American Journal of Case Reports最新文献

BACKGROUND Perivascular epitheloid cell neoplasm (PEComa) is a rare mesenchymal tumor that is evaluated in the same tumor family as angiomyolipoma, sugar cell tumor of the lung, and lymphangioleiomyomatosis. Immunohistochemically, the disease can express melanocytic and myogenic markers, such as HMB45, HMSA1, MelanA/Mart1, and actin. The disease can be seen in almost every organ, especially the uterus and retroperitoneum. Adrenal gland-derived PEComa is extremely rare and leads to difficulties in diagnosis. Here, we present a case of a adrenal gland PEComa in which we applied postoperative radiation therapy. CASE REPORT A 24-year-old female patient visited the doctor in April 2022 due to abdominal pain that had been increasing steadily for the previous few months. Abdominopelvic computed tomography shows a solid mass of 10 cm on the right adrenal gland. Right adrenal gland mass excision surgery was performed in May 2022. The pathology was reported as malign PEComa. The patient was admitted for postoperative radiotherapy because of uncertainty about the surgical boundaries. Systemic treatment was not required. A fraction dose of 4680 cGy/26 was applied by 8-field IMRT to the tumor bed area. In December 2022, the patient's radiotherapy was completed. No acute adverse effects from the radiotherapy were observed. The patient's follow-up after treatment continued, without disease and long-term adverse effects. CONCLUSIONS Surgical resection is the primary treatment approach in the treatment of localized disease. Although the literature is far from making a clear recommendation on adjuvant therapy, pathologic risk factors should be considered when deciding on adjuvant therapy.

BACKGROUND Acute epiploic appendagitis is an uncommon cause of acute abdominal pain characterized by pain in the left or right lower quadrants of the abdomen. It is caused by torsion or spontaneous venous thrombosis of one of the epiploic appendages, which are found along the colon, most commonly in the sigmoid colon. The literature consistently compares the presenting symptoms and clinical picture of acute epiploic appendagitis to acute diverticulitis and acute appendicitis. However, ovarian torsion is not reported as a differential diagnosis for this pathology in the literature. CASE REPORT This case report demonstrates a female patient in her late 30s presenting with acute left iliac fossa pain associated with vomiting, in the context of a negative beta-hCG blood test. The history of severe unilateral intermittent pelvic pain progressing to constant pain associated with vomiting led to a working differential diagnosis of ovarian torsion. A bimanual vaginal examination was positive for tenderness in the left iliac fossa with no palpable adnexal masses or cervical motion tenderness. Therefore, the patient underwent an emergency diagnostic laparoscopy and was found to have normal ovaries, with torsion of an epiploic appendage identified. A diagnosis of acute epiploic appendagitis was made. CONCLUSIONS This case report demonstrates the importance of considering acute epiploic appendagitis as a rare differential diagnosis for ovarian torsion in female patients. With the management of this pathology being non-operative, identification of this condition on ultrasound or computed tomography is essential in avoiding unnecessary surgery for patients with this pathology.

BACKGROUND Most Fusobacterium necrophorum infections originate in the head and neck region. Infections originating from sites other than the head and neck are rare but are more common in older than in younger adults and have a higher mortality rate than that of infections originating from the head and neck region. CASE REPORT We present the case of a previously healthy 16-year-old female patient who developed bacteremia and pleural effusions with a burn ulcer on the lower leg but had no abnormality in the head and neck region. She sustained a second-degree burn injury on the left shin that remained untreated for several weeks, resulting in the development of Fusobacterium necrophorum bacteremia. She was admitted after developing fever, chest pain, and dyspnea. Blood culture revealed Fusobacterium necrophorum, but no abnormality was noted in the head and neck region, and a second-degree burn was observed on the left shin. She had bilateral pleural effusions assumed to result from a burn ulcer and was intravenously treated with tazobactam/piperacillin and therapeutic thoracentesis. She responded to therapy and made a full recovery. CONCLUSIONS While the origin of the Fusobacterium necrophorum infection in the burn ulcer could not be detected, this case report suggests that burn ulcers are a potential source of systemic Fusobacterium necrophorum infection and highlights the importance of early medical and surgical treatment and antimicrobial therapy.

