Pseudomyxoma retroperitonei masquerading as a psoas abscess

2021 ◽  
Vol 14 (6) ◽  
pp. e240299
Author(s):  
Padma Vikram Badhe ◽  
Dasari Ravi Kiran ◽  
Harini Seshadri
Keyword(s):  
Psoas Abscess ◽  
Treatment Plan ◽  
Psoas Muscle ◽  
Sinus Tract ◽  
Large Collection ◽  
Iliac Region ◽  
The Past ◽  
Local Site ◽  
Vertebral Involvement ◽  
The Right

A 52-year-old woman was referred to our department with multiple discharging sinuses and swelling in the right flank and iliac region for the past year. Ultrasound revealed a large collection in the right psoas muscle with the sinus tract reaching up to the skin in the right iliac region. Despite repeated attempts at drainage, the collection continued to increase in size. CT was requested and revealed a large heterogeneous irregular collection in the right psoas with fistulous communication with the cecum and skin with the erosion of the overlying ilium. Because of lack of vertebral involvement, enhancing internal septations, non-visualisation of the appendix and feculent material admixed with mucinous discharge from the sinus, pseudomyxoma retroperitonei secondary to ruptured mucinous neoplasm of the appendix was suspected. Mucoid material at the local site was sent for histopathology, which confirmed our suspicion. Our treatment plan after ileostomy was cytoreductive surgery along with adjuvant radiotherapy (40 Gy in 20 fractions) with chemotherapy (5-fluorouracil and folinic acid given for 30 weeks, once a week). However, after ileostomy, the patient refused further treatment, citing financial reasons.

scholarly journals Large Psoas Hematoma Complicating Anti-coagulant Therapy Poses a Diagnostic and Therapeutic Challenge

2021 ◽  
pp. 40-44
Author(s):  
Brahim Nassour A. ◽  
Hissein Hagguir ◽  
Noel Mahoungou ◽  
Harouna Seydou ◽  
Fadoul Adam ◽  
...  
Keyword(s):  
Vitamin K ◽  
Lower Limb ◽  
Psoas Muscle ◽  
Bed Rest ◽  
Lumbar Pain ◽  
Ultrasound Scan ◽  
Large Collection ◽  
Therapeutic Challenge ◽  
Ultimate Outcome ◽  
The Right

Spontaneous psoas haematoma in patients on anti-coagulant therapy is a rare phenomenon. It poses a real diagnostic problem and a real therapeutic challenge. We report the case of a 51 year old patient, under anti-vitamin K (acenocoumarone) following a stenosante and tricuspid mitral plasty who presented with right lumbar pain radiating to the lower limb leading to functional impotence. Clinically, he was hemodynamically stable with a hematoma measuring 88x29 mm and extending to 161 mm. The ultrasound scan showed a large collection at the expense of the lumbar psoas muscle and the CT scan showed a swollen appearance of the right psoas muscle in its iliac portion. Management was conservative: discontinuation of anti-vitamin K, bed rest, antibiotic therapy, and monitoring (clinical, biological and radiological). The ultimate outcome was favourable.

scholarly journals Psoas Muscle Infiltration Masquerading Distant Adenocarcinoma

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Kamel A. Gharaibeh ◽  
Arnaldo Lopez-Ruiz ◽  
Tauqeer Yousuf
Keyword(s):  
Ct Scan ◽  
Psoas Abscess ◽  
Psoas Muscle ◽  
Needle Aspiration ◽  
Imaging Studies ◽  
Lower Quadrant ◽  
History Of ◽  
Undifferentiated Adenocarcinoma ◽  
Poorly Differentiated ◽  
The Right

Malignant metastasis to the psoas muscle is rare. We report a case that clinically mimicked psoas abscess that was subsequently proven to be from metastatic disease secondary to adenocarcinoma of the duodenum. A 62-year-old male presented with a seven-month history of right lower quadrant abdominal pain and progressive dysphagia. CT scan of abdomen-pelvis revealed a right psoas infiltration not amenable to surgical drainage. Patient was treated with two courses of oral antibiotics without improvement. Repeated CT scan showed ill-defined low-density area with inflammatory changes involving the right psoas muscle. Using CT guidance, a fine needle aspiration biopsy of the right psoas was performed that reported metastatic undifferentiated adenocarcinoma. Patient underwent upper endoscopy, which showed a duodenal mass that was biopsied which also reported poorly differentiated adenocarcinoma. In this case, unresponsiveness to medical therapy or lack of improvement in imaging studies warrants consideration of differential diagnosis such as malignancy. Iliopsoas metastases have shown to mimic psoas abscess on their clinical presentation and in imaging studies. To facilitate early diagnosis and improve prognosis, patients who embody strong risk factors and symptoms compatible with underlying malignancies who present with psoas imaging concerning for abscess should have further investigations.

