AB0770 A RARE CASE OF SYNOVIAL METASTASIS REVEALED BY KNEE PAIN

Background:Intra-articular masses are not frequently encountered in clinical practice. However, the differential diagnosis can be broad. Synovial metastasis is a rare presentation that carries a poor prognosis with a poor survival rate.Objectives:Here by a case of synovial metastasis of the knee joint in a patient diagnosed with an adenocarcinoma of the lung.Methods:A 60-year-old man with no remarkable past medical history presented to our department of rheumatology with right knee pain. He described a dull ache and swelling in his right knee with a dragging sensation, waking him up at night on a regular basis. The symptoms lasted from 6 months and were partially improved by analgesics and anti-inflammatory drugs. On examination, temperature was normal. The knee was edematous, erythematous, and warm with a range of motion of <90°. Laboratory investigations showed high acute phase reactants, the erythrocyte sedimentation rate was 75 mm. A plain radiograph of the left knee demonstrated a lytic lesion of the upper tibia. A magnetic resonance imaging of the right knee showed diffuse enlargement of the joint space due to a tissue infiltration within the synovium. These structures demonstrated heterogeneously increased T2 signal and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyper enhancing synovium. At that time, differential considerations included severe inflammatory arthritis and synovial chondromatosis rather than unusual metastasis.Results:Biopsy concluded to synovial metastasis from primary adenocarcinoma. Further investigations were necessary. Chest tomography showed a tumor process of left lower lobe associated with mediastinal lymphadenopathy. The patient was treated with palliative external radiotherapy to the right knee. The evolution was marked by the appearance of multiple tracheobronchial fistulas. The patient died 3 months later due to the progression of the disease.Conclusion:We report a rare case of synovial metastasis concomitant to a lung adenocarcinoma. It is important to make a rapid diagnosis as early recognition of malignant infiltration into joints ensure appropriate multidisciplinary management decisions.Disclosure of Interests:None declared

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Posttraumatic bronchobiliary fistulae due to foreign body remnants after a road traffic injury: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02859-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Seyed-ahmad Seyed-alagheband ◽

Mohammad-kazem Shahmoradi ◽

Ramin Shekouhi

Keyword(s):

Foreign Body ◽

Hydatid Cyst ◽

Liver Abscess ◽

Rare Case ◽

Motor Vehicle ◽

Lower Lobe ◽

Polymerase Chain Reaction Test ◽

Regenerated Cellulose ◽

Bronchobiliary Fistula ◽

The Right

Abstract Background Bronchobiliary fistula is an extremely rare disease that involves abnormal communication between a hepatic segment and bronchial tree. It is mostly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. Case presentation We experienced an extremely rare case of bronchobiliary fistula after motor vehicle accident. A 15-year-old Persian boy visited our clinic with chief complaints of persistent pleuritic chest pain, productive cough, weight loss, and fever for 2 months. Coronavirus disease 2019 reverse transcription polymerase chain reaction test was negative. Chest X-ray revealed hazy opacification of right lower lobe. Bronchoalveolar lavage for acid-fast bacillus came back negative. Thoracoabdominal computed tomography scan revealed a collection in segment VIII of the liver communicating with another 13 × 5 cm multiloculated collection in the lower lobe of the right lung, with air foci within the collection. Right posterolateral thoracotomy was performed with the impression of bronchobiliary fistula. Drainage of hepatic collection with debridement, diaphragmatic repair, and open decortication of lung followed by resection of the involved segment of the right lung was performed. Histopathologic evaluations revealed abscess formation in pulmonary tissue, and many multinucleated giant cells were seen that appear to be due to foreign body remnants after previous laparotomy surgery. The foreign body seemed to be the remnants of Surgicel absorbable hemostat. Conclusions Herein, we report an extremely rare case of a posttraumatic bronchobiliary fistula caused by remnants of Surgicel hemostatic agent. Bronchobiliary fistula is mainly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. Migration and erosion of oxidized regenerated cellulose through the diaphragm seems to be the causative factor of bronchobiliary fistula in this patient.

