Curious case of Retrosternal Colloid Goitre

Background: Retrosternal goitre is considered to be a rare entity. It is a slow growing enlargement of the thyroid gland which remains asymptomatic for many years. Symptoms are mainly due to compression of airways and oesophagus. Surgical management with the removal of the involved lobe is considered sufficient. Summary: Here we report a case of a 33 yrs. old lady who presented to us with complaints of neck pain, facial flushing, difficulty in breathing and vague body ache. Clinical examination was within normal limits. The patient was referred to orthopedician for further evaluation. MRI cervical spine was done which was suggestive of large swelling in left lobe of thyroid with retrosternal extension causing deviation of trachea to opposite side. FNAC was done which was inconclusive. The involved lobe was removed surgically with frozen section suggestive of Colloid goitre. Conclusion: Retrosternal goitre are slow growing enlargement of thyroid gland which may present with vague symptoms, best managed surgically often followed relief from the symptoms post-surgery.

Thyroid Papillary Carcinoma and Hyperthyroidism: A Case Study

Background: Concurrent thyroid cancer and hyperthyroidism is a rare finding. The frequency of this association is very variable. A rare case of papillary thyroid cancer associated with hyperthyroidism is described here. Case: A 49-year-old male presented to the authors’ outpatient clinic with complaints of a painless left-sided anterior neck swelling that had persisted for the past 8 months. He also reported weight loss for the same duration. The anterolateral swelling was non-tender, asymmetrical, mobile, and rubbery. Investigations: Biochemical analysis confirmed hyperthyroidism. Ultrasound examination of the neck showed a well-defined, solid, and cystic lesion in the left lobe and isthmus of thyroid gland. The solid portion had few specks of calcification. A radioactive thyroid scan showed increased tracer uptake in the left lobe. Papillary carcinoma of thyroid origin was discovered after fine-needle aspiration of the left anterior cervical lymph node. After preparation, a total thyroidectomy was done. Examination of histopathology confirmed papillary thyroid carcinoma. Treatment: Following radioactive thyroid ablation, the patient was started on suppressive doses of thyroxine daily. Conclusion: Although thyroid cancer with hyperthyroidism is a rare finding, it should not be disregarded. To avoid missing this unusual yet uncommon discovery, a detailed history and physical examination should be performed, as well as all required investigations.

Adaptive morphogenesis of lamb liver under Anthropobiocenosis conditions lamb liver morphogenesis

Investigated the histological features of the structure of hepar of one-day-old lambs (ODL) using a complex of morphological techniques. It was found that hepar in ODL is formed by stroma and parenchyma. The stromal elements of the organ are formed by loose lugs of hematopoietic connective tissue, which in turn forms a capsule (2.80-7.23 microns thick), as well as the septa of the lobules, which include the hepar triads and paravasal tissue of efferent blood vessels. As a result of the studies, the prevalence of the stroma in the hematopoietic foci around large afferent blood vessels, especially in the hepar hilus, was revealed. The hepar parenchyma in ODL has structural incompleteness. It is formed by hepar cells and numerous resinusoidal cells located in the subcapsular, peripheral, central zones in the lobus hepatis. Hepar cells located in the subcapsular zone (SZ) have a more optically cleared (OC) cytoplasm, and the practically cleared cytoplasm of the hepatocyte diameter (HD) decreases towards the central zone (CZ). In the hepar parenchyma of the ODL, hematopoiesis foci (HF) are established in each of the lobes, which tend to decrease from the periphery to the center of the lobes. Hemopoetic cells (HC) are located between hepatocytes, densely layering on top of each other, and there are also cells located sparsely between the liver cells (LC). The number of hepatocytes per 1 mm2 of the area of the histological specimen in the left lobe (LL) of the ODL reaches the highest value 5983.79 ± 90.40, in the right lobe (RL) of the liver it is 5358.80 ± 646.60, while in the middle it has a minimum value and reaches 5133.10 ± 205.75.

