302 Migratory Foreign Body in The Neck- How A Fishbone Morphed into A Piece of Glass In 18 Months

Abstract Background Foreign body (FB) ingestion is a common presentation to ear, nose, and throat (ENT) surgeons. Usual culprits include fish or chicken bones, steak, or non-organic items. FBs can be categorised into batteries, hard objects, and soft boluses. Hard objects that have not passed beyond the post-cricoid region require removal to minimise perforation risk. In rare cases FBs are reported to migrate extra-luminally into surrounding tissues of the neck necessitating cross-sectional imaging ahead of neck exploration. Case Report A 70-year-old lady presented to A&E with a sensation of FBs in her throat. She was aphagic without dyspnoea. Home-cooked fish ingestion was the precursor. Panendoscopy was clear. The patient was discharged once tolerating fluids and soft diet. She presented 14 months later to the ENT clinic with a persistent FB sensation in her throat. A computed-tomography scan of neck showed a right sided, radio-opaque, 3 cm foreign body sitting just anterior to the carotid sheath, behind the right superior thyroid lobe. An elective external neck exploration revealed a 3 cm shard of glass which was successfully removed without complications. Conclusions Extra-luminal migration of FBs is extremely rare. They may present with life-threatening suppurative or vascular complications. A literature review revealed that migratory FBs tend to be sharp and long such as needles, wires, or fishbones. To allow prompt diagnosis and management, we propose a low threshold for CT imaging in instances with a clear history and persistent symptoms even when panendoscopy is negative.

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Extraluminal Migration of Foreign Body: A Report of Two Cases

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1150 ◽

2013 ◽

Vol 4 (2) ◽

pp. 98-101 ◽

Cited By ~ 3

Author(s):

K Ramachandran ◽

GM Divya ◽

A Shahul Hameed ◽

KV Vinayak

Keyword(s):

Foreign Body ◽

Digestive Tract ◽

Foreign Bodies ◽

Vascular Complications ◽

Neck Exploration ◽

Upper Digestive Tract ◽

Life Threatening ◽

Ingested Foreign Body ◽

Head Neck

ABSTRACT Ingested foreign body is one of the most frequently encountered emergencies in otolaryngology practice. Many of these foreign bodies get lodged in the upper digestive tract and can be removed endoscopically. Few of these foreign bodies can perforate the upper digestive tract and an even smaller number of these can migrate extraluminally. Although, a migrating foreign body can remain quiescent, they can cause life-threatening suppurative or vascular complications; hence, location and removal is essential. Here we report two cases of extraluminal migration of foreign body which was removed by neck exploration. How to cite this article Divya GM, Hameed AS, Ramachandran K, Vinayak KV. Extraluminal Migration of Foreign Body: A Report of Two Cases. Int J Head Neck Surg 2013;4(2):98-101.

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Systemic arteriopulmonary venous fistula (APVF): case presentation of an asymptomatic individual and a review of the literature

BMJ Case Reports ◽

10.1136/bcr-2021-241644 ◽

2021 ◽

Vol 14 (7) ◽

pp. e241644

Author(s):

Paul Jenkins ◽

Prageeth Dissanayake ◽

Richard Riordan

Keyword(s):

Chest Radiograph ◽

Cardiovascular Health ◽

Incidental Finding ◽

Chest Radiographs ◽

Cross Sectional ◽

Arterial Circulation ◽

Cross Sectional Imaging ◽

Venous Fistula ◽

The Right

Abnormal communications between the systemic and pulmonary venous systems are rare but can present as a opacity on chest radiograph. A solitary vessel communicating as a fistula directly between the systemic arterial circulation and the pulmonary venous system is not widely described. These may have significant implications in the long-term cardiovascular health of an individual acting as a left to right shunt. There is no clear consensus as to the management, but surgical management and endovascular embolisation have been successfully used. We present a case where a systemic arteriaopulmonary fistula originating from the abdominal aorta and connecting to the right inferior pulmonary vein manifested as an incidental finding on a chest radiograph and was further evaluated on cross-sectional imaging in a young patient. Chest radiographs are non-specific and it is important to be aware of the less frequent but important pathologies that can be picked up on plain chest radiographs, which inturn should warrant further investigation. This is presented in conjunction with a review of the available literature along with a discussion regarding the differential diagnosis and management applicable to the general clinician.

