Robotic excision of interaortocaval paraganglioma: a case report with the literature review

Abstract Background Paragangliomas are rare neuroendocrine tumors of extra adrenal origin. The symptomatic paragangliomas require multimodal treatment approach. Case Presentation We report a case of 34-year-old female who presented with complains of headache and blurring of vision. Examination revealed Hypertensive crisis with grade 3 retinopathy. The patient was diagnosed as a case of extra-adrenal paraganglioma during evaluation for secondary hypertension. Magnetic Resonance Imaging of the abdomen revealed 23*28*28 mm mass lesion in the inter-aortocaval region at the level of L3–L4. The patient was started on medical management for hypertension and was managed safely with robot-assisted surgery, owing to enhanced visualization of feeding vessels and avoidance of excessive manipulation of tumor. Conclusions Our case report emphasizes on the robot assisted surgical technique for the removal of tumor in a vulnerable anatomical position and presents a review of the literature.

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Lymphangiography and focal pleurodesis treatment of chylothorax with an aberrant thoracic duct following oesophagectomy: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0709-3 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Tomoyuki Ishida ◽

Jun Kanamori ◽

Hiroyuki Daiko

Keyword(s):

Magnetic Resonance Imaging ◽

Interventional Radiology ◽

Case Report ◽

Magnetic Resonance ◽

Thoracic Duct ◽

Rare Case ◽

Resonance Imaging ◽

Case Presentation ◽

Thoracostomy Tube ◽

Magnetic Resonance Imaging Mri

Abstract Background Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR). Case presentation The patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission. Conclusions Chylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.

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Isolated nausea and vomiting as the cardinal presenting symptoms of clozapine-induced myocarditis: a case report

BMC Psychiatry ◽

10.1186/s12888-020-02955-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

M. Z. van der Horst ◽

F. van Houwelingen ◽

J. J. Luykx

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Clinical Symptoms ◽

Early Recognition ◽

Nausea And Vomiting ◽

Resonance Imaging ◽

Treatment Resistant ◽

Laboratory Examination ◽

Case Presentation ◽

Presenting Symptoms

Abstract Background Clozapine is an atypical antipsychotic proven to be superior in the treatment of treatment-resistant schizophrenia. Myocarditis is a rare, but well-known complication of treatment with clozapine. Only few cases have been reported in which nausea and vomiting were prominent symptoms. This is the first described report in which nausea and vomiting were the only presenting symptoms of clozapine-induced myocarditis. Case presentation We report a case of a 58-year-old woman, suffering from schizoaffective disorder, who is being treated with clozapine. Two weeks after initiation of clozapine, she developed nausea and vomiting, in absence of any other clinical symptoms. Laboratory examination and magnetic resonance imaging confirmed the diagnosis of clozapine-induced myocarditis. Clozapine was discontinued and the patient recovered fully. Conclusions This case emphasizes the importance of recognizing myocarditis as a cause of isolated nausea and vomiting in patients treated with clozapine. Early recognition improves clinical outcome and reduces mortality.

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Silent Hypertensive Crisis in an Adolescent: First Case Report of Pediatric Pheochromocytoma from Indonesia

Global Pediatric Health ◽

10.1177/2333794x211015484 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110154

Author(s):

Cahyani Gita Ambarsari ◽

Eka Laksmi Hidayati ◽

Bambang Tridjaja ◽

Chaidir Arif Mochtar ◽

Haryanti Fauzia Wulandari ◽

...

Keyword(s):

Case Report ◽

Hypertensive Crisis ◽

Pediatric Nephrology ◽

Tumor Resection ◽

Secondary Hypertension ◽

Antihypertensive Medications ◽

First Case ◽

History Of ◽

The Right ◽

Clinical Awareness

Secondary hypertension in children, to the rare extent, can be caused by endocrine factors such as pheochromocytoma, an adrenal tumor that secretes catecholamine. Only a few cases have been reported in the past 3 decades. To the best of our knowledge, this is the first case report of pediatric pheochromocytoma from Indonesia. We reviewed a case of a 16-year-old Indonesian boy with history of silent hypertensive crisis who was referred from a remote area in an island to the pediatric nephrology clinic at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Despite medications, his symptoms persisted for 14 months. At the pediatric nephrology clinic, pheochromocytoma was suspected due to symptoms of catecholamine secretion presented, which was palpitation, diaphoresis, and weight loss. However, as the urine catecholamine test was unavailable in Indonesia, the urine sample was sent to a laboratory outside the country. The elevated level of urine metanephrine, focal pathological uptake in the right adrenal mass seen on 131I-MIBG, and histopathology examination confirmed the suspicion of pheochromocytoma. Following the tumor resection, he has been living with normal blood pressure without antihypertensive medications. This case highlights that pheochromocytoma should always be included in the differential diagnoses of any atypical presentation of hypertension. In limited resources setting, high clinical awareness of pheochromocytoma is required to facilitate prompt referral. Suspicion of pheochromocytoma should be followed by measurement of urine metanephrine levels. Early diagnosis of pheochromocytoma would fasten the optimal cure, alleviate the symptoms of catecholamine release, and reverse hypertension.

