Journal of Medical Case Reports最新文献

Background: Only a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo-Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures.

Case presentation: The patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury.

Conclusions: Immediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments.

Background: Cystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment.

Case presentation: A 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement.

Conclusion: Cystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation.

Background: Calcifying epithelial odontogenic tumor is a rare benign tumor that predominantly occurs in posterior sites of the mandible in adults.

Case presentation: This case report describes a case of calcifying epithelial odontogenic tumor in a 37-year-old Iranian female with the chief complaint of swelling in the anterior region of the mandible and tooth displacement. This paper summarized the pathological findings, radiographical features and clinical management of the patient. Clinical examinations revealed a bony hard swelling ~ 3 cm × 4 cm in size with tenderness in the chin area. Radiography revealed an expansile mixed radiolucent and radiopaque lesion with cortical borders. A minimally aggressive surgical approach is used to remove the lesion.

Conclusion: This case report outlines the successful outcomes of this surgical approach and the positive outcome associated with the restoration of lost functions of displaced mobile teeth in an arranged and nonmobile way after treatment.

Background: Synchronous abscesses of the prostate and seminal vesicles represent a rare but clinically significant form of purulent retention. They pose diagnostic and therapeutic challenges and are associated with considerable morbidity and a high risk of sepsis.

Case presentation: We present the case of a 60-year-old Caucasian man with a history of insulin-dependent diabetes mellitus, who had a voluminous prostatic abscess associated with a right seminal vesicle abscess due to compression of the right ejaculatory duct, and who presented to our department with sepsis. He had clinical and radiological confirmation with computed tomography scan and magnetic resonance imaging. The patient underwent percutaneous drainage of the prostatic abscess resulting in the subsidence of the seminal vesicle abscess. The treatment also consisted on prolonged antibiotic therapy. The clinical evolution was favorable.

Conclusion: We conclude that prostatic abscesses can lead to synchronous seminal vesicle abscesses due to ejaculatory duct compression. Percutaneous drainage of the prostatic abscess by transrectal ultrasound-guided drainage, combined with prolonged antibiotic therapy, can effectively treat both abscesses.

Background: Histoplasma is a fungal pathogen found in many parts of the world. In North America, its distribution is traditionally thought to be endemic to the Ohio and Mississippi River valleys. Development of histoplasmosis after Histoplasma exposure is related to degree of inoculum exposure and susceptibility, for example, immunocompromised status. Most exposed, healthy individuals are asymptomatic and few develop pulmonary symptoms. A limited number of infectious etiologies (that is, Histoplasma, Coccidioides, and Mycobacterium tuberculosis) can cause miliary pattern on chest imaging, and thus, histoplasmosis should be considered whenever a patient presents with pulmonary symptoms and these unique radiographic findings.

Case presentation: A previously healthy 13-year-old Hispanic male presented as a transfer from an outside hospital with fever and hypoxia in the setting of a progressive, subacute gastrointestinal illness. Given hypoxia, the concern for sepsis, and unclear etiology of his illness, broad-spectrum antimicrobial therapy and noninvasive ventilation were started. Initial evaluation demonstrated miliary pulmonary infiltrates, and travel history raised suspicion for coccidioidomycosis or tuberculosis. After a complete evaluation, lab studies confirmed a diagnosis of histoplasmosis, and the patient made a full recovery after the initiation and completion of antifungal therapy.

Conclusion: Herein, we present a patient who acquired histoplasmosis from an area of Mexico not currently acknowledged as endemic and review recently published data emphasizing new areas of Histoplasma endemicity in North America, particularly the southwest USA and most states of Mexico. Though limited surveillance data exist, mounting case reports/series and local epidemiologic studies illustrate the expanding worldwide endemicity of Histoplasma and underscore histoplasmosis as a growing global health concern.

Introduction: Ludwig angina is a rare, rapidly spreading submaxillary, submandibular, and sublingual necrotizing life-threatening widespread cellulitis of the soft tissue on the floor of the mouth that can cause fatal complications because of airway obstruction. Currently, there are few published studies assessing the efficacy of superficial cervical plexus block for airway surgery and there is no agreement in the literature about airway management. The published recommendations differ and are based on the authors' own experiences and available resources. This report aimed to provide insight into critical patient management by performing regional anesthesia with fewer complications to the cardiovascular and respiratory systems.

Case presentation: We report the case of a 70 year-old hypertensive Black Ethiopian woman with American Society of Anesthesiologist-Physical Status class III and hypertension, who was admitted to the hospital for treatment by her surgeon. The surgeon diagnosed her with Ludwig angina. After adequate physical examination and laboratory investigation, she arrived at the operation room for exploration and drainage of the abscess with a superficial cervical plexus block. She arrived safely at the adult intensive care unit for frequent suctioning. The block was effective until 6 h after the procedure with visual analogue scale (2/10), her vital signs remained stable throughout the postoperative period, and then the tracheostomy tube was removed by the surgeon after 10 days. The patient's hemodynamic status and breathing effort were satisfactory, and she was discharged 15 days later.

Clinical discussion: Proper airway management is critical for the survival of patients diagnosed with Ludwig angina. According to recent studies, an increasing number of patients with Ludwig angina require intensive care unit admission for tracheal intubation and mechanical breathing. However, it is uncertain whether intensive care reduces the death rate in patients with Ludwig angina. Finally, it is suggested that studies with large sample sizes and strong levels of evidence be conducted to conclude the effectiveness of superficial cervical plexus block for airway emergency surgeries.

