scholarly journals Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Upper and Lower Limbs: A Report of Three Cases and Review of Literature

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maryada Venkateshwar Reddy ◽  
Anjaneyulu Kandukuri ◽  
Vidyasagar Chandankere ◽  
Vinay Mathew Joseph ◽  
Annappareddy Venkata Gurava Reddy
Keyword(s):  
Benign Lesion ◽  
Plain Radiograph ◽  
Lower Limbs ◽  
Radiological Evaluation ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
Diagnostic Dilemma ◽  
Small Bones ◽  
The Right ◽  
High Index Of Suspicion

Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare bone pathology affecting small bones of hand and feet. This benign lesion needs to be distinguished from many malignant bone tumors as it poses a diagnostic dilemma due to its clinical, radiological, and histological picture. We report three cases of BPOP affecting the hand and foot. Case 1: A 21-year-old gentleman presented with painful swelling in the long finger of the right hand. A plain radiograph showed a radio dense mass which was later excised and diagnosis confirmed in histopathology. There was no recurrence in 2 years of follow-up. Case 2: A 5-year-old boy presented with painful swelling over the right ankle with no history of antecedent trauma. Following radiological evaluation, the patient was successfully treated with excision. Case 3: A 35-year-old lady presented with a painful swelling on the dorsal aspect of her hand which was gradually increasing in size. After radiological evaluation, the patient was successfully treated with excision and lesion confirmed to be BPOP on histological examination. She was symptom free without recurrence in up to 2 years of follow-up. Conclusion: Nora’s lesion is a rare pathology requiring high index of suspicion. Excision is the recommended mode of treatment. All our cases responded well with excision with immediate pain relief following surgery and no recurrence in up to 2 years of follow-up. Keywords: Nora, bizarre parosteal osteochondromatous proliferation, neoplasm, tumor, benign.

scholarly journals Nora’s lesion: bizarre parosteal osteochondromatous proliferation in right foot: a case report

2021 ◽  
Vol 7 (5) ◽  
pp. 1043
Author(s):  
Shikhar Yadav ◽  
Divya G. ◽  
Jithin Mohan ◽  
Joice Varghese
Keyword(s):  
Benign Lesion ◽  
Plain Radiograph ◽  
Excision Biopsy ◽  
Bizarre Parosteal Osteochondromatous Proliferation ◽  
Nora’S Lesion ◽  
First Metatarsal ◽  
Benign Pathology ◽  
One Year ◽  
The Right ◽  
Hands And Feet

<p class="abstract"><span lang="EN-US">Nora’s lesion is a benign lesion involving mainly the proximal phalanges, metatarsals or metacarpals in the hands and feet. It may be easily confused with a malignant entity and was first identified and reported by Nora et al. in 1983. We present a case of a 12 years old female with complains of a swelling over the right foot noticed 4 months ago. Plain radiograph revealed heterotrophic calcification over the dorso-lateral aspect of the head of the first metatarsal. MRI scan of the foot was suggestive of a benign pathology with a differential of bizarre parosteal osteochondromatous proliferation (BPOP) or an osteochondroma. The patient was managed with excision biopsy and lesion was excised along with the pseudo-capsule and adjoining periosteum. Cortex appeared normal and wound was washed with hydrogen peroxide and incision closed. Histopathology report was suggestive of Nora’s lesion. One year follow up of the patient showed no recurrence. BPOP proliferation is a benign lesion however differentials need to be kept in mind and treatment with excision of the lesion along with the pseudo-capsule and periosteal tissue beneath the lesion has low rates of recurrence. </span></p>

scholarly journals MANAGEMENT OF THROMBOANGIITIS OBLITERANS - A CASE REPORT

2021 ◽  
Vol 9 (7) ◽  
pp. 1560-1563
Author(s):  
Vishal Chougule ◽  
Shailesh Shetty
Keyword(s):  
Case Report ◽  
Strong Association ◽  
Complete Healing ◽  
Lower Limbs ◽  
Thromboangiitis Obliterans ◽  
Foul Smell ◽  
Treatment Principle ◽  
The Right ◽  
Time Of Admission