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Case 9.28

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0250 ◽

2014 ◽

pp. 476-477

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Small Bowel ◽

Cross Sectional ◽

New Era ◽

True Incidence ◽

Live Births ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

The Right ◽

Left Abdomen

11-year-old boy with suspected IBD Coronal SSFSE images (Figure 9.28.1) demonstrate abnormal orientation of large and small bowel, with small bowel in the right abdomen and colon in the left abdomen. Malrotation Classic thinking regarding malrotation holds that most cases are detected within the first few months of life. However, in the new era of cross-sectional imaging for everyone, more and more adults with asymptomatic malrotations are noted and the true incidence is not entirely certain. Estimates in the literature range from 1 in 6,000 to 1 in 200 live births. Autopsy studies suggest that some form of malrotation exists in 0.5% to 1% of the population....

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Broken metallic tracheostomy tube migrating into the tracheobronchial tree

Surgical Techniques Development ◽

10.4081/std.2016.6466 ◽

2016 ◽

Vol 6 (1) ◽

Author(s):

Nilam U. Sathe ◽

Ratna Priya ◽

Sheetal Shelke ◽

Kartik Krishnan

Keyword(s):

Foreign Body ◽

Tracheostomy Tube ◽

Main Bronchus ◽

Tracheobronchial Tree ◽

Life Saving ◽

Wear And Tear ◽

Life Threatening ◽

History Of ◽

The Right ◽

Periodic Replacement

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening.

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Sectional anatomy of the ventricular septal defect in double outlet right ventricle—correlation of magnetic resonance images from autopsied hearts with anatomic sections

Cardiology in the Young ◽

10.1017/s1047951100001372 ◽

1993 ◽

Vol 3 (2) ◽

pp. 118-123 ◽

Cited By ~ 3

Author(s):

Shi-Joon Yoo ◽

Siew Yen Ho ◽

Philip J. Kilner ◽

Jeong-Wook Seo ◽

Robert H. Anderson

Keyword(s):

Ventricular Septal Defect ◽

Right Ventricle ◽

Septal Defect ◽

Double Outlet Right Ventricle ◽

Magnetic Resonance Images ◽

Cross Sectional ◽

Posterior Limb ◽

Imaging Characteristics ◽

Cross Sectional Imaging ◽

The Right

AbstractA ventricular septal defect is, almost always, an integral part of double outlet right ventricle and has been classified into the subaortic, subpulmonary, doubly committed and non-committed varieties. This study was performed to correlate the cross-sectional imaging characteristics of such ventricular septal defect in double outlet right ventricles using pathological specimens. The extent and the orientation of the outlet septum were the most important in the differentiation of the four varieties of ventricular septal defect. In the subaortic variety, the outlet septum fused with the left anterior margin of the defect, this being marked by the anterior limb of the septomarginal trabeculation. In the subpulmonary variety, the outlet septum fused with the right posterior margin of the defect, this being the posterior limb of the septomarginal trabeculation. The outlet septum was vestigial in case with doubly committed defects. In those with non-committed defects, the defect was not shown in those images or sections which demonstrated the outlet septum.

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Pulmonary Arterial Dilatation: Imaging Evaluation Using Multidetector Computed Tomography

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734225 ◽

2021 ◽

Author(s):

Sreenivasa Narayana Raju ◽

Niraj Nirmal Pandey ◽

Arun Sharma ◽

Amarinder Singh Malhi ◽

Siddharthan Deepti ◽

...

