patients with PAS at a centralised, tertiary referral centre. Methods An analysis of a prospectively collected data set, consisting of all women presenting with PAS at our institution between November 2013 and June 2019. Patients who required urological intervention were identified, and perioperative details were retrieved. Results Forty-two cases of PAS were identified. The mean maternal age was 35 years, and mean gestational age at delivery was 34 weeks. Thirty-seven cases were managed electively, with 5 cases managed conservatively (no hysterectomy) and 5 requiring emergency management. Fifteen patients (36%) had suspected bladder invasion on MRI. A total of 36 patients (86%) had ureteric catheters inserted, 14 (33%) required bladder repair, and 2 had ureteric injuries (5%). Conclusions PAS frequently requires urological intervention to prevent and repair injury to the urinary bladder and ureter. PAS is a rare condition that is best managed in an MDT setting in a centralised, tertiary, high-volume centre with access to a variety of medical and surgical sub-specialities.

Rapp-Hodgkin Syndrome with palmoplantar keratoderma

Rapp-Hodgkin syndrome is a rare condition that is characterized by ectodermal dysplasia and palatal abnormalities. We describe a 15-year-old male who has Rapp-Hodgkin syndrome that is associated with a palmoplantar keratoderma.

A New Subform? Fast-Progressing, Severe Neurological Deterioration Caused by Spinal Epidural Lipomatosis

Spinal epidural lipomatosis (SEL) is a rare condition caused by hypertrophic growth of epidural fat. The prevalence of SEL in the Western world is approximately 1 in 40 patients and is likely to increase due to current medical and socio-economic developments. Rarely, SEL can lead to rapid severe neurological deterioration. The pathophysiology, optimal treatment, and outcome of these patients remain unclear. This study aims to widen current knowledge about this “SEL subform” and to improve its clinical management. A systematic literature review according to the PRISMA guidelines using PubMed, Scopus, Web of Science, and Cochrane Library was used to identify publications before 7 November 2021 reporting on acute/rapidly progressing, severe SEL. The final analysis comprised 12 patients with acute, severe SEL. The majority of the patients were male (9/12) and multimorbid (10/12). SEL mainly affected the thoracic part of the spinal cord (11/12), extending a median number of 7 spinal levels (range: 4–19). Surgery was the only chosen therapy (11/12), except for one critically ill patient. Regarding the outcome, half of the patients regained independence (6/11; = modified McCormick Scale ≤ II). Acute, severe SEL is a rare condition, mainly affecting multimorbid patients. The prognosis is poor in nearly 50% of the patients, even with maximum therapy. Further research is needed to stratify patients for conservative or surgical treatment.

Tumor-induced osteomalacia: a case report

Background Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness. Case presentation We report a case of 74–year–old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition. Conclusion Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.

Case Report of Rare Parathyroid Tumor with Atypical Presentation and Early Diagnosis

Parathyroid carcinoma is a rare condition, accounting for 1% of cases of hyperparathyroidism. Other causes of hyperparathyroidism main group are single adenoma and parathyroid hyperplasia. The clinics presented by the patients are typical of hyperparathyroidism (fatigue, weakness, weight loss, and anorexia), bone impairment, pain, and fractures, in addition to affecting the renal system The diagnosis of parathyroid carcinoma is most often done postoperatively by means of a histological study. The case report is a 49-year-old male patient who came to the emergency room of Mackenzie Evangelical University Hospital complaining of progressive “muscle weakness” and “joint” that started about 2 months ago. To raise the suspicion of parathyroid carcinoma, it is essential to perform the correlation of the clinical picture, biochemical values, and imaging exams, but to obtain the definitive diagnosis, intraoperative recognition of the tumor and the result of the histopathological examination of the resected tumor are necessary.

