scholarly journals PROMPT RECOGNITION OF STUMPAPPENDICITIS IS IMPORTANT TO AVOID SERIOUS COMPLICATIONS: A CASE REPORT

2020 ◽  
pp. 1-2
Author(s):  
Anil Kumar M S ◽  
D. Shiva Manohar
Keyword(s):  
Psoas Abscess ◽  
Rare Condition ◽  
Late Complications ◽  
Retroperitoneal Abscess ◽  
Lower Quadrant ◽  
Stump Appendicitis ◽  
Histologic Evaluation ◽  
History Of ◽  
Appendicular Stump ◽  
The Right

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to stump appendicitis. A 50-year-old female was admitted with history of abdominal pain more in the right lower quadrant for 1 week. History of fever present since week associated with chills, History of poor stream of urine for 1 week, not associated with burning micturition. Her past medical history showed a laparoscopic appendectomy operation performed 5 months ago. Computed tomography of abdomen and pelvis showed features suggestive of right psoas abscess with possible communication with the tubular structure arising from IC junction (? appendicular stump), Ill-defined peripherally enhancing collection in presacral region and bilateral ischiorectal region -? Abscess. CECT Abdomen and pelvis showed right mild Hydroureteronephrosis. Cystoscopy + DJ stenting was done post which Exploration with drainage of retroperitoneal abscess with stump appendectomy done on 15/2/19. Intraoperatively 50cc pus with caseous material was drained, psoas was bulky. 3cm appendicular stump was noted, dissected, ligated and buried. A drain was placed in the site of the operation. Post-operative course was uneventful and he was discharged 9 days after surgery. The histologic evaluation reported suppurative stump appendicitis. Residual long stump of the appendix after appendectomy might lead to persistence of infection and possibly late complications such as intraperitoneal, retroperitoneal or iliopsoas abscess. Surgical exploration may be necessary in persistent cases of Retroperitoneal abscess, to allow for recognition and treatment of the underlying pathology.

scholarly journals A rare case of unilateral breast filariasis mimicking chronic mastitis

2021 ◽  
Vol 8 (7) ◽  
pp. 2228
Author(s):  
Varsha A. Sharma ◽  
Manmohan M. Kamat ◽  
Jeena K. Sathyan ◽  
Seema Barman ◽  
Shravani Shetye
Keyword(s):  
Benign Lesion ◽  
Rare Condition ◽  
Surgical Excision ◽  
Axillary Lymph Nodes ◽  
Excision Biopsy ◽  
Axillary Lymph ◽  
Presumptive Diagnosis ◽  
Lower Quadrant ◽  
History Of ◽  
The Right

Filariasis of the breast is a very rare condition. In India, largest number (around 600 million) of people live in endemic areas. Despite the huge number, it is quite rare to find microfilaria in routine smears and body fluids and it is even more rare to find it in breasts. A 40 years old female, presented with a history of lump in the right breast approximately 3x3 cm in size in the right lower quadrant. Findings were confirmed by clinical examination which did not reveal any palpable ipsilateral or contralateral axillary lymph nodes. FNAC showed it as a benign lesion. After local excision, histopathology revealed a filarial worm. Filariasis of the breast is a rare disease. The presence of microfilaria in breasts using FNAC has been reported at times but the presence of the filarial worms can only be confirmed on histopathology, hence a core biopsy or an excision biopsy is a must in all the cases. A presumptive diagnosis of filariasis can be made on sonography if the worms are alive and active, the typical presentation on USG is the filarial dance. Surgical excision of the lump followed by DEC therapy is the treatment of choice for filarial lump of the breast.

scholarly journals Psoas Muscle Infiltration Masquerading Distant Adenocarcinoma

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Kamel A. Gharaibeh ◽  
Arnaldo Lopez-Ruiz ◽  
Tauqeer Yousuf
Keyword(s):  
Ct Scan ◽  
Psoas Abscess ◽  
Psoas Muscle ◽  
Needle Aspiration ◽  
Imaging Studies ◽  
Lower Quadrant ◽  
History Of ◽  
Undifferentiated Adenocarcinoma ◽  
Poorly Differentiated ◽  
The Right

