scholarly journals More than Pus – Primary Hepatic Epithelioid Angiomyolipoma Masquerading as Liver Abscess

2021 ◽  
pp. 1-8
Author(s):  
Wen Hao Justin Leong ◽  
Xia Huang Andrew Tan ◽  
Ennaliza Salazar
Keyword(s):  
Liver Abscess ◽  
Epigastric Pain ◽  
Epithelioid Angiomyolipoma ◽  
Rare Type ◽  
Function Test ◽  
History Of ◽  
Cluster Of Differentiation ◽  
Epithelioid Variant ◽  
Minimal Fluid ◽  
Mesenchymal Tumours

Hepatic angiomyolipomas (AML) are rare mesenchymal tumours of which the epithelioid type is a rare type with malignant potential. We report a case of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess. A 46-year-old man presented with a 5-day history of fever with epigastric pain and nausea. On the night of admission, his temperature spiked to 39°C, his blood pressure was 135/79, his heart rate 98, his liver function test revealed albumin 37 g/L, bilirubin 25 μmol/L, ALP 298 U/L, ALT 247 U/L, and AST 344 U/L. The clinical suspicion was hepatobiliary sepsis and intravenous ceftriaxone was commenced. CT of the abdomen showed an ill-defined hypodense focus in segment 4A/8 (4.5 × 3.5 cm) with a minimal fluid component implying a developing abscess or phlegmon. The images were reviewed by a radiologist and showed minimal fluid for percutaneous drainage. MRI of the liver was performed to further characterize the lesion and revealed a solid mass with nodular areas of arterial enhancement and washout, suspicious of neoplasm. Ultrasound-guided liver biopsy of the lesion was performed. Histology showed a histiocyte-rich epithelioid neoplasm consistent with the epithelioid variant of AML. Immunohistochemical staining was positive for human melanoma black 45, melan-A and cluster of differentiation 68. He successfully underwent liver resection of segment 4A/8 after 6 weeks of antibiotics. To our knowledge, this is the first reported case in the literature of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess.

scholarly journals Cryptogenic Pyogenic Liver Abscess Due to Fusobacterium nucleatum in an Immunocompetent Patient

2020 ◽  
Author(s):  
Neeraja Swaminathan ◽  
Francisco Aguilar
Keyword(s):  
Liver Abscess ◽  
Fusobacterium Nucleatum ◽  
Pyogenic Liver Abscess ◽  
Immunocompetent Patient ◽  
Immunocompetent Host ◽  
Source Of Infection ◽  
Function Test ◽  
History Of ◽  
Anaerobic Infections ◽  
Dental Work

In this case, a 76-year-old female presented with 3–4 days of fever with no other localizing signs. Notably, she had had an untreated Fusobacterium bacteraemia approximately 8 weeks prior to admission. She underwent abdominal imaging which demonstrated a liver abscess and had percutaneous drainage of the same. Blood and pus cultures both grew Fusobacterium nucleatum, which is an unusual organism to be associated with a liver abscess, especially in an immunocompetent host with no risk factors for this condition. Interestingly, this patient did not have any history of dental work, instrumentation, liver function test (LFT) abnormalities and no extrahepatic source for the abscess. This case highlights the importance of having a high index of clinical suspicion for an occult source of infection and emphasizes the importance of following up on cultures even after discharge of a patient, since anaerobic infections such as those caused by Fusobacterium can have a largely indolent course.

scholarly journals Small Intestinal Strangulation Due to a Rare Type of Primary Internal Hernia

2013 ◽  
Vol 98 (4) ◽  
pp. 409-411 ◽  
Author(s):  
Makoto Takeda ◽  
Yoshinori Ohnuki ◽  
Takashi Uchiyama ◽  
Osamu Kubota ◽  
Kousuke Ohishi
Keyword(s):  
Internal Hernia ◽  
Epigastric Pain ◽  
Past History ◽  
Hepatic Flexure ◽  
Rare Type ◽  
Paracolic Gutter ◽  
Internal Hernias ◽  
History Of ◽  
The Right ◽  
Severe Epigastric Pain

Abstract Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

Adenoid cystic carcinoma of the labium oris with rare metastasis to the pleural cavity

2021 ◽  
Vol 14 (1) ◽  
pp. e237622
Author(s):  
Osama Mosalem ◽  
Anas Alsara ◽  
Fawzi Abu Rous ◽  
Borys Hrinczenko
Keyword(s):  
Side Effects ◽  
Adenoid Cystic Carcinoma ◽  
Pleural Cavity ◽  
Epigastric Pain ◽  
Asian Woman ◽  
Upper Lip ◽  
Adenoid Cystic ◽  
History Of ◽  
The Right

