Abnormal drainage pathway of a supracardiac total anomalous pulmonary venous drainage in a neonate: a case report

Supracardiac total anomalous pulmonary venous drainage is commonly associated with a left-sided ascending vein draining into innominate vein. We present a case of a newborn with a right-sided ascending vein, draining into the right superior caval vein with stenosis at the SVC-ascending vein junction, posing a surgical dilemma in corrective surgery. Usage of three-dimensional computed tomographic scan was essential in delineating the anatomy and aiding surgery. The case demonstrates the rarity of this type of cardiac disease and the complications that develop.

Hypertriglyceridemia-Induced Pancreatitis

A 31-year-old woman was admitted with abdominal pain. Her blood sample was noted to be lipemic. She was not known to have diabetes, hypothyroidism or family history of hyperlipidaemia and denied alcohol intake. She had no eruptive xanthoma or corneal arcus. On admission, triglycerides were 118mmol/L (normal range < 1.8). Computed tomographic scan demonstrated swollen pancreas, extensive peripancreatic inflammation and fatty liver. A diagnosis of hypertriglyceridemia-induced pancreatitis was made. She was kept nil by mouth and commenced on insulin infusion, fenofibrate and a low-fat diet. Her admission was complicated by acute respiratory distress syndrome and difficult pain control requiring morphine patient-controlled analgesia. Her triglycerides gradually reduced and on day 12 it was 6.6mmol/L. This case illustrates the importance of multidisciplinary input with endocrinologist, intensivist, gastroenterologist and dietician. Other treatments that could have been initiated was plasma apheresis but as she improved this was not required.

Thoracic Trauma

More than 85% of blunt and penetrating trauma to the thorax results in injury to the lungs or ribs. Among civilians, blunt trauma is the most common mechanism, while penetrating trauma is the most common among military sectors. This review describes the assessment and stabilization, diagnosis, treatment and disposition, and outcomes of thoracic trauma. Videos shows the “lung point” sign on M-mode and two-dimensional ultrasonography, and a transthoracic echocardiogram clip of pericardial clot and tamponade due to a gunshot wound. Figures show a sonogram showing the “lung point sign”, a chest x-ray and computed tomographic scan demonstrating right-sided hemothorax in a patient with a right chest stab wound, and a three-dimensional computed tomographic scan and chest x-ray of a blunt trauma patient with displaced fractures of the left lateral sixth to ninth ribs. Tables list types of injuries, NEXUS chest decision instrument imaging criteria, level 2 evidence-based recommendations for the management of pulmonary contusion and flail chest by the Eastern Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma practice guidelines for managing issues with pulmonary contusion and flail chest, and the Vancouver simplified and University of Washington grading systems for blunt aortic injury. This review contains 2 videos, 4 highly rendered figures, 10 tables, and 94 references.

Pulmonary and pleural metastasis mimicking COVID-19 infection in stage IV ovarian cancer: a case report

Background: The differential diagnosis of lung and pleural metastases and coronavirus disease 2019 (COVID-19) can be challenging. Case: We report a case of a 41-year-old woman with FIGO (International Federation of Gynecology and Obstetrics) stage IV ovarian cancer with pleural and pulmonary spread. After primary cytoreduction was performed, she developed a high fever and worsening dyspnea with desaturation (92% in ambient air). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was suspected, but three swabs gave negative results. Computed tomographic scan showed radiologic imaging strongly suspect for COVID-19 and the patient was transferred to a COVID-19 ward. The final diagnosis was paraneoplastic fever. Conclusion: Lung and pleural metastases can mimic SARS-CoV-2 infection.

Four-Corner Arthrodesis Using a Dedicated Dorsal Circular Plate

Background: Scaphoid excision and 4-corner fusion is a standard procedure for advanced carpal collapse. The purpose of this study was to evaluate its effectiveness using a specific designed locking plate of the latest generation. Methods: Between October 2012 and December 2015, 12 patients underwent this procedure using the Flower (KLS Martin Group, Tuttlingen, Germany) circular locking plate. The surgical technique is standardized. Three patients were affected by a scapholunate advanced collapse and 9 patients by a scaphoid nonunion advanced collapse. All patients underwent a computed tomographic scan to study the real achievement of the fusion. Results: Only 2 patients did not show complete fusion. All the patients with successful fusion returned to previous work and manual activities. Conclusions: Four-corner arthrodesis with circular locking plate is an alternative surgical treatment for carpal arthritic collapse.

Rhinolith in the concha bullosa as a rare location: a case report

The presence of a rhinolith is a rare condition, which can cause long-standing symptoms, such as rhinorrhea, foul-smelling discharge, nasal obstruction, and headache. A rhinolith is usually easily diagnosed by a clinical examination and a paranasal computed tomographic scan. Rhinoliths are usually found in nasal cavities, but rare locations are also possible. We report a patient who was evaluated in our clinic for nasal obstruction, headache, and snoring symptoms. A clinical examination showed no major findings, but a paranasal computed tomographic scan of coronal sections showed a hyperdense mass within the right concha bullosa. A rhinolith in the concha bullosa is a rare condition. Our case is the third case of a rhinolith in the concha bullosa to be reported in the literature.