Collision tumor of the thyroid – a challenge during the COVID-19 pandemic

Some of the patients with anaplastic thyroid carcinomas have a coexistent differentiated thyroid cancer, sustaining the hypothesis that this cancer may develop from more differentiated tumors. We describe a case with a collision tumor of the thyroid, defined as a neoplastic lesion composed of two distinct cell populations, with distinct borders. The patient presented during the COVID-19 pandemic with dysphonia, dyspnea, multinodular goiter and a painless, rapidly enlarging, left cervical swelling. She had been first time diagnosed with left nodular goiter in 2007, with an indication for surgery, which she declined. After partial excision of the left latero-cervical adenopathy, the pathological analysis showed massive lymph node metastasis from anaplastic thyroid cancer. A total thyroidectomy was done; the postoperative pathological exam identified a papillary thyroid microcarcinoma in the right lobe and an anaplastic thyroid cancer in the left lobe. Postoperatively, levothyroxine treatment was started and the patient was referred to radiotherapy. This case highlights the importance of urgent management of some cases with compressive multinodular goiter, even during the COVID-19 pandemic.

P-L05 Enterohepatic migration of ingested fishbone resulting in hepatic abscess- Case report and review of literature

Background Ingestion of foreign bodies is common, particularly in children. In adults, most foreign body ingestions are related to food bolus or bone. The majority present with pharyngeal symptoms. Most foreign bodies exit the gastrointestinal tract without complication. However, around 1% result in perforation. Patients may have a delayed presentation with nonspecific symptoms and pose a diagnostic dilemma. We report a rare case of silent migration of a fishbone into the liver and a review of the literature. Methods We present the case of a 56 year old man who presented with a liver abscess second to an ingested fishbone. We conducted a PUBMED search and reviewed the published data over a period of thirty years. We identified 52 similar cases and compared the presentation, site of perforation and location of the fish bone. We observed the different approaches in presentation and management of such patients. Results A 56-year-old man presented to his local hospital with dull epigastric pain and raised inflammatory markers. CT scan revealed a 4 cm abscess in the left lobe of the liver, with a linear radio-dense body within. The patient was given antibiotics and the abscess was aspirated. The patient was transferred to our Hepatopancreaticobiliary unit for further management. Laparoscopy was performed. The left lateral segment of the liver was adherent to the gastric antrum. The hepato-gastric fistula was disconnected. The fishbone was retrieved from the liver. The abscess was drained and wash out performed. The patient was discharged the following day. Conclusions Left lobe liver abscess should raise suspicion of foreign body. Although antibiotic treatment may be effective in the short term, there is no long-term data regarding recurrence. We believe that laparoscopic drainage of the abscess and extraction of the foreign body offer control of the source of sepsis and reduces the risk of recurrence.

Diagnosis particularities of lung cancer in a young patient without external risk factors – A case report

Lung cancer is the most common type of cancer worldwide, smoking being the strongest risk factor. We present the case of a non-smoker, a 23-year-old patient, without environmental exposure or personal pathological history, who was hospitalised for dry cough, a unique episode of haemoptysis and low-graded fever. He was admitted with a left basal diminished vesicular murmur, without detectable rales, and normal oxygen saturation. The chest X-ray highlighted left pleural effusion in a medium amount. A chest ultrasound revealed also an adjacent pulmonary consolidation. The cytological examination of the pleural fluid detected the presence of lymphocytes 36%, eosinophils 25%, polymorphonuclear 39% and frequent red blood cells. Angio-computer tomography confirmed the existence of a left hilar tumour formation with a mass effect on the hilar structures, possibly a few tumoral emboli in the lateral and posterior basal segmentary arteries, a lower left lobe consolidation, a left pleural effusion with hydroaeric level, and a left pneumothorax. The patient required a fibre bronchoscopy that showed us a proliferative infiltrative process, stenosis of the left lower bronchia, and extrinsic compression of the left lower lobe and the 6th segment. Infiltration of mucosa at the left basal pyramid was also detected. The histological examination argued for pulmonary adenocarcinoma. The particularities of the case consist of the lack of exposure to known risk factors for bronchopulmonary neoplasm and the early appearance of lung cancer and its complications in a young patient.

