scholarly journals Tophaceous gout in the sternoclavicular joint

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Nikhil Sahdev ◽  
Jeremy Smelt ◽  
Zoe Avila ◽  
Duncan Tennent ◽  
Ian Hunt
Keyword(s):  
Amorphous Material ◽  
Gouty Arthritis ◽  
Mass Effect ◽  
Sternoclavicular Joint ◽  
Necrotic Lesion ◽  
Excision Biopsy ◽  
Thoracic Cage ◽  
Tophaceous Gout ◽  
Adjacent Structures ◽  
Bony Mass

Abstract Gouty arthritis commonly occurs in peripheral synovial joints and involvement in the thoracic cage is extremely rare. We report a case of a 52-year-old presenting with a painful bony mass in her sternal notch. Imaging demonstrated a lobulated calcified and necrotic lesion causing mass effect on adjacent structures. Excision biopsy confirmed a benign cystic lesion with amorphous material containing needle-shaped refractile crystals suggestive of uric acid. Tophaceous gout was diagnosed. Presence of a periarticular mass with characteristics of gout should warrant investigation with biopsy and imaging. This can prevent misdiagnosis of malignancy and avoid unnecessary surgery in asymptomatic lesions.

scholarly journals Hyperuricemia and Gout – Ins and Out

2020 ◽  
Vol 15 (2) ◽  
pp. 227-234
Author(s):  
Md Abdur Razzak ◽  
Quazi Audry Arafat Rahman ◽  
Fahtiha Nasreen
Keyword(s):  
Gouty Arthritis ◽  
Polarized Light ◽  
Acute Gout ◽  
Women Patients ◽  
Monosodium Urate ◽  
Tophaceous Gout ◽  
First Metatarsal ◽  
Birefringent Crystals ◽  
Inflammatory Drugs ◽  
Urate Crystals

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are also commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids and analgesics. In patients without complications, NSAID therapy is preferred. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 227-234

scholarly journals Role of MRI in the evaluation of acoustic schwannoma and its comparison to histopathological findings

1970 ◽  
Vol 37 (3) ◽  
pp. 92-96 ◽  
Author(s):  
S Haque ◽  
A Hossain ◽  
MA Quddus ◽  
MU Jahan
Keyword(s):  
Imaging Modality ◽  
Contrast Material ◽  
High Sensitivity ◽  
Mass Effect ◽  
Female Ratio ◽  
Perilesional Edema ◽  
Adjacent Structures ◽  
Dural Tail ◽  
Acoustic Schwannoma ◽  
Magnetic Resonance Imaging Mri

Magnetic Resonance Imaging (MRI) has been the primary imaging modality and has revolutionized the imaging of brain tumors. MRI can display accurate multi planer imaging without interfering of adjacent structures specially for posterior fossa mass lesion. MRI is the imaging modality of choice for cerebollo-pontine (CP) angle Schwannoma. The study was performed to determine, the diagnostic accuracy of MRI in the evaluation of intracranial extra axial CP angle Schwannoma. MRI scan of brain was done on 42 consecutively selected patients referred for the evaluation of CP Acoustic Schwannoma. The age range from 21-60 years and the mean age was 42.85(+9.5) years. Highest incidence of cerebollo-pontine angle (CPA) mass were found 42.86% in 41-50 age group of patients. Male and Female ratio was 1.083:1. The most common presenting feature of the patients with CP angle Acoustic Schwannoma were headache 90.48%. Acoustic Schwannoma is T1 hypointense 100%, T2 hyper intense 84.61% and heterogeneously hyper intense 92.30% in FLAIR image. After giving contrast agents, homogeneous enhancement 57.69% and heterogeneous 42.31% cases of Acoustic Schwannoma. Overall 61.54% Acoustic Schwannoma strong contrast enhancement was observed. Dural tail was observed in 26.92% cases. Perilesional edema was observed 38.46% cases. Mass effect was observed in 76.92%. After complete MRI evaluation 61.9% had Acoustic Schwannoma. Histopathologicaly proved cases showed out of all patients Acoustic Schwannoma 59.52%. The overall sensitivity of MRI to diagnose Acoustic Schwannoma were found, Sensitivity- 96%, Specificity- 88.2%, PPV-92.31%, NPV-93.75% and Acceuracy 92.86%. Test is significant with p<0.0001 level. It is conceivable that MRI is a highly accurate, sensitive and Gadolinium enhanced MRI is more sensitive in detection of acoustic Schwannoma. MR imaging is the study of choice for the examination of the patient of cerebellopontine angle Schwannoma because of its high sensitivity specially after use of contrast material. DOI: http://dx.doi.org/10.3329/bmrcb.v37i3.9120 BMRCB 2011; 37(3): 92-96

scholarly journals Resection of a Catecholamine-Elaborating Retroperitoneal Paraganglioma Invading the Inferior Vena Cava

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
E. M. Mannina ◽  
Z. Xiong ◽  
R. Self ◽  
E. Kandil
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Standard Of Care ◽  
Mass Effect ◽  
Preoperative Imaging ◽  
Critical Component ◽  
Adjacent Structures