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Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

International Journal of Cancer and Oncology ◽

10.15436/2377-0902.19.2440 ◽

2019 ◽

Vol 6 (1) ◽

pp. 1-3

Author(s):

Anna Shestakova ◽

Nicolas Gallegos ◽

Beverly Wang ◽

Bosemani Thangavijayan

Keyword(s):

Differential Diagnosis ◽

Stable Condition ◽

Lower Lobe ◽

Lymphomatoid Granulomatosis ◽

Endobronchial Ultrasound ◽

Mediastinal Lymphadenopathy ◽

Radiographic Evaluation ◽

Lung Mass ◽

Complete Occlusion ◽

The Right

Background: Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus (EBV)-driven lymphoproliferative disease. LYG is characterized by a progressive clinical course, which virtually always involves the lungs. LYG characteristically presents as bilateral pulmonary nodules. Pathologically, it is characterized by an angiocentric and angiodestructive infiltration of atypical EBV-positive B-lymphocytes admixed with reactive T-lymphocytes. We report a case of pulmonary LYG that presented as a large mass with complete occlusion of the right main stem bronchus intermedius in an 81-year-old female. Case: An 81-year-old female presented with shortness of breath to the emergency department. Inpatient imaging revealed bulky mediastinal lymphadenopathy with a right lower lobe collapse, shift of the cardiomediastinal silhouette, and a large right upper lung mass. Endobronchial ultrasound-guided biopsy (EBUS) revealed complete occlusion of right mainstem bronchus due to the right upper lung mass growth into the bronchus intermedius. Histopathological examination demonstrated clusters of large atypical EBV-positive B cells interspersed in a minimally polymorphous lymphocytic background, consistent with lymphomatoid granulomatosis, grade 3/3. Patient was treated with immunochemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone - CHOP) and Rituximab (anti-CD20 antibody). At the patient’s most recent follow-up, 6 months later, she was in a stable condition and her respiratory symptoms have improved. Conclusion: Lymphomatoid granulomatosis is a rare disease that should be considered in the differential diagnosis of a radiographic evaluation of a solitary pulmonary lung mass. Since the radiographic impression might favor carcinoma as the top differential diagnosis, biopsy of the lesion is paramount to ensure the correct diagnosis. Lymphomatoid granulomatosis is usually treated with an immunochemotherapy regimen with CHOP, and/or interferon, and Rituximab.

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Coincident detection of lung metastasis of prostate cancer and primary lung cancer: A case report

Canadian Urological Association Journal ◽

10.5489/cuaj.2376 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 524

Author(s):

Yusuke Muro ◽

Takeo Kosaka ◽

Tai Hato ◽

Shuji Mikami ◽

Mototsugu Oya

Keyword(s):

Prostate Cancer ◽

Lung Cancer ◽

Lung Metastasis ◽

Needle Biopsy ◽

Rare Case ◽

External Beam Radiotherapy ◽

Primary Lung Cancer ◽

Lower Lobe ◽

Lung Lesion ◽

The Right

We report an extremely rare case of 79-year-old man, who was discovered with coincidental lung metastasis of prostate cancer and primary lung cancer. The patient presented with low prostatespecific antigen and two lung lesions: one in the right lower lobe, and one in the right upper lobe, 3 years after, he was treated with external beam radiotherapy for Gleason score 4+3=7, cT3aN0M0 prostate cancer. A computed tomography-guided needle biopsy of a nodule in the right lower lobe revealed suspicious metastasis of prostate cancer. Thoracoscopic excisions of both lesions were performed, and each lung lesion was diagnosed as being metastatic prostate cancer and primary lung cancer.

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Langerhans Cell Histiocytosis of the Right Scapula

Journal of Biomedical Research & Environmental Sciences ◽

10.37871/jbres1223 ◽

2021 ◽

Vol 2 (4) ◽

pp. 268-271

Author(s):

M Moradi ◽

S Babaniamansour ◽

M Majidi ◽

S Karkon-Shayan ◽

MD Firouzabadi ◽

...

Keyword(s):

Langerhans Cell Histiocytosis ◽

Rare Case ◽

Unknown Origin ◽

Good Prognosis ◽

Langerhans Cell ◽

Lytic Lesion ◽

Granulomatous Disease ◽

Radiological Imaging ◽

The Right ◽

Microscopic Investigations

Langerhans Cell Histiocytosis (LCH) is a rare granulomatous disease with an unknown origin. LCH occurs at any age and affects any organ. It is presented as self-limited to aggressive forms. Late diagnosis of LCH, after the evidence is revealed at the radiological imaging or microscopic investigations, aggravates the possible complications. This study reported a rare case of LCH with a bone lytic lesion at the right scapula with a good prognosis.

