Clinical Case Reports最新文献

Tracheal diverticulum is a rare paratracheal air cyst. It is often asymptomatic. Large symptomatic cases may compress the recurrent laryngeal nerve (RLN) and cause hoarseness. It is a rare presentation, in < 0.2 cases per year in the world. We present a 45-year-old woman that had 6 months of chronic cough, dysphagia, odynophagia, dyspnea, hoarseness, hemoptysis, choking, and neck pain. She was not a smoker. Spirometry showed mild obstruction pattern (FEV1 78%). CT with 3D reconstruction revealed a 4 × 5 cm right posterolateral tracheal diverticulum (fifth–seventh rings, 8 mm communication). Bronchoscopy confirmed limited right vocal cord mobility. We did an open cervical excision that preserved the RLN. Histopathology confirmed acquired diverticulum. Hoarseness resolved in 3 weeks; repeat bronchoscopy showed normal vocal cord mobility. 3-month CT confirmed resolution; 1-year FEV1 improved. Asymptomatic at 12 months. Systematic review (1998–2025) found 4 prior hoarseness cases (total n = 5): 60% female, 80% right posterolateral, mean size 3.0 cm, 80% complete recovery in 3 weeks via open surgery. Largest reported diverticulum is with hoarseness. This is the first case with documentation of RLN stretching and quantitative improvement with spirometry. Multimodal imaging and early open excision with nerve preservation can cause excellent outcomes.

Lemmel's syndrome can cause obstructive jaundice due to a periampullary duodenal diverticulum, leading to biliary obstruction without stones or tumors. The blockage can be intermittent as stasis in the diverticulum promotes enterolith or debris formation, which may temporarily obstruct the bile duct, causing fluctuating symptoms.

Kartagner syndrome is a rare congenital autosomal recessive disorder of ciliary movement, characterized by triad of chronic sinusitis, situs inversus and bronchiectasis leading to recurrent chest and sinuses infections. The primary objectives of this case report is to highlight the presentation of this rare disorder, its surgical challenge with minimally invasive procedures, and contribute to literature of this rare syndrome in pediatric patient of 9-year-old female presented with a complaint of high grade fever and productive cough for 3 days. The X-ray findings showed Dextrocardia and right sided stomach gas, suggesting Situs inversus. The chest computerized tomography revealed right side apex beat, aortic arch on right side and right lower lobe bronchiectasis. Considering these clinical signs and radiological examination, the patient was diagnosed with Kartagener's syndrome. During Hospitalization, along with conservative treatment, the patient had undergone successful thoracoscopic right lower lobectomy for bronchiectasis secondary to Kartagener's syndrome. This case report presents a rare disorder, highlights the importance of considering Kartagener's syndrome as a differential diagnosis in patients with recurrent respiratory infection and atypical radiological findings such as situs inversus. Surgical management such as thoracoscopic right lower lung lobectomy requires expertise due to atypical anatomical arrangement. This case contributes to the existing literature of Kartagener's syndrome in pediatric patients and provides its effective comprehension of surgical management and emphasizes the need for timely intervention by experienced surgeons.

Erdheim–Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized by multisystem involvement and frequent diagnostic delay due to nonspecific clinical manifestations. We report a 42-year-old asymptomatic man with persistently elevated erythrocyte sedimentation rate (ESR) detected during routine laboratory evaluation. Physical examination revealed bilateral peri-ocular xanthomas. Multimodal imaging demonstrated bilateral perirenal soft-tissue infiltration with a characteristic “hairy kidney” appearance on computed tomography, symmetric skeletal involvement on bone scintigraphy, and metabolically active lesions on ¹⁸F-FDG PET/CT. Histopathological examination of a peri-ocular xanthoma biopsy revealed CD68-positive, CD1a-negative foamy histiocytes, confirming the diagnosis of Erdheim–Chester disease. Given the patient's oligosymptomatic presentation and absence of critical organ involvement, a watch-and-wait strategy with close surveillance was adopted. This case highlights the diagnostic value of subtle clinical findings, such as isolated inflammatory marker elevation and peri-ocular xanthomas, and emphasizes the importance of accessible tissue biopsy combined with characteristic imaging features for early diagnosis of ECD.

