scholarly journals A common symptom with an uncommon diagnosis

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Prabu Velayutham ◽  
Prem Davis ◽  
Nishanth Savery ◽  
Ramprasath Vaigundavasan
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Rare Disease ◽  
Histopathological Examination ◽  
Common Symptom ◽  
Computerised Tomography ◽  
Case Presentation ◽  
Contrast Enhanced ◽  
Life Threatening ◽  
The Right ◽  
Undifferentiated Nasopharyngeal Carcinoma

Abstract Background Nasopharyngeal carcinoma is one of the uncommon tumours and the most difficult tumour to diagnose at an earlier stage due to the clandestine and deceptive nature. The incidence is more common in men with a peak incidence of 50 to 60 years. The suspicion of tumour at the earliest stage is very helpful in reducing morbidity and mortality. Case presentation A 45-year-old female presented with right hemi cranial headache for 2years without any comorbidities for that she consulted many hospitals and got symptomatic and empherical treatment in which her symptoms resolved temporarily and recurred. We did diagnostic nasal endoscopy and found a smooth globular mass in the right nasopharynx with contrast enhanced computerised tomography mass extending into the muscle plane which was found with the confirmation of diagnosis as undifferentiated nasopharyngeal carcinoma by histopathological examination and treated accordingly. Conclusion Although the diagnosis of the nasopharyngeal carcinoma in the earlier stage is difficult, it is an imperative one because the prognosis depends upon the stage of the disease in which it has been diagnosed. The clinicians always should have a suspicion of the rare disease for a day-to-day unresolved symptom, because the earlier diagnosis and appropriate management helps in the prevention of the life-threatening complications of any disease.

scholarly journals Uncommon manifestations of a rare disease: a case of autoimmune GFAP astrocytopathy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Di ◽  
Yue Yin ◽  
Ruxuan Chen ◽  
Yun Zhang ◽  
Jun Ni ◽  
...  
Keyword(s):  
Rare Disease ◽  
Hormone Secretion ◽  
White Matter Lesions ◽  
Signs And Symptoms ◽  
Careful Examination ◽  
Case Presentation ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Contrast Enhanced ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Abstract Background Manifestations of intractable hyponatremia and hypokalemia in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy have been rarely reported. Case presentation A 75-year-old male patient presented as the case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and intractable hypokalemia, showed fever, fatigue, and mental disorders. Signs and symptoms of meningoencephalitis, ataxia, and cognitive abnormalities. Magnetic resonance imaging (MRI) revealed multiple white matter lesions of the central nervous system. He had GFAP-IgG in the cerebrospinal fluid (CSF). After treatment with corticosteroids, his symptoms were alleviated gradually, and the level of electrolytes was normal. However, head contrast-enhanced MRI + susceptibility-weighted imaging (SWI) showed a wide afflicted region, and the serum GFAP-IgG turned positive. Considering the relapse of the disease, ha was treated with immunoglobulin and mycophenolate mofetil (MMF) to stabilize his condition. Conclusion This case showed a rare disease with uncommon manifestations, suggesting that careful examination and timely diagnosis are essential for disease management and satisfactory prognosis.

scholarly journals Melanosis coli in a peritoneal dialysis patient: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nor Fadhlina Zakaria ◽  
Nurul Izah Ahmad ◽  
Elmina Mokhtar ◽  
Wan Zul Haikal Hafiz Wan Zukiman ◽  
Anim Md Shah
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Diarrhea ◽  
Histopathological Examination ◽  
Hypovolemic Shock ◽  
Peritoneal Dialysis Patient ◽  
Electrolyte Imbalance ◽  
Case Presentation ◽  
Melanosis Coli ◽  
Life Threatening ◽  
Black Discoloration