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Primary Angiosarcoma of Humerus – A Case Report and Literature Review

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i05.2186 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Madhan Jeyaraman ◽

Sathish Muthu ◽

Manoj Prabhakar ◽

Naveen Jeyaraman ◽

Garima Agarwal ◽

...

Keyword(s):

Case Report ◽

Proximal Humerus ◽

Multimodality Imaging ◽

Plain Radiograph ◽

Treatment Protocol ◽

Lytic Lesion ◽

Vascular Tumors ◽

Tissue Mass ◽

History Of ◽

The Right

Introduction: Osseous angiosarcoma is a very rare tumor of bone with aggressive behavior, propensity for recurrences, and distant metastasis. The etiology of osseous angiosarcoma is uncertain; however, specific risk factors have been recognized. The diagnosis of angiosarcoma of bone demands multimodality imaging in conjunction with histopathological and vascular marker evaluation to aptly differentiate them from other vascular tumors. Treatment of osseous angiosarcoma remains controversial. Case Report: A 53-year-old male presented with pain and swelling of the right upper 1/3rd of the arm following heaviness while lifting weight for 3 months. He had a history of significant weight loss and appetite with no history of inciting trauma or irradiation in the past. On examination, a diffuse swelling was noted in the right shoulder and right scapular aspect with varied consistency and ill-defined borders and margins. The skin over the swelling was stretched and shiny with dilated engorged veins over it. The plain radiograph of the right shoulder with humerus revealed a large expansile lytic soft-tissue mass in the right proximal humerus with a wide zone of transition without sclerotic margins. Magnetic resonance imaging showed T1 hypointense, T2/PDFS hyperintense large well-defined expansile lytic lesion with multi-loculated cysts, and multiple blood-fluid levels involving right proximal humerus. The patient underwent an incisional biopsy which exhibited angiosarcoma of the humerus. The patient was treated with six cycles of chemotherapy with a mesna, doxorubicin, ifosfamide, and dacarbazine regimen. The patient was still under follow-up. Conclusion: Being a rare clinical entity, controversy exists in angiosarcoma of humerus regarding its etiology and recommended management protocols. Histopathology and immunohistochemistry remain the gold standard in differentiating osseous angiosarcoma from other osseous vascular tumors. The treatment protocol has to be standardized to

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Persistent Atraumatic Knee Pain in a Teenage Female with Bony Protuberance Secondary to Hook-Shaped Osteochrondroma

Case Reports in Pediatrics ◽

10.1155/2021/3088992 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Adityanarayan Rao ◽

Joshua Pryor ◽

Jaclyn Otero ◽

Molly Posa

Keyword(s):

Medical History ◽

Knee Pain ◽

Conservative Management ◽

Plain Radiograph ◽

Surgical Excision ◽

Initial Presentation ◽

Medial Aspect ◽

Skin Changes ◽

The Right

A 13-year-old female presented at her pediatrician’s office with a complaint of sharp, intermittent, right-sided knee pain that had been present for the previous three days without any known trauma and no association with activity. Her medical history was significant for fractures, and on physical exam, there was a hard mass palpated on the medial aspect of her distal thigh that was nontender, nonmobile, and without overlying skin changes. The plain radiograph findings were consistent with a hook-shaped osteochondroma of the right medial distal metaphysis. Orthopedics recommended conservative management with continued ibuprofen for pain and six-week follow-up with repeat radiograph to evaluate for progression. The follow-up radiograph showed no interval growth. However, due to continued pain, the patient had surgical excision of the osteochondroma six months after initial presentation, allowing her to finish her current soccer season. The surgery was successful, and the patient did well after operation with no residual pain.

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Methimazole-Induced Pleural Effusion in the Setting of Graves’ Disease

Case Reports in Endocrinology ◽

10.1155/2019/5748938 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Le Yu Khine ◽

Dong Won Kim ◽

Omolola Olajide ◽

Chelsey White ◽

Yousef Shweihat ◽

...

