Rare condition: Upper & lower limb lymphoedema

Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call atention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

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Acute ischemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thromboembolic disease as the initial manifestation of lung adenocarcinoma: A case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab426 ◽

2021 ◽

Author(s):

Julien Polo ◽

Daniele Raufast ◽

Dimitri Cornand ◽

Antoine Elias

Keyword(s):

Mitral Valve ◽

Lung Adenocarcinoma ◽

Popliteal Artery ◽

Lower Limb ◽

Thrombotic Event ◽

Rare Condition ◽

Transoesophageal Echocardiography ◽

Pet Scan ◽

Acute Ischemia ◽

Initial Manifestation

Abstract Background Non-bacterial thrombotic endocarditis (NBTE) is a rare condition. Optimal management is based on early diagnosis which remains difficult. Case summary A 75-year-old male patient was admitted to the hospital with acute ischemia of the left lower limb due to popliteal artery occlusion despite anticoagulation with rivaroxaban for pulmonary embolism diagnosed two weeks earlier. Transoesophageal echocardiography (TEE) showed a mobile vegetation with mild mitral valve regurgitation. Positron emission tomography (PET) scan did not show hyperfixation at the mitral valve but rather lymphadenopathy hyperfixation at different sites. Biopsy of a lymph node from Barety’s space identified a bronchopulmonary adenocarcinoma. The outcome was favorable after popliteal artery thrombectomy and low-molecular-weight heparin treatment. The patient was referred to the department of onco-pneumology for further care. Discussion Upon clinical presentation, the combination of an arterial and prior venous thrombotic event suggested that the origin could be either a patent foramen ovale (PFO) or a thrombosis from an underlying cancer. A transthoracic echocardiography and TEE excluded a PFO and demonstrated a mobile echogenic mass at the mitral valve site together with a mild regurgitation. The diagnosis of non-bacterial thrombotic endocarditis was suggested given the absence of clinical and biological infectious signs, negative blood cultures and serology for endocarditis, the presence of both arterial and venous thrombosis, as well as the presence of intra-thoracic lymphadenopathy hyperfixation on the PET scan for which a biopsy demonstrated lung adenocarcinoma.

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Isolated Arteritis of Both Lower Limbs

Prague Medical Report ◽

10.14712/23362936.2018.7 ◽

2018 ◽

Vol 119 (1) ◽

pp. 70-75

Author(s):

Miroslav Průcha ◽

Alena Šnajdrová ◽

Pavel Zdráhal

Keyword(s):

Autoimmune Disease ◽

Lower Extremity ◽

Lower Limb ◽

Imaging Techniques ◽

Rare Condition ◽

Rapid Diagnosis ◽

Vascular Imaging ◽

Lower Limbs ◽

Systemic Autoimmune Disease ◽

Successful Therapy

Isolated arteritis of the lower limb vessels is an extremely rare condition. The use of modern vascular imaging techniques substantially facilitates and accelerates the diagnostics. In the isolated lower limb arteritis, it is always necessary to exclude Takayasu’s and giant-cell arteritis. We present the case of a female patient with an isolated lower extremity arteritis without any other symptoms of systemic vascular damage or systemic autoimmune disease. Immunosuppressive therapy is obligatory in this case. Interdisciplinary co-operation is required for rapid diagnosis and successful therapy. Our patient has consented to the publication of this report.

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Intramedullary glioblastoma multiforme in young patients: A case report and brief review

10.25259/aujmsr_24_2021 ◽

2021 ◽

Vol 0 ◽

pp. 1-5

Author(s):

Pedro Lukas do Rêgo Aquino ◽

Erlan Pércio Lopes Rufino ◽

Assíria Maria Santana Santos ◽

Luana Cristina Rodrigues de Oliveira Costa ◽

Camila Flach Weinmann ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Lower Limb ◽

Patient Survival ◽

Current Knowledge ◽

Young Patients ◽

Rare Condition ◽

Lower Limbs ◽

Age Group ◽

Young Population ◽

Intramedullary Lesion

Cervical glioblastoma multiforme (GBM) is rare, and its early diagnosis and management is crucial to patient survival. In the young population, it’s even more difficult to diagnose. The main challenges in GBM therapy are associated with the location of the disease and its complex and heterogeneous biology. Here, we present a case of a 35-year-old female patient admitted due to complain of pain in her right lower limb. She reported the evolution of the condition for dysesthesia in upper limbs and lower limbs 4 weeks ago. MRI showed an intramedullary lesion extending from C2 to C5. The patient was managed surgically. The purpose of this report is to document this rare condition, especially in the young age group, and reveal the current knowledge regarding intramedullary GBM.

