Incidental neuroendocrine tumor of a complete subserosal appendix: an unusual presentation of a rare anatomical variation. A case report and review of literature

Abstract Background Appendix’ anatomical variations are a rare occurrence which can mislead diagnosis and delay appropriate treatment. Case presentation We present a 9-year-old female patient that came with a clinical picture compatible with acute appendicitis. However, a cecal mass was identified instead of an inflamed appendix during surgery. Therapeutic decisions were extremely challenging due to clinical deterioration and an uncertain etiology. Only the histopathology report revealed the presence of a complete subserosal appendix which was responsible for the entire symptomatology. Here, we review all case reports regarding intramural, intracecal or subserosal appendixes. A discussion of the general approach to this specific case and the importance of consensual diagnostic criteria for these specimens are also presented. At last, an incidental finding is exposed and final treatment options are discussed given the overall presentation. Conclusions Considering these variants would guide physicians towards a more accurate approach to similar clinical pictures and hence an improved long-term prognosis.

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Clinical features and endodontic treatment of two-rooted mandibular canines: Report of four cases

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1410592s ◽

2014 ◽

Vol 142 (9-10) ◽

pp. 592-596 ◽

Cited By ~ 2

Author(s):

Igor Stojanac ◽

Milica Premovic ◽

Milan Drobac ◽

Bojana Ramic ◽

Ljubomir Petrovic

Keyword(s):

Root Canal ◽

Case Reports ◽

Anatomical Variation ◽

Anatomical Variations ◽

Endodontic Treatment ◽

Careful Examination ◽

Root Canals ◽

Working Length ◽

Canal Systems ◽

Root Canal Morphology

Introduction. Predictable endodontic treatment depends on the dentist?s knowledge about root canal morphology and its possible anatomic variations. The majority of mandibular canines have one root and root canal, but 15% may have two canals and a smaller number may have two distinct roots. The following clinical reports describe endodontic treatment of mandibular canines with two roots and two root canals. Outline of Cases. Four clinical case reports are presented to exemplify anatomical variation in the human mandibular canine. Detailed analysis of the preoperative radiographs and careful examination of the pulp chamber floor detected the presence of two root canal orifices in all canines. Working length was determined with an electronic apex locator and biomechanical preparation was carried out by using engine driven BioRaCe Ni-Ti rotary instruments in a crown-down manner, followed by copious irrigation with 1% sodium hypochlorite. Definitive obturation was performed using cold lateral condensation with gutta-percha cones and Top Seal paste. The treatment outcome was evaluated using postoperative radiographs. Conclusion. Endodontists should be aware of anatomical variations of the treated teeth, and should never presume that canal systems are simple.

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Anatomical Variation of the Psoas Valley: A Scoping Review

10.21203/rs.3.rs-16684/v2 ◽

2020 ◽

Author(s):

Yuichi Kuroda ◽

Ankit Rai ◽

Masayoshi Saito ◽

Vikas Khanduja

Keyword(s):

Scoping Review ◽

Case Reports ◽

Anatomical Variation ◽

Case Series ◽

Anatomical Variations ◽

Anterior Wall ◽

Computer Search ◽

Retrospective Case ◽

Cross Sectional ◽

Acetabular Rim

Abstract Background: This scoping review aimed to investigate the literature on the anatomy of the psoas valley, an anterior depression on the acetabular rim, and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications. Methods: A systematic computer search of EMBASE, PubMed and Cochrane for literature related to the psoas valley was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series, case reports and review articles that described the psoas valley and its synonyms were included. Studies on animals as well as book chapters were excluded. Results: Of the 313 articles, the filtered literature search identified 14 papers describing the psoas valley and its synonyms such as iliopsoas notch, a notch between anterior inferior iliac spine and the iliopubic eminence, Psoas-U and anterior wall depression. Most of these were cross-sectional studies that mainly analyzed normal skeletal hips. In terms of anatomical variation, 4 different configurations of the anterior acetabular rim have been identified and it was found that the curved type was the most frequent while the straight type may be nonexistent. Additionally, the psoas valley tended to be deeper in males as compared with females. Several papers established the psoas valley, or Psoas-U in a consistent location at approximately 3 o'clock on the acetabular rim which may have implications with labral pathology. Conclusion: This review highlights the importance of the anatomy of the psoas valley which is a consistent bony landmark. The anatomy and the anatomical variations of the psoas valley need to be well-appreciated by surgeons involved in the management of young adults with hip pathology and also joint replacement surgeons to ensure appropriate seating of the acetabular component.