Thromboangitis obliterans (TAOs) is a rare disease affecting arteries and veins of the upper and lower limbs. The condition has a strong association with the use of tobacco. Thromboangitis obliterans also known as Buerger's disease is found in the age group between 40 to 45 years, and men are most prone to get affected. The present case is a male aged 65 years complaining of a wound on the heel on the right foot, associated with pain, discharge, slough, foul smell, edema and discolouration of the skin for which he visited our hospital, the patient was previ- ously diagnosed as TAO, considering his clinical features at the time of admission, an intervention was planned based on the treatment principle of Dusta Vrana like Virechana, Basti and Raktamokshana. There was complete healing of the wound at the end of the treatment with no signs of recurrence during the follow-up suggesting the need for Shodhana in the effective management of TAO. Keywords: Dushta Vrana, Thromboangiitis Obliterans, Ayurveda, Panchakarma, Shodhana, Case report

scholarly journals An isolated pilomatricoma of the leg: a rare location – A Case Study

2021 ◽  
pp. 28
Keyword(s):  
Head And Neck ◽  
Lower Limbs ◽  
Surgical Removal ◽  
Skin Tumour ◽  
Postoperative Course ◽  
Hair Matrix ◽  
Rare Location ◽  
The Right

Pilomatricoma is a rare, benign skin tumour arising from the hair matrix. The usual locations are the head and neck. Localization in the lower limbs is exceptional. The diagnosis of certainty is histological. Treatment is complete surgical removal to avoid recurrence. We report in this article the case of a rare localization of a pilomatricoma on the right leg, in a 25-year-old patient operated with complete surgical removal. The postoperative course was simple and without recurrence after 2 months of follow-up.

scholarly journals Retracted: Diagnostic Dilemma of a Diaphragmatic Hernia

2018 ◽  
Vol 4 (3) ◽  
Author(s):  
Salman Yahya ◽  
Sonia Zafar ◽  
Hafsa S. Babar
Keyword(s):  
Diaphragmatic Hernia ◽  
Turning Point ◽  
Rare Complication ◽  
Young Male ◽  
Acute Ischemia ◽  
Radiological Findings ◽  
Diagnostic Dilemma ◽  
High Index Of Suspicion ◽  
Disease Free

Diaphragmatic hernia post esophagectomy is a rare complication but a reality in its existence. It is typically difficult to diagnose but highly depends on keeping high index of suspicion. In our case report, the young male who underwent esophagectomy for esophageal carcinoma, remained disease free and stable in his 9 months follow up, suddenly presented in the emergency department with the symptoms of shortness of breath, chest pain, vomiting and tachycardia. The case was typically complicated by the initial treatment given for acute ischemia and cardiogenic shock. Radiological findings proved to be helpful and turning point in the diagnosis and overall management.

scholarly journals Melanotic neuroectodermal tumour of infancy presenting as a lytic lesion in femur: a rare tumour at a rare site with an unusual behaviour

2019 ◽  
Vol 12 (10) ◽  
pp. e231959
Author(s):  
Nishu Bhardwaj ◽  
Rajni Yadav ◽  
Venkatesan Sampath Kumar ◽  
Shah Alam Khan
Keyword(s):  
Head And Neck ◽  
Spontaneous Regression ◽  
Benign Lesion ◽  
Osteolytic Lesion ◽  
Lytic Lesion ◽  
Rare Tumour ◽  
Neuroectodermal Tumour ◽  
Rare Site ◽  
The Right

Melanotic neuroectodermal tumour of infancy (MNTI) is an uncommon tumour, predominantly occurring in head and neck, mostly maxilla, but also in skull and mandible. Although a benign lesion, it is known to recur in 15%–27% of cases, and rarely, may undergo malignant transformation. We present a case of a 5-month-old female patient, who presented with a gradually progressive swelling in the right thigh. On imaging, an osteolytic lesion was seen, involving the metadiaphysis of shaft of right femur. A biopsy was performed, on which diagnosis of MNTI was made. MNTI is rarely seen in extremities. To the best of our knowledge, only six cases have been reported in femur, the present case being the seventh. The tumour showed spontaneous regression on follow-up in our patient, which has rarely been described. A knowledge of characteristic morphology and immunohistochemistry is the key to differentiate it from other tumours.

Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an infant

2010 ◽  
Vol 5 (6) ◽  
pp. 586-590 ◽  
Author(s):  
Balaji Srinivas ◽  
Vivek Joseph ◽  
Geeta Chacko ◽  
Vedantam Rajshekhar
Keyword(s):  
Marked Reduction ◽  
Left Kidney ◽  
Lower Limbs ◽  
Resonance Imaging ◽  
Abdominal Organs ◽  
Left Lower Limb ◽  
Extradural Cyst ◽  
The Right ◽  
Slow Growing

Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.

scholarly journals A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection

2016 ◽  
Vol 8 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Cláudia Borbinha ◽  
João Pedro Marto ◽  
Sofia Calado ◽  
Miguel Viana-Baptista
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Vascular Events ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Varicella Zoster Infection

Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.

scholarly journals Congenital Posteromedial Bowing of the Tibia: A Single Center Experience

2017 ◽  
Vol 34 (4) ◽  
pp. 293-300
Author(s):  
Dragoljub Živanović ◽  
Andjelka Slavković ◽  
Zoran Marjanović ◽  
Ivona Djordjević ◽  
Nikola Bojović ◽  
...  
Keyword(s):  
Skeletal Maturity ◽  
Lower Limbs ◽  
Ankle Foot Orthosis ◽  
Single Center Experience ◽  
Walking Age ◽  
Elastic Nails ◽  
The Right ◽  
Limb Length Inequality ◽  
Foot Orthosis

Summary Congenital posteromedial bowing of the tibia (CPMBT) is a rare congenital anomaly of the lower limbs. The aim of the present study was to analyze our experience in the treatment of CPMBT. A retrospective study of patients treated for CPMBT in the period January 2000 – June 2016 was performed. In the observed period, six patients were treated (five girls and one boy), with predominance of the right tibia involvement (5:1). The initial treatment included a series of corrective casts (4-9) applied in all patients, followed by removable splints and physiotherapy. Four children with residual angulation of tibia after walking age were prescribed ankle-foot orthosis (AFO) as a prevention of pathological fractures. Both posterior and medial angulation correct over time. Mean initial shortening was 11 mm. At the last follow-up visit, mean shortening was 23.33mm. Three patients had lower limb shortening of more than 2 cm. In two of them, with shortening of 27 mm and 35 mm, Ilizarov lengthening was performed. In one girl, we performed lengthening over titanium elastic nails. In the other girl, after lengthening, circular frame was exchanged with a locking plate to reduce fixator wearing time. There were no major complications of treatment. Patients were followed up for 2-12 years (mean 6.83 years). None of them reached skeletal maturity yet. Primary manifestation of CPMBT – angulation of tibia and fibula as well as calcaneovalgus deformity usually correct spontaneously or with conservative measures. However, limb length inequality, as a consequence of CPMBT, progresses with growth and may require surgical correction in some children. Therefore, all children with CPMBT should be followed up until skeletal maturity.

scholarly journals Lethal Midline Granuloma in a 15-Year-Old Girl: A Diagnostic Dilemma

2018 ◽  
Vol 33 (2) ◽  
pp. 37-40
Author(s):  
Ian Christian A. Gonzales
Keyword(s):  
Nk Cell ◽  
Cell Lymphoma ◽  
Diagnostic Dilemma ◽  
Lethal Midline Granuloma ◽  
Multiple Biopsies ◽  
Atypical Cells ◽  
High Index Of Suspicion ◽  
Lost To Follow Up ◽  
Midline Granuloma

Objective: To report a case of lethal midline granuloma and discuss the diagnostic and treatment dilemma, and management. Methods             Design:           Case Report             Setting:           Tertiary Government Hospital             Patient:           One Results: A 15-year-old girl under treatment for pulmonary tuberculosis presented to the Emergency Room for epistaxis and a nasopalatine lesion. She was managed as a case of nasopalatine osteomyelitis for one month and discharged on antibiotics. She returned due to bleeding after being lost to follow up for 3 more months. Hemostasis, debridement and biopsy yielded atypical cells, possibly lymphoma. Immunohistochemistry confirmed the diagnosis of NK-cell lymphoma. Unfortunately, she expired prior to initiation of chemotherapy. Conclusion: Clinicians must have a high index of suspicion for lethal midline granuloma in chronic, non-healing midline lesions. Multiple biopsies confirm the diagnosis, and earlier initiation of treatment may improve prognosis.   Keywords: Granuloma, lethal midline; Lymphoma, extranodal NK-T-cell

scholarly journals Sacral Tuberculosis: An Atypical Manifestation

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Faisal Amir Si Mirah ◽  
Ahmad Faizal Roslan ◽  
Ed Simor Khan Mor Japar Khan ◽  
Rajandra Kumar Karupiah ◽  
Zamzuri Zakaria @ Mohamad
Keyword(s):  
Correct Diagnosis ◽  
Lower Limbs ◽  
Mantoux Test ◽  
Ct Guided ◽  
Walking Aids ◽  
Grade 5 ◽  
History Of ◽  
Prolapsed Intervertebral Disc ◽  
The Right ◽  
High Index Of Suspicion

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated.

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