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 PROMPT RECOGNITION OF STUMPAPPENDICITIS IS IMPORTANT TO AVOID SERIOUS COMPLICATIONS: A CASE REPORT

2020 ◽  
pp. 1-2
Author(s):  
Anil Kumar M S ◽  
D. Shiva Manohar
Keyword(s):  
Psoas Abscess ◽  
Rare Condition ◽  
Late Complications ◽  
Retroperitoneal Abscess ◽  
Lower Quadrant ◽  
Stump Appendicitis ◽  
Histologic Evaluation ◽  
History Of ◽  
Appendicular Stump ◽  
The Right

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to stump appendicitis. A 50-year-old female was admitted with history of abdominal pain more in the right lower quadrant for 1 week. History of fever present since week associated with chills, History of poor stream of urine for 1 week, not associated with burning micturition. Her past medical history showed a laparoscopic appendectomy operation performed 5 months ago. Computed tomography of abdomen and pelvis showed features suggestive of right psoas abscess with possible communication with the tubular structure arising from IC junction (? appendicular stump), Ill-defined peripherally enhancing collection in presacral region and bilateral ischiorectal region -? Abscess. CECT Abdomen and pelvis showed right mild Hydroureteronephrosis. Cystoscopy + DJ stenting was done post which Exploration with drainage of retroperitoneal abscess with stump appendectomy done on 15/2/19. Intraoperatively 50cc pus with caseous material was drained, psoas was bulky. 3cm appendicular stump was noted, dissected, ligated and buried. A drain was placed in the site of the operation. Post-operative course was uneventful and he was discharged 9 days after surgery. The histologic evaluation reported suppurative stump appendicitis. Residual long stump of the appendix after appendectomy might lead to persistence of infection and possibly late complications such as intraperitoneal, retroperitoneal or iliopsoas abscess. Surgical exploration may be necessary in persistent cases of Retroperitoneal abscess, to allow for recognition and treatment of the underlying pathology.

Rare case of osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a postmenopausal woman

2021 ◽  
Vol 14 (2) ◽  
pp. e237611
Author(s):  
Jin-Ju Kim ◽  
Ricardo Lessa de Castro Junior ◽  
Mark Schauer ◽  
Laura D Bauler
Keyword(s):  
Postmenopausal Woman ◽  
Vertebral Osteomyelitis ◽  
Psoas Muscle ◽  
Needle Aspiration ◽  
Gardnerella Vaginalis ◽  
Canal Stenosis ◽  
History Of ◽  
The Right ◽  
Pyogenic Osteomyelitis ◽  
Streptococcus Parasanguinis

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus. Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body’s normal barriers.

scholarly journals Reduction en masse of inguinal hernia after self-reduction: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Khosrow Najjari ◽  
Hossein zabihi Mahmoudabadi ◽  
Seyed Zeynab Seyedjavadeyn ◽  
Reza Hajebi
Keyword(s):  
Case Report ◽  
Inguinal Hernia ◽  
Ct Scan ◽  
Lower Quadrant ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Patient Reported ◽  
History Of ◽  
Old Persian ◽  
The Right

Abstract Background Reduction en mass (REM) is one of the rare complications of inguinal hernia reduction. Although REM can be detected on the basis of specific computed tomography (CT) scan findings, many radiologists are not familiar with its radiological appearance because of the scarcity of this complication, which may cause a delay in diagnosis. Case presentation The patient reported in this article was a 50-year-old Persian man with a history of inguinal hernia, who had been referred with the periumbilical pain that radiated to the right lower quadrant and developed following hernia replacement by the patient himself. REM diagnosis was based on clinical examination and CT scan findings, and surgical treatment was performed by the Lichtenstein repair and mesh implantation. Conclusions Although REM usually occurs after reduction with compression in the inguinal hernia, this unique case report highlighted the possibility of REM after self-reduction. Surgeons and radiologists should consider REM in patients with a history of inguinal hernia presenting with intestinal obstruction symptoms, even without any apparent signs of hernia in the physical examination.

scholarly journals Thyroid Carcinoma on the Side of the Absent Lobe in a Patient with Thyroid Hemiagenesis

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Hiroki Sato ◽  
Kiyoaki Tsukahara ◽  
Ray Motohashi ◽  
Midori Wakiya ◽  
Hiromi Serizawa ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Papillary Carcinoma ◽  
Thyroid Tissue ◽  
Needle Aspiration ◽  
Left Lobe ◽  
Thyroid Hemiagenesis ◽  
Poorly Differentiated ◽  
Node Metastases ◽  
Right Lobe ◽  
The Right