Abstract Background Patients who undergo peritoneal dialysis (PD) are at risk of gut bacteria translocation leading to peritonitis when there is chronic diarrhea. Chronic diarrhea is defined as any course of diarrhea that lasts at least 4 weeks, which can be continuous or intermittent. Chronic diarrhea of any duration may cause dehydration, electrolyte imbalance, and life-threatening hypovolemic shock. In PD patients, excessive ultrafiltration from the exchanges, combined with severe gastrointestinal loss, may cause hypovolemic shock, electrolyte imbalance, and metabolic acidosis. There are multiple causes of chronic diarrhea in PD patients including infective causes, mitotic lesions, and rarely the regular and excessive use of laxatives, which is a diagnosis of exclusion. Case presentation We report a case of Melanau lady with chronic diarrhea secondary to laxative usage in a patient being treated with automated peritoneal dialysis (APD). The patient went into hypovolemic shock, but luckily did not contract peritonitis. A colonoscopy revealed brown to black discoloration of the colon, a feature suggestive of melanosis coli. A biopsy of the intestine further confirmed the diagnosis by histopathological examination. Withdrawal of laxatives and the introduction of probiotics improved the symptoms tremendously. Conclusions The chronic use of laxatives in PD patients can potentially lead to a devastating problem; thus, the management team must monitor treatment commencement appropriately.

scholarly journals Acute Abdomen due to Mutual Tangle of Two Small Paratubal Cysts

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Hiroharu Kobayashi ◽  
Shinichi Shibuya ◽  
Kentaro Iga ◽  
Keiichiro Kato ◽  
Airi Kato ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Histopathological Examination ◽  
Lower Abdominal Pain ◽  
Cystic Teratoma ◽  
Cystic Mass ◽  
Mature Cystic Teratoma ◽  
Contrast Enhanced ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Paratubal Cyst

A 30-year-old woman (gravida 0) visited our hospital with a complaint of right lower abdominal pain. Transvaginal ultrasonography revealed a 5-cm swollen right ovary, which was suspected to be a mature cystic teratoma. Pelvic examination revealed moderate pain. Contrast-enhanced computed tomography showed a 44-mm cystic mass containing fat and calcified material in the right pelvis. Since torsion was suspected, emergent laparoscopic surgery was performed. Intraoperative findings were a swollen right ovary without torsion or congestion. Two small pedunculated 1- and 2-cm diameter paratubal cysts that grew from almost the same place of the ampulla of the right fallopian tube were observed. The thin stalk of the 1-cm paratubal cyst was entangled around the stalk of the 2-cm paratubal cyst, with its head congested. Through a small abdominal laparoscopic incision, the tumor of the right ovary and the two paratubal cysts were excised. Histopathological examination revealed that the right ovarian tumor was a mature cystic teratoma, and the two paratubal cysts had no malignancy. This case showed that only a 2-cm tumor with congestion caused the acute abdomen.

Direct traumatic optic neuropathy in a temporal laceration: A case report

Trauma ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 66-68
Author(s):  
Simon WJ Grant ◽  
Moorthy Halsnad ◽  
Steve Colley ◽  
Ian Sharp
Keyword(s):  
Optic Neuropathy ◽  
Penetrating Trauma ◽  
Temporal Region ◽  
Computerised Tomography ◽  
Traumatic Optic Neuropathy ◽  
Maxillofacial Region ◽  
Case Presentation ◽  
Orbital Wall ◽  
The Right ◽  
Tomography Scan

Facial lacerations are a common presentation in emergency departments. It is important to appreciate the mechanism of injury and the anatomy of structures involved in penetrating lacerations in the maxillofacial region. A 65-year-old man suffered an accidental penetrating injury with a sharp kitchen knife to the right temporal region. There was a single laceration to the right temporal region. The right eye had no perception to light, a total afferent and efferent pupillary defect and partial ophthalmoplegia. Computerised tomography scan revealed signs of penetration through the skin, temporalis, postero-lateral orbital wall and orbital apex. There was no injury to the globe or either retrobulbar or intracranial haemorrhage. A diagnosis of direct traumatic optic neuropathy was made following consultation with opthalmology and neurosurgery teams. Only two similar cases of penetrating trauma in the temporal region resulting in direct traumatic optic neuropathy have been identified in the literature. This case presentation highlights the structures that are at risk of damage from penetrating trauma in the maxillofacial region.