scholarly journals Psoas major abscess by heroin addictive patients: A case report

2011 ◽  
Vol 58 (3) ◽  
pp. 117-120
Author(s):  
Marko Bumbasirevic ◽  
Slavisa Zagorac ◽  
Aleksandar Lesic ◽  
Vesna Bumbasirevic ◽  
Ljubomir Djurasic
Keyword(s):  
Groin Pain ◽  
Psoas Abscess ◽  
Good Condition ◽  
Psoas Muscle ◽  
Medical Complications ◽  
Emergency Center ◽  
Clinical Center ◽  
The Right ◽  
Psoas Major ◽  
Hiv Negative

Drug abuse is related to many medical complications, which depend on the drug type, dose injected, the method of delivery and site of injection. We report a case of psoas abscess in young heroin addict, HIV negative, who was admitted in Emergency Center of Clinical Center in Belgrade because of fever, anaemia, prostration and right groin pain. Clinical and radiological examination were performed. CT showed large abscess of the right psoas muscle, 12x4cm large. Treatment included percutaneous drainage and administration of iv antibiotics. There is regression of inflamation. At discharge patient was in good condition without signs of infection.

scholarly journals Lesion of the femoral nerve caused by a hydatid cyst of the right psoas muscle

2010 ◽  
Vol 138 (7-8) ◽  
pp. 502-505 ◽  
Author(s):  
Dragoljub Bilanovic ◽  
Darko Zdravkovic ◽  
Tomislav Randjelovic ◽  
Borislav Toskovic ◽  
Jasna Gacic
Keyword(s):  
Hydatid Disease ◽  
Femoral Nerve ◽  
Psoas Muscle ◽  
Cystic Mass ◽  
Loss Of Function ◽  
Duration Of Symptoms ◽  
Retroperitoneal Tumour ◽  
Vertebral Involvement ◽  
One Year ◽  
The Right

Introduction. Hydatidosis is a human disease caused by the larval form of Echinococcus granulosus. All organs in the human body may be affected by hydatid disease, but excluding liver and lungs, all other organs are considered as uncommon locations. Hydatid disease located in the psoas muscle is uncommon. Case Outline. The authors present a 36-year-old male living in endemic areas of Serbia, admitted due to pain and weakness of the right thigh and weight loss. Duration of symptoms was one year. CT and MRI revealed a big cystic mass (20 cm long) in the right psoas muscle. Neurological investigation showed a loss of function of the right femoral nerve. Serology for Echinococcosis was negative. Surgery was indicated and performed by median laparotomy. Total excision of the cyst was done. Pathohystology confirmed the nature of the cyst. Three years after operation the patient was without any signs of disease relapse. Conclusion. Echinococcal disease of the psoas has been very rarely reported, sometimes associated with paraspinal disease and often with vertebral involvement. Cystic or complex retroperitoneal tumour, pyogenic abscess of the psoas and even tuberculosis should be considered in the differential diagnosis. Treatment of choice is surgery. The greatest danger for the patient is dissemination and anaphylactic reaction. Also, compression of adjacent organs may produce significant morbidity.

scholarly journals An Easily Overlooked Presentation of Malignant Psoas Abscess: Hip Pain

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Ayhan Askin ◽  
Korhan Baris Bayram ◽  
Umit Secil Demirdal ◽  
Merve Bergin Korkmaz ◽  
Alev Demirbilek Gurgan ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Psoas Abscess ◽  
Psoas Muscle ◽  
Hip Pain ◽  
High Morbidity ◽  
The Past ◽  
Insidious Onset ◽  
History Of ◽  
Underlying Diseases ◽  
Diagnostic Delays

Psoas abscess is a rare infectious disease with nonspecific clinical presentation that frequently causes a diagnostic difficulty. Its insidious onset and occult characteristics can cause diagnostic delays. It is classified as primary or secondary. Staphylococcus aureus is the most commonly causative pathogen in primary psoas abscess. Secondary psoas abscess usually occurs as a result of underlying diseases. A high index of clinical suspicion, the past and recent history of the patient, and imaging studies can be helpful in diagnosing the disease. The delay of the treatment is related with high morbidity and mortality rates. In this paper, 54-year-old patient with severe hip pain having an abscess in the psoas muscle due to metastatic cervical carcinoma is presented.