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Sarcomatoid Hepatocellular Carcinoma With Skull Base Metastasis: A Case Report

10.21203/rs.3.rs-757587/v1 ◽

2021 ◽

Author(s):

Chen Lin ◽

Bo-An Chen ◽

Shih-Ming Jung ◽

Cheng-Chi Lee

Keyword(s):

Hepatocellular Carcinoma ◽

Skull Base ◽

Treatment Approach ◽

Jugular Foramen ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Resonance Imaging ◽

Endoscopic Endonasal ◽

Case Presentation ◽

Promising Treatment

Abstract Background Sarcomatoid hepatocellular carcinoma (SHC) is a relatively malignant tumor due to its recurrence and metastasis. Although metastatic SHC has been reported, skull base metastasis has not yet been documented. Case presentation: We herein report on a 51-year-old male with left throbbing headache and cranial nerve neuropathies. Magnetic resonance imaging revealed an extradural lesion of over 4 cm involving the jugular foramen, hypoglossal canal, clivus and the atlas. An endoscopic endonasal approach (EEA) was adopted for tissue biopsy and decompression, and the symptoms of the patient improved significantly after the surgery. Conclusions SHC invading the skull base is an extremely rare circumstance. For such extradural lesions, EEA is the most applicable and promising treatment approach.

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Pheochromocytoma: A Rare Cause of Secondary Hypertension

Journal of Lumbini Medical College ◽

10.22502/jlmc.v1i1.17 ◽

2013 ◽

Vol 1 (1) ◽

pp. 48

Author(s):

Sahadeb Prasad Dhungana ◽

G P Acharya ◽

R M Piryani ◽

S K Shrestha

Keyword(s):

Blood Pressure ◽

Case Report ◽

Antihypertensive Drugs ◽

Hypertensive Crisis ◽

Frozen Shoulder ◽

Case Series ◽

Secondary Hypertension ◽

Catecholamine Excess ◽

Contrast Enhanced Ct ◽

Adrenal Pheochromocytoma

Introduction: Pheochromocytoma is a rare tumor, originating from the chromaffin tissue. Its frequency is approximately 1/100,000. The clinical manifestation is due to catecholamine excess, which includes high blood pressure, palpitation, headache, sweating, nausea, vomiting, trembling, weakness, irritation, abdominal and chest pain, dyspnea, red warm face, constipation, polyuria, and polydipsia. Case Report: We present a case of 53 years old male, hospitalized for hypertensive crisis following the manipulation of left sided frozen shoulder. He had labile blood pressure ranging from 220/120 systolic- 90/60 diastolic, profuse sweating and tachycardia. Findings of Contrast enhanced CT of abdomen was consistent with right adrenal pheochromocytoma and 24 hours urinary VMA was 17 mg /24 hr (Normal <13.6 mg /24hr). After the clinical, paraclinical investigations and radiological tests, it was proved to be a pheochromocytoma. The surgical intervention was planned. But due to unavailability of required antihypertensive drugs in Nepal (alpha-blockers like phentolamine and phenoxybenzamine), surgeons were reluctant to operate, although blood pressure was well controlled with use of sodium nitroprusside during hypertensive crisis and prazosin, a selective alpha blocker as maintainance therapy. The use of prazosin to control hypertension secondary to pheochromocytoma is limited to case report and case series. Conclusion: Although rare, pheochromocytoma is a treatable surgical cause of secondary hypertension.

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Extra-adrenal Paraganglioma: An Uncommon Cause of Secondary Hypertension in a Young Subject

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v31i3.4965 ◽

2011 ◽

Vol 31 (3) ◽

pp. 238-240

Author(s):

SK Kota ◽

S Jammula ◽

S Panda

Keyword(s):

Case Report ◽

Key Words ◽

Rare Disease ◽

Tuberculous Meningitis ◽

Young Subject ◽

Secondary Hypertension ◽

Key Words Paraganglioma ◽

Extra Adrenal Paraganglioma

An 8 year boy was admitted with features of tuberculous meningitis. He was detected to have hypertension. Further investigations revealed an extra-adrenal paraganglioma. Tuberculous meningitis and paraganglioma could be chance associations. Paraganglioma is a rare and potentially lethal cause of secondary hypertension, very uncommon at this age. If left untreated it leads to complications arising from unrelenting hypertension. We report a case report on this very rare disease of paraganglioma presenting in an unexpected way. Key words: Paraganglioma; Tuberculous meningitis; Secondary hypertension DOI: http://dx.doi.org/10.3126/jnps.v31i3.4965 J Nep Paedtr Soc 2011;31(3): 238-240

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An impacted urethral stone: a rare cause of acute urinary retention in women—case report