Background. Thyroid carcinoma complicated by hemiagenesis is very rare, and previous reports have not described this cancer on the side of the absent lobe. Methods and Results. We report the case of a 64-year-old woman in whom left thyroid hemiagenesis was discovered incidentally during investigations of abnormal sensation during swallowing. A tumorous 1.4 cm lesion was also found on the side of the absent lobe, left of the isthmus. Fine-needle aspiration biopsy revealed class V papillary carcinoma, but no lymph node metastases. Total thyroidectomy was performed for stage cT1bN0M0 carcinoma. Histopathology revealed normal thyroid tissues in the right lobe and isthmus, while the left lobe was absent. The mostly papillary carcinoma was adjacent to the truncated thyroid tissue, with a portion histologically consistent with poorly differentiated carcinoma. Conclusions. All previously reported cases of thyroid cancer complicated by hemiagenesis have represented carcinoma occurring within the present lobe. This case is extremely rare.

scholarly journals SUN-934 A Rare Case of Hyperparathyroidism - Parathyroid Carcinoma, Atypical Adenoma, or Both?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Petra Krutilova ◽  
Harjyot Sandhu ◽  
Michael Salim ◽  
Janice L Gilden ◽  
Paula Butler
Keyword(s):  
Parathyroid Carcinoma ◽  
Rare Case ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Mitotic Rate ◽  
Fluid Replacement ◽  
Cancer Center ◽  
Subtotal Parathyroidectomy ◽  
History Of ◽  
The Right

Abstract Introduction: Parathyroid carcinoma (PC) is a rare endocrine malignancy. It accounts for <1% cases of primary hyperparathyroidism (PHPT). We present a rare case of concurrent PC and atypical parathyroid adenoma (PA). Case presentation: A 72-year-old woman presented with 1-week history of generalized weakness, confusion, and auditory hallucinations. Her medical history was significant for PHPT known for 5 years, CAD and CHF. The patient appeared mildly volume depleted and was tachycardic (105/min). The rest of her physical exam was unremarkable. Calcium (Ca) was 15.1 mg/dL (8.4–10.2 mg/dL) and intact PTH 451.9 pg/mL (12–88 pg/mL). Her condition improved with aggressive fluid replacement, pamidronate, and cinacalcet. A sestamibi scan revealed increased uptake of bilateral parathyroid tissue. Fine needle aspiration (FNA) revealed PA. Surgical treatment was postponed for control of cardiac comorbidities. One month later, she presented again with symptomatic hypercalcemia. Her Ca was 16.1 md/dL and PTH 761.5 pg/mL. Initial medical management was followed by subtotal parathyroidectomy – three masses were removed (one on the right and two on the left). Final pathology revealed PC within the left parathyroid, the others were consistent with hypercellular parathyroid tissue. One month later, the patient underwent left hemithyroidectomy, right parathyroidectomy, and central neck dissection. PTH level dropped to 2.4 pg/mL and Ca level was 7.6 mg/dL after surgery. She was discharged home on Ca and vitamin D supplements. Pathology was sent to a referral cancer center and revealed PC vs. atypical PA within the right parathyroid. Discussion: PC is a rare endocrine malignancy. Further, there are not many cases of synchronous PC and PA or multifocal PC. Diagnosing PC preoperatively is challenging since it shares overlapping characteristics with PA. Patients with malignancy commonly present with larger tumor size, higher level of Ca (>14.6 mg/dL), and PTH (5-fold higher than the upper limit of normal). Our patient had a history of multiple admissions due to symptomatic HC. She had no palpable neck masses on exam. Her initial FNA was consistent with PA. Hence, we presumed that her hypercalcemia was caused by PA. Establishing a definitive diagnosis of PC by frozen sections intraoperatively is difficult. Histopathologic findings of atypical cells, high mitotic rate, and cellular invasions can suggest the diagnosis, though they are often negative. Even postoperatively, pathologists often disagree on cytologic interpretation. However, differentiating PA and PC is important since earlier and more aggressive treatment is needed to reduce the morbidity and mortality in case of malignancy.

scholarly journals A Rare Presentation of Poorly Differentiated Lung Carcinoma with Duodenal Metastasis and Literature Review

2020 ◽  
Vol 14 (1) ◽  
pp. 186-196
Author(s):  
Ahmed Ahmed ◽  
Umair M. Nasir ◽  
Paul Delle Donna ◽  
Vanessa Swantic ◽  
Shahida Ahmed ◽  
...  
Keyword(s):  
Lung Carcinoma ◽  
Neuroendocrine Differentiation ◽  
Needle Aspiration ◽  
Gi Tract ◽  
Rare Presentation ◽  
Metastatic Lung ◽  
History Of ◽  
Multiple Blood ◽  
Poorly Differentiated ◽  
Metastatic Lung Carcinoma