COMMONWEALTH Forum: The Politics of Science or the Science of Politics

Commonwealth ◽  
2017 ◽  
Vol 19 (1) ◽  
Author(s):  
John Arway
Keyword(s):  
Public Policy ◽  
Natural Resource ◽  
Factual Information ◽  
The Past ◽  
Difference Of Opinion ◽  
History Of ◽  
The Right ◽  
Scientific Facts ◽  
Environmental Agency ◽  
Laws And Regulations

The challenges of including factual information in public policy and political discussions are many. The difficulties of including scientific facts in these debates can often be frustrating for scientists, politicians and policymakers alike. At times it seems that discussions involve different languages or dialects such that it becomes a challenge to even understand one another’s position. Oftentimes difference of opinion leads to laws and regulations that are tilted to the left or the right. The collaborative balancing to insure public and natural resource interests are protected ends up being accomplished through extensive litigation in the courts. In this article, the author discusses the history of environmental balancing during the past three decades from the perspective of a field biologist who has used the strength of our policies, laws and regulations to fight for the protection of our Commonwealth’s aquatic resources. For the past 7 years, the author has taken over the reins of “the most powerful environmental agency in Pennsylvania” and charted a course using science to properly represent natural resource interests in public policy and political deliberations.

Accelerating Agricultural Growth—Is Irrigation Institutional Reform Necessary? (Distinguishedl Lecture)

1996 ◽  
Vol 35 (4I) ◽  
pp. 399-417 ◽  
Author(s):  
John W. Mellor
Keyword(s):  
Growth Rates ◽  
Irrigation System ◽  
Institutional Reform ◽  
Residual Effect ◽  
Agricultural Growth ◽  
The Past ◽  
Major Reform ◽  
History Of ◽  
The Right ◽  
Economic Growth Rates

The right to the flow of income from water is vigorously pursued, protected, and fought over in any arid part of the world. Pakistan is of course no exception. Reform of irrigation institutions necessarily changes the rights to water, whether it be those of farmers, government, or government functionaries. Those perceived rights may be explicit and broadly accepted, or simply takings that are not even considered legitimate. Nevertheless they will be fought over. Pakistan has a long history of proposals for irrigation reform, little or none being implemented, except as isolated pilot projects. Thus, to propose major changes in irrigation institutions must be clearly shown to have major benefits to justify the hard battles that must be fought and the goodwill of those who might win those battles for reform. Proponents of irrigation institution reform have always argued the necessity of the reforms and the large gains to be achieved. Perhaps, however, those arguments have not been convincing. This paper will briefly outline the failed attempts at irrigation reform to provide an element of reality to the discussion. It will then proceed to make the case of the urgency of reform in a somewhat different manner to the past. Finally, current major reform proposals will be presented. This paper approaches justification of irrigation reform by focusing on the agricultural growth rate. It does so because that is the critical variable influencing poverty rates and is a significant determinant of over-all economic growth rates. The paper decomposes growth rates and suggests a residual effect of deterioration of the irrigation system that is large and calls for policy and institutional reform. The data are notional, suggesting the usefulness of the approach and paves the way for more detailed empirical analysis and enquiry for the future.

Does the Injunction Gap Violate Implementers’ Fair Trial Rights Under the ECHR?

2020 ◽  
Author(s):  
Léon E Dijkman
Keyword(s):  
Human Rights ◽  
Case Law ◽  
Fair Trial ◽  
European Convention ◽  
The Past ◽  
European Court ◽  
The Subject ◽  
The Right ◽  
Federal Supreme ◽  
Validity Of A Patent

Abstract Germany is one of few jurisdictions with a bifurcated patent system, under which infringement and validity of a patent are established in separate proceedings. Because validity proceedings normally take longer to conclude, it can occur that remedies for infringement are imposed before a decision on the patent’s validity is available. This phenomenon is colloquially known as the ‘injunction gap’ and has been the subject of increasing criticism over the past years. In this article, I examine the injunction gap from the perspective of the right to a fair trial enshrined in Art. 6 of the European Convention on Human Rights. I find that the case law of the European Court of Human Rights interpreting this provision supports criticism of the injunction gap, because imposing infringement remedies with potentially far-reaching consequences before the validity of a patent has been established by a court of law arguably violates defendants’ right to be heard. Such reliance on the patent office’s grant decision is no longer warranted in the light of contemporary invalidation rates. I conclude that the proliferation of the injunction gap should be curbed by an approach to a stay of proceedings which is in line with the test for stays as formulated by Germany’s Federal Supreme Court. Under this test, courts should stay infringement proceedings until the Federal Patent Court or the EPO’s Board of Appeal have ruled on the validity of a patent whenever it is more likely than not that it will be invalidated.