Malignant metastasis to the psoas muscle is rare. We report a case that clinically mimicked psoas abscess that was subsequently proven to be from metastatic disease secondary to adenocarcinoma of the duodenum. A 62-year-old male presented with a seven-month history of right lower quadrant abdominal pain and progressive dysphagia. CT scan of abdomen-pelvis revealed a right psoas infiltration not amenable to surgical drainage. Patient was treated with two courses of oral antibiotics without improvement. Repeated CT scan showed ill-defined low-density area with inflammatory changes involving the right psoas muscle. Using CT guidance, a fine needle aspiration biopsy of the right psoas was performed that reported metastatic undifferentiated adenocarcinoma. Patient underwent upper endoscopy, which showed a duodenal mass that was biopsied which also reported poorly differentiated adenocarcinoma. In this case, unresponsiveness to medical therapy or lack of improvement in imaging studies warrants consideration of differential diagnosis such as malignancy. Iliopsoas metastases have shown to mimic psoas abscess on their clinical presentation and in imaging studies. To facilitate early diagnosis and improve prognosis, patients who embody strong risk factors and symptoms compatible with underlying malignancies who present with psoas imaging concerning for abscess should have further investigations.

Coexistence of Stump Appendicitis and Ovarian Fibro-Thecoma in a Young Women with Recurrent Right Iliac Fossa Pain During Pregnancy; A Rare Case Report

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 59-62
Author(s):  
Sana Ansari
Keyword(s):  
Rare Case ◽  
Iliac Fossa ◽  
Previous History ◽  
Ovarian Mass ◽  
Lower Quadrant ◽  
Stump Appendicitis ◽  
Mixed Features ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Appendicular Stump

Ovarian Fibro-thecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian Fibro-thecoma is Uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumors. We describe a rare case of Fibro-thecoma in a 27- year women with a history of recurrent right iliac fossa pain during pregnancy associated with fever and vomiting with previous history of laparotomy for appendicular abscess 10 years back. She presented to us during pregnancy with this complain for which she was managed conservatively. She did not maintain her follow up regularly at our hospital and visited again after delivery of her baby with a still birth outcome with a newly diagnosed complex bilateral ovarian cyst demonstrated on ultrasound and computed tomography showed inflammatory Right sided tubo-ovarian mass along with inflammatory thickening of ileum in right lower quadrant adjacent to right ovarian mass lesion. The patient underwent laparotomy for this with the removal of mass along with the removal of appendicular stump for appendicular stump appendicitis which was diagnosed intraoperatively. The finding from histopathological examination of the mass was consistent with the diagnosis of Fibro-thecoma.

scholarly journals P043 Fascinating phosphate: seek and you will find

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jyoti Bakshi ◽  
Clare Batten
Keyword(s):  
Back Pain ◽  
Degenerative Change ◽  
Nasal Bone ◽  
Rare Condition ◽  
Whole Body ◽  
Excision Biopsy ◽  
Small Lesion ◽  
History Of ◽  
The Right ◽  
Fgf 23

Abstract Background/Aims  A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods  The case is discussed below. Results  Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion  Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure  J. Bakshi: None. C. Batten: None.

scholarly journals A Case of Unilateral Coccidioidal Chorioretinitis in a Patient with HIV-Associated Meningoencephalitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher B. Toomey ◽  
Andrew Gross ◽  
Jeffrey Lee ◽  
Doran B. Spencer
Keyword(s):  
Risk Factors ◽  
Vision Loss ◽  
Complement Fixation ◽  
Rare Condition ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Blurry Vision ◽  
Systemic Symptoms ◽  
The Right

