Intrathoracic Caecal Perforation Presenting as Dyspnea

Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult.Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications.Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

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Rare Intercondylar Distal Femoral Brodie’s Abscess in a 21-Year-Old Man Who Refused Medical Care for Three Years after Initial Symptoms

Medicina ◽

10.3390/medicina57060544 ◽

2021 ◽

Vol 57 (6) ◽

pp. 544

Author(s):

Bogdan Gheorghe Hogea ◽

Jenel Marian Patrascu ◽

Adrian Emil Lazarescu ◽

Louchi El Mehdi ◽

Andrei Daniel Bolovan ◽

...

Keyword(s):

Medical Care ◽

Young Male ◽

Septic Complications ◽

Case Presentation ◽

Brodie’S Abscess ◽

Initial Symptoms ◽

Magnetic Resonance Imaging Mri ◽

Physiological Values ◽

Aggressive Debridement

Brodie’s abscess is a rare form of sub-acute osteomyelitis that implies the collection of pus inside bone tissue. The present paper presents an extremely rare case of Brodie’s abscess located in the distal femur in a young male patient who refused medical care for three years and presented directly with spontaneous fistula and septic complications. Laboratory tests also suggested chronic septic alterations. Complex imaging investigations including X-ray (RX), computer tomography (CT) and Magnetic Resonance imaging (MRI) confirmed the diagnosis with characteristic aspects, such as the penumbra sign on the T1 weighted MRI image. Management included aggressive debridement, defect reconstruction, and long-term specific antibiotics according to culture harvested intra-operatively. Evolution was positive with inflammatory blood tests returning to physiological values within four weeks and patient full recovery within six months, without any physical deficits. The novelty aspect found in this case presentation is represented by the long-term natural evolution of this pathology, and the fact that even in these conditions, the Brodie’s abscess did not evolve into a ‘malignant’ septic condition, but remained rather benign until the spontaneous fistula prompted the patient to seek medical care.

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Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

BMJ Case Reports ◽

10.1136/bcr-2020-235281 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235281

Author(s):

Sanjan Asanaru Kunju ◽

Prithvishree Ravindra ◽

Ramya Kumar Madabushi Vijay ◽

Priya Pattath Sankaran

Keyword(s):

Tension Pneumothorax ◽

Emergency Laparotomy ◽

Severe Respiratory Distress ◽

Mediastinal Shift ◽

Breath Sounds ◽

Chest X Ray ◽

The Right ◽

Tension Gastrothorax ◽

Obstructive Shock ◽

Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

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A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

Surgical Case Reports ◽

10.1186/s40792-021-01147-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takehiko Manabe ◽

Kenji Ono ◽

Soichi Oka ◽

Yuichiro Kawamura ◽

Toshihiro Osaki

Keyword(s):

Thoracic Surgery ◽

Surgical Repair ◽

Abdominal Cavity ◽

Case Presentation ◽

X Ray ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Pleuroperitoneal Communication ◽

Small Pore ◽

Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

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Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

The Surgery Journal ◽

10.1055/s-0041-1731443 ◽

2021 ◽

Vol 07 (03) ◽

pp. e124-e126

Author(s):

Mark Portelli ◽

Mark Bugeja ◽

Charles Cini

Keyword(s):

Computed Tomography ◽

Young Adult ◽

Rare Case ◽

Surgical Repair ◽

Bochdalek Hernia ◽

Case Presentation ◽

Atypical Case ◽

Accident And Emergency ◽

History Of ◽

Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

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NCOG-42. INITIAL PRESENTATION AND OUTPATIENT VISIT COMPLIANCE OF INMATES WITH BRAIN TUMORS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.580 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii138-ii138

Author(s):

Iyad Alnahhas ◽

Appaji Rayi ◽

Yasmeen Rauf ◽

Shirley Ong ◽

Pierre Giglio ◽

...

