BJR Case Reports最新文献

Spontaneous rupture of ovarian dermoid cysts is uncommon. We describe a case of a 32-year-old female who presented to the emergency room with abdominal pain and distension. The patient was discovered to have a ruptured dermoid cyst which caused chemical peritonitis and was managed surgically.

Giant cell tumours (GCTs) of the larynx are extremely rare. The most affected structure is the thyroid cartilage and only 44 cases are reported in the literature.¹ Clinically, their first manifestation is usually a palpable neck mass, often accompanied by hoarseness, dyspnoea, and/or dysphagia depending on size and location. GCTs are benign neoplasms, yet awareness of this entity is crucial as their aggressive local behaviour can cause significant morbidity with airway obstruction and can simulate a malignancy. The differential diagnosis is broad and remains a clinical and radiological challenge. Indeed, the final diagnosis is established by histology postoperatively. Surgery is the preferred treatment but may impair voice quality. For incomplete surgical resections and high surgical risk lesions, denosumab treatment is a valuable option. We share our experience on GCTs in a young adult presenting as a supraglottic mass.

Aneurysms of an aberrant right subclavian artery (ARSA) are rare but constitute a potentially lethal condition, especially with concomitant Marfan syndrome (MFS). A 27-year-old female with confirmed MFS presented with a relevant progression of a known aneurysm of an ARSA in MRI. The patient had undergone valve-sparing aortic root replacement (David procedure) 4 months prior. After interdisciplinary discussion, she underwent endovascular exclusion of the aneurysm using a combination of established vascular plugs and novel shape memory polymer embolization plugs to fill the large ARSA aneurysm volume. The shape memory polymer embolization plugs expand in the vessel to a porous scaffold, designed to support thrombus formation throughout its structure. The polymer is also radiolucent, which minimizes artefact and facilitates follow-up imaging. Development of a strategy for the treatment of ARSA aneurysms is challenging and different surgical, endovascular, and combined approaches have been published. Interdisciplinary discussion is crucial to minimize the overall risk and trauma. In our case of a young female and new mother, an endovascular approach was successfully and safely performed. The future need for surgery due to concomitant MFS is expected.

Gastric pneumatosis is a rare finding, and clinicians, when under pressure, find it challenging to immediately identify the cause and decide if the patient requires emergency surgery. We present a case where an initial CT scan demonstrated gastric pneumatosis involving only the greater curvature of the antrum caused by a strangulated hiatus hernia and malrotation of the distal stomach. The CT features suggested the patient required immediate surgery; however, a conservative approach was taken, and a follow-up CT scan 4 days after the onset demonstrated complete resolution and no long-term complications.

Hyperpneumatization is a rare pathological process where air-filled cavitation form within solid bone architecture occurring at sites where physiological pneumatization is not seen. Extension of this process into the atlanto-occipital region is considered extremely rare and is only quoted several times in the literature. In this case report, we present a 66-year-old man who presented with an 8-month history of a worsening frontal headache and blocked sensation in his left ear. Subsequent CT head evaluation revealed hyperpneumatization affecting C1 vertebra, temporal and occipital bones with extension into the clivus. A rare complication of epidural emphysema was seen. The aetiology of hyperpneumatization is uncertain, although it is thought to be either congenital or acquired. In our case, clinical suggestion of eustachian tube dysfunction and radiological findings of thickened sinus mucosa and a unilateral nasal polyp point to chronic recurrent coryzal illnesses, which may indicate an acquired mechanism. Management is mostly conservative with surgical management reserved for high risk or refractory cases.

