Incomplete septal cirrhosis: An uncommon condition

AbstractRight heart thrombus (RHT) in transit is an uncommon condition associated with high mortality. Increased use of echocardiography has allowed an easier detection of RHT; however, there is no consensus about the most appropriate management of this critical situation. Therapeutic strategy should be decided according to patient’s haemodynamic parameters, clinical data, and bleeding risk. This paper, referring to the most current evidences, underlines the difficulty to establish the best therapeutic strategies in RHT among complex patients as there are no relevant guidelines. In some conditions, multidisciplinary management is the best way to find the most correct therapy despite the bad prognosis.

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A non-resolving splenic ‘abscess’ in an elderly male – An unusual manifestation of splenic lymphoma

Tropical Doctor ◽

10.1177/0049475520981305 ◽

2020 ◽

pp. 004947552098130

Author(s):

Raj K Nagarajan ◽

Balasubramanian Gopal ◽

Muhamed Tajudeen ◽

Sarath C Sistla ◽

K Balamourougan

Keyword(s):

Risk Factors ◽

Splenic Abscess ◽

Low Grade ◽

Surgical Drainage ◽

Elderly Male ◽

Unusual Manifestation ◽

Splenic Lymphoma ◽

Haematogenous Spread ◽

Uncommon Condition ◽

Abscess Wall

Splenic abscess is a relatively uncommon condition, posing a diagnostic and therapeutic challenge for the treating physician. It occurs due to haematogenous spread from endocarditis or other septic foci, especially in immune-compromised individuals and diabetics. We describe an elderly male who presented with splenomegaly and low-grade fever with no predisposing factors. Examination revealed a tender splenomegaly. Ultrasonography (US) showed a hypoechoic area within the spleen from which guided aspiration of pus grew Staphylococcus aureus and Klebsiella pneumoniae. Percutaneous drainage and culture-based antibiotics failed to resolve the abscess, obligating surgical drainage. Intraoperative biopsy from the abscess wall was reported as splenic marginal lymphoma. This unusual presentation of lymphoma needs to be considered in splenic abscess without known risk factors.

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Evaluation and management of obstetric genital fistulas treated at a pelvic floor centre in Germany

BMC Women s Health ◽

10.1186/s12905-021-01175-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christl Reisenauer ◽

Bastian Amend ◽

Claudius Falch ◽

Harald Abele ◽

Sara Yvonne Brucker ◽

...

Keyword(s):

Pelvic Floor ◽

Developed Countries ◽

Vaginal Wall ◽

Fistula Closure ◽

Fistula Repair ◽

Anterior Position ◽

Multiparous Women ◽

Uncommon Condition ◽

Rectovaginal Fistulas ◽

Vesicovaginal Fistulas

Abstract Background Obstetric genital fistulas are an uncommon condition in developed countries. We evaluated their causes and management in women treated at a German pelvic floor centre. Methods Women who had undergone surgery for obstetric genital fistulas between January 2006 and June 2020 were identified, and their records were reviewed retrospectively. Results Eleven out of 40 women presented with genitourinary fistulas, and 29 suffered from rectovaginal fistulas. In our cohort, genitourinary fistulas were more common in multiparous women (9/11), and rectovaginal fistulas were more common in primiparous women (24/29). The majority of the genitourinary fistulas were at a high anterior position in the vagina, and all rectovaginal fistulas were at a low posterior position. While all genitourinary fistulas were successfully closed, rectovaginal fistula closure was achieved in 88.65% of cases. Women who suffered from rectovaginal fistulas and were at high risk of recurrence or postoperative functional discomfort and desired another child, we recommended fistula repair in the context of a subsequent delivery. For the first time, pregnancy-related changes in the vaginal wall were used to optimize the success rate of fistula closure. Conclusions In developed countries, birth itself can lead to injury-related genital fistulas. As fistula repair lacks evidence-based guidance, management must be tailored to the underlying pathology and the surgeon’s experience. Attention should be directed towards preventive obstetric practice and adequate perinatal and postpartum care. Although vesicovaginal fistulas occur rarely, in case of urinary incontinence after delivery, attention should be paid to the patient, and a vesicovaginal fistula should be ruled out. Trial registration Retrospectively registered, DRKS 00022543, 28.07.2020.