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Garengeot’s hernia: two case reports with CT diagnosis and literature review

Open Medicine ◽

10.1515/med-2016-0065 ◽

2016 ◽

Vol 11 (1) ◽

pp. 354-360 ◽

Cited By ~ 9

Author(s):

Cristina Garcia-Amador ◽

Roberto De la Plaza ◽

Vladimir Arteaga ◽

Aylhin Lopez-Marcano ◽

Jose Ramia

Keyword(s):

Incidental Finding ◽

Case Reports ◽

Treatment Options ◽

Diagnostic Methods ◽

Open Approach ◽

Contrast Enhanced ◽

Choice Of Treatment ◽

Preoperative Ct ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

AbstractGarengeot’s hernia (GH) is defined as the presence of the appendix inside a femoral hernia. It occurs in 0.9% of femoral hernias and is usually an incidental finding during surgery. Its treatment is controversial and the aim of this article is to review the diagnostic methods and surgical considerations.We report two cases diagnosed preoperatively by contrast-enhanced computed tomography (CT) and discuss the treatment options based on a review of the literature published in PubMed updated on 1 December, 2015.Fifty articles reporting 64 patients (50 women, mean age 70 years) with GH were included in the analysis. Diagnosis was performed by preoperative CT in only 24 cases, including our two. The treatment of GH is emergency surgery. Several options are available laparoscopic or open approach: insertion of a mesh or simple herniorrhaphy, with or without appendectomy.ConslusionThe preoperative diagnosis with CT can guide the choice of treatment. Appendectomy and hernioplasty should be performed via inguinotomy, if there is no perforation or abscess formation.

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Jones Fractures in Sumo Wrestlers: Three Case Reports

Case Reports in Orthopedics ◽

10.1155/2019/9051327 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Takashi Hoshino ◽

Tomohiko Tateishi ◽

Tsuyoshi Nagase ◽

Arata Yuki ◽

Teruhiko Nakagawa ◽

...

Keyword(s):

Risk Factors ◽

Case Reports ◽

Treatment Options ◽

Treatment Compliance ◽

Treatment Method ◽

Delayed Union ◽

Duration Of Treatment ◽

Operative Case ◽

Appropriate Treatment ◽

And Training

Jones fractures sometimes occur in athletes and are known to have complications, such as nonunion, delayed union, and recurrence, even with treatment. We describe three cases of Jones fractures in sumo wrestlers with treatment-related difficulties. All patients discontinued treatment at their own discretion. The two conservative cases had nonunion or delayed union, and the operative case had a broken screw. However, all patients continued sumo wrestling, with little impact on their careers. The risk factors of Jones fractures in sumo wrestling may be heavy weight, and training or competition characteristics unique to sumo wrestling. In cases of a complete Jones fracture, operative treatment is most commonly selected, as the risk for nonunion or refractures is less than that for conservative treatment. However, in the case of sumo wrestlers, there are risks of infection and problems with treatment compliance. As taking a rest may result in a lowered rank, completing a sufficient duration of treatment is difficult. Treatment is difficult and controversial in sumo wrestlers; all three patients discontinued treatment of their own accord. These cases suggest that it is important to thoroughly inform sumo wrestlers of the treatment options, and to decide the most appropriate treatment method for each patient.

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Retropharyngeal Calcific Tendonitis Mimics a Retropharyngeal Abscess

Case Reports in Otolaryngology ◽

10.1155/2013/818561 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Natasha Pollak ◽

Sonya Wexler

Keyword(s):

Case Reports ◽

Treatment Options ◽

Fluid Collection ◽

Treatment Strategies ◽

Retropharyngeal Abscess ◽

Retropharyngeal Space ◽

Appropriate Treatment ◽

Calcific Tendonitis ◽

Limiting Condition ◽

Operative Drainage

Retropharyngeal calcific tendonitis (RCT) is an uncommon, self-limiting condition that is often omitted in the differential diagnosis of a retropharyngeal fluid collection. This condition mimics a retropharyngeal abscess and should be considered when evaluating a fluid collection in the retropharyngeal space. Although calcific tendonitis at other sites has been well described in the medical literature, it appears that this entity has been underreported in the otolaryngology literature where only a few case reports have been identified. Presumably, the actual incidence is higher than the reported incidence, due to lack of familiarity with this disorder. As an otolaryngologist’s scope of practice includes the managements of retropharyngeal lesions, it is important for the otolaryngologist to recognize the presentation of acute RCT and be familiar with appropriate treatment strategies. Retropharyngeal calcific tendonitis presents with neck pain, limitation of neck range of motion and includes inflammation, calcifications, and a sterile effusion within the longus colli muscle. Treatment is medical with nonsteroidal anti-inflammatory medications. RCT does not require surgical treatment, and an accurate diagnosis can prevent unnecessary attempts at operative drainage. In this study, we discuss two cases of RCT, summarize the salient features in diagnosis, including key radiologic features, discuss treatment options, and review the literature.

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Toxic Bradycardias in the Critically Ill Poisoned Patient

Emergency Medicine International ◽

10.1155/2012/852051 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Melissa L. Givens

Keyword(s):

Critically Ill ◽

Case Reports ◽

Treatment Options ◽

Cardiovascular Drugs ◽

Poison Control ◽

Poison Control Center ◽

Common Cause ◽

Control Center ◽

Therapeutic Decisions ◽

Extracorporeal Therapy

Cardiovascular drugs are a common cause of poisoning, and toxic bradycardias can be refractory to standard ACLS protocols. It is important to consider appropriate antidotes and adjunctive therapies in the care of the poisoned patient in order to maximize outcomes. While rigorous studies are lacking in regards to treatment of toxic bradycardias, there are small studies and case reports to help guide clinicians’ choices in caring for the poisoned patient. Antidotes, pressor support, and extracorporeal therapy are some of the treatment options for the care of these patients. It is important to make informed therapeutic decisions with an understanding of the available evidence, and consultation with a toxicologist and/or regional Poison Control Center should be considered early in the course of treatment.