A 57-year-old Southeast Asian woman with a remote history of adenoid cystic carcinoma (ACC) of the right labium superius oris (upper lip) presented to the hospital with vague epigastric pain. On workup, she was found to have multiple pleural nodules. Histopathology confirmed the diagnosis of metastatic ACC. After 8 months of active surveillance, evidence of disease progression was found and the patient was started on pembrolizumab. Follow-up after starting pembrolizumab showed stable disease with no significant side effects.

scholarly journals Spontaneous haemorrhage of an adrenal angiomyolipoma: case report

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Danielle Whiting ◽  
Ian Rudd ◽  
Amit Goel ◽  
Seshadri Sriprasad ◽  
Sanjeev Madaan
Keyword(s):  
Case Reports ◽  
Case Presentation ◽  
Open Adrenalectomy ◽  
Large Size ◽  
History Of ◽  
Loin Pain ◽  
Benign Tumours ◽  
Spontaneous Haemorrhage ◽  
Mesenchymal Tumours

Abstract Background Angiomyolipomas are rare mesenchymal tumours arising from the perivascular epithelioid cells consisting of variable amounts of adipose, thick-walled blood vessels and smooth muscle cells. These benign tumours commonly occur in the kidney with only a few case reports of adrenal angiomyolipomas which have the potential to reach a large size and haemorrhage. Case presentation A 45-year-old lady presented with a 3-week history of right loin pain, nausea and vomiting. A CT scan revealed a right adrenal angiomyolipoma measuring 6.3 × 6.8 cm with associated haemorrhage. The lesion was successfully treated with right open adrenalectomy, and histology confirmed the diagnosis of adrenal angiomyolipoma. The patient remained well with no evidence of recurrence at the 36-month follow-up. Conclusion Adrenal angiomyolipomas are rare benign tumours that have the ability to reach a large size and potential to bleed. Here, we report the second case of spontaneous haemorrhage in an adrenal angiomyolipoma, which was successfully treated with open adrenalectomy.

scholarly journals Unusual Tissue – Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction

2021 ◽  
pp. 338-343
Author(s):  
Thu L. Nguyen ◽  
Shivani Kapur ◽  
Stephen C. Schlack-Haerer ◽  
Grzegorz T. Gurda ◽  
Milan E. Folkers
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Needle Aspiration ◽  
Pancreatic Tissue ◽  
Cystic Mass ◽  
Pancreatic Heterotopia ◽  
History Of

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

scholarly journals Melioidosis: A Rare Cause of Liver Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Peter Franz M. San Martin ◽  
Catherine S. C. Teh ◽  
Ma. Amornetta J. Casupang
Keyword(s):  
Liver Abscess ◽  
Burkholderia Pseudomallei ◽  
Abdominal Ultrasound ◽  
Open Drainage ◽  
High Grade Fever ◽  
Rare Presentation ◽  
Culture Studies ◽  
Moderate Growth ◽  
Male Farmer ◽  
History Of

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth ofBurkholderia pseudomalleiin which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound.Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused byBurkholderia pseudomalleihas not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence.

Intraductal Papillary Mucinous Neoplasm of the Pancreas

2021 ◽  
Vol 8 (28) ◽  
pp. 2562-2566
Author(s):  
Jayalatha Nethagani ◽  
Priyanka Govula ◽  
Revathi Chandu ◽  
Pravin Raj T
Keyword(s):  
Epigastric Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Uncinate Process ◽  
Cystic Lesions ◽  
Chronic Alcoholic ◽  
Contrast Enhanced ◽  
History Of ◽  
Head Of The Pancreas ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

A 36-year-old non-smoker, chronic alcoholic female presented with recurrent episodes of epigastric pain and vomiting in the last 10 days. H/o similar episodes of pain 3 times, with last episode was noted 2 months back. She also had history of vomiting (3 episodes). Jaundice/melena/steatorrheas was not observed. Subsequently, contrast-enhanced computed tomography (CECT) of the patient was done and it showed well defined multiple cystic lesions with peripheral wall enhancement involving head and body of pancreas, largest measuring 24 X 22 X 22 mm in the head of the pancreas, the lesion was seen abutting antro-pyloric region anteriorly. Main pancreatic is mildly dilated measuring 4 mm in diameter. A well-defined heterogeneously hypodense (necrotic) para duodenal lesion, was noted inferior to uncinate process, m/s 22 X 20 X 20 mm, which is indicative of lymph nodal deposit. On magnetic resonance cholangiopancreatography (MRCP): few cystic lesions were seen scattered in the pancreatic parenchyma, with one of the cysts showing communication with main pancreatic duct (MPD) ab.

