Bony cystic lesion with associated submandibular lymphadenopathy on a background of breast carcinoma: an unexpected case of cervicofacial actinomycosis

Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of Actinomyces israelii and a diagnosis of cervicofacial actinomycosis with mandibular osteomyelitis. The patient was successfully treated with prolonged antibiotics.

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Dynamic Contrast-Enhanced CT Characterization of Xp11.2 Translocation/TFE3 Gene Fusions versus Papillary Renal Cell Carcinomas

BioMed Research International ◽

10.1155/2015/298679 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Jian He ◽

Kefeng Zhou ◽

Bin Zhu ◽

Gutian Zhang ◽

Xiaogong Li ◽

...

Keyword(s):

Renal Cell ◽

Gene Fusions ◽

Renal Cell Carcinomas ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Xp11.2 Translocation ◽

Clinical Records

Purpose. To compare the differences of CT characteristics between renal cell carcinomas (RCCs) associated with Xp11.2 translocation/TFE3 gene fusions (Xp11.2 RCCs) and papillary cell renal cell carcinomas (PRCCs). Methods. CT images and clinical records of 64 patients (25 Xp11.2 RCCs, 15 type 1 and 24 type 2 PRCCs) were analyzed and compared retrospectively. Results. Xp11.2 RCC more frequently affected young (30.7±8.7 years) women (16/25, 64%) with gross hematuria (12/25, 48%), while PRCC more frequently involved middle-aged (54.8±11.1 years) men (28/39, 71.8%) asymptomatically. Xp11.2 RCC tended to be heterogeneous density with some showing circular calcification. Lesion sizes of Xp11.2 RCC (5.4±2.2 cm) and type 2 PRCC (5.7±2.5 cm) were significantly larger than that of type 1 PRCC (3.8±1.8 cm). Xp11.2 RCC contained more cystic components (22/25, 88%) than type 1 PRCC (all solid) and type 2 PRCC (9/24, 36.0%). Type 1 PRCC (13/15, 86.7%) and Xp11.2 RCC (21/25, 84.0%) showed more clear boundary than type 2 PRCC (12/24, 50.0%). Conclusion. CT features including diameter, boundary, attenuation, nature, and circular calcification of the tumor, combined with demographic information and symptoms, may be useful to differentiate Xp11.2 RCC from different subtypes of PRCC.

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Misdiagnosis of Rectus Abdominis Abscess Owing to Delayed Contrast-Enhanced Computed Tomography

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_003097 ◽

2021 ◽

Author(s):

Yuichiro Nagase ◽

Yukinori Harada

Keyword(s):

Computed Tomography ◽

Laboratory Tests ◽

Rectus Abdominis ◽

Rectus Abdominis Muscle ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

A 77-year-old man, who was on anticoagulation, presented with a painful lump on the right abdominal wall. Laboratory tests showed slight anaemia and elevated inflammatory markers. Abdominal plain computed tomography (CT) revealed a mass in the right rectus abdominis muscle. He was admitted with a diagnosis of primary rectus abdominis haematoma. However, on the next day, the diagnosis was corrected to primary rectus abdominis abscess, following contrast-enhanced CT of the abdomen. This case illustrates the importance of considering primary rectus abdominis abscess in patients with suspected primary rectus abdominis haematoma, and contrast should be used when performing CT.

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Resolution of grade IV hypertensive retinopathy in an adult with pheochromocytoma: post-tumor resection

BMJ Case Reports ◽

10.1136/bcr-2019-231245 ◽

2020 ◽

Vol 13 (2) ◽

pp. e231245

Author(s):

Aparajita Banerjee ◽

Bhagabat Nayak ◽

Gargi Verma ◽

Sucheta Parija

Keyword(s):

Blood Pressure ◽

Tumor Resection ◽

Hypertensive Retinopathy ◽

Corrected Visual Acuity ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Hypertensive Woman ◽

Systemic Examination ◽

The Right

A 64-year-old hypertensive woman presented with complaints of a painless, progressive decrease in vision, headache, dizziness for the last month. She was a known case of diabetes mellitus on insulin therapy. On examination, best-corrected visual acuity was 6/12 in the right eye and 6/18 in the left eye. The fundus examination in both eyes revealed features of grade IV hypertensive retinopathy. Systemic examination revealed the raised blood pressure of 200/110 mm Hg. Diagnosis of pheochromocytoma was made on the basis of increased urinary norepinephrine (892.8 mg/dL) and mass in the left adrenal gland (measuring 31×28 mm) at contrast-enhanced CT. Medical management to control hypertension was done and ultimately, she underwent left laparoscopic adrenalectomy. After 10 months of surgery, the patient was asymptomatic, blood pressure was within normal limit and her vision improved to 6/6 in both the eyes. The retinal features of hypertensive retinopathy had completely disappeared.