BACKGROUND Amyloidosis is a group of diseases characterized by the pathological deposition of misfolded proteins in various organs, including the heart, leading to structural and functional alterations. The primary types of cardiac amyloidosis are light chain amyloidosis and transthyretin amyloidosis. Early diagnosis is critical for effective management. This report describes the case of a 68-year-old Colombian man presenting with heart failure and a diagnosis of cardiac amyloidosis. CASE REPORT A 68-year-old man presented with heart failure symptoms, biceps tendon rupture, neuropathic pain in the extremities, and an electrocardiogram showing low QRS voltage and a pseudo-infarct pattern. Transthoracic echocardiogram revealed a left ventricular ejection fraction of 30%, severely thickened walls with a speckled appearance, a global longitudinal strain of -6.2% in a bull's eye pattern, and a left ventricular posterior wall thickness of 21.3 mm. Cardiac magnetic resonance imaging showed severe symmetric hypertrophy, moderate global dysfunction, and an elevated native T1 value of 1225 milliseconds. Post-gadolinium T1 mapping revealed a significantly increased extracellular volume of 72%. Perugini grade 3 pyrophosphate scintigraphy, negative hematological tests, and endomyocardial biopsy confirmed the diagnosis of amyloidosis, without monoclonal spikes. Genetic testing identified a heterozygous c.424G>A (p.Val142Ile) variant in the transthyretin gene, consistent with variant transthyretin amyloidosis. CONCLUSIONS Amyloidosis may affect up to 13% of patients with heart failure and preserved ejection fraction. Early recognition of red flags and implementation of a diagnostic algorithm are crucial for timely intervention in this population.

BACKGROUND Optic disc melanocytoma (magnocellular nevus of the optic disc) is a benign congenital pigmented tumor, usually unilateral, asymptomatic, and mostly discovered in routine examinations in adult patients; however, it is associated with choroidal neovascularization. It can be difficult to differentiate it from juxta-papillary choroidal melanoma. Aflibercept is a monoclonal antibody targeting vascular endothelial growth factor A (anti-VEGF-A). This report describes a 54-year-old man with a diagnosis of optic disc melanocytoma complicated by choroidal neovascularization who was treated with intravitreal injection of anti-VEGF-A with intermittent follow-up. CASE REPORT A 54-year-old man received a diagnosis of asymptomatic right optic disc melanocytoma in a routine examination in 2015. We decided to follow up every 6 months, and 1 year later, due to growth of the lesion, we performed magnetic resonance imaging to exclude malignant transformation. The patient was lost to follow-up from 2019 to 2021. He came back 6 years after diagnosis, and fundus examination revealed multiple perilesional and macular exudates. We diagnosed a neovascular membrane by multimodal imaging. According to recommendation from our expert colleagues at the Curie Institute, he was treated with intravitreal injection of anti-VEGF-A with intermittent follow-up, and the evolution was favorable. CONCLUSIONS Optic disc melanocytoma is a rare benign tumor, but neovascularization can occur in <1% of cases. Because it is a very pigmented lesion, we need multimodal imaging to diagnose choroidal neovascularization. Choroidal neovascularization associated with magnocellular nevus of the optic disc can be successfully treated by intravitreal VEGF-A in a "treat and extend" protocol.

BACKGROUND Due to the complexity of the golf swing, poor form affects performance and lead to injuries in the spine and extremities. The Titleist Performance Institute (TPI) has created a movement screen to identify a golfer's physical limitations. The TPI includes 16 movement patterns within a golfer's swing that could lead to poor performance, dysfunction, and pain. TPI recommends specific exercises to address any dysfunctions. CASE REPORT This case report examined the benefit of a TDI-specific exercise program for a 78-year-old man with a history of low back pain and decreasing golf performance. Treatments included 3 sessions over 10 weeks, including lumbar stabilization exercises, balance training, and manual therapy. The dependent variables were the TDI movement screen, Trackman Driver analysis, and 3D Kvest Swing analysis. The patient's main goal was to increase driving distance and be able to play a round of golf without pain. The patient's specific functional scale showed that trunk rotation, right shoulder mobility, and hamstring length improved. His TPI Fitness handicap decreased, and his Trackman Driver averages improved. CONCLUSIONS This case report demonstrates that the TDI movement screen and TDI-recommended exercises in combination with manual therapy improved a golfer's TPI composite score, overall performance, and kinematic sequencing. Although, based on a case report, cause and effect cannot be established, it does appear that interventions, in this case, contributed to a decrease in low back pain and self-reported disability, improved golf swing and performance, and met the patient's objectives.

BACKGROUND Cardiac tumors are divided into 2 categories: primary, originating from the heart, and metastatic, which spread to the heart from a different location, with metastatic tumors representing the vast majority. Cardiac tumors, depending on the size and location, can predispose patients to arrhythmic or hemodynamic complications. We present a patient with a history of B-cell lymphoma (DLBCL) in remission for 3 years who developed acute onset congestive heart failure and complete heart block secondary to DLBCL invasion of the myocardium. CASE REPORT A 67-year-old female patient with a history of stage IV double-hit DLBCL in remission for 3 years presented with acute-onset heart failure. Nuclear medicine PET/CT revealed a massive poorly defined right lower anterior mediastinal mass extending into the entire cardiac base and right ventricular myocardium, with cardiophrenic and retroperitoneal adenopathy. Vital signs and laboratory test results were significant for a heart rate of 56 beats per min (bpm) and elevated brain natriuretic peptide. Electrocardiogram was significant for a complete heart block, maintained by a junctional escape rhythm. Biopsies of the mass revealed recurrence of DLBCL. The patient was treated with diuretics and later started on RICE chemotherapy. CONCLUSIONS Mediastinal DLBCL infiltrating the myocardium is aggressive and presents a treatment dilemma, as retreat of the mass from emergency chemotherapy can result in catastrophic complications. Our patient's condition, rarely described in literature, was severe blood flow obstruction and significant arrhythmia, both of which improved after only 1 cycle of chemotherapy and without need for permanent pacemaker.