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The giant resectable carcinoma of gall bladder—a case report

BMC Surgery ◽

10.1186/s12893-021-01117-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lovenish Bains ◽

Haraesh Maranna ◽

Pawan Lal ◽

Ronal Kori ◽

Daljit Kaur ◽

...

Keyword(s):

Case Report ◽

Gall Bladder ◽

Lymph Node Involvement ◽

Chronic Cholecystitis ◽

Large Size ◽

Node Involvement ◽

Uncommon Condition ◽

Well Differentiated ◽

Vague Abdominal Pain ◽

Common Malignancy

Abstract Background Gall bladder cancer (GBC) is the fifth most common malignancy in the gastrointestinal system and the most common malignancy of the biliary system. GBC is a very aggressive malignancy having a 5 year survival rate of 19%. Giant Gall Bladder (GGB) is an uncommon condition that can result from cholelithiasis or chronic cholecystitis and rarely with malignancy. Case report A 65 year old lady presented with vague abdominal pain for 12 years and right abdominal lump of size 20 × 8 cms was found on examination. CT scan showed a circumferentially irregularly thickened wall (2.5 cm) of gall bladder indicative of malignancy. Per-operatively a GB of size 24 × 9 cm was noted and patient underwent radical cholecystectomy. It was surprise to find such a giant malignant GB with preserved planes. Histopathology, it was well differentiated adenocarcinoma of gall bladder of Stage II (T2a N0 M0). Discussion It is known that mucocoele of GB can attain large size, however chronic cholecystitis will lead to a shrunken gall bladder rather than an enlarged one. A malignant GB of such size and resectable is rare without any lymph node involvement or liver infiltration. Few cases of giant benign gall bladder have been reported in literature, however this appears to be the largest resectable gall bladder carcinoma reported till date as per indexed literature. Conclusion Giant GB is an uncommon finding. They are mostly benign, however malignant cases can occur. Radiological findings may suggest features of malignancy and define extent of disease. Prognosis depends on stage of disease and resectability, irrespective of size.

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Pericardial Effusion as a Complication of PICC Line Insertion

Journal of Neonatology ◽

10.1177/09732179211007615 ◽

2021 ◽

pp. 097321792110076

Author(s):

Abdah Hrfi ◽

Mohammed H.A. Mohammed ◽

Omar Tamimi

Keyword(s):

Birth Weight ◽

Pericardial Effusion ◽

Metabolic Diseases ◽

Neonatal Period ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Preterm Baby ◽

Line Insertion ◽

Uncommon Condition ◽

Picc Line

Cardiac tamponade as a result of pericardial effusion (PE) is a serious uncommon condition in the neonatal period. PE in such cases could be associated with hydrops fetalis, neonatal sepsis, metabolic diseases, or as a complication of percutaneous indwelling central catheter. 1 We are reporting a preterm baby, with low birth weight who developed large PE as a complication of total parenteral nutrition via a peripherally inserted central catheter, managed successfully with pericardiocentesis.

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Bilateral Congenital Humeroradial Synostostis Presenting with Bilateral Proximal Radius Fractures: A Case Report

Case Reports in Orthopedic Research ◽

10.1159/000512183 ◽

2021 ◽

pp. 29-32

Author(s):

Elsiddig E. Mahmoud

Keyword(s):

Case Report ◽

Elbow Joint ◽

Parental Education ◽

Functional Disability ◽

Congenital Abnormalities ◽

Rare Condition ◽

Radius Fractures ◽

Proximal Radius ◽

History Of ◽

Uncommon Condition

Congenital bilateral humeroradial synostosis (HRS) is a rare condition. It is generally divided into 2 categories. In the first group, which is mainly sporadic, additional upper limb hypoplasia typically coexists. In the second group, which is classically familial, HRS is commonly an isolated upper extremity anomaly. HRS can lead to variable degrees of functional disability. The clinical case reported here illustrates a possibly avoidable presentation of this uncommon condition. In this case report, we present a 6-week-old male who presented with bilateral radius fractures. Radiography revealed congenital HRS at both elbows. No other associated congenital abnormalities were detected, and there was no family history of similar conditions in any first-degree relatives. In cases of congenital HRS, movement at the elbow joint is not possible. Parents who are unaware of this information might try to straighten their infant’s elbows, which in turn may result in fractures of the proximal radius. Hence, early diagnosis and proper parental education could prevent fractures as a sequela of HRS.