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Peroneal nerve palsy caused by a synovial cyst of the proximal tibiofibular joint: A case report

Case Studies in Surgery ◽

10.5430/css.v4n2p11 ◽

2018 ◽

Vol 4 (2) ◽

pp. 11

Author(s):

Swantje M. Kruspi ◽

Michael Dietrich

Keyword(s):

Lower Limb ◽

Peroneal Nerve ◽

Nerve Palsy ◽

Rare Condition ◽

Synovial Cyst ◽

Sudden Onset ◽

Proximal Tibiofibular Joint ◽

Peroneal Nerve Palsy ◽

Fast Recovery ◽

Tibiofibular Joint

Peroneal nerve entrapment is the most common entrapment found in the lower limb, even though nerve palsy caused by a synovial cyst of the proximal tibiofibular joint (PTFJ) is a very rare condition. We report the case of a 54-year-old man who developed sudden onset of an incomplete foot droop and therefore presented himself to the emergency room. Further examination showed a compression of the peroneal nerve provoked by a synovial cyst of the PTFJ. Treatment involved puncture of the cyst. The patient showed a complete and fast recovery. We discuss our case with regards to the recent literatures.

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Acute leukemia presenting as acute lower limb ischemia

VASA ◽

10.1024/0301-1526/a000977 ◽

2021 ◽

Author(s):

Alkis Bontinis ◽

Vangelis Bontinis ◽

Andreas Koutsoumpelis ◽

Perifanis Vasileios ◽

Kaiafa Georgia ◽

...

Keyword(s):

Acute Leukemia ◽

Lower Limb ◽

Meta Analysis ◽

Significant Proportion ◽

Rare Condition ◽

Limb Ischemia ◽

Initial Symptom ◽

Case Control Studies ◽

Term Survival ◽

Lower Limb Ischemia

Summary: Objectives: Acute lower limb ischemia (ALLI) is a common vascular emergency. However, ALLI presenting as the initial symptom of acute leukemia (AL) is scarce. Here we present a case of ALLI in the setting of acute myeloid leukemia (AML) while systematically reviewing the current literature to withdraw conclusions about the management, prognosis, and treatment for this atypical presentation of AL. Methods: We conducted a systematic electronic research according to Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA) for articles published from January 1981 up to January 2021 concerning ALLI in the setting of acute leukemia (AL). Patients’ baseline characteristics were recorded and nine outcomes of interest were studied. Results: Twenty-six individuals, 16 males with a mean age of 46.3 years (±20) were included in this review. The diagnosis included 13 AML patients (50%), 11 acute promyelotic leukemia (APL) (42.3%) and two acute lymphoblastic leukemias (ALL) (7.7%). Treatment varied among nine different regimens. Four patients were treated with chemotherapy alone (15.4%), four with thrombectomy alone (15.4%), and 11 with a combination of chemotherapy and thrombectomy (42.3%). Eight major amputations were recorded (30. 8%). Thirty-day mortality was 35.7%. Forty-eight peripheral thrombotic events were recorded with 12 patients suffering recurrent thrombotic events. Conclusion: ALLI as the presenting symptom of AL is a rare condition that carries significant mortality and amputation rates. Timely diagnosis is crucial concerning short-term survival and limb salvage. APL, despite being the rarest form of AL, represented a significant proportion of the patient population in this review. The role of leukostasis in the disease’s progression and the efficacy of leukapheresis as a treatment regimen should be further investigated through case-control studies.

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Benign acute childhood myositis: importance of early recognition

British Journal of Nursing ◽

10.12968/bjon.2019.28.9.560 ◽

2019 ◽

Vol 28 (9) ◽

pp. 560-564

Author(s):

Amanda Catherine Steinson ◽

Tayyib Mubashar ◽

Alison Frances Janzen ◽

Dawn Poulton ◽

Siba Prosad Paul

Keyword(s):

Creatine Kinase ◽

Lower Limb ◽

Joint Pain ◽

Early Recognition ◽

Rare Condition ◽

Calf Muscle ◽

Muscle Fibres ◽

Limb Pain ◽

Lower Limb Pain ◽

Supportive Management

Cases of children presenting with limb or joint pain are relatively common and are due mainly to benign conditions. Early diagnosis will help reduce unnecessary invasive investigations so, although a relatively rare condition, benign acute childhood myositis (BACM), which presents with acute lower limb pain and an isolated rise in creatine kinase, should be considered. BACM is characterised by an infiltration of viruses into calf muscle fibres, which may cause a subsequent inflammatory response leading to calf-muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. This article discusses the management of a 10-year-old boy with a classical presentation of BACM, alongside differentials and management for clinician consideration.