BACKGROUND The thumb is crucial for the aesthetic and functional aspects of the upper extremity. A crushed thumb injury can be particularly challenging, especially for individuals with high demands. Currently, there is no consensus on the best approach for treating a crushed thumb. The scapular flap, vascularized by the subscapular artery system, shows great potential as a free flap option. This report aims to highlight the use of a triple flap procedure to preserve the function of the crushed thumb. CASE REPORT A 47-year-old man had a severe injury to his left hand, resulting in significant soft tissue damage in the thenar region, an amputated thumb, and multiple fractures in the phalanx and metacarpal bones. The case was managed using a combination of scapular, parascapular, and osteo-cutaneous parascapular flaps. The first surgery focused on debridement and preserving viable structures, while the second surgery, performed 3 days later, involved the creation of a triple flap, utilizing the circumflex scapular artery and thoracodorsal artery as skin paddles. The flap remained viable, and 6 months postoperatively, the patient regained significant strength and functionality in his left hand. CONCLUSIONS This case demonstrates that severe hand injuries with thumb amputation require a strategic approach based on wound condition and reconstruction feasibility. Triple flaps can be an effective option for such injuries. This report highlights the challenges of treating severe hand crush injuries and emphasizes the importance of personalized surgical approaches for optimal outcomes.

BACKGROUND Necrobiotic pulmonary nodules represent an exceptionally rare extraintestinal manifestation of inflammatory bowel disease (IBD), comprising conditions such as Crohn's disease and ulcerative colitis. These nodules pose significant diagnostic challenges, often mimicking autoimmune pathologies like sarcoidosis, rheumatoid arthritis, and other granulomatous diseases, thereby complicating the clinical management of affected patients. The rarity and nonspecific clinical presentation of necrobiotic pulmonary nodules necessitate a reliance on a combination of radiological and histological findings for accurate diagnosis. Herein, we discuss a 36-year-old woman with necrobiotic pulmonary nodules, underscoring this rarity and application of a surgical diagnostic approach. CASE REPORT This case study describes a 36-year-old woman with ulcerative colitis who developed necrobiotic pulmonary nodules, a rare extraintestinal manifestation of IBD with initial presentation of persistent cough. Further investigations revealed multiple bilateral lung nodules through computed tomography (CT) and positron emission tomography (PET) scans. CT-guided biopsy was not conclusive; therefore, uniportal video-assisted thoracoscopic surgery (VATS) was done for histological confirmation, which indicated necrosis without evidence of malignancy or infection. CONCLUSIONS The diagnosis of necrobiotic pulmonary nodules represents a formidable challenge in clinical practice, largely attributable to their rarity and the limited number of documented cases in the medical literature, with only 7 instances reported thus far. Compounding this difficulty is their clinical and radiological similarity to various autoimmune and infectious conditions, which often leads to diagnostic ambiguity. This case study underscores the utility of VATS as a diagnostic tool that is minimally invasive in the management of necrobiotic pulmonary nodules.

BACKGROUND Occipital neuralgia is a headache caused by irritation or damage to the occipital nerves situated at the rear of the head and neck. It is characterized by sharp, stinging, or electric shock-like pain in the distribution area of the occipital nerve, which often causes patients acute pain and discomfort. To report on the feasibility of non-drug therapy in addressing this condition, we present a case report showcasing the remarkable improvement in occipital neuralgia symptoms achieved with a single acupuncture session, followed by a brief period of care. CASE REPORT The patient was a 76-year-old man who had persistent head pain for over a decade. This pain significantly disrupted his daily activities and diminished his quality of life. Seeking to avoid pharmacological treatments, with their associated adverse effects, and invasive surgical procedures, the patient opted for acupuncture treatments. Over a period of 12 days, the patient underwent 6 acupuncture sessions, each carefully planned and performed by a skilled acupuncturist, ensuring utmost safety and precision. Astonishingly, following the very first session, the patient reported significant alleviation from his head pain. CONCLUSIONS Although the initial approach to managing occipital neuralgia often primarily revolves around conservative drug treatment, acupuncture has emerged as a highly effective modality in alleviating pain symptoms associated with this condition. The favorable outcome of this case report provides convincing evidence that acupuncture can serve as a highly advantageous treatment approach for occipital neuralgia. This case report acts as an encouraging starting point, facilitating the investigation of non-invasive and non-pharmacological pain management strategies.