Intraocular coccidioidomycosis is a rare condition, with the most commonly reported presentation being an idiopathic iritis in patients who live in or have traveled thorough endemic areas. A paucity of reports exists describing the chorioretinal manifestations of coccidioidomycosis. Here we report a case of unilateral coccidioidal chorioretinitis and meningoencephalitis in an AIDS patient that led to near complete unilateral loss of vision. A 48-year-old Hispanic female with poorly controlled HIV/AIDS in southern California presented with a three-week history of headache, nausea, vomiting, right eye blurry vision, and a one-day history of subjective fever. Examination of the right eye revealed vitritis and several large chorioretinal lesions scattered throughout the periphery and macula with optic disc pallor. Serum coccidioidomycoses complement fixation (CF) was positive (titers of 1 : 256). Neuroimaging revealed a new area of enhancement in the left anterior frontal lobe consistent with meningoencephalitis. The patient was treated with intravenous fluconazole and intravitreal voriconazole with resolution of systemic symptoms and vitritis but persistence of unilateral, severe chorioretinal scarring and vision loss. In conclusion, in spite of the rarity of intraocular coccidioidomycosis, one must carry a degree of suspicion for this vision- and life-threatening condition as a potential etiology of chorioretinitis in individuals with pertinent risk factors.

Thyroid tuberculosis: an unexpected diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e238795
Author(s):  
Alexandra Novais Araújo ◽  
Tânia Matos ◽  
João Boavida ◽  
Maria João Guerreiro Martins Bugalho
Keyword(s):  
Lymph Node ◽  
Positive Culture ◽  
Rare Condition ◽  
Pulmonary Involvement ◽  
Needle Aspiration ◽  
Tuberculous Infection ◽  
History Of ◽  
Right Lobe ◽  
Thyroid Tuberculosis ◽  
The Right

Mycobacterium tuberculosis (MTB) is an aerobic bacillus responsible for tuberculous infection. The the thyroid gland being affected by MTB is a rare condition. A 71-year-old woman had 6 months of slight cervical discomfort. Her neck ultrasound showed, at the right lobe of the thyroid, a dominant heterogeneous nodule of 18 mm and homolateral lymph nodes with suspicious ultrasonographic features. The patient underwent fine-needle aspiration, the results of which were non-diagnostic (thyroid nodule) and reactive pattern (lymph node). A total thyroidectomy was performed and a lymph node was sampled for extemporaneous examination. Surprisingly, necrotising granulomas were documented. The diagnosis was definitely established by a positive culture of the lymph node tissue and molecular detection of MTB. Pulmonary involvement was excluded and she was started on antituberculous agents. In the absence of systemic, specific complaints or history of exposition, histopathology and culture of MTB remain a key step for the diagnosis.

PSEUDOHYPOPARATHYROIDISM

PEDIATRICS ◽  
1949 ◽  
Vol 4 (6) ◽  
pp. 790-797
Author(s):  
M. G. PETERMAN ◽  
J. L. GARVEY
Keyword(s):  
Physical Examination ◽  
Mental Disease ◽  
Rare Condition ◽  
Palpebral Fissure ◽  
Pituitary Extract ◽  
History Of ◽  
Convulsive Disorders ◽  
Hoarse Voice ◽  
The Right ◽  
Hospital Clinic

THIS case is presented because the circumstances provided an unusual opportunity to review and study a rare condition. The child concerned had been diagnosed as having a case of hypothyroidism and epilepsy and the parents had been advised to place her in an institution. The child was referred to the authors in a further effort to obtain relief or advice. CASE HISTORY A 12 yr. old girl was examined because of "incessant talking in a silly, immature fashion; excessive greed for food and salt; lethargy, fatigue, over-affection and clumsiness, awkwardness, inability to skate or ride a bicycle." A year before admission she began to scream in her sleep once or twice every night. Six months later she began to scream during the day. The attacks of screaming occurred suddenly without warning. She abruptly stopped what she was doing, stared ahead and screamed in a loud, hoarse voice for several seconds. Immediately afterward, she was embarrassed and tried to withdraw from the scene. Treatment elsewhere with adequate doses of phenobarbital, tridione, benzedrine, thyroid and pituitary extract had been ineffective. Report of a previous examination at a university clinic was "moderately plump girl with a round face and lethargic appearance. There was narrowing of the right palpebral fissure and mild ataxia of the lower extremities. The physical examination was otherwise unimportant. The IQ was 80." Examination later at a hospital-clinic was reported as "revealing obesity and cretinism in spite of a basal metabolic rate of minus 6 and minus 7." Mother and father are intelligent and the 4 siblings are normal and well-adjusted. There is no history of convulsive disorders or mental disease.