Paragangliomas are rare tumors originating outside of the adrenal medulla which can be associated with catecholamine secretion or mass effect, one of which typically leads to their discovery. The differences between these tumors and traditional intra-adrenal pheochromocytomas are a subject of recent investigations. Standard of care therapy is medical management and surgical resection of the tumor. When tumors are biochemically active, medical optimization of the autonomic nervous system is a critical component to a safe, definitive resection. Tumors arising in the retroperitoneum present technical challenges for the surgeon as they are often large and difficult to access, making an oncologic resection much more difficult. Lastly, these tumors are mostly benign and rarely invade adjacent structures—an operative finding not always predicted by preoperative imaging—which, if present, adds significant complexity and risk to the resection. A case illustrating these challenges in the management of a biochemically active retroperitoneal paraganglioma invading the inferior vena cava follows.

scholarly journals Pleomorphic Adenoma of Lacrimal Gland: A Rare Entity

2021 ◽  
Vol 8 (7) ◽  
pp. C100-104
Author(s):  
Kirti Chadha Kazi ◽  
Vivek Choodamani Parameshwar ◽  
Vikas S Kavishwar ◽  
Prithesh Bhaskar Shetty
Keyword(s):  
Pleomorphic Adenoma ◽  
Lacrimal Gland ◽  
Histopathological Examination ◽  
Mass Effect ◽  
Final Diagnosis ◽  
Myoepithelial Cells ◽  
Significant Loss ◽  
Excision Biopsy ◽  
Post Surgery ◽  
Rare Tumours

Among the various tumours affecting the lacrimal gland, pleomorphic adenomas though most common can present clinically and radiologically as worrisome tumours. Histopathologic diagnosis hence is very critical for these tumours. We present a case of pleomorphic adenoma of the lacrimal gland which we encountered at our institutes. The patient was a 46-year-old male who came with complaints of a gradually progressing swelling in the right eye not associated with much pain or significant loss of vision. MRI revealed a large lobulated extrachoanal mass causing mass effect and scalloping of the adjacent bony structures. An excision biopsy was done and sent for histopathological examination. Histologically the tumour showed a biphasic morphology comprising of epithelial (ductal and myoepithelial) and chondromyxoid stromal components. Immunohistochemistry showed positivity for pan CK and CK 7 in ductal epithelial cells, p63 and S100 in myoepithelial cells and a low Ki67 index. On the basis of immunohistochemistry profile along with clinicoradiological correlation a final diagnosis of pleomorphic adenoma of the lacrimal gland was made. The patient post-surgery was doing well but was lost to follow up. It can thus be seen that is it absolutely necessary to accurately diagnose these benign but clinically misconceiving rare tumours of the lacrimal gland for appropriate management of such patients.

scholarly journals Bilateral elbow indirect Cubital tunnel syndrome due to mass effect of Gouty tophi

2021 ◽  
Vol 13 (4) ◽  
pp. 70-73
Author(s):  
Akshay Lekhi
Keyword(s):  
Uric Acid ◽  
Case Reports ◽  
Surgical Excision ◽  
Mass Effect ◽  
Cubital Tunnel Syndrome ◽  
Pharmaceutical Drugs ◽  
Monosodium Urate ◽  
Tophaceous Gout ◽  
Tunnel Syndrome ◽  
Urate Crystals

Gout is an inflammatory arthritis associated with raised uric acid levels in blood. The pathology involves infiltration and destruction of ligament, cartilage, tendons, bone and skin by deposition of urate crystals. Our purpose of writing this case is to report rare bilateral neurological symptoms due to compression, by tophaceous gout around elbows. A 32-year-old male had presented with episodic tingling in bilateral ulnar nerve distributions for fourteen days. Surgical excision of the tophi around elbows that were causing the neural compression symptoms was done and symptoms relieved gradually over 6 weeks. Tophi are late presentations. They can present with symptoms from depositing at different sites that is evidenced in existing literature case reports. Controlling serum uric acid levels below deposition threshold either by dietary or pharmaceutical drugs is the mainstay of management, resulting in dissolution of monosodium urate crystals.

Narrowing the Pipe: Different Etiologies of Tracheal Stenosis

Neurographics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 248-258
Author(s):  
P.Y. Baral ◽  
E. Friedman ◽  
M.O. Patino
Keyword(s):  
Tracheal Stenosis ◽  
Virtual Endoscopy ◽  
Mass Effect ◽  
Cross Sectional ◽  
Stenotic Lesion ◽  
Imaging Characteristics ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Adjacent Structures ◽  
Differential Imaging