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Treatment of symptomatic coral reef aorta with an uncovered stent graft

Vascular ◽

10.1177/1708538114559325 ◽

2014 ◽

Vol 23 (5) ◽

pp. 555-557 ◽

Cited By ~ 3

Author(s):

DC Bosanquet ◽

A Wood ◽

IM Williams

Keyword(s):

Coral Reef ◽

Lower Limb ◽

Rare Condition ◽

Suprarenal Aorta ◽

Uncovered Stent ◽

Renal Hypoperfusion ◽

Vascular Procedure ◽

Distal Embolisation ◽

Extensive Coral

Coral reef aorta is a rare condition characterised by extreme calcific growths affecting the juxta and suprarenal aorta. It can cause symptoms due to visceral ischaemia, lower limb hypoperfusion, and distal embolisation. We present a case of a 61-year-old man with unresponsive hypertension, who was found to have an occluded right renal artery, and an extensive coral reef aorta with a marked pressure gradient across the lesion. Renal hypoperfusion secondary to aortic coral reef aorta was thought to be the cause for his hypertension. Endovascular placement of a balloon expandable uncovered stent resolved his hypertension within one month, with no adverse effects noted at subsequent follow-up. Endovascular treatment of coral reef aorta is technically possible and avoids a major vascular procedure.

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Combination of active stage of diabetic Charcot neuroosteoarthropathy and diabetic lower limb macroangiopathy

Diabetes Mellitus ◽

10.14341/dm10103 ◽

2020 ◽

Vol 22 (5) ◽

pp. 491-498

Author(s):

Anastasia G. Demina ◽

Vadim B. Bregovskiy ◽

Irina A. Karpova

Keyword(s):

Lower Limb ◽

Clinical Course ◽

Early Stage ◽

Rare Condition ◽

Charcot Foot ◽

Active Stage ◽

X Ray ◽

First Case ◽

Left Lower Limb ◽

Mild Temperature

Combination of active stage of diabetic Charcot neuroosteoarthropathy and diabetic lower limb macroangiopathy is the rare condition. In the present paper we describe two cases of development of acute Charcot foot in the non-critically ischemic foot. The first case is the patient with previously diagnosed intermitted claudication and the second case is patient who developed the Charcot foot 5 months later after successful endovascular treatment of arterial occlusions of his left lower limb. In both cases the absence of redness in the early stage, the mild-to-moderate pain and mild temperature gradient between affected and non-affected feet were noticed. The clinical course of the Charcot disease in the first patient was favourable. He used walker for 9 months and his foot shape was preserved and deformity was considered as mild. The second patient had more active and profound destructions due to delay of the treatment. He was casted, however his deformity progressed and the treatment continues up to date. In both patients the MRI revealed more affected bones compared with X-ray. These cases emphasize the importance of keeping in mind the Charcot disease even in patients with diabetic peripheral vascular disease.

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Congenital Angiodysplasia of the Lower Limb: The Klippel—Trenaunay Syndrome and Arteriovenous Fistulae

Phlebology The Journal of Venous Disease ◽

10.1177/026835558800300105 ◽

1988 ◽

Vol 3 (1) ◽

pp. 31-39 ◽

Cited By ~ 1

Author(s):

Axel Lendorf ◽

Jan Struckmann ◽

Hans H. Strange-Vognsen ◽

S. Levin Nielsen

Keyword(s):

Lower Limb ◽

Drainage System ◽

Rare Condition ◽

Venous Drainage ◽

Injection Technique ◽

Noninvasive Methods ◽

Arteriovenous Fistulae ◽

Klippel Trenaunay Syndrome ◽

Hemodynamic Consequence

During a 10-year period 13 patients were admitted on suspicion of congenital arteriovenous fistulae. Two patients turned out to have a Klippel-Trenaunay syndrome without evidence of arteriovenous fistula and two patients had agenesis of the venous drainage system. Evaluation by noninvasive methods for classification of this rare condition is of the microsphere injection technique before arteriography and venous emptying measurement before venography. From our experience only the microsphere technique is recommended to evaluate the severity of the shunting. The possibility of a partial excision of the angiodysplasia is the task of the surgeon facing the impossibility of radical operation. Therefore arteriograms should guide the surgeon in his attempt to reduce the hemodynamic consequence of shunting. Patients having a normal arteriogram should have a venogram before surgical exploration is attempted. In the series three patients turned out to have venous defects and removal of superficial varicosities would have aggravated the situation.

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