Nivolumab induced hypophysitis in an advanced RCC patient

Introduction: Immune checkpoint inhibitors (ICIs) are being commonly used to treat solid tumours such as renal cell carcinoma. Hypophysitis is an acute or chronic inflammation of the pituitary gland and nivolumab or pembrolizumab induced hypophysitis is markedly lower compared to ipilimumab. Case report: We present a novel case of a patient with mRCC who was diagnosed with nivolumab induced hypophysitis based on clinical suspicion due to his hormonal profile and a range of symptoms that he developed during nivolumab immunotherapy. Management and outcome: He was treated with high dose of hydrocortisone administered intravenously, subsequently changed to the oral route and physiologic dose. Discussion: Nivolumab induced hypophysitis is a rare condition that usually presents with fewer symptoms. High degree of clinical suspicion and a multidisciplinary team required to diagnose and treat such cases.

Gangrenous Cholecystitis From Gallbladder Volvulus With a Hiatal Hernia

Gallbladder volvulus is a rare condition involving the rotation of the gallbladder about the cystic duct and vascular pedicle, compromising biliary drainage and blood flow. This report describes a case of gallbladder volvulus presenting in an 88-year-old female with acute onset of right upper quadrant abdominal pain, nausea, and vomiting. Complete work-up included a physical exam, laboratory studies, and computed tomography (CT), which was notable for a markedly distended gallbladder with circumferential wall thickening, pericholecystic fluid, a 12 mm common bile duct, and a hiatal hernia. Given that her initial presentation was consistent with acute cholecystitis, we elected to perform laparoscopic cholecystectomy. The definitive diagnosis of gallbladder volvulus was made intraoperatively after decompression of the gallbladder and visualization of counterclockwise rotation of the gallbladder around the hilum and the infundibulum. This case illustrates the challenge in preoperative diagnosis of gallbladder volvulus, which requires high clinical suspicion to provide prompt surgical intervention.

Testicular metastasis in prostate cancer: A rare case of testicular metastasis diagnosed with 68Ga-PSMA and review of the literature

Objective: Testicular metastasis in prostate cancer is a rare entity. We aimed to report the case where this rare condition was diagnosed with Gallium prostate-specific membrane antigen–positron emission tomography/computed tomography (68Ga-PSMA-PET/CT). Subjects/patients and methods: A 68-year-old male with a prostate adenocarcinoma presented with testicular metastasis. The patient was diagnosed with 68Ga-PSMA-PET/CT, and bilateral inguinal orchiectomy was performed. Herein, our case is presented, and a short review of the literature is carried out. Conclusion: 68Ga-PSMA-PET/CT is an effective imaging method for detecting rare metastases. Level of evidence: 4

Purposeful use of multimodality imaging in the diagnosis of caseous mitral annular calcification: a case series report

Background Caseous mitral annular calcification (CMAC) is a rare liquefactive variant of mitral annular calcification (MAC) and superficially mimics a cardiac vegetation or abscess. CMAC is viewed as a benign condition of MAC, while MAC has clinical implications for patients’ lives. Correctly diagnosing CMAC is essential in order to avoid unnecessary interventions, cardiac surgery or even psychological suffering for the patient. Case presentation We report on 6 patients with suspected intra-cardiac masses of the mitral annulus that were referred to our institution for further clarification. A definitive diagnosis of CMAC was achieved by combining echocardiography (Echo), cardiac magnetic resonance imaging (MRI) and cardiac computed tomography (CT) for these patients. Echo assessed the mass itself and possible interactions with the mitral valve. MRI was useful in differentiating the tissue from other benign or malign neoplasms. CT revealed the typical structure of CMAC with a “soft” liquefied centre and an outer capsule with calcification. Conclusion CMAC is a rare condition, and most clinicians and even radiologists are not familiar with it. CMAC can be mistaken for an intra-cardiac tumour, thombus, vegetation, or abscess. Non-invasive multimodality imaging (i.e. Echo, MRI, and CT) helps to establish a definitive diagnosis of CMAC and avoid unnecessary interventions especially in uncertain cases.