Keyword(s):

Brain Tumors ◽

Civil Liberties ◽

Delayed Diagnosis ◽

Low Grade ◽

Small Series ◽

Initial Symptoms ◽

The Ohio State University ◽

American Civil Liberties Union ◽

Lost To Follow Up

Abstract INTRODUCTION While advocacy for inmates with cancer has recently gained momentum, little is known about management of brain tumors in inmates. Delays in acknowledging or recognizing nonspecific initial symptoms can lead to delayed diagnosis and treatment. Inmates with cancer are reported to either be ignored or receive substandard care due in part to cost or logistics (American Civil Liberties Union; ASCO Post 2018). METHODS In this retrospective study, we identified inmates with gliomas seen in the Ohio State University Neuro-oncology Center between 1/1/2010-4/20/2019. RESULTS Twelve patients were identified. Median age at presentation was 39.5 years (range 28-62). Eleven patients were Caucasian and one was African American. Diagnoses included glioblastoma (GBM) (n=6), anaplastic astrocytoma (n=1), anaplastic oligodendroglioma (n=1), low-grade astrocytoma (n=3) and anaplastic pleomorphic xanthroastrocytoma (n=1). Patients were more likely to present early after seizures or focal neurologic deficits (9/12) than after headaches alone. Patients with GBM started RT 12-71 days after surgery (median 34.5). One patient’s post-RT MRI was delayed by a month and another with GBM had treatment held after 4 cycles of adjuvant temozolomide (TMZ) due to “incarceration issues”. For one patient who received adjuvant TMZ, the facility failed to communicate with the primary team throughout treatment. Two patients suffered significant nausea while on chemotherapy due to inability to obtain ondansetron in prison, or due to wrong timing. 7/12 (58%) patients were lost to follow-up for periods of 3-15 months during treatment. Three patients refused adjuvant treatment. CONCLUSIONS Although this is a small series, our results highlight the inequities and challenges faced by inmates with gliomas who are more likely to forego treatments or whose incarceration prevents them from keeping appropriate treatment and follow-up schedules. Additional studies are needed to define and address these deficiencies in the care of inmates with brain tumors and other cancers.

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Incidental whole-body MRI evidence of COVID-19 in an asymptomatic patient in a high prevalence region

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00288-x ◽

2020 ◽

Vol 51 (1) ◽

Cited By ~ 1

Author(s):

Valentina Angelini ◽

Alberta Villanacci ◽

Angelo Belotti ◽

Francesca Castagnoli ◽

Barbara Frittoli ◽

...

Keyword(s):

Asymptomatic Patient ◽

Whole Body ◽

Diagnostic Tools ◽

Historical Period ◽

Case Presentation ◽

Whole Body Mri ◽

High Prevalence ◽

Chest X Ray ◽

Full Knowledge ◽

Polymerase Chain

Abstract Background The purpose of this case report is to emphasize the importance of curing any clinical radiological elements in this historical period, especially in the area of endemic to coronavirus disease 19 (COVID-19) such as Lombardy and to stress the importance of the management of the asymptomatic patient, their crucial role in the spread of contagion. Case presentation We reported the case of incidental diagnosis of interstitial pneumonia by first finding on whole-body MR (WB-MR) in the patient affected by multiple myeloma (MM), with a negative respiratory symptoms at the time and with previous (1 month before) negative chest X-ray. The patient was promptly subjected to chest CT, which confirmed the suspicion of interstitial COVID-19 pneumonia and, in hospitalization, performed nasopharyngeal swabs for real-time polymerase chain reaction (RNA-PCR), with a doubtful outcome. Once the bacterial nature of the alterations was serologically and radiologically excluded, the patient was definitively diagnosed with COVID-19 and appropriately treated in hospitalization. Conclusion The clinical choices must, therefore, to make use of all the diagnostic tools available and full knowledge of the limitation of each of them.

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Sinonasal mucosal melanoma: treatment strategies and survival rates for a rare disease entity

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01847-6 ◽

2021 ◽

Author(s):

Alexandros Andrianakis ◽

Peter Kiss ◽

Markus Pomberger ◽

Axel Wolf ◽

Dietmar Thurnher ◽

...