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Unique levoatriocardinal veins in neonates with hypoplastic left heart syndrome and intact atrial septum

Cardiology in the Young ◽

10.1017/s1047951117001445 ◽

2017 ◽

Vol 28 (1) ◽

pp. 150-152 ◽

Cited By ~ 1

Author(s):

Chiaki Iida ◽

Jun Muneuchi ◽

Mamie Watanabe

Keyword(s):

Hypoplastic Left Heart Syndrome ◽

Atrial Septum ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Intact Atrial Septum ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Left Heart Syndrome

AbstractWe had two cases of neonates with hypoplastic left heart syndrome and intact atrial septum who had unique levoatriocardinal veins. Contrast-enhanced CT and angiography revealed that previously unknown communicating vessels ran from the top of the left atrium and drained into the right atrium. We emphasise that transcatheter atrial septostomy should be performed not through these communicating vessels but using the trans-septal approach in neonates with hypoplastic left heart syndrome and an intact atrial septum.

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Anesthetic management of gigantic pheochromocytoma resection with inferior vena cava and right atrium tumor thrombosis: A case report

10.21203/rs.2.301/v1 ◽

2019 ◽

Author(s):

Jingli Chen ◽

Caihua Liu ◽

Chang Liu ◽

Quanyuan Fu ◽

Dingwei Peng ◽

...

Keyword(s):

Inferior Vena Cava ◽

Surgical Resection ◽

Right Atrium ◽

Inferior Vena ◽

Anesthetic Management ◽

Vena Cava ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right

Abstract Background: This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension into vena cava and right atrium in a patient. Report for anesthetic management is limited in these patients under surgical resection until now. Case presentation: In September 2015, a 24-year-old male presented to the department of cardiology with right flank pain and hypertensive urgency in our hospital. Contrast-enhanced CT abdomen and MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Echocardiography shown no abnormal detection. Finally, this patient gave up the surgical resection of phaeochromocytoma and chose the expectant treatment. In April 2018, this patient once again presented to the emergence department with a persistent cough and intermittent wheezing character for 5 hour. Contrast-enhanced CT and echocardiography shown existing IVC thrombus had extended into the right atrium. After the careful preoperative preparation, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team. After one month post-operation care, the patient healthily leave our hospital. Conclusion: To the best of our knowledge, the occurrence of pheochromocytoma in IVC and right atrium thrombosis has not been reported so far from mainland China. This clinical case may supply a rare reference experience for surgical treatment and anesthetic management in the group of phaeochromocytoma patient with distance vascular extension. Keywords: Adrenal tumor; Malignant phaeochromocytoma; Inferior vena cava; Right atrium; Tumor thrombus.

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Takayasu’s Arteritis Diagnosed in an Adolescent Patient with Crohn’s Disease: Management of Biologicals

Life ◽

10.3390/life11101019 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1019

Author(s):

Kazuya Kishimoto ◽

Yuji Nozaki ◽

Toshiharu Sakurai ◽

Koji Kinoshita ◽

Masanori Funauchi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis ◽

Arm Pain ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Necrosis Factor

We report a 14-year-old man with Crohn’s disease (CD) who developed right upper arm pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. There were no symptoms suggestive of active CD, but the inflammatory response was high, and a contrast-enhanced CT showed the occlusion of the right brachial artery. We diagnosed the patient as having Takayasu’s arteritis (TA) and started treatment with corticosteroids, then tapered off the steroids as the symptoms of TA resolved. Later, TA flared up, and his treatment was changed from infliximab to an anti-IL-6 receptor antibody, tocilizumab. The change to TCZ stabilized TA, but exacerbated CD. It is difficult to control both diseases at the same time, and the choice of biologics for treatment must be carefully considered.

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A surgical case of mediastinal hematoma caused by a minor traffic injury

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-1065-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Katsuyuki Suzuki ◽

Satoshi Shiono ◽

Kazuki Hayasaka ◽

Makoto Endoh

Keyword(s):

Inferior Thyroid Artery ◽

Case Presentation ◽

Mediastinal Hematoma ◽

Traffic Injury ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

A Minor

Abstract Background Mediastinal hematoma rarely occurs after a minor traffic injury. Case presentation A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery. Conclusions It is possible that mediastinal hematoma might be caused by a minor traffic injury.

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Anesthetic management of gigantic pheochromocytoma resection with inferior vena cava and right atrium tumor thrombosis: A case report

10.21203/rs.2.301/v2 ◽

2019 ◽

Author(s):

Jingli Chen ◽

Caihua Liu ◽

Chang Liu ◽

Quanyuan Fu ◽

Dingwei Peng ◽

...