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Anatomical Variation of the Psoas Valley: A Scoping Review

10.21203/rs.3.rs-16684/v1 ◽

2020 ◽

Author(s):

Yuichi Kuroda ◽

Ankit Rai ◽

Masayoshi Saito ◽

Vikas Khanduja

Keyword(s):

Scoping Review ◽

Case Reports ◽

Anatomical Variation ◽

Case Series ◽

Anatomical Variations ◽

Anterior Wall ◽

Computer Search ◽

Retrospective Case ◽

Cross Sectional ◽

Acetabular Rim

Abstract Background: The aim of this scoping review was to investigate the literature on the anatomy of the psoas valley, an anterior depression on the acetabular rim, and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications. Methods: A systematic computer search of EMBASE, PubMed and Cochrane for literature related to the psoas valley was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series, case reports and review articles that described the psoas valley and its synonyms were included. Studies on animals as well as book chapters were excluded. Results: Of the 313 articles, the filtered literature search identified 14 papers describing the psoas valley and its synonyms such as iliopsoas notch, notch between anterior inferior iliac spine and the iliopubic eminence, Psoas-U and anterior wall depression. Most of these were cross-sectional studies that mainly analysed normal skeletal hips. In terms of anatomical variation, 4 different configurations of the anterior acetabular rim have been identified and it was found that the curved type was the most frequent while the straight type may be nonexistent. Additionally, the psoas valley tended to be deeper in males as compared with females. Several papers established the psoas valley, or Psoas-U in a consistent location at approximately the 3 o'clock on the acetabular rim which may have implications with labral pathology. Conclusion: This review highlights the importance of the anatomy of the psoas valley which is a consistent bony landmark. The anatomy and the anatomical variations of the psoas valley need to be well-appreciated by surgeons involved in the management of young adults with hip pathology and also joint replacement surgeons to ensure appropriate seating of the acetabular component.

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AGENESIS OF THE POSTERIOR ARCH OF THE ATLAS: AN INCIDENTAL FINDING IN A POLYTRAUMATIZED PATIENT

Coluna/Columna ◽

10.1590/s1808-185120191801187278 ◽

2019 ◽

Vol 18 (1) ◽

pp. 81-83

Author(s):

Rodrigo Mota Pacheco Fernandes ◽

Lucas Alves Sarmento Pires ◽

Jorge Henrique Martins Manaia ◽

Rafael Cisne de Paula ◽

Marcio Antonio Babinski

Keyword(s):

Motor Vehicle ◽

Incidental Finding ◽

Anatomical Variation ◽

Cervical Vertebra ◽

Anatomical Variations ◽

Posterior Arch ◽

Level Of Evidence ◽

Emergency Team ◽

Male Victim ◽

Vehicle Collision

ABSTRACT The first cervical vertebra is subject to numerous anatomical variations. One of these is posterior arch agenesis, which is classified into five distinct morphological types. Together, all types of posterior arch agenesis comprise only 4% of atlas variations. Furthermore, complete agenesis of the posterior arch associated with the presence of the posterior tubercle is rare. This work reports a case of posterior arch agenesis with the presence of the posterior tubercle in a 33 year-old male victim of a motor vehicle collision. Despite being asymptomatic, this anatomical variation can present with headaches and neck pain. It is mostly found as an incidental finding in imaging studies performed by the emergency team and, as a result, it is often misdiagnosed as a C1 fracture. Knowledge of the variations relating to the first cervical vertebra is therefore essential to avoid delays in diagnosis and treatment of polytraumatized patients. Level of evidence V; Case report.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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Candida albicans endocarditis involving a normal native aortic valve in an immunocompetent patient

BMJ Case Reports ◽

10.1136/bcr-2020-236902 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236902

Author(s):

Taha Sheikh ◽

Jeremy C Tomcho ◽

Mohammed T Awad ◽

Syeda Ramsha Zaidi

Keyword(s):

Candida Albicans ◽

Mortality Rate ◽

Aortic Valve ◽

High Mortality ◽

Treatment Options ◽

Immunocompetent Patient ◽

Fungal Endocarditis ◽

Appropriate Treatment ◽

Mechanical Valves ◽

Serious Infection

Fungal endocarditis, specifically from Candida species, is a rare but serious infection with a high mortality rate. Most cases occur in bioprosthetic or mechanical valves and are uncommon in native, structurally normal valves. When Candida endocarditis is detected and appropriate treatment is initiated earlier, there is an improvement in mortality. While the recommendation is usually to treat with a combination of surgery and antifungal medications, patient comorbidities may limit treatment options.

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