Traumatic orbital ligament avulsion diagnosed with cross-sectional imaging in three dogs

2020 ◽  
Vol 8 (3) ◽  
pp. e001143
Author(s):  
Emilie M Hanot ◽  
David L Williams ◽  
Abby Caine
Keyword(s):  
Surgical Intervention ◽  
Specific Treatment ◽  
Linear Structure ◽  
Facial Trauma ◽  
Visual Axis ◽  
Cross Sectional ◽  
Zygomatic Process ◽  
Frontal Process ◽  
Cross Sectional Imaging ◽  
Uncommon Condition

The aim of the study was to describe the clinical and imaging findings of three dogs diagnosed with orbital ligament avulsion. Three immature dogs presented following a facial bite trauma, including multiple skull fractures and ventral, ventrolateral or rostrolateral displacement of the affected eye. The extent of lesions and orbital ligament avulsion were assessed and diagnosed using CT (n=2) or MRI (n=1). Orbital ligament avulsion was identified as an interruption of the linear structure between the zygomatic process of the frontal bone and the frontal process of the zygomatic bone. One dog was treated surgically to correct a visual axis alteration, while the remaining two dogs were managed conservatively. Orbital ligament avulsion is an uncommon condition that should be considered following a facial trauma. Concurrent lesions might necessitate surgical intervention, but it remains unclear if the avulsion of the orbital ligament itself requires a specific treatment.

scholarly journals Incidental non-complicated posterior rectus sheath hernia

2020 ◽  
Vol 6 (1) ◽  
pp. 20190072
Author(s):  
Peter Connell ◽  
James Hennebry ◽  
Senan Alsanjari ◽  
Riddhika Chakravartty ◽  
Mona Sabala
Keyword(s):  
Surgical Intervention ◽  
Incidental Finding ◽  
Rectus Sheath ◽  
Evidence Base ◽  
Cross Sectional ◽  
Posterior Portion ◽  
Rare Finding ◽  
Posterior Rectus Sheath ◽  
Cross Sectional Imaging ◽  
Uncommon Condition

Posterior rectus sheath hernia is a truly rare finding, with only 11 documented cases since the first report in 1937. A posterior rectus sheath hernia is herniation of bowel and/or omentum through the posterior portion of the rectus sheath, but not through any other structure. This can only occur medial to the spigelian fascia, differentiating it from a spigelian hernia. Previous missed cases have led to complications such as bowel incarceration, obstruction or even strangulation and have required surgical intervention. In this case report, we describe an incidental finding of a non-complicated posterior rectus sheath hernia in an 83-year-old male. Annotated cross-sectional imaging provides anatomical context that is not widely available in the existing literature. Due to its rarity and potential complications, it is also important to report this case in order to enhance the evidence base for posterior rectus sheath hernia and to familiarize this uncommon condition to radiologists, clinicians and surgeons.

scholarly journals A Rare Case of Chronic Appendicitis Superimposed on an Incarcerated de Garengeot Hernia Prospectively Identified on Computed Tomography

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Goldbach ◽  
Partha Hota ◽  
Andrew Czulewicz ◽  
Christine Burgert-Lon ◽  
Omar Agosto
Keyword(s):  
Femoral Hernia ◽  
Surgical Intervention ◽  
Incidental Finding ◽  
Critical Role ◽  
Fluid Collection ◽  
Cross Sectional ◽  
Chronic Appendicitis ◽  
Hernia Sac ◽  
Cross Sectional Imaging ◽  
De Garengeot Hernia

The de Garengeot hernia is an uncommon and potentially confounding pathologic process in which the appendix is contained within a femoral hernia. While typically a benign incidental finding, superimposed acute appendicitis is a rare but serious complication. Identification of this entity is crucial to patient management and ultimately outcome with imaging playing a critical role. Cross-sectional imaging, with either CT or MRI, should be performed in all cases of suspected incarcerated de Garengeot hernia to facilitate the appropriate diagnosis and surgical intervention. Herein, we present the fifth case of a prospective CT diagnosis of the de Garengeot hernia in a 61-year-old female who presented with an irreducible right femoral hernia. The patient underwent CT examination which demonstrated the appendix within the femoral hernia sac with an associated periappendiceal fluid collection. The patient was taken for emergent surgical intervention at which time the appendix was found within the hernia sac. The appendix was removed, the defect repaired, and ultimately the patient recovered well.

scholarly journals Adrenal Incidentaloma: A Cautionary Tale of Three Cases of Adrenocortical Carcinoma Arising from Apparently Benign Incidentalomas