Keyword(s):

Pleural Effusion ◽

Lower Lobe ◽

Antineutrophil Cytoplasmic Antibody ◽

Endobronchial Ultrasound ◽

Ventricular Rate ◽

Mediastinal Lymphadenopathy ◽

Graves Disease ◽

X Ray ◽

Chest X Ray ◽

The Right

Methimazole is a thionamide drug that inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland. We report a case of methimazole-induced recurrent pleural effusion. A 67-year-old female with recently diagnosed Graves’ disease on methimazole 20mg daily was admitted with dyspnea and new onset atrial fibrillation with rapid ventricular rate. Chest X-ray revealed a unilateral right pleural effusion, which was consistent with a transudate on thoracocentesis. She was managed as a case of congestive heart failure and methimazole dose was increased to 30 mg daily. She was readmitted twice with recurrent right pleural effusion. The fluid revealed an exudative process on repeat thoracocentesis. CT scan of the chest with contrast showed mediastinal lymphadenopathy and a diffuse ground glass process involving the right lower lobe suggestive of pneumonitis. Bronchoalveolar lavage showed neutrophil predominant fluid, and cytology and adenosine deaminase were negative. Patient also had an endobronchial ultrasound guided biopsy of the lymph nodes (EBUS). She was treated empirically with steroids 40 mg for 10 days and the methimazole was also discontinued. The antinuclear antibodies (ANA) came back positive with a speckled pattern; antineutrophil cytoplasmic antibody (c-ANCA) and antimyeloperoxidase were also positive. The effusion resolved but recurred on rechallenge with methimazole. She was referred for urgent thyroidectomy. The patient’s repeat chest X-ray showed complete resolution of the pleural effusion after stopping the methimazole. Few weeks later, repeat ANCA and antimyeloperoxidase antibody were both negative. Our case report highlights the importance of the recognition of a rare side effect of methimazole. Timely diagnosis would ensure that appropriate treatment is given.

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A Pelvic Pseudotumor in a Nonhemophilic Patient: An Unusual Presentation

Case Reports in Hematology ◽

10.1155/2015/359735 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Mohamad Gouse ◽

Abel Livingston ◽

Dan Barnabas ◽

Vinoo Mathew Cherian

Keyword(s):

Complete Blood Count ◽

Rare Complication ◽

Iliac Fossa ◽

Plain Radiograph ◽

Factor Ix ◽

Lytic Lesion ◽

Excision Biopsy ◽

History Of ◽

Factor Ix Deficiency ◽

The Right

Hemophilic pseudotumor is a rare complication of hemophilia, occurring in 1 to 2 percent of individuals with severe factor VIII or factor IX deficiency. A 35-year-old male presented with a swelling in the right lower abdomen for 3 months. There was no history of trauma. Examination revealed a swelling over the right iliac fossa. Right hip showed 30° flexion deformity. Blood investigations like complete blood count, APTT, PT, bleeding and clotting time, and fibrinogen were all normal. Plain radiograph and MRI showed a lytic lesion in the right iliac wing. Excision biopsy of the swelling showed organized hematoma with a fibrous capsule suggestive of a pseudotumor. Further haematological workup like factors VIII and IX was normal. At 2 years follow-up, there was no recurrence. We report this case of pseudotumour in patient without any bleeding disorder. Such case has not been reported in literature to the best of our knowledge.

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Age-Related Pattern and Distribution of Covid-19 on Pulmonary Computed Tomography

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666201223144539 ◽

2020 ◽

Vol 16 ◽

Author(s):

Omar Muayad Sultan ◽

Dhia Mahdey Alghazali ◽

Haider Al-Tameemi ◽

Mohammed Abed ◽

Dhaffer Abdullah Hawiji ◽

...