Keyword(s):

Pulmonary Artery ◽

Bronchial Tree ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Imaging Evaluation ◽

Cross Sectional ◽

Clinical Background ◽

Cross Sectional Imaging ◽

Life Threatening ◽

Pulmonary Arterial

AbstractPulmonary artery dilatation comprises a heterogeneous group of disorders. Early diagnosis is important as the presentation may be incidental, chronic, or acute and life threatening depending upon the etiology. Cross-sectional imaging plays an important role, with CT pulmonary angiography being regarded as the first line investigation in the evaluation of pulmonary artery pathologies. Moreover, effects of pulmonary artery lesions on proximal and distal circulation can also be ascertained with the detection of associated conditions. Special attention should also be given to the left main coronary artery and the trachea-bronchial tree as they may be extrinsically compressed by the dilated pulmonary artery. In context of an appropriate clinical background, CT pulmonary angiography also helps in treatment planning, prognostication, and follow-up of these patients. This review mainly deals with imaging evaluation of the pulmonary arterial dilatations on CT with emphasis on the gamut of etiologies in the adult as well as pediatric populations.

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A Rare Case of Life-Threatening Bleeding Caused by a Jejunal GIST

Surgical Case Reports ◽

10.31487/j.scr.2019.06.04 ◽

2019 ◽

pp. 1-2

Author(s):

Aloka Liyanage ◽

R Kalaiselvan ◽

R Rajaganeshan ◽

S P B Thalgaspitiya

Keyword(s):

Rare Case ◽

Haemorrhagic Shock ◽

Gi Tract ◽

Gastrointestinal Stromal Tumours ◽

Cross Sectional ◽

Male Preponderance ◽

Cross Sectional Imaging ◽

Life Threatening ◽

Intermittent Bleeding ◽

Mesenchymal Tumours

Gastrointestinal Stromal Tumours (GISTs) are rare mesenchymal tumours that are specific to GI tract. GISTs usually associated with advanced age and have a slight male preponderance. GISTs are commonly found in stomach. Jujunal GISTs are the rarest and account for about 0.1-3% of all GI tumours [1]. The most common clinical manifestation of symptomatic GISTs includes intermittent bleeding due to mucosal ulceration. Massive, life threatening gastrointestinal (GI) bleeding is a rare occurrence. We report a rare case of bleeding Jejunal GIST in a 32-year-old female who presented with haemorrhagic shock that required resuscitative laparotomy. Histopathology and immunohistochemistry confirmed the tumour to have features of GIST with clear margins and post-operative cross-sectional imaging excluded any metastatic deposits.

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P-EGS03 Curious Case of Life Threatening Gastrointestinal Bleed

British Journal of Surgery ◽

10.1093/bjs/znab430.063 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

VIBHA SINGH

Keyword(s):

Arteriovenous Malformation ◽

Gastrointestinal Stromal Tumors ◽

Severe Anaemia ◽

Intestinal Bleeding ◽

Cross Sectional ◽

Stromal Tumors ◽

Cross Sectional Imaging ◽

Life Threatening ◽

Cells Of Cajal ◽

Resection And Anastomosis

Abstract Background Gastrointestinal stromal tumors are mesenchymal in origin, being derived from the interstitial cells of Cajal. These can be found anywhere in the gastrointestinal tract and are commonly found in the stomach followed by the small bowel. Gastrointestinal stromal tumors are usually asymptomatic and are often found incidentally. Chronic bleeding is one of the most common presentation. Gastrointestinal stromal tumors presenting with massive gastro intestinal haemorrhage and mimicking arteriovenous malformation on radiology are rare with only few cases reported. Methods Herein we present such a case of a 45-year-old gentleman with massive gastro intestinal bleeding. At presentation, patient was in congestive heart failure due to severe anaemia with a hemoglobin of 2.9g/dL. CECT Angiography localised the bleed to be from a jejunal mass lesion with radiological features consistent with those of arteriovenous malformation. Patient underwent laparoscopy assisted resection and anastomosis. Results Histopathology examination revealed a low risk jejunal gastrointestinal stromal tumor with no evidence of arteriovenous malformation. The mass was removed completely and the patient was discharged on 5th post-operative day. Patient was followed up in the out-patient department and was found to be doing well. Conclusions Gastrointestinal stromal tumors though relatively uncommon should be kept as important differentials for acute torrential gastrointestinal bleeding. It is highlighted that a presentation of gastrointestinal stromal tumors similar to that of arteriovenous malformations on cross sectional imaging should be kept in mind. The present case is reported in hope of expanding the knowledge of a rare occurrence, its aetiology, clinical impact and treatment.