Conclusion: Management of the airway in patients with Ludwig angina is challenging. Clinicians must take precautions and make sharp decisions on the basis of a variety of circumstances, including the availability of equipment at medical facilities, such as fiberoptic intubation equipment; the anesthetist's level of experience, such as performing superficial regional block and good mask ventilation; and the patient's medical status at the time of presentation. As a result, intervention needs to be quick so as to avoid airway obstruction and further complications.

Background: The complications associated with cardiac device implants ranges between 5.3% and 14.3%. Cardiac perforation due to "leads" represent a very rare complication of cardiac device implantation, ranging between 0.3% and 0.7%. Clinically, they can manifest different, nonspecific symptoms; hence, the diagnosis may not be immediate.

Case presentation: Our clinical case describes the successful treatment of cardiac tamponade occurring in a Caucasian 79-year-old man following a pacemaker implantation. Two days after the procedure, the patient reported an episode of nonspecific chest pain associated with syncope. The echocardiogram performed revealed a pericardial effusion in the apical area, along the right chambers, with a thickness of 7 mm, not hemodynamically significant. A chest computed tomography scan with contrast showed hemopericardium (maximum thickness of 11 mm), caused by an atrial perforation. A few hours later, the patient experienced hemodynamic instability. For this reason, an urgent sternotomy was performed with drainage of a significant hemopericardial effusion, revealing a perforation of the upper free wall of the right atrium with pericardial injury caused by the retractable screw lead. The perforation site was sutured and the sternal wound was closed. The patient was discharged after 4 days without further complications. At the control visit, scheduled 30 days after the hospital discharge, the patient was in good conditions.

Conclusions: Although the atrial perforations from leads are very rare complications of pacemaker implantation procedures, they are potentially lethal. In conclusion, this clinical case highlights the need, before hospital discharge, of an accurate screening for evaluation the pericardial effusion in patients that undergo to the cardiac implantable electronic devices.

Background: Juxtaposition of the atrial appendages is an extremely rare congenital cardiac malformation. It is usually discovered incidentally during autopsy or surgery. This report aims to increase awareness of right juxtaposition of the left atrial appendage.

Case presentation: We report a Chinese Han female aged 2 years and 10 months with recurrent lung infections after birth, who was diagnosed with congenital heart disease, corrected transposition of the great arteries, ventricular septal defect, and arterial ductus arteriosus at the local hospital and improved after the pulmonary artery banding procedure. The patient presented to our hospital with intermittent cough. During preoperative evaluation, a review of imaging data revealed a right juxtaposition of the left atrial appendage on enhanced computed tomography.

Conclusion: Right juxtaposition of the left atrial appendage is a rare congenital heart anomaly that often occurs in conjunction with complex cardiac malformations. Diagnosis requires a combination of imaging modalities to improve detection rates. Careful identification of cardiac structures during surgery is crucial, as alterations in cardiac anatomy may increase surgical risks. For instance, the opening of juxtaposed atrial appendages could be mistaken for an atrial septal defect.

Introduction: Sarcomas with muscle differentiation (for example, rhabdomyosarcoma, leiomyosarcoma, and pleomorphic sarcoma) are uncommon in the adult bladder.

Case presentation: In this case report, we describe a 69-year-old Chinese male patient who presented to the urology outpatient clinic because of intermittent full-course macroscopic hematuria for 10 days. A B ultrasound indicated hypoechoic nodules in the right upper wall of the bladder. Transurethral resection of the bladder tumor and cystoscopic multipoint random biopsy was performed. Postoperative pathological findings showed pleomorphic rhabdomyosarcoma of the adult bladder. Later, he was transferred to the Department of Medical Oncology of our hospital for further postoperative chemotherapy. The chemotherapy regimen used was intravenous chemotherapy of dacarbazine with doxorubicin. The patient in this case has survived for 12 months postoperatively.

Conclusion: From this case, our elderly patient with early pleomorphic rhabdomyosarcoma of the urinary bladder received transurethral resection of bladder tumor and postoperative chemotherapy, and there had been no recurrence 12 months postoperatively. The aforementioned treatment modality may offer a favorable prognosis.

Background: Mucormycosis is a severe and fatal fungal infection in patients with coronavirus disease 2019 caused by Mucorales. Here we present a case of a 63-year-old man with coronavirus disease 2019 infection, along with rhinosinusitis mucormycosis caused by Rhizopus delemar.

Case presentation: A 63-year-old Iranian man suffering from a coronavirus disease 2019 infection with symptoms of cough, shortness of breath, and generalized body pain. On the basis of the clinical manifestations, such as headache, a history of black nasal discharge, nasal hypoesthesia, facial swelling, numbness, nasal obstruction, presence of necrotic lesions on the nasal passages on physical examination, and abnormal computed tomography scans of paranasal sinuses, the patient underwent surgical debridement. Direct microscopy of specimens obtained from the paranasal sinuses, and subsequent isolation and identification, revealed a rhinosinusitis mucormycosis caused by R. delemar. Despite therapeutic measures, such as sinus debridement surgery and antifungal therapy with amphotericin B injection (50 mg/day), the patient died after 35 days of hospitalization.

Conclusion: In this report, we present the first documented case of human infection with R. delemar in a patient with coronavirus disease 2019 infection, who also exhibited rhinosinusitis mucormycosis. R. delemar appears to be an emerging agent of rhinosinusitis mucormycosis in this region. Furthermore, prompt diagnosis and the exploration of alternative antifungal treatments, beyond amphotericin B, may be crucial for effectively managing patients with R. delemar infections.