Keyword(s):

Inferior Vena Cava ◽

Surgical Resection ◽

Right Atrium ◽

Inferior Vena ◽

Anesthetic Management ◽

Vena Cava ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right

Abstract Background: This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension into vena cava and right atrium in a patient. Report for anesthetic management is limited in these patients under surgical resection until now. Case presentation: In September 2015, a 24-year-old male presented to the department of cardiology with right flank pain and hypertensive urgency in our hospital. Contrast-enhanced CT abdomen and MRI abdomen revealed a mass phaeochromocytoma in right adrenal, which invaded the right inferior vena cava（IVC）wall along with IVC thrombus. Echocardiography shown no abnormal detection. Finally, this patient gave up the surgical resection of phaeochromocytoma and chose the expectant treatment. In April 2018, this patient once again presented to the emergence department in our hospital, he had experienced persistent cough and intermittent wheezing for 5 hour. Contrast-enhanced CT and echocardiography shown existing IVC thrombus had extended into the right atrium. After the careful preoperative preparation, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team. After one month post-operation care, this patient healthily left our hospital. Conclusion: To the best of our knowledge, the occurrence of pheochromocytoma with IVC and right atrium thrombosis has not been reported in mainland China so far. This clinical case may supply a rare reference experience for surgical treatment and anesthetic management in the group of phaeochromocytoma patient with distance vascular extension.

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Triphase contrast-enhanced CT to evaluate indications for autologous liver transplantation in patients with end-stage hepatic alveolar echinococcosis

Scientific Reports ◽

10.1038/s41598-021-01586-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jing Chen ◽

Li Wei ◽

Tian-Wu Chen ◽

Rui Li ◽

Xiao-Ming Zhang ◽

...

Keyword(s):

3D Reconstruction ◽

Preoperative Evaluation ◽

Liver Volume ◽

Porta Hepatis ◽

Hepatic Alveolar Echinococcosis ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

End Stage

AbstractAutologous liver transplantation (ALT) to cure end-stage hepatic alveolar echinococcosis (HAE) requires that hepatobiliary surgeons understand the invasion of intrahepatic structure and adjacent tissues or organs. Triphase contrast-enhanced CT of the liver has been widely used for diagnosis and preoperative evaluation of HAE. Three-dimensional (3D) reconstruction allows for accurate measurement of remnant liver volume (RLV). The objective of the study was to evaluate value of triphase contrast-enhanced CT together with 3D reconstruction in preoperative evaluation of indications for ALT in patients with end-stage HAE. This cohort include twenty-one consecutive patients with end-stage HAE, who preoperatively underwent triphase enhanced CT together with 3D reconstruction for ALT. To depict the indications, the 2D image data were reviewed statistically focusing on porta hepatis invasion, retrohepatic vena cava (RHVC) involvement and degrees of intrahepatic vessel invasion, and the 3D reconstruction was performed to obtain ratio of RLV to standard liver volume (SLV). The results showed that 95.24% patients (20/21) had porta hepatis invasion. When lesions located in right liver lobe, porta hepatis invasion occurred most commonly in the second and third porta hepatis (7/10), whereas the first, second and third porta hepatis were most commonly invaded by lesions in the right and caudate / left medial liver lobes (7/11) (P < 0.05). The mean value of longitudinal invasion of RHVC was 8.0 cm, and 95.2% (20/21) of patients had RHVC invasion with ≥ 180° circumferential invasion. As for the important vascular events, moderate and severe invasion occurred most commonly in the right hepatic vein, right branch of portal vein and RHVC each in 95.2% (20/21) patients (P < 0.05). We also found that preoperative CT had a good agreement with intraoperative findings in assessing intrahepatic vascular involvement by HAE (kappa index = 0.77). The estimated average ratio of RLV to SLV was 0.95 (range, 0.43–1.62). In conclusion, the 2D contrast-enhanced CT could well depict anatomic location and size of HAE, and invasion of porta hepatis and vascular by this disease, and involvement of other adjacent organs and tissues. Above all, 3D reconstruction could accurately measure RLV in patients with end-stage HAE for ALT.

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Cerebral Venous Thrombosis in Evan’s Syndrome: An Unusual Presentation

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v15i2.396 ◽

2020 ◽

Vol 15 (2) ◽

Author(s):

Cheng MH ◽

Norzila TAB

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Vision Loss ◽

Limb Weakness ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Ct Brain ◽

The Right ◽

Evan’S Syndrome

Cerebral Venous Thrombosis in patients with Evan’s Syndrome of autoimmune hemolytic anemia is rare. The common neurological symptoms are headaches, vision loss, dyslexia without agraphia, motor aphasia, unilateral upper limb weakness and papilloedema. We present a case report of a lady with a known case of Evan’s Syndrome whom presented with severe anemia and unilateral right sided hemiparesis with right facial weakness. Plain and Contrast enhanced CT brain showed bilateral high parietal white matter edema with venous thrombosis in the right transverse and superior sagittal venous sinuses. At the time of the diagnosis, she was in hematological remission.

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