Keyword(s):

Computed Tomography ◽

Young Adult ◽

Old Age ◽

Age Groups ◽

Lower Lobe ◽

Pulmonary Nodules ◽

Middle Lobe ◽

Mediastinal Lymphadenopathy ◽

Age Related ◽

The Right

Background: COVID-19 has emerged recently and become of global concern. Computed tomography (CT) plays a vital role in the diagnosis. Objectives: To characterize the pulmonary CT changes and distributions of COVID-19 infection in regard to different age groups. Methods: Chest CT scan of 104 symptomatic patients with COVID-19 infection, from 7 Iraqi isolation centers were retrospectively analyzed between March 10th and April 5th, 2020. Patients were sub-classified according to their ages to three groups (young adult:20-39years, middle age:40-59years and old age:60- 90years). Results: The most common findings were ground-glass opacities (GGO) (92.3%, followed by consolidation (27.9%), bronchovascular thickening (15.4%), and crazy-paving (12.5%). Less commonly, there were tree-inbud (6.7%), pulmonary nodules (5.8%), bronchiectasis (3.8%), pleural effusion (1.9%), and cavitation (1%). There were no hallo sign, reversed hallo sign, nor mediastinal lymphadenopathy. Pulmonary changes were unilateral in 16.7% and bilateral in 83.3%, central in 14.6%, peripheral in 57.3%, and diffuse (central and peripheral) in 28.1%. Most cases showed multi-lobar changes (70.8%), while the lower lobe was more commonly involved (17.7%) than middle lobe/lingula (8.3%) and upper lobe (3.1%). In unilateral involvement, changes were more on the right (68.8%) than left (31.2%) side. Compared with middle and old age groups, young adult patients showed significantly lesser frequency of consolidation (17% vs. 13.3% and 37%), diffuse changes 28.1% (14.2% vs. 35.3% and 40.5%), bilateral disease (71.4% vs. 94.1% and 85.2%), and multi-lobar involvement (51.4% vs. 82.4% and 81.4%) respectively. Conclusion: Bilateral and peripheral GGO were the most frequent findings with the right side and lower lobar predilection. Extent and pattern seem to be age-related.

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Pulmonary hydatidosis presenting as pyopneumothorax in a 15 year old male

Panacea Journal of Medical Sciences ◽

10.18231/j.pjms.2021.071 ◽

2021 ◽

Vol 11 (2) ◽

pp. 357-359

Author(s):

Gaurang Aurangabadkar ◽

Saood Ali ◽

Ulhas Jadhav ◽

Ajay Lanjewar

Keyword(s):

Hydatid Cyst ◽

Pleural Fluid ◽

Lower Lobe ◽

Paediatric Population ◽

Mediastinal Lymphadenopathy ◽

Low Grade ◽

Igg Antibody ◽

Chest Drainage Tube ◽

The Right ◽

Pulmonary Hydatid Cyst

Pulmonary hydatid cyst is an exceptional cause of pyopneumothorax that should be considered in countries where hydatid disease is endemic. The documented rates of simple pneumothorax in patients with pulmonary hydatidosis ranges from 2.4-6.2%. Hydatidosis is a parasitic zoonosis of the genus Echinococcus that infects herbivores and humans in its larvae stage(hydatid) and in paediatric population, generally presents as pulmonary hydatidosis. Misdiagnosis of this condition as tubercular in origin can cause treatment and prognostic delays for the patient. We report a case of a 15 year old male presenting with complaints of breathlessness (Grade 2 MMRC) since 3 months and dry cough, low grade fever with chills since 3 months. He had previously received AKT therapy and IV antibiotics. His blood investigations were normal. His sputum for AFB, CBNAAT was negative. His initial chest xray was suggestive of right sided hydropneumothorax. CECT Thorax revealed features suggestive of hydatid cyst in right posterobasal segment lower lobe with loculated pyopneumothorax with collapsed and consolidated right lung with mediastinal lymphadenopathy. After admission, Intercostal chest drainage tube was inserted on the right side and connected to underwater seal and pleural fluid was drained. Pleural fluid investigations revealed exudative effusion by Lights criteria, ADA was 150, culture and sensitivity revealed no growth and cytology revealed features of empyema.The patient was started on IV Piperacillin+Tazobactam, IV Metronidazole and Tab Albendazole for 14 days along with AKT considering raised pleural fluid ADA levels as suggestive of tubercular pleural effusion. The patients hydatid serology (Echinococcus IgG Antibody ELISA- 0.88) came out to be positive which confirmed our diagnosis of hydatidosis. After repeat chest x ray, there was resolution noted in effusion and ICD tube was removed and the patient was discharged on oral antibiotics for 14 days and Tab Albendazole for 3 months.

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