scholarly journals A Rare Cause of Acute Abdomen: Perforation of Double Meckel’s Diverticulum

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
İlhan Tas ◽  
Serdar Culcu ◽  
Yigit Duzkoylu ◽  
Sadik Eryilmaz ◽  
Mehmet Mehdi Deniz ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Meckel’S Diverticulum ◽  
Ileocecal Valve ◽  
Rare Condition ◽  
Meckel's Diverticulum ◽  
Rare Entity ◽  
Lower Quadrant ◽  
X Ray ◽  
The Right ◽  
Right Lower Quadrant

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. In this report, we aimed to represent a case of intestinal perforation, caused by double Meckel’s diverticulum, which is a very rare entity in surgical practice. The patient was a 20-year-old Caucasian man, admitted to hospital with complaints of abdominal pain, nausea, and vomitting during the last 3 days. Physical examination indicated tenderness, rebound, and guarding in the right lower quadrant of abdomen. Abdominal X-ray revealed a few air-liquid levels in the left upper quadrant. In the operation, 2 Meckel’s diverticula were observed, one at the antimesenteric side, at 70 cm distance to the ileocecal valve, approximately in 3 cm size, and the other between the mesenteric and antimesenteric sides, approximately in 5 cm size. The first one had been perforated at the tip and wrapped with omentum. A 30 cm ileal resection, including both diverticula with end-to-end anastomosis, was performed. The diagnosis of symptomatic Meckel’s diverticulum is considerably hard, especially when it is complicated. Diverticulectomy or segmentary resections are therapeutic options. In patients with acute abdomen clinic, Meckel’s diverticulum and its complications should be kept in mind, and the intestines should be observed for an extra diverticulum for caution although it is a very rare condition.

Case 11.3

2014 ◽  
pp. 534-535
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Left Ovary ◽  
Quadrant Pain ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Weighted Image ◽  
Right Lower Quadrant Pain ◽  
History Of ◽  
The Right ◽  
Superior Margin ◽  
Right Lower Quadrant

11-year-old girl with a 3-month history of increasing intermittent right lower quadrant pain Coronal oblique FSE T2-weighted images (Figure 11.3.1) demonstrate a markedly enlarged right ovary that contains a prominent cyst (the normal left ovary can be seen along the left superior margin of the right ovary, with multiple small follicles). Sagittal fat-suppressed FSE T2-weighted image (...

Bilateral Preiser Disease in a Patient with Sickle Cell Anemia

2020 ◽  
Author(s):  
Joseph Catapano ◽  
Oluwatola O. Overduin ◽  
Herbert P. von Schroeder
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Scaphoid Fracture ◽  
Rare Condition ◽  
Dominant Male ◽  
Resonance Imaging ◽  
Steroid Use ◽  
History Of ◽  
The Right ◽  
Vascularized Bone

AbstractPreiser disease is a rare condition of avascular necrosis of the scaphoid occurring in the absence scaphoid fracture or trauma. While the etiology of Preiser disease remains unknown, it has been associated with steroid use, chemotherapy, and infrequently with systemic diseases. No reports have associated Preiser disease with hemoglobinopathy. Due to the rarity of Preiser disease, management remains controversial and evidence is limited. Here, we describe the case of a 32-year-old right-hand dominant male with sickle cell anemia and a 4-year history of bilateral wrist pain. Radiographs and gadolinium-enhanced magnetic resonance imaging revealed bilateral Preiser disease. He was successfully managed with a 1,2 intercompartmental supraretinicaular artery vascularized bone graft to the right scaphoid.

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