The Specter of the Past: Reconstructing Conservative Historical Memory in South Korea

2021 ◽  
Vol 49 (3) ◽  
pp. 337-362
Author(s):  
Myungji Yang
Keyword(s):  
South Korea ◽  
Historical Memory ◽  
Political Legitimacy ◽  
New Right ◽  
Historical Narratives ◽  
Right Wing ◽  
Far Right ◽  
The Past ◽  
The Republic ◽  
The Right

Through the case of the New Right movement in South Korea in the early 2000s, this article explores how history has become a battleground on which the Right tried to regain its political legitimacy in the postauthoritarian context. Analyzing disputes over historiography in recent decades, this article argues that conservative intellectuals—academics, journalists, and writers—play a pivotal role in constructing conservative historical narratives and building an identity for right-wing movements. By contesting what they viewed as “distorted” leftist views and promoting national pride, New Right intellectuals positioned themselves as the guardians of “liberal democracy” in the Republic of Korea. Existing studies of the Far Right pay little attention to intellectual circles and their engagement in civil society. By examining how right-wing intellectuals appropriated the past and shaped triumphalist national imagery, this study aims to better understand the dynamics of ideational contestation and knowledge production in Far Right activism.

scholarly journals Sudden Unexpected Death Associated with Arrhythmogenic Cardiomyopathy: Study of the Cardiac Conduction System

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1323
Author(s):  
Giulia Ottaviani ◽  
Graziella Alfonsi ◽  
Simone G. Ramos ◽  
L. Maximilian Buja
Keyword(s):  
Fibromuscular Dysplasia ◽  
Ventricular Myocardium ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Future Research ◽  
Cardiac Conduction System ◽  
Arrhythmogenic Cardiomyopathy ◽  
Unexpected Death ◽  
The Past ◽  
The Right

A retrospective study was conducted on pathologically diagnosed arrhythmogenic cardiomyopathy (ACM) from consecutive cases over the past 34 years (n = 1109). The anatomo-pathological analyses were performed on 23 hearts diagnosed as ACM (2.07%) from a series of 1109 suspected cases, while histopathological data of cardiac conduction system (CCS) were available for 15 out of 23 cases. The CCS was removed in two blocks, containing the following structures: Sino-atrial node (SAN), atrio-ventricular junction (AVJ) including the atrio-ventricular node (AVN), the His bundle (HB), the bifurcation (BIF), the left bundle branch (LBB) and the right bundle branch (RBB). The ACM cases consisted of 20 (86.96%) sudden unexpected cardiac death (SUCD) and 3 (13.04%) native explanted hearts; 16 (69.56%) were males and 7 (30.44%) were females, ranging in age from 5 to 65 (mean age ± SD, 36.13 ± 16.06) years. The following anomalies of the CCS, displayed as percentages of the 15 ACM SUCD cases in which the CCS has been fully analyzed, have been detected: Hypoplasia of SAN (80%) and/or AVJ (86.67%) due to fatty-fibrous involvement, AVJ dispersion and/or septation (46.67%), central fibrous body (CFB) hypoplasia (33.33%), fibromuscular dysplasia of SAN (20%) and/or AVN (26.67%) arteries, hemorrhage and infarct-like lesions of CCS (13.33%), islands of conduction tissue in CFB (13.33%), Mahaim fibers (13.33%), LBB block by fibrosis (13.33%), AVN tongue (13.33%), HB duplicity (6.67%%), CFB cartilaginous meta-hyperplasia (6.67%), and right sided HB (6.67%). Arrhythmias are the hallmark of ACM, not only from the fatty-fibrous disruption of the ventricular myocardium that accounts for reentrant ventricular tachycardia, but also from the fatty-fibrous involvement of CCS itself. Future research should focus on application of these knowledge on CCS anomalies to be added to diagnostic criteria or at least to be useful to detect the patients with higher sudden death risks.

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