The trachea serves as the conduit for passage of air between the larynx and the lung bronchi. The tracheal luminal caliber may be narrowed in adults by extrinsic mass effect from adjacent structures; intrinsic stenosis secondary to intubation, inflammatory, systemic, or idiopathic disorders; and benign or malignant masses. Contrast-enhanced CT accurately depicts the source of the stenosis and can measure the length and cross-sectional area of the stenosis and evaluate the extent of locoregional spread with malignancies. In addition, the data are capable of being reformatted by several techniques, including virtual endoscopy and surface-rendered reconstruction. Certain imaging characteristics such as the presence of calcifications and involvement or sparing of the posterior membrane can be useful to suggest a particular diagnosis or differential. Imaging, however, is not usually pathognomonic for a specific benign or malignant tracheal stenotic lesion, and ultimately biopsy is needed to establish a definitive histopathologic diagnosis.Learning Objective: To describe the different etiologies of tracheal stenosis

scholarly journals Tophaceous Gout and Renal Insufficiency: A New Solution for an Old Therapeutic Dilemma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Anne-Kathrin Tausche ◽  
Carsten Wunderlich ◽  
Martin Aringer
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Life Expectancy ◽  
Renal Impairment ◽  
Gouty Arthritis ◽  
Serum Urate ◽  
Oxidase Inhibitor ◽  
The Novel ◽  
Tophaceous Gout ◽  
Rapid Control

The prevalence of gout is increasing with increased life expectancy. Approximately half of the patients with gout have some degree of renal impairment. If both conditions persistently coexist, and in severe tophaceous gout, in particular, treatment has been difficult. We here report on the case of an 87-year-old woman, who had been suffering from recurrent gouty arthritis over 4 years. Monthly polyarthritis attacks were accompanied by subcutaneous tophi. Serum uric acid levels were constantly above 600 μmol/L (10 mg/dL). Allopurinol was no option because of intolerance, while benzbromarone was ineffective because of renal impairment. Therefore, the novel xanthin oxidase inhibitor febuxostat was started, achieving rapid control of serum urate levels (<360 μmol/L). After initial worsening of inflammation in the first weeks, gouty attacks stopped and all tophi resolved within the following 10 months. Renal function remained stable.

Gout

2019 ◽  
pp. 167-169
Author(s):  
Josephina A. Vossen
Keyword(s):  
United States ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Gouty Arthritis ◽  
Joint Space ◽  
The United States ◽  
Initial Evaluation ◽  
Tophaceous Gout ◽  
Acute Arthritis ◽  
Msu Crystals

Chapter 35 discusses gout, a metabolic disorder in which hyperuricemia leads to deposition of monosodium urate (MSU) crystals in soft tissues and joints. Gout is the most common crystalline type of arthropathy in the United States. Gout is considered to have 4 phases, characterized by asymptomatic hyperuricemia, recurrent attacks of acute arthritis, intercritical gout and chronic tophaceous gout. Radiography is generally used in the initial evaluation of gouty arthritis. Characteristic of gout are well-defined, punched-out erosions with overhanging edges, with late preservation of the joint space, lack of periarticular osteopenia, asymmetrical involvement, and soft tissue nodules that may calcify.

Dysphonia Caused by Forestier's Disease

1988 ◽  
Vol 97 (3) ◽  
pp. 275-276 ◽  
Author(s):  
Isaac Gay ◽  
Joseph Elidan
Keyword(s):  
Ct Scan ◽  
Vertebral Body ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Mass Effect ◽  
Forestier’S Disease ◽  
Bony Mass ◽  
First Time ◽  
Forestier's Disease

A case of diffuse idiopathic skeletal hyperostosis (Forestier's disease) causing dysphonia as the presenting and only symptom is reported. The dysphonia is attributed to the mass effect in the hypopharynx and the mild pressure on the larynx. The bony mass anterior to the vertebral body is demonstrated by CT scan for the first time in the literature on Forestier's disease.

scholarly journals Fibrous Dysplasia, Paget's Disease of Bone, and Other Uncommon Sclerotic Bone Lesions of the Craniofacial Bones

2020 ◽  
Vol 24 (05) ◽  
pp. 570-578
Author(s):  
Nick Van de Voorde ◽  
Geert R. Mortier ◽  
Filip M. Vanhoenacker
Keyword(s):  
Fibrous Dysplasia ◽  
Paget’S Disease ◽  
Mass Effect ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Systematic Evaluation ◽  
Bone Lesions ◽  
Imaging Features ◽  
Paget's Disease Of Bone ◽  
Adjacent Structures

AbstractImaging studies of the brain, head and neck, sinuses, and dental computed tomography are among the most frequently performed procedures in radiologic departments. Systematic evaluation in the bone window may reveal common and uncommon sclerotic osseous abnormalities of the craniofacial skeleton.Most of these findings are incidental and unrelated to the initial clinical indications. Sporadically symptoms may arise due to lesional mass effect with compression on adjacent structures and neuroforaminal encroachment, resulting in proptosis, vision, or hearing loss. Other symptoms include craniofacial deformity, mandibular occlusion deformity, and local pain.This article reviews the most common disorders characterized by an increased bone density involving the craniofacial bones including fibrous dysplasia, Paget's disease of bone, meningioma with associated hyperostosis, and osteoma. Finally, typical examples of rarer sclerosing bone dysplasias are discussed as well.Emphasis is placed on imaging features and the differential diagnosis.

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