Spontaneous intracapsular hemorrhage of a giant hepatic cavernous hemangioma: a rare case report and literature review

Abstract Background Hepatic cavernous hemangioma is the most common type of benign liver tumor. Although ruptures and hemorrhages of hepatic hemangioma are rare complications, they are associated with high mortality. Most practitioners only pay more attention to abdominal hemorrhages caused by the rupture of hepatic hemangiomas. However, spontaneous intracapsular hemorrhages can often be neglected and poorly understood. Case presentation A 65-year-old man was referred to our institution with right upper quadrant pain, which had occurred suddenly and without a history of recent trauma. The blood test results were normal. Magnetic resonance imaging (MRI) of the abdomen showed a cystic mass in the right liver lobe. Considering the possibility of hepatic cystadenoma with hemorrhage, the patient underwent a right hepatic lobectomy. The pathological findings unexpectedly revealed intratumoral hemorrhage of hepatic hemangioma. The patient recovered well and was discharged eight days after surgery. Conclusions Intracapsular hemorrhage of hepatic cavernous hemangioma is challenging to diagnose and has a high potential risk of rupture. MRI is beneficial for diagnosing subacute internal hemorrhage cases, and it is recommended to undergo surgery for patients with a definitive diagnosis.

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Symptomatic giant cavernous hemangioma of the liver in a 42-year-old man

Pyramid Journal of Medicine ◽

10.4081/pjm.2019.18 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Abdu Hamisu Dambatta

Keyword(s):

Computed Tomography ◽

Cavernous Hemangioma ◽

Previous History ◽

Abdominal Ultrasound ◽

Mass Lesion ◽

Hepatic Hemangioma ◽

Case File ◽

History Of ◽

Upper Abdominal ◽

The Right

Most cases of liver hemangioma are asymptomatic and discovered incidentally on liver ultrasound or computed tomography scan. Giant cavernous hemangioma (GCH) are however clinically distinct from smaller asymptomatic ones and may be confused with primary or metastatic malignancy. Symptomatic GCH of the liver are rare. The aim of the study was to show the rare case of symptomatic giant cavernous hemangioma of the liver which may be confuse with primary or metastatic malignancy. The patient’s images (abdominal ultrasound and computed tomography scans) and case file were reviewed and summarized. The subject matter of giant cavernous hemangioma was reviewed in the literature. The index case was discussed and compared with literature. We report a 42-year-old man who presented with a 2-year history of right upper abdominal pain and 6-month history of chest pain. No history of jaundice, body swelling or previous history of blood transfusion. No history of smoking or alcohol consumption. The patient is a known diabetic. Abdominal ultrasound scan showed hepatomegaly with a huge well defined oval shaped mixed echogenic mass lesion with lobulated margins occupying 4th and 5th segments of liver, measuring 84.9×111 mm in size suggestive of adenoma. The remaining hepatic parenchyma was normal. No intrahepatic biliary dilatation was seen. Initial histological examination revealed adenoma. Repeat histology done later however revealed hepatitis. Abdominal CT scan was later carried out and showed hepatomegaly but with no discernible mass lesion on precontrast images. Contrast enhanced images however, showed a fairly rounded mass lesion with peripheral enhancement and delayed filling-in at the venous phase, seen in the superior aspect of the right lobe extending to the dome. The intrahepatic vasculature and biliary ducts are not dilated. A diagnosis of cavernous hemangioma was made based on criteria of delayed (centripetal) filling-in. The patient however was lost to follow up. Hepatic hemangioma can be giant and symptomatic and despite its rarity, may still be encountered in practice.

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Granulomatous orchitis: case report and review of the literature

Journal of International Medical Research ◽

10.1177/03000605211003773 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110037

Author(s):

Liu Liang ◽

Wang Jiajia ◽

Li Shoubin ◽

Qi Yufeng ◽

Wang Gang ◽

...

Keyword(s):

Color Doppler ◽

Radical Resection ◽

Blood Flow Imaging ◽

Low Intensity ◽

Disease Characteristics ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Combined Spinal Epidural Anesthesia ◽

Spinal Epidural

We report the disease characteristics, diagnosis, and treatment of granulomatous orchitis. A 38-year-old man presented with a history of intermittent swelling, pain, and discomfort in the right testicle of 3 days’ duration. Unenhanced magnetic resonance imaging (MRI) of the testis and scrotum revealed an oval mass in the right testis measuring approximately 17 mm in diameter, with clear borders and a target ring-like appearance from periphery to center. T1-weighted imaging (T1WI) showed uniform low-intensity signals, and T2WI showed mixed high- and low-intensity signals. Diffusion-weighted imaging (DWI) signals were iso-intense, and the outer ring on enhanced scans showed progressive enhancement. We performed radical resection of the right testis under combined spinal–epidural anesthesia. The pathological diagnosis was granulomatous right orchitis. Two months postoperatively, ultrasonography showed no testis and epididymal echo signals in the right scrotum, and no obvious abnormalities; color Doppler blood flow imaging (CDFI) findings were normal. Granulomatous orchitis is rare in clinical practice, and the cause is unknown. The disease involves non-specific inflammation; however, it is currently believed that antibiotics and steroids are ineffective for conservative treatment, and orchiectomy should be actively performed.