Giant cervical decidual polyps during pregnancy increase the risk of miscarriage and preterm delivery; however, optimal management has not yet been established. We report the case of a pregnant woman who presented at 11 weeks of gestation with a bleeding 4-cm cervical polyp. Oral lactoferrin and probiotics (Clostridium butyricum, Enterococcus faecium, and Bacillus subtilis) were administered. The polyp stalk near the external cervical os was ligated with triclosan-coated polydioxanone, resulting in necrosis and removal at 13 weeks, with complete resolution by 14 weeks. Vaginal Lactobacillus spp. increased and cervicitis resolved by 20 weeks without the use of antibiotics, despite the presence of Ureaplasma and/or Mycoplasma in vaginal secretions. The patient delivered a healthy infant at 40 weeks. This case highlights a minimally invasive strategy—polyp ligation combined with lactoferrin and probiotics—to help restore vaginal homeostasis, avoid the use of antibiotics, and achieve a favorable pregnancy outcome.

Hypercoiling of the umbilical cord can lead to fetal growth restriction and stillbirth because the cord is vulnerable to blood flow disturbances caused by external forces. A single umbilical artery (SUA) is a relatively common abnormality; however, isolated SUA is associated with fetal growth restriction and stillbirth. We report a case of fetal growth restriction with both SUA and hypercoiling. A 27-year-old primigravida was evaluated at 37 weeks of gestation. Prenatal ultrasonography revealed a small-for-gestational-age fetus with a single umbilical artery and a hypercoiled umbilical cord. Continuous fetal monitoring was initiated upon admission. Cardiotocography demonstrated recurrent prolonged decelerations, necessitating an emergency cesarean section. Placental histopathology revealed fetal vascular malperfusion with hyalinized avascular villi and thrombotic occlusion of one umbilical artery, indicating disturbed fetoplacental circulation likely related to SUA and hypercoiling. The coexistence of hypercoiling and a single umbilical artery was associated with the risk of fetal vascular malperfusion and growth restriction. Careful antenatal surveillance and timely delivery are essential to prevent adverse perinatal outcomes in multiple umbilical cord anomalies.

Iatrogenic retained foreign bodies can occur even after minimally invasive procedures like liposuction or dental interventions. Persistent or unexplained cutaneous symptoms should raise clinical suspicion. Early imaging and prompt removal are crucial to prevent complications and ensure patient safety.

Young adults presenting with acute psychiatric symptoms followed by rapid neurological decline, catatonia, and autonomic instability should prompt consideration of anti–NMDA receptor encephalitis, even without detectable tumors; early recognition and immunotherapy are critical for favorable neurological recovery.

Papillary tumor of the pineal region (PTPR) is a rare central nervous system neoplasm with an unpredictable clinical course. Gross total resection, the preferred treatment, is often unachievable due to the tumor's deep-seated location, necessitating alternative therapies. We report the case of a 24-year-old male with recurrent grade 3 PTPR. Initial subtotal resection followed by adjuvant volumetric modulated arc therapy (50.4 Gy in 28 fractions) failed to control tumor progression. After a second subtotal resection for recurrence, the patient underwent fractionated stereotactic radiotherapy (fSRT) using Gamma Knife Icon, delivering a total dose of 28 Gy in eight fractions. One year post-fSRT, significant tumor shrinkage was observed, and the patient maintained clinical stability. This case highlights fSRT's potential as an effective salvage treatment for recurrent PTPR, particularly in anatomically challenging regions where gross total resection is not feasible. To our knowledge, this is the first report detailing the successful use of fractionated Gamma Knife radiosurgery for a large, recurrent primary PTPR refractory to previous multimodal treatment, suggesting a valuable therapeutic option for this challenging condition.

Melatonin is a neurohormone that primarily regulates sleep patterns and circadian rhythms by interacting with melatonin receptors MT1 and MT2. Disruptions in circadian rhythms may contribute to mood disorders; for example, individuals with major depressive disorder often have significantly lower melatonin levels compared to healthy individuals. In this report, we present a patient who experienced a depressed mood and nighttime sleep disturbances and was treated with melatonin. In patients with depression, factors such as insomnia or poor psychosocial conditions can increase the risk of suicidal thoughts.