scholarly journals Primary leiomyoma of the ureter: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Shingo Morinaga ◽  
Shigeyuki Aoki ◽  
Motoi Tobiume ◽  
Genya Nishikawa ◽  
Hiroyuki Muramatsu ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Histopathological Examination ◽  
Urine Cytology ◽  
Benign Tumors ◽  
Case Presentation ◽  
Old Japanese ◽  
Retrograde Pyelogram ◽  
History Of ◽  
The Right ◽  
Enhanced Computed Tomography

Abstract Background Only 14 cases of leiomyoma with ureteral origin have been reported previously. Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult. Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor. We report the 15th case of primary leiomyoma with a ureteral origin. Case presentation A 51-year-old Japanese man presented with a chief complaint of asymptomatic gross hematuria with a history of hypertension. Enhanced computed tomography showed a tumor at the upper part of the right ureter that appeared to be the cause of hydronephrosis and contracted kidney; no retroperitoneal lymphadenopathy and distal metastasis were observed. A well-defined 20-mm (diameter) defect was identified at the upper of the right ureter on retrograde pyelogram with no bladder cancer on cystoscopy. Urine cytology and right divided renal urine cytology findings were negative. Laparoscopic nephroureterectomy was performed, and the extracted tumor measured 20 × 13 mm. Histopathological examination revealed primary leiomyoma with no recurrence 16 months after the operation. Conclusions Preoperative examination with the latest available ureteroscopic technology can help preserve renal function in the case of benign tumors by enabling preoperative ureteroscopic biopsy or intraoperative rapid resection. Moreover, nephroureterectomy is recommended in the case of preoperative suspicion of ureteral malignant tumors.

scholarly journals Life-threatening, delayed epistaxis after Le Fort I osteotomy: a case report

2021 ◽  
Author(s):  
Amir Eleuch ◽  
Maha Ben Rejeb ◽  
Anis Ayadi ◽  
Samia Ayachi ◽  
Ramzi Moatemri ◽  
...  
Keyword(s):  
Case Report ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Le Fort I Osteotomy ◽  
Case Presentation ◽  
Le Fort ◽  
Operative Complication ◽  
Life Threatening ◽  
The Right ◽  
Le Fort I

Abstract Introduction: When performing a Le Fort 1 osteotomy, there is always a risk of injuring the internal maxillary artery or one of its branches. This diagnosis should be considered when confronted to recurrent or massive epistaxis following surgery.Case presentation: The authors present a case of a life-threatening, delayed and massive epistaxis caused by a ruptured pseudoaneuvrysm of the right sphenopalatine artery as a post-operative complication of a Le Fort I osteotomy successfully managed by anterior and posterior nasal packing.Conclusion: Despite its simplicity and attested reliability, Le Fort I osteotomy is not completely free of complications.

scholarly journals Ultrasound Detection of the Aquarium Sign at the Bedside

2020 ◽  
Author(s):  
Mihiro Kaga ◽  
Emi Yamashita ◽  
Takeshi Ueda
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Test Results ◽  
Mesenteric Ischaemia ◽  
Contrast Enhanced ◽  
Life Threatening ◽  
Hepatic Portal ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
The Relationship

Objectives: The aquarium sign is the name given to a large quantity of bubble-like echoes that suggests the presence of hepatic portal venous gas (HPVG). Few studies in the literature have addressed the relationship between the aquarium sign and HPVG. In some cases, HPVG can only be detected using ultrasonography. HPVG can be observed in a variety of conditions, including those that require emergency surgery, such as acute mesenteric ischaemia (AMI). Therefore, it is important to identify the presence of HPVG as soon as possible.  Materials and methods: We report a case of the aquarium sign, where bubble-like echoes flowed from the right atrium towards the right ventricle, which was identified using bedside cardiac ultrasonography as part of a point-of-care ultrasound test. Results: This aquarium sign finding led to the diagnosis of AMI, which was confirmed using contrast-enhanced computed tomography (CT).  Conclusion: The aquarium sign is a useful finding suggestive of HPVG and mesenteric ischaemia, which can be rapidly and easily observed using bedside cardiac ultrasonography. However, there are very few reports on the aquarium sign. The inability of other more cumbersome diagnostic imaging modalities, such as CT and magnetic resonance imaging, to detect HPVG emphasizes the utility and convenience of detecting the aquarium sign using bedside ultrasonography. This technique can lead to early detection of life-threatening diseases as well as improve the prognosis for patients. The diagnostic implications of the aquarium sign for HPVG are still unclear and require further research.