African Journal of Urology ◽

10.1186/s12301-021-00225-y ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Babatunde K. Hamza ◽

Ahmad Bello ◽

Musliu Adetola Tolani ◽

Jerry G. Makama ◽

Nuhu Yusuf

Keyword(s):

Case Report ◽

Urinary Retention ◽

Acute Urinary Retention ◽

Treatment Approach ◽

Urethral Meatus ◽

Associated Anomalies ◽

Female Urethra ◽

Case Presentation ◽

Male And Female ◽

Urethral Stone

Abstract Background Urethral calculi are rare, representing 1–2% of all calculi affecting the urinary tract. Impacted urethra calculi are commoner in males due to anatomical differences between the male and female urethra. The treatment approach is determined by the size and location of the stone, associated anomalies and available facilities. Case presentation We present the case of 35-year-old woman who presented with acute urinary retention secondary to an impacted urethral stone. The calculus could not be removed through the external urethral meatus due to the size of the stone. She had cystolithotomy after retrograde manipulation to the bladder. She did well postoperatively. This line of management was based on the size of the stone, and the available facilities which are typical of many hospitals in developing countries. Conclusions Urethral calculi are extremely rare in women. The treatment should be individualized.

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Mastoid cholesterol granuloma: a case presentation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20163479 ◽

2016 ◽

Vol 2 (4) ◽

pp. 271

Author(s):

Roa Talal Halawani ◽

Talaat Yossef

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Magnetic Resonance ◽

Middle Ear ◽

Petrous Apex ◽

High Signal ◽

Cholesterol Granuloma ◽

Resonance Imaging ◽

Case Presentation ◽

Mastoid Bone

<p class="abstract"><span lang="EN-IN">Cholesterol granuloma (CG) may involve the petrous apex and rarely may involve the middle ear and the mastoid bone. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2- weighted images. This is a case report of mastoid cholesterol granuloma in association of cholesteotoma causing persistent ear discharge in a 12 years old boy.</span></p>

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Management of a catecholamine-secreting tympanicum glomus tumour: case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215108001801 ◽

2008 ◽

Vol 122 (12) ◽

pp. 1377-1380 ◽

Cited By ~ 6

Author(s):

H Kouzaki ◽

J Fukui ◽

T Shimizu

Keyword(s):

Case Report ◽

Osteolytic Lesion ◽

Hypertensive Crisis ◽

Potassium Titanyl Phosphate ◽

Glomus Tumour ◽

Vanillylmandelic Acid ◽

Tissue Mass ◽

Feeding Vessels ◽

Angiographic Examination ◽

Potassium Titanyl Phosphate Laser

AbstractObjective:To report the safe management and treatment of a catecholamine-secreting tympanicum glomus tumour.Case report:A 73-year-old women presented with a catecholamine-producing glomus tympanicum tumour, complaining of hearing impairment and left ear pain. Physical examination revealed a red, pulsating swelling in the left tympanic membrane. Computed tomography demonstrated a soft tissue mass filling the entire middle-ear cavity and a partial osteolytic lesion in the internal carotid artery. Angiographic examination revealed a densely contrasting tumour with feeding vessels from the ascending pharyngeal artery. Concentrations of serum noradrenalin and urine vanillylmandelic acid (VMA) were high. The tumour was completely resected using a potassium titanyl phosphate laser, the feeding vessels having been embolised the previous day. Concentrations of serum noradrenalin and urine VMA normalised following the operation.Conclusion:Pre-operative embolisation is useful in the treatment of catecholamine-secreting tympanicum glomus tumours, not only for preventing a hypertensive crisis but also for reducing bleeding. The potassium titanyl phosphate laser is useful for complete resection of the tumour.

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Optic nerve Hemangioblastoma with bilateral frontal lobe Oedema: a case report

BMC Ophthalmology ◽

10.1186/s12886-020-01706-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shujia Xu ◽

Qian Li ◽

Bingyang Bian ◽

Hongli Zhou ◽

Dan Li

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Case Report ◽

Optic Nerve ◽

Frontal Lobe ◽

Tumour Resection ◽

Resonance Imaging ◽

Case Presentation ◽

Von Hippel Lindau ◽

Benign Tumours

Abstract Background Hemangioblastomas are rare benign tumours that are most commonly detected in the subtentorium or spinal cord. Optic nerve hemangioblastoma is very rare and is most commonly associated with Von Hippel-Lindau (VHL) syndrome. Case presentation Here, we report a case of hemangioblastoma of the optic nerve with bilateral frontal lobe oedema without VHL syndrome, which has not yet been reported. A 51-year-old woman presented with progressive and painless deteriorating vision in the left eye. Magnetic resonance imaging showed a mass at the back of the left orbital optic nerve. Endoscopic-assisted intraorbital tumour resection was performed successfully. The pathological diagnosis was left optic nerve hemangioblastoma. Conclusions This is the first reported case of optic nerve hemangioblastoma (HBL) with bilateral frontal lobe oedema.

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