Evaluation of predictors of mortality in patients of ruptured liver abscess: a prospective study

Background: Ruptured liver abscess is a rare condition which is associated with high mortality. Ruptured liver abscess should be assessed carefully especially in patients with poor prognostic factors, which highlight the need for early diagnosis to further improve our results of management. The aim of the present study was to evaluate the predictors of mortality in patients of ruptured liver abscess.Methods: This was a prospective study, performed at Jawaharlal Nehru medical college, AMU, Aligarh between October 2015 to October 2017. For each case-patient, we reviewed demographic data, underlying medical conditions, clinical features, laboratory data, imaging and microbial findings and treatment. The prognostic factors independently related to mortality were then identified using univariate and multivariate analysis considering significance at p<0.05.Results: The overall in-hospital mortality was 27% (11 out of 40). On multivariate regression analysis, the factors that independently predicted mortality were shock at presentation, time of presentation (>48 hours), left lobe abscess and APACHE II score on admission more than 15.Conclusions: The independent predictors of mortality in ruptured liver abscess are shock at presentation, delayed presentation, higher APACHE II score on admission and left lobe abscess.

OV17 LAPAROSCOPIC REPAIR OF A DIAPHRAGMATIC EVENTRATION

Aim Diaphragmatic eventration (DE) is a rare condition affecting 0,05% of general population. DE is the abnormal elevation of a portion of a entire hemidiaphragm due to a lack of muscle or nerve function. It can be congenital or acquired. The most common cause of DE is cardiac surgery. It can be asymptomatic or present mild symptoms as dispnea, palpitations, pneumonia. Material and Methods 61 years old male with medical history of arterial hypertension, DMII, Hyperlipidemia. He had a motor vehicle accident with 6 to 9 left ribs fractures. One month later complained of dyspnea with shortness of air to normal activity. Rx: elevation of left diaphragm. CT scan: elevation of left diaphragm without rupture, passive atelectasis of inferior left lobe of the lung. He initiated respiratory physiotherapy without improvement of the symptoms. 4 months after the accident, we had a stroke with right hemiparesis. This situation produced worsening of the dyspnea. Physiotherapy was reinforced with recuperation of the hemiparesis, but poor improvement of the dyspnea. 10 months after the accident, surgery was indicated for plication of the diaphragm to improve the respiratory function. Results The video shows the radiological exams and the surgery performed. Laparoscopic diaphragmatic plication with a reinforcement with a coated mesh (Uncoated monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier). He was discharge 2 days after surgery. The patient improved significantly in his respiratory symptoms an imaging exams. Conclusions Posttraumatic DE must be treated surgically with low morbidity and good functional results.

Outcome and Complications of Percutaneous Transhepatic Biliary Drainage: Influence of Liver Entry Site

Objective: To determine the outcome and complications of percutaneous transhepatic biliary drainage (PTBD) performed via right lobe and left lobe duct puncture. Study Design: Cross-sectional study. Place and Duration of Study: Department of Interventional Radiology, Dow Institute of Radiology, Dow University of Health Sciences from July 2020 to March 2021. Methodology: Both adult male and female patients with obstructive jaundice having dilated intrahepatic biliary ducts on ultrasound were included. PTBD was performed under ultrasound guidance. Following intrahepatic biliary duct puncture, a guide wire was inserted followed by placement of 8 Fr or 10 Fr pigtail drainage catheter. Total bilirubin level was measured before and one day after the procedure. Cholangiogram was performed 48 hours after the procedure to check the drain placement and residual dilatation. Results: 130 patients were included with mean age of 55.3 ± 12.3 years. Success rate was same in patients with right and left lobe puncture i.e. 96.9%. The frequency of complication in right lobe puncture was higher (37.5%). Mean procedure time was significantly higher in patients who developed complications (75.92 ± 19.20 minutes) as well as mean exposure time was also significantly higher in patients who developed complications (12.00 ± 6.87 minutes) as compared to patients who did not develop any complication (8.08 ± 3.43 minutes) (p <0.05). Conclusion: It was concluded that the success rate in right and left lobe puncture was equal and complication rate in right lobe puncture was observed to be high as compared to left lobe puncture. Keywords: Biliary drainage, Complications, Effect, Liver