Lung cancer is a common malignancy which is frequently found to metastasize to distant sites including bone, liver, and adrenal glands. There are rare reports of metastases to the gastrointestinal (GI) tract, with the duodenum being the most uncommon. We present a rare case of a poorly differentiated lung carcinoma metastasizing to the duodenum. This case enhances the medical literature as it provides additional distinct features to the clinical and histological presentation of metastatic lung carcinoma to the GI tract. A 61-year-old male with a history of poorly differentiated lung carcinoma presented with worsening dizziness, fatigue, and early satiety. He had extensive workup done in the past for hemoptysis including a computerized tomography scan of the chest which showed a new lobulated, apical lesion and hilar lymphadenopathy. He ultimately had a transthoracic fine-needle aspiration (FNA) of the mass and was later diagnosed with poorly differentiated lung carcinoma. On examination, the patient was noted to be pale, tachycardic, and hypotensive. The patient was noted to have an acute drop in his hemoglobin requiring fluid resuscitation, multiple blood transfusions, and evaluation with an esophagogastroduodenoscopy. He was found to have an oozing ulcer in the third portion of the duodenum whose biopsies showed poorly differentiated carcinoma with areas of neuroendocrine differentiation, similar to his lung biopsy results, which was consistent with metastatic lung carcinoma.

scholarly journals Resection of a colonic mass following trauma: a diagnostic dilemma

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Paul Burchard ◽  
Alan A Thomay
Keyword(s):  
Ct Scan ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Symptomatic Improvement ◽  
Diagnostic Dilemma ◽  
Vehicle Accident ◽  
Abdomen Ct ◽  
History Of ◽  
Mitotic Figures ◽  
The Right

Abstract A 53-year-old Caucasian male presented with a 2-week history of abdominal distension, pain, nausea and lethargy. His symptoms began 1 day after an all-terrain vehicle accident during which he suffered blunt-force trauma to his mid-right abdomen. CT scan demonstrated abnormal thickening of the ascending colon and terminal ilium with surrounding inflammation within the retroperitoneum and colonic mesentery. Given his likely mechanism and symptomatic improvement, he was initially managed conservatively. However, he was readmitted with recurrence of symptoms, and a repeat CT scan demonstrated no interval improvement. An exploratory laparotomy was performed and a firm, fixed mass of the right-colon and colonic mesentery was found. Final histopathology of the mass revealed a diffuse lymphoid infiltrate with numerous mitotic figures and apoptotic cells. Immunohistochemical staining was positive for CD45, CD20, CD10, and BCL-6 and negative for CD3, TdT, and BCL-2, indicating a diagnosis of Burkitt lymphoma.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

Electrochemotherapy with intra-tumoral cisplatin for the treatment of fibrosarcoma in a horse

2018 ◽  
Author(s):  
M. Bharathidasan ◽  
B. Justin William ◽  
Ravi Sundar George Sundar George ◽  
A. Arunprasad ◽  
R. Sivasankar
Keyword(s):  
Complete Response ◽  
Tumour Volume ◽  
Needle Aspiration ◽  
Medial Aspect ◽  
History Of ◽  
Subcutaneous Tissues ◽  
Needle Aspiration Cytology ◽  
One Year ◽  
The Right

A two years old Kathiawar stallion was reported with the history of two, pedunculated hard mass medially on the thigh and hock of the right hind limb, progressively increasing for the past two months. Fine needle aspiration cytology revealed fibrosarcoma.The tumour on the medial aspect of the thigh was injected with cisplatin intra-tumorally at a dose rate of 0.3 mg/cm3 of tumour volume and was exposed to ECT. The tumour on the medial aspect of the hock was excised incompletely to preserve skin and subcutaneous tissues around the tumour for wound opposition and treated with intra-tumoral injection of cisplatin followed by ECT. Following electrochemotherapy complete response was noticed onthe 3rd and 4th week for the tumours on the thigh and hock respectively. No recurrence was noticed during the follow-up period of one year revealing ETC with cisplatin as a single treatment and also in combination with surgery is effective for the treatment of fibrosarcoma in equines.

Thyroid tuberculosis: an unexpected diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e238795
Author(s):  
Alexandra Novais Araújo ◽  
Tânia Matos ◽  
João Boavida ◽  
Maria João Guerreiro Martins Bugalho
Keyword(s):  
Lymph Node ◽  
Positive Culture ◽  
Rare Condition ◽  
Pulmonary Involvement ◽  
Needle Aspiration ◽  
Tuberculous Infection ◽  
History Of ◽  
Right Lobe ◽  
Thyroid Tuberculosis ◽  
The Right

Mycobacterium tuberculosis (MTB) is an aerobic bacillus responsible for tuberculous infection. The the thyroid gland being affected by MTB is a rare condition. A 71-year-old woman had 6 months of slight cervical discomfort. Her neck ultrasound showed, at the right lobe of the thyroid, a dominant heterogeneous nodule of 18 mm and homolateral lymph nodes with suspicious ultrasonographic features. The patient underwent fine-needle aspiration, the results of which were non-diagnostic (thyroid nodule) and reactive pattern (lymph node). A total thyroidectomy was performed and a lymph node was sampled for extemporaneous examination. Surprisingly, necrotising granulomas were documented. The diagnosis was definitely established by a positive culture of the lymph node tissue and molecular detection of MTB. Pulmonary involvement was excluded and she was started on antituberculous agents. In the absence of systemic, specific complaints or history of exposition, histopathology and culture of MTB remain a key step for the diagnosis.

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