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Aseptic abscess syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-236437 ◽

2020 ◽

Vol 13 (10) ◽

pp. e236437

Author(s):

Hannah Fillman ◽

Patricio Riquelme ◽

Peter D Sullivan ◽

André Martin Mansoor

Keyword(s):

Abdominal Pain ◽

Immunosuppressive Agents ◽

High Dose ◽

Cross Sectional ◽

Abdominal Abscesses ◽

Intravenous Antibiotics ◽

Cross Sectional Imaging ◽

Aseptic Abscess ◽

Intravenous Steroids ◽

The Right

A 43-year-old woman with Crohn’s disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient was not on steroids or other immunosuppressive agents. Cross-sectional imaging of the abdomen revealed active colitis and multiple splenic and hepatic abscesses. All culture data were negative, including aspiration of purulent material from the spleen. Despite weeks of intravenous antibiotics, daily fever and abdominal pain persisted, the intra-abdominal abscesses grew, and she developed pleuritic chest pain and consolidations of the right lung. The patient was ultimately diagnosed with aseptic abscess syndrome, a rare sequelae of inflammatory bowel disease. All antimicrobials were discontinued and she was treated with high-dose intravenous steroids, resulting in rapid clinical improvement. She was transitioned to infliximab and azathioprine as an outpatient and repeat imaging demonstrated complete resolution of the deep abscesses that had involved her spleen, liver and lungs.

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A Rare Case of Fungal Necrotising Otitis Externa Centred on the Left Temporomandibular Joint

Case Reports in Otolaryngology ◽

10.1155/2020/8874754 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

A. Khan ◽

E. Omakobia ◽

S. Hasnie ◽

R. Barton ◽

P. Gopalan ◽

...

Keyword(s):

Temporomandibular Joint ◽

Antifungal Therapy ◽

Otitis Externa ◽

Pcr Analysis ◽

Causative Organism ◽

Cross Sectional ◽

Chronic Renal Impairment ◽

Cross Sectional Imaging ◽

Life Threatening ◽

High Index Of Suspicion

Introduction. Necrotising otitis externa (NOE) is a rare life-threatening complication of simple otitis externa which can be difficult to diagnose and manage. It is very rarely centred on the temporomandibular joint (TMJ). Fungi cause NOE in approximately 5–20% of patients, and a high index of suspicion is required for diagnosis, particularly when there is no improvement with prolonged topical and intravenous antibiotic therapy. Objective. To report a novel case of fungal NOE centred on the left TMJ in an immunocompromised adult male with a focus on investigations and optimal management. Case Report. A 67-year-old male with comorbid chronic renal impairment presented to our otolaryngology department with prolonged left otalgia and otorrhoea. Subsequent cross-sectional imaging demonstrated left NOE centred on the TMJ. Poor resolution with prolonged courses of systemic and topical anti-pseudomonal antibiotics prompted maxillofacial surgical input for left TMJ exploration, washout, and biopsy from the joint capsule. The causative organism was identified as Aspergillus flavus on PCR analysis. The patient was successfully treated with oral posaconazole and repeated topical insertions of amphotericin B-soaked ribbon gauze to the left ear. Discussion. A combination of various imaging modalities including CT, MRI, Tc-99, and gallium-67 are utilised in clinical practice both to diagnose NOE and subsequently monitor disease progression or resolution. Immunocompromised patients with confirmed fungal NOE may require a combination of treatments including surgical debridement and prolonged antifungal therapy for a number of months, if not lifelong, treatment. Initiating empirical antifungal therapy may be justified in some patients. However, this should be judged on a case-by-case basis and guided by discussion with the local microbiology and infectious diseases departments. However, there is no national guideline or consensus regarding treatment of these patients, especially in cases of fungal NOE.

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