2011 ◽  
Vol 3 (3) ◽  
pp. 137-143
Author(s):  
Chris Armstrong ◽  
Janice L Pasieka ◽  
Adrian Harvey
Keyword(s):  
Adrenocortical Carcinoma ◽  
Surgical Intervention ◽  
Adrenal Incidentaloma ◽  
Adrenal Incidentalomas ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Biochemical Testing ◽  
Average Size

ABSTRACT Unexpected incidental findings on cross-sectional imaging are becoming more commonplace in today's medical practice. These are likely due to ongoing improvements in the resolution of cross-sectional imaging and our increasing use of these tests combined with an aging population. In the case of the adrenal incidentalomas the majority of these represent benign nonfunctional adenomas and these are believed to have no malignant potential. On the contrary adrenocortical carcinoma (ACC) is an uncommon malignancy that carries a high mortality. Current biochemical and radiological follow-up investigations are expensive and are of limited benefit in the majority of cases of adrenal incidentalomas. This has created a dilemma for the proper diagnostic, clinical and radiologic follow-up as well as the triggers for surgical intervention. We present a series of three patients presenting with ACC that retrospectively arose from a small incidentally found adrenal lesion. Three patients were identified with ACC arising from an apparently benign adrenal incidentaloma. The average size of the original lesion was 1.6 cm whereas the average size of their adrenal tumor was 9.3 cm when they presented with ACC. Two of the three cases were found to develop functional tumors at the time of the diagnosis of ACC. Two of the three cases underwent surgical resection. The third patient was found to have metastatic disease at presentation and declined surgical intervention. We agree that current follow-up guidelines result in an increasing burden on our healthcare system; with expensive biochemical testing and imaging for what in most cases will prove to be a benign adenoma, these three cases have influenced our current strategies for follow-up. At the present time, we continue to follow the AAES/AACE guidelines. The development of improved methods of biochemical, radiologic and tissue diagnosis may help to improve our ability to recognize an ACC in this population at an earlier and potentially curable stage.

scholarly journals 851 Giant Oncocytoma In A Solitary Kidney: A Case Report on Balancing Surgical Resection Against Surveillance

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Srivastava ◽  
J B Neves ◽  
M G B Tran
Keyword(s):  
Surgical Intervention ◽  
Left Kidney ◽  
Stage Iv ◽  
Solitary Kidney ◽  
Histopathological Analysis ◽  
Renal Lesion ◽  
Cross Sectional ◽  
Renal Lesions ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Abstract Renal oncocytomas are benign kidney neoplasms that are typically small, unilaterally localised (95%) and challenging to differentiate on cross-sectional imaging, hence requiring surgical intervention. We herein present the extremely rare case of a patient with giant, bilateral oncocytomas and oncocytosis, and chronic kidney disease (CKD) and discuss the associated treatment challenges. A 61-year-old male with no past medical history presented with CKD (eGFR of 32ml/min). On investigation, cross sectional imaging revealed bilateral, multifocal, solid and vascular renal lesions. The largest lesion measuring 115mm x 102mm was situated in the right kidney, with multiple lesions noted in the left kidney, measuring up to 44mm. He subsequently underwent a right radical nephrectomy and histopathological analysis reported oncocytosis of the background kidney. The largest left sided renal lesion was biopsied, also confirmatory of benign oncocytoma. eGFR after surgery was 26ml/min. Following patient-centric consultations, further surgical intervention for the left sided renal lesions was declined, aiming to avoid renal replacement therapy (RRT). He has remained on active surveillance with biannual scans for 6 years. The lesions in his remaining kidney have since grown and coalesced into a single large lesion, with axial dimensions in the most recent MRI scan of 104mm x 306mm. He has progressed to stage IV CKD (eGFR 16ml/min), but still currently without need of RRT. This case study underscores both the significance of shared decision making in urology and surgery. Ultimately, the most significant skill lies in knowing when to not operate, especially when presented with the rarest of cases.