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Comorbid Depressive Disorders in Epilepsy

CNS Spectrums ◽

10.1017/s1092852900004223 ◽

2010 ◽

Vol 15 (S4) ◽

pp. 3-6 ◽

Cited By ~ 3

Author(s):

Andres M. Kanner ◽

Andrew J. Cole

Keyword(s):

Emergency Room ◽

Depressive Disorders ◽

Clonic Seizure ◽

Resonance Imaging ◽

Abnormal Signal ◽

The Past ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

History Of Depression

A 27-year-old woman presented to the emergency room after having witnessed generalized tonic clonic seizure while asleep. Birth and development were normal. She had suffered a single febrile seizure at 13 months of age, but had no other seizure risk factors. She was otherwise well except for a history of depression for which she was taking sertraline. Depressive symptoms had been well controlled over the past 3 months, but she had been under increased stress working to finish a doctoral thesis. Neurological examination was normal. Magnetic resonance imaging (MRI) showed modest asymmetry of the hippocampi, slightly smaller on the right, but no abnormal signal and well-preserved laminar anatomy. An electroencephalogram was negative. She was discharged from the emergency room with no treatment. Three weeks later, the patient's boyfriend witnessed an episode of behavioral arrest with lip smacking and swallowing automatisms lasting 45 seconds, after which the patient was confused for 20–30 minutes. The next morning she and her boyfriend kept a previously scheduled appointment with a neurologist.

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A rare case of cavernous hemangioma accompanied with diffuse hepatic hemangiomatosis

Surgical Case Reports ◽

10.1186/s40792-020-01023-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Takuji Ota ◽

Toshiya Kamiyama ◽

Takuya Kato ◽

Takayuki Hanamoto ◽

Kunihiro Hirose ◽

...

Keyword(s):

Oral Contraceptives ◽

Cavernous Hemangioma ◽

Contraceptive Use ◽

Careful Examination ◽

Pathological Examination ◽

Surgical Removal ◽

Adjacent Area ◽

Oral Contraceptive Use ◽

History Of ◽

Magnetic Resonance Imaging Mri

Abstract Background Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown. Case presentation A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully. Conclusion We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

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Congenital Facial Palsy- A Rare Case Report

10.37191/mapsci-joo-1-008 ◽

2021 ◽

Author(s):

Meenakshi Wadhwani

Keyword(s):

Facial Palsy ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Rare Entity ◽

Provisional Diagnosis ◽

Live Births ◽

Rare Case Report ◽

History Of ◽

The Right

Congenital facial palsy is a very rare entity with an incidence of 2 per 1000 live births. It can be congenital, traumatic associated with birth trauma in the form of forceps delivery or developmental. We present the case of a 1-year-old girl who presented to the eye department of our tertiary care hospital with a deviation of face to the right side since birth along with watering of left eye and difficulty in taking feeds. There was a history of forceps-assisted vaginal delivery; a provisional diagnosis of congenital facial palsy was done with the probable cause of trauma.

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Intracranial subdural osteoma

European Journal of Inflammation ◽

10.1177/2058739220926854 ◽

2020 ◽

Vol 18 ◽

pp. 205873922092685

Author(s):

Yunna Yang ◽

Zheng Gu ◽

Yinglun Song

Keyword(s):

Dura Mater ◽

Histopathological Examination ◽

Surgical Excision ◽

Benign Neoplasms ◽

Resonance Imaging ◽

Inner Surface ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

T1 Hyperintensity ◽

The Right

Subdural osteomas are extremely rare benign neoplasms. Here, we report the case of a 35-year-old female patient with a right frontal and parietal subdural osteoma. The patient presented with a 2-year history of intermittent headache and fatigue. Computerized tomography (CT) scan showed a high-density lesion attached to the inner surface of the right frontal and parietal skull. Magnetic resonance imaging (MRI) demonstrated T1 hyperintensity and T2 hypointensity of the lesion. Intraoperatively, the hard mass was located in subdural space and attached to the dura mater. Histopathological examination revealed lamellated bony trabeculae lined by osteoblasts and the intertrabecular marrow spaces occupied by adipose tissue. The patient underwent neurosurgical resection and recovered without complication. Surgical excision is recommended to extract the symptomatic lesions with overlying dura mater.

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Long term follow-up in a patient with papillary glioneuronal tumor

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000500024 ◽

2004 ◽

Vol 62 (3b) ◽

pp. 869-872 ◽

Cited By ~ 24

Author(s):

Guilherme Borges ◽

Leonardo Bonilha ◽

Ana Silvia Menezes ◽

Luciano de Souza Queiroz ◽

Edmur Franco Carelli ◽

...