Keyword(s):

Rare Disease ◽

Survival Data ◽

Survival Rates ◽

Delayed Diagnosis ◽

Distant Metastases ◽

Primary Treatment ◽

Mucosal Melanoma ◽

Disease Entity ◽

Improve Outcome ◽

Initial Symptoms

Summary Background Sinonasal mucosal melanoma (SNMM) is a rare disease entity comprising 0.4–1.3% of all melanomas. Surgery with free margins has been the primary treatment over decades. Neither the addition of radiotherapy nor chemotherapy could significantly improve outcome rates of this devastating malignancy. This study presents our clinical experience with SNMM over a 19-year period and summarizes the current body of literature on SNMM. Methods This retrospective analysis included 12 patients with SNMM treated from 2001 to 2019 at an academic center. Additionally, a literature review of the last 29 years on treatment and survival data of SNMM was conducted. Results Main initial symptoms were epistaxis and nasal obstruction. Of the patients 9 underwent endoscopic surgery, 6 received adjuvant therapy. 3 patients who did not undergo surgery, received chemoradiotherapy, radiotherapy alone, and chemotherapy alone, respectively. At the time of diagnosis 2 patients had distant metastases and 4 patients developed distant metastases during the course of the disease. Mean overall survival (OS) was 30.6 months, 3‑year and 5‑year OS were 25%, and 18.2%, respectively. Conclusion Unspecific symptoms and hidden anatomic locations lead to delayed diagnosis and increased rates of metastatic dissemination. Distant metastasis is the main treatment failure in SNMM. Surgery with free margins remains the primary treatment for SNMM. Adjuvant radiotherapy might improve local control in individual cases but efficient systemic therapy is needed to improve outcome rates. To evaluate and define more effective targeted treatment options and improve outcome rates, homogeneous data and prospective multicentric analysis are needed.

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Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease

Case Reports in Medicine ◽

10.1155/2018/3515370 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Esha M. Kapania ◽

Christina Link ◽

Joshua M. Eberhardt

Keyword(s):

Case Report ◽

Complete Resolution ◽

Clinical Symptoms ◽

Case Reports ◽

Delayed Diagnosis ◽

Spontaneous Resolution ◽

Radiographic Evidence ◽

Case Presentation ◽

Chilaiditi Syndrome

Background. Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation. Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions. This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.

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Delayed Diagnosis of Unilateral Mandibular Condylar Fracture in a Posterior Edentulous Patient

Case Reports in Dentistry ◽

10.1155/2021/5579236 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Sahani Anupama ◽

Pilana Vithanage Kalani Shihanika Hettiarachchi

Keyword(s):

Early Diagnosis ◽

Clinical Case ◽

Delayed Diagnosis ◽

Mandibular Fractures ◽

Edentulous Patient ◽

Condylar Fracture ◽

Physical Finding ◽

Case Presentation ◽

Edentulous Patients ◽

Condylar Fractures

Background. Fractures of the mandible are common in elderly patients, and among them, condylar fractures are the most frequent type. A change in occlusion is the most common physical finding in patients with fractures of the mandible. Therefore, it is challenging to identify mandibular fractures in posterior edentulous patients due to the lack of posterior occlusal contacts. It is crucial to do radiological investigations in such patients to exclude fractures. Case Presentation. This article describes a case of delayed diagnosis of a unilateral mandibular condylar fracture for a week’s duration and treating the condition as temporomandibular pathology in a posterior edentulous, 52-year-old patient. Conclusion. This clinical case highlights the importance of radiological investigations and occlusal analysis for early diagnosis of condylar fractures, particularly in posterior edentulous patients, lacking posterior occlusal contacts.

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Hoarseness of Voice as a Rare Presentation of Tuberculosis: A Case Report Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.817 ◽

2019 ◽

Vol 7 (19) ◽

pp. 3262-3264

Author(s):

Taher Felemban ◽

Abdullah Ashi ◽

Abdullah Sindi ◽

Mohannad Rajab ◽

Zuhair Al Jehani

Keyword(s):

Laryngeal Carcinoma ◽

Incidental Finding ◽

Chain Reaction ◽

Rare Presentation ◽

Case Presentation ◽

X Ray ◽

History Of ◽

Chest X Ray ◽

Polymerase Chain ◽

Laryngeal Tuberculosis

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.

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