BMJ Case Reports最新文献

The authors present the case of a multiparous woman, gravida 4, para 2+1, in her late 30s presenting with a 1-day history of acute onset, severe left-sided abdominal pain and nausea at 8 weeks gestation. She was tender on examination, with normal vital signs and a slightly raised C-reactive protein.Transvaginal ultrasound showed a live intrauterine pregnancy with features of left adnexal torsion. The left ovary was enlarged, globular, oedematous and displaced to the pouch of Douglas. It measured about 10 cm with a hypoechoic corpus luteum cyst measuring approximately 9 cm.At emergency laparoscopy, a left large adnexal complex involving a bulky oedematous ovary was seen and twisted four times. No sign of revascularisation was seen after detorsion, and a left salpingo-oophorectomy was done. The histology confirmed a coagulative tissue necrosis. She had an elective caesarean section at 39 weeks gestation with a live baby and no complications.

A phantom or vanishing tumour of the lung is an uncommon radiographic finding, often linked to fluid overload conditions such as heart failure or chronic kidney disease. It is characterised by the presence of interlobular effusion within the transverse or oblique fissure of the right lung. Despite its infrequency, it is a significant differential diagnosis for radiographic opacities in the right middle lung zone, given its potential to mimic more ominous pathologies such as neoplastic masses or infiltrative processes.In this report, we present a case involving a man in his 70s who presented with a 10-day history of productive cough, chest pain and shortness of breath. An initial chest X-ray (CXR) showed a well-defined, dense, round mass in the right lower lobe. An echocardiogram revealed a significantly reduced left ventricular ejection fraction. Following the initiation of loop diuretics and fluid restriction, the mass-like opacity completely disappeared on follow-up CXR after 7 days, confirming the diagnosis of a vanishing tumour. This case highlights the critical importance of addressing the underlying heart failure prior to considering further invasive diagnostic procedures, as this can help avoid unnecessary, expensive, and potentially harmful interventions.

Postoperative vocal cord dysfunction can be caused by direct laryngeal trauma, nerve injury or can occur spontaneously. Patients with connective tissue disorders such as Marfan syndrome may be at higher risk for arytenoid dislocation due to tissue laxity. A woman in the 50s with Marfan syndrome underwent emergent total arch replacement for Type A aortic dissection. On endotracheal extubation, she was noted to have stridor. Fibreoptic examination was notable for an immobile right arytenoid. This case highlights the risk of arytenoid dislocation following endotracheal intubation in patients with connective tissue disorders such as Marfan syndrome. Conservative therapy can result in complete recovery without surgery. Furthermore, this case demonstrates that subsequent endotracheal intubations can be performed safely with proper airway planning. Increased awareness and further reporting are needed to understand and mitigate the risk in this vulnerable population.

Adrenal myelolipomas are benign adrenal tumours containing adipose and haematopoietic tissue. Although rare, they are significantly more common in patients with poorly controlled classical congenital adrenal hyperplasia (CAH) due to chronic adrenocorticotropic hormone (ACTH) overstimulation. This case describes a male patient in his 40s with longstanding CAH (21-hydroxylase deficiency) who presented with symptomatic bilateral giant adrenal myelolipomas and testicular adrenal rest tumours (TARTs). He presented acutely to hospital with abdominal pain, nausea and vomiting. Urgent imaging demonstrated giant bilateral adrenal masses with benign appearances in keeping with myelolipomas. Subsequently, he underwent open bilateral adrenalectomy. Postoperatively, his quality of life improved markedly and his steroid requirements reduced. This case illustrates the importance of increased awareness of myelolipomas in patients with poorly controlled CAH and highlights the need for vigilant endocrine management and a multidisciplinary approach to prevent other long-term complications such as TARTs.

Paraneoplastic microangiopathic haemolytic anaemia (MAHA) is a rare condition characterised by tumour-driven erythrocyte destruction and platelet consumption. It is uncommon in colorectal cancer (CRC) and, without treatment, is often fatal within days. We describe a woman in her 50s who developed transfusion-refractory anaemia and thrombocytopaenia during workup for suspected metastatic CRC. Haemolysis screen was positive, and blood film showed fragmentation and leukoerythroblastosis, suggesting paraneoplastic MAHA. Following multidisciplinary discussion, she underwent D3 right hemicolectomy and bilateral salpingo-oophorectomies. Despite brief postoperative improvement, her MAHA progressed, and she passed away on day 2. Pathology revealed ileocaecal signet ring cell adenocarcinoma with bilateral Krukenberg tumours, peritoneal metastases and 31/31 positive nodes (stage IVc). This case highlights the life-threatening nature of CRC-MAHA and challenges in diagnosis and management. Prompt anticancer therapy offers the only hope at remission; however, salvage is difficult. Emergency surgery may be considered in exceptional cases where rapid deterioration precludes systemic therapy.

We report the case of a middle childhood female child who presented with acute encephalopathy following multiple episodes of projectile vomiting and subsequently developed progressive cognitive decline, behavioural changes, visual impairment and motor regression. Neurological evaluation and imaging revealed multifocal demyelination with bilateral optic neuritis. Further work-up uncovered the coexistence of myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and N-methyl-d-aspartate receptor encephalitis. Early initiation of immunotherapy with intravenous methylprednisolone and intravenous immunoglobulin led to significant clinical improvement. The case underscores the importance of screening for coexisting autoimmune conditions in demyelinating disorders, given the therapeutic and prognostic implications.

Psychological trauma after anaesthesia in children is recognised but often underestimated. Forced induction, though sometimes used under time pressure, may lead to long-term effects including post-traumatic stress disorder (PTSD). A boy in middle childhood required surgery for a fractured arm. He expressed fear of masks. His mother revealed a past surgical procedure under general anaesthesia, which the child did not recall. Despite a preoperative consultation, he became distressed and uncooperative. Anaesthesia was forcibly induced using restraint. He later developed PTSD symptoms (nightmares, separation anxiety and hypervigilance), without receiving psychiatric care. At our institution, we used a trauma-informed, child-