Severe pancreatitis following retrograde cholangiopancreatography (ERCP) is an infrequent occurrence. Even rarer are the additional non-pancreatic symptoms that can emerge after ERCP-induced pancreatitis, such as panniculitis and polyarthritis. This combination of symptoms is recognized as the pancreatitis, panniculitis, and polyarthritis syndrome (PPPS). PPPS typically manifests as reddish subcutaneous nodules, primarily in the lower extremities. In some cases, the condition may progress into the bones, causing intramedullary fat necrosis/bone infarcts. Joint complications involve polyarthritis and affect both small and large joints. PPPS tends to develop 3-6 weeks after the peak of clinical pancreatitis. In this report, we present a case of PPPS that occurred as a complication following ERCP. This particular case became further complicated by the presence of bacteraemia and fungaemia, leading to the subsequent development of multi-focal osteomyelitis. The medical imaging included in this report provides a comprehensive overview of the entire clinical course, starting from the initial post-procedural complication and pancreatitis, followed by multi-modal imaging depicting panniculitis using ultrasound and MRI, and finally illustrating the development of multi-focal osteomyelitis. This case serves as an opportunity to explore and understand 2 rare complications associated with pancreatitis: PPPS and multi-focal osteomyelitis.

Ascaris lumbricoides is one of the most well-known helminthic parasites affecting humans. Ascariasis is prevalent in developing countries where inadequate water, sanitation, and hygiene facilitate human-to-human transmission. In this report, we present a case of a 20-year-old male who arrived at the emergency room with severe right flank pain, high-grade fever, and recurrent vomiting. Diagnostic evaluations were conducted, including a complete blood count test, urinalysis, stool analysis, abdominal ultrasound, and CT scan. The final diagnosis was A lumbricoides found in the distal part of the ureter. A ureteroscopy procedure confirmed the diagnosis and extracted the worm, which measured 6 cm in length, had a brown colour, and exhibited a tight elastic consistency. While Ascaris is commonly found in the gastrointestinal tract, its occurrence in the urinary tract is an extremely rare phenomenon. In our case, the most likely explanation is that the Ascaris accessed the distal ureter through retrograde migration, wherein the worm traverses from the bladder into the ureter.

A 19-year-old woman presented to the emergency department with arrhythmia and signs of cardiogenic shock. After a 12-lead electrocardiogram ruled out acute myocardial infarction, and cardiac magnetic resonance showed no sign of cardiomyopathy, cardiac computed tomography angiography (CCTA) was performed, displaying ostial atresia of the right coronary artery. She was thus referred to a specialist centre for congenital cardiovascular disease, where an electrophysiological study observed an arrhythmogenic focus on the posteromedial papillary muscle, which was ablated, and she has been asymptomatic since. When dealing with patients presenting with arrhythmias or cardiogenic shock, and no signs of myocardial infarction or cardiomyopathy, performing CCTA to study the anatomy of the coronary arteries is vital.

Desmoid tumours are rare benign tumours that show locally aggressive and invasive features leading to potential complications. They can be quite challenging for the treating surgeon if they occur adjacent to neurovascular structures. The aetiology of these tumours is still unclear, but the incidence is higher in females and in patients with a history of trauma or surgical procedures, raising the possibility of genetic and hormonal factors as well as post-traumatic or post-operative inflammatory changes promoting the formation of desmoid fibromatosis. We report a case of a 34-year-old Asian female who presented to our hospital with a history of difficulty in swallowing due to an enlarging lump on the left side of her neck. Patient had a past medical history of previous cervical spinal disc surgery due to a herniated disc. Diagnostic imaging showed a large soft tissue mass centred between the left common carotid artery and the cervical vertebrae displacing the trachea and oesophagus to the right side. A biopsy was obtained, and histopathological examination was suggestive of a desmoid tumour. The patient underwent surgical resection of the tumour but returned later with recurrence and had to undergo the surgery again to achieve full cure.

Appendiceal diverticulitis, although rare, is an important differential diagnosis in cases of right iliac fossa pain. Previously, it has often been considered as a variant of acute appendicitis, due to its seemingly similar clinical presentation. However, recent research indicates that appendiceal diverticulitis is a distinct clinical entity, with demographic characteristics and clinical features that are different to acute appendicitis. It is also associated with higher risk of severe morbidity and mortality, necessitating timely diagnosis and management. In this report, we present a case of a 58-year-old male patient with diverticulitis of the vermiform appendix and review the relevant literature. We describe the classification of appendiceal diverticulosis and diverticulitis, their clinical presentation, and their potential complications. We outline the radiological findings of appendiceal diverticulitis and acute appendicitis and discuss the important role of diagnostic imaging in distinguishing between these 2 conditions.