Blunted hypoxic ventilatory drive in subjects susceptible to high-altitude pulmonary edema

1989 ◽  
Vol 66 (3) ◽  
pp. 1152-1157 ◽  
Author(s):  
Y. Matsuzawa ◽  
K. Fujimoto ◽  
T. Kobayashi ◽  
N. R. Namushi ◽  
K. Harada ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Edema ◽  
High Altitude ◽  
Pulmonary Function Test ◽  
Ventilatory Response ◽  
Hypoxic Ventilatory Response ◽  
High Altitude Pulmonary Edema ◽  
Function Test ◽  
History Of ◽  
Low Altitude

It has been proposed that subjects susceptible to high-altitude pulmonary edema (HAPE) show exaggerated hypoxemia with relative hypoventilation during the early period of high-altitude exposure. Some previous studies suggest the relationship between the blunted hypoxic ventilatory response (HVR) and HAPE. To examine whether all the HAPE-susceptible subjects consistently show blunted HVR at low altitude, we evaluated the conventional pulmonary function test, hypoxic ventilatory response (HVR), and hypercapnic ventilatory response (HCVR) in ten lowlanders who had a previous history of HAPE and compared these results with those of eight control lowlanders who had no history of HAPE. HVR was measured by the progressive isocapnic hypoxic method and was evaluated by the slope relating minute ventilation to arterial O2 saturation (delta VE/delta SaO2). HCVR was measured by the rebreathing method of Read. All measurements were done at Matsumoto, Japan (610 m). All the HAPE-susceptible subjects showed normal values in the pulmonary function test. In HCVR, HAPE-susceptible subjects showed relatively lower S value, but there was no significant difference between the two groups (1.74 +/- 1.16 vs. 2.19 +/- 0.4, P = NS). On the other hand, HAPE-susceptible subjects showed significantly lower HVR than control subjects (-0.42 +/- 0.23 vs. -0.87 +/- 0.29, P less than 0.01). These results suggest that HAPE-susceptible subjects more frequently show low HVR at low altitude. However, values for HVR were within the normal range in 2 of 10 HAPE-susceptible subjects. It would seem therefore that low HVR alone need not be a critical factor for HAPE. This could be one of several contributing factors.

scholarly journals Analysis of Clinical Characteristics of 19 Patients with Endophthalmitis Caused by Liver Abscess

2021 ◽  
Author(s):  
guangsen liu ◽  
Yue Li ◽  
Wei Wang ◽  
Lei Gao
Keyword(s):  
Visual Acuity ◽  
Liver Abscess ◽  
Diagnosis And Treatment ◽  
Endogenous Endophthalmitis ◽  
Klebsiella Pneumonia ◽  
Microbial Culture ◽  
Poor Vision ◽  
Ocular Symptoms ◽  
History Of ◽  
First Time

Abstract Objective: To analyze the clinical features, treatment, and prognosis of endophthalmitis caused by a liver abscess.Methods: All cases of endogenous endophthalmitis caused by a liver abscess in our hospital in the past 7 years were analyzed retrospectively. The data collected included age, sex, history of diabetes, initial and final vision, pathogen, course of the disease, treatment, and prognosis.Results: 21 eyes of 19 patients were complicated with liver abscess. The average age was 55.9 ±9.8 years old, including 10 males (52.6%) and 9 females (44.4%), 13 patients complicated with diabetes (71.4%), 14 patients (66.7%) first went to the ophthalmology department for diagnosis and treatment and 5 with hepatobiliary surgery (33.3%). 14 patients had a fever before onset, with an average fever time of 5.8 days. Before treatment, the duration of ocular symptoms was 7.71 ±6.68 days, 5.71 ±1.25 days for patients who go to ophthalmology for diagnosis and treatment for the first time, and 12.2 ±3.58 days for patients who go to other departments. After treatment, the average visual acuity of 21 eyes was 0.013, and the average best-corrected visual acuity was 0.79. In the 21 eyes, vitreous fluid culture was positive in 7 eyes (33.3%), all of which were Klebsiella pneumonia. Among the 14 patients with fever during hospitalization, 5 cases were positive for blood microbial culture, all of which were Klebsiella pneumonia. After vitrectomy, the average visual acuity was improved by 4.90 ±2.47 letters and that of patients without vitrectomy was-0.25±0.16letters. The visual acuity of patients who underwent postoperative visual was significantly better than that of patients without postoperative visual (P＜0.096). The visual acuity of patients without vitrectomy was significantly higher than that of patients without vitrectomy (P ＜0.01). 3 eyes (33.3%) of 9 eyes in the IVI group were removed because of uncontrolled inflammation, and 1 eye of 12 eyes in the PPV group was removed because of inflammation recurrence.Conclusion: The prognosis of endogenous endophthalmitis caused by liver abscess is generally poor, but early treatment can save part of the vision. The first visit non-ophthalmology department will delay the early diagnosis of the disease. Diabetes is an important risk factor for endogenous endophthalmitis and poor vision in patients with liver abscess. Klebsiella pneumonia is the main pathogen of intraocular infection. Vitrectomy combined with vitreous injection of antibiotics can improve the prognosis. A systematic and thorough treatment of a liver abscess is of great significance to prevent the recurrence of endophthalmitis in a liver abscess.

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