Oculostapedial synkinesis following idiopathic facial palsy: something to listen out for

2018 ◽  
Vol 132 (8) ◽  
pp. 757-758
Author(s):  
T Williams ◽  
B Tungland ◽  
N Stobbs ◽  
G Watson
Keyword(s):  
Facial Palsy ◽  
Complete Resolution ◽  
Rare Case ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Facial Movement ◽  
Cross Sectional ◽  
Team Members ◽  
Cross Sectional Imaging ◽  
Idiopathic Facial Palsy

AbstractObjectiveThis paper presents a rare case of oculostapedial synkinesis.Case reportAfter partial resolution of an idiopathic facial palsy, a male patient presented with persistent distortion of hearing when blinking and closing his eye. Audiometry findings were unremarkable, and cross-sectional imaging of the facial nerve revealed no abnormalities apart from an incidental contralateral meningioma. Initial conservative management, with referral to a specialist physiotherapist, failed to resolve the symptoms. The patient subsequently opted for surgical intervention, and underwent a transmeatal tympanotomy and transection of the stapedial tendon. Following this, he had complete resolution of symptoms.ConclusionOculostapedial synkinesis is a rare complication of facial palsy, but is recognised in the literature. Given its unusual presentation, it can be overlooked, especially by more junior team members. This case highlights the need to pay careful attention to patients' symptoms and listen out for the description of hearing distortion on facial movement.

scholarly journals A primary inferior lumbar hernia misdiagnosed as a lipoma

2019 ◽  
Vol 101 (4) ◽  
pp. e96-e98 ◽  
Author(s):  
B Kadler ◽  
A Shetye ◽  
DK Patten ◽  
A Al-Nowfal
Keyword(s):  
Laparoscopic Surgery ◽  
Gold Standard ◽  
Mesh Repair ◽  
Surgical Intervention ◽  
Lumbar Hernia ◽  
Cross Sectional ◽  
Open Mesh Repair ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Open Mesh

Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted.Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparoscopic surgery may give the best results. In view of the scarcity of published cases, we aim to add to the literature to raise the index of suspicion and to promote prompt surgical management of lumbar hernias.

scholarly journals Severe Sepsis due toClostridium perfringensBacteremia of Urinary Origin: A Case Report and Systematic Review

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Michael A. Millard ◽  
Kathleen A. McManus ◽  
Brian Wispelwey
Keyword(s):  
Surgical Intervention ◽  
Chronic Diarrhea ◽  
Altered Mental Status ◽  
Clinical Syndrome ◽  
Definitive Treatment ◽  
Cross Sectional ◽  
Appropriate Treatment ◽  
Cross Sectional Imaging ◽  
Work Up ◽  
Purulent Drainage

Clostridium perfringensbacteremia is an uncommon yet serious clinical syndrome that typically arises from a gastrointestinal source. However, clinicians should consider nongastrointestinal sources as well. We present a rare case ofC. perfringensbacteremia of urinary origin that required surgical intervention for definitive treatment. A 61-year-old male presented with acute nausea and vomiting, altered mental status, and chronic diarrhea. His physical exam revealed right costovertebral tenderness and his laboratory work-up revealed acute renal failure. Percutaneous blood cultures grewC. perfringens. Cross-sectional imaging revealed a right-sided ureteral stone with hydronephrosis, which required nephrostomy placement. On placement of the nephrostomy tube, purulent drainage was identified and Gram stain of the drainage revealed Gram-variable rods. A urinary source ofC. perfringenswas clinically supported. Although it is not a common presentation, nongastrointestinal sources such as a urinary source should be considered inC. perfringensbacteremia because failure to recognize a nongastrointestinal source can delay appropriate treatment, which may include surgical intervention.

State-of-the-art pulmonary arterial imaging – Part 2

VASA ◽  
2018 ◽  
Vol 47 (5) ◽  
pp. 361-375 ◽  
Author(s):  
Harold Goerne ◽  
Abhishek Chaturvedi ◽  
Sasan Partovi ◽  
Prabhakar Rajiah
Keyword(s):  
Pulmonary Artery ◽  
State Of The Art ◽  
Therapy Monitoring ◽  
Pulmonary Arteries ◽  
Imaging Modalities ◽  
Cross Sectional ◽  
Multiple Imaging ◽  
Cross Sectional Imaging ◽  
Pulmonary Arterial ◽  
Arterial Imaging

Abstract. Although pulmonary embolism is the most common abnormality of the pulmonary artery, there is a broad spectrum of other congenital and acquired pulmonary arterial abnormalities. Multiple imaging modalities are now available to evaluate these abnormalities of the pulmonary arteries. CT and MRI are the most commonly used cross-sectional imaging modalities that provide comprehensive information on several aspects of these abnormalities, including morphology, function, risk-stratification and therapy-monitoring. In this article, we review the role of state-of-the-art pulmonary arterial imaging in the evaluation of non-thromboembolic disorders of pulmonary artery.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

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