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Imaging of endometrial osseous metaplasia—an uncommon but treatable cause of infertility

Middle East Fertility Society Journal ◽

10.1186/s43043-020-00045-0 ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Abdul Haseeb Wani ◽

Arshed Hussain Parry ◽

Imza Feroz ◽

Majid Jehangir ◽

Masarat Rashid

Keyword(s):

Inflammatory Cells ◽

Osseous Metaplasia ◽

Dystrophic Calcification ◽

Non Invasive ◽

Dilatation And Curettage ◽

Clinical Scenarios ◽

Uncommon Condition ◽

Urinary Tuberculosis ◽

Hypointense Signal ◽

Metaplastic Ossification

Abstract Background Endometrial osseous metaplasia (EOM) is an uncommon condition characterised by metaplastic transformation of endometrial tissue into osteoblasts (mature or immature bone in the endometrium). Etiopathogenesis of EOM is explained by multiple putative mechanisms like dystrophic calcification, metaplastic ossification, retained foetal bones after abortions and genito-urinary tuberculosis. EOM has varied clinical presentation ranging from patient being asymptomatic to secondary infertility. Although hysteroscopy is the gold standard for its diagnosis and treatment, non-invasive imaging comprising chiefly of ultrasonography (USG) is increasingly becoming the mainstay of diagnosis. We aim to present the imaging findings in EOM to acquaint radiologists and gynaecologists with this condition to avert misdiagnosis of this uncommon yet treatable cause of infertility. Results Mean age of patients was 31.4 ± 5.4 (S.D) years. USG revealed linear or tubular densely echogenic endometrium with posterior acoustic shadowing in all the 14 patients. MRI in 3 patients revealed diffuse or patchy areas of T1W and T2W hypointense signal intensity with unilateral (n = 2) and bilateral (n = 1) ovarian cysts. One patient who underwent CT scan revealed dense endometrial calcification. Histopathologic examination (HPE) revealed lamellar (n = 6) or trabecular (n = 4) bone within endometrium (EOM) and inflammatory cells with calcification in four patients (calcific endometritis). Twelve patients conceived after dilatation and curettage within 15 months. Conclusion Familiarity with the imaging appearances of EOM is indispensable to clinch this diagnosis and avert misdiagnosis of this rare but potentially treatable cause of infertility. USG is usually sufficient for diagnosis. MRI and CT are only supplementary tools in difficult clinical scenarios.

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Platypnoea–orthodeoxia syndrome induced by short-term weight loss: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa498 ◽

2020 ◽

Author(s):

Yudai Tamura ◽

Tomohiro Sakamoto

Keyword(s):

Weight Loss ◽

Septal Defect ◽

Case Series ◽

Transoesophageal Echocardiography ◽

Sitting Position ◽

Short Time Period ◽

Time Period ◽

Uncommon Condition ◽

The Right ◽

Short Time

Abstract Background Platypnoea–orthodeoxia syndrome (POS) is an uncommon condition characterized by dyspnoea and arterial desaturation in the standing or sitting position that improves in the supine position. Case summary We report two cases of POS caused by an atrial septal defect (ASD) and a patent foramen ovale (PFO). Both cases reported a recent decrease in body weight of more than 10 kg in a short time period. Transoesophageal echocardiography (TOE) with agitated saline bubble study revealed and a large amount of contrast bubble through the ASD (Patient 1) or the PFO (Patient 2) from the right atrium to the left atrium in the sitting position. Both patients were diagnosed by the finding of positional dyspnoea and the results of TOE using agitated saline bubble contrast. Discussion Taken together, their presentations suggest that weight loss in a short time period could be a pathogenic factor for POS.

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