scholarly journals Concomitant bilateral mandibular cemento-ossifying fibroma and cementoblastoma: case report of an extremely rare occurrence

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Madiha Bilal Qureshi ◽  
Muhammad Usman Tariq ◽  
Jamshid Abdul-Ghafar ◽  
Muhammad Raza ◽  
Nasir Ud Din
Keyword(s):  
Unusual Case ◽  
Histopathological Examination ◽  
Single Case ◽  
Ossifying Fibroma ◽  
Case Presentation ◽  
Left Posterior ◽  
Left Mandible ◽  
Left And Right ◽  
Characteristic Features ◽  
The Right

Abstract Background Cemento-ossifying fibroma (COF) and cementoblastoma (CB) are rare benign odontogenic tumors with a predilection for the mandible. Cemento-ossifying fibroma is a fibro-osseous lesion that originates in the tooth bearing areas of jaw and shows cementum-like tissue in a fibrotic stroma. Cementoblastoma is classically related to roots of teeth with the presence of calcified cementum-like material. To date, only a single case of concomitant unilateral COF and CB has been reported in the literature. Case presentation We present an unusual case of a 37-year-old female who presented with two discrete bilateral swellings in the right and left mandible for 10 years. The larger tumor involved the left posterior mandible with extension anteriorly to the left and right anterior mandibles, and the smaller tumor was present in right posterior mandible. Radiology revealed two distinct lesions involving both sides of mandible. Histopathological examination showed characteristic features of cemento-ossifying fibroma in sections of the larger tumor and cementoblastoma in sections of smaller tumor. Conclusion This case shows the very unique bilateral co-existence of COF and CB, the second case reported in literature to date.

scholarly journals Benign mesenteric lipomatous tumor in a child: a case report and literature review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Naoki Hashizume ◽  
Takato Aiko ◽  
Suguru Fukahori ◽  
Shinji Ishii ◽  
Nobuyuki Saikusa ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Abdominal Mass ◽  
Soft Tissue Tumors ◽  
Resonance Imaging ◽  
Case Presentation ◽  
Lipomatous Tumor ◽  
Longitudinal Length ◽  
The Right ◽  
Left Abdomen ◽  
Lipomatous Tumors

Abstract Background Lipomatous tumors are the most common type of soft-tissue tumors. Benign lipomatous tumors are lipomas and lipoblastoma. We herein report a case of benign mesenteric lipomatous tumor and the largest collection of known benign mesenteric lipomatous tumors in children in the literature. Case presentation A 3-year-old girl presented with repeated dull abdominal pain and left abdominal mass swelling. On a physical examination, the child had a soft, moderately distended left abdomen that was not tender when palpated. Computed tomography and magnetic resonance imaging demonstrated a large fatty mass within the mesentery, measuring approximately 8 × 6 cm. The mass extended from the right upper quadrant to the lower pole of the kidneys. Laparotomy with resection of the mesenteric tumor was performed under general anesthesia. A well-capsuled tumor was a soft, yellow mass and found loosely attached to the mesenterium of the ileum. A histopathological examination demonstrated the lobular proliferation of mature adipocytes. Atypical lipoblasts were not seen. These features are compatible with benign lipomatous tumor, such as lipoma or lipoblastoma with maturation. Conclusion In conclusion, benign mesenteric lipomatous tumors tend to be large in size over 10 cm in longitudinal length. However, resection is well tolerated in the vast majority of cases with benign post-operative courses.

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