Keyword(s):

Brain Tumor ◽

Young Female ◽

Cystic Mass ◽

Glioneuronal Tumor ◽

Surgical Specimen ◽

Papillary Glioneuronal Tumor ◽

Parietal Lobes ◽

Long Term Follow Up ◽

History Of ◽

The Right

We report a case of a young female patient with a rare and recently described form of brain tumor. This patient had a history of headache, hemiparesis and motor simple partial seizures. Her investigation revealed a brain tumor involving the left frontal and parietal lobes. The radiological images showed a cystic mass with multiple nodular masses and a rim of contrast enhancement extending from the right parietal cortex to the ipsilateral ventricle and corpus callosum. The patient underwent gross resection of the lesion and the histological analysis of the surgical specimen revealed a pseudopapillary structure formed by delicate vessels intermixed with a fibrillary pattern and bordered by intense astrocytic reaction with Rosenthal fibers. These features correspond to the recently described mixed neuronal-glial neoplasm, the papillary glioneuronal tumor. The patient has been followed for five years since the surgical treatment, without evidence of tumor recurrence, confirming the indolent behavior of this type of tumor.

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Metronidazole-Induced Encephalopathy: Case Report and Review of MRI Findings

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011951 ◽

2011 ◽

Vol 38 (3) ◽

pp. 512-513 ◽

Cited By ~ 5

Author(s):

Jamsheed A. Desai ◽

Jessica Dobson ◽

Michel Melanson ◽

Giovanna Pari ◽

Albert Yongwon Jin

Keyword(s):

Imaging Finding ◽

Sensory Loss ◽

Mri Findings ◽

Axonal Polyneuropathy ◽

Large Fibre ◽

History Of ◽

Impaired Balance ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Vibration Threshold

A 74-year-old man presented with a four week history of behavioural disturbances, upper and lower extremity numbness and impaired balance. He had been treated with metronidazole for six months for osteomyelitis of the right hallux. Examination revealed encephalopathy, and glove-and-stocking sensory loss to pinprick with reduced vibration threshold at the toe. The gait was wide based and ataxic. Nerve conduction studies showed a large fibre sensory-motor axonal polyneuropathy. Magnetic resonance imaging (MRI) revealed a solitary restricted diffusion lesion in the splenium of the corpus callosum (Figure A, B) with subtle prolongation of T2 (Figure C). The radiographic differential diagnosis included hypoglycaemia, viral encephalitis, antiepileptic drug toxicity/withdrawal and metronidazole toxicity. The combination of the imaging finding with the history of prolonged metronidazole use suggested metronidazole induced encephalopathy.

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Ectopic intraconal orbital meningioma – A rare case report

Surgical Neurology International ◽

10.25259/sni_84_2021 ◽

2021 ◽

Vol 12 ◽

pp. 305

Author(s):

Anil Kumar Sharma ◽

Charandeep Singh Gandhoke ◽

Somen Misra ◽

Ashik Ravi ◽

Rakesh Kumar Gupta ◽

...

Keyword(s):

Optic Nerve ◽

Visual Outcome ◽

Surgical Excision ◽

Histopathological Diagnosis ◽

Who Grade ◽

Rare Case Report ◽

History Of ◽

The Right ◽

Orbital Meningioma

Background: Ectopic orbital meningiomas (OM) are a rare subset of OMs which are neither attached to the optic nerve sheath nor to the surrounding bone. Case Description: We report the case of a 65-year-old female who presented with a 1 year history of proptosis followed by visual loss and restricted right eye movements since 3 months. Radiology of the orbits was suggestive of intraorbital, intraconal, and heterogeneous contrast enhancing right eye lesion which was completely excised through supraorbital orbitotomy approach. Intraoperatively, the right optic nerve, though compressed, and displaced inferiorly, was free from the lesion. The final histopathological diagnosis was “Meningioma WHO Grade I.” At 3 months follow-up, patient’s vision in the right eye improved from perception of light positive to 6/12 and there was no evidence of recurrence. Conclusion: Rarity of ectopic OM, total surgical excision with an excellent postoperative visual outcome prompted us to report this case.

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Synchronization of Synovial Chondromatosis and Mycobacterium intracellurae Infection in Olecranon Bursitis: A Case Report

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.1.46 ◽

2019 ◽

Vol 22 (1) ◽

pp. 46-49

Author(s):

Dong Hyun Kim ◽

Seunggi Min ◽

Hyun Joo Lee ◽

Hee-June Kim ◽

Hoseok Lee ◽

...

Keyword(s):

Past History ◽

Mycobacterial Infection ◽

Synovial Chondromatosis ◽

Cystic Mass ◽

Resonance Imaging ◽

Olecranon Bursitis ◽

Rice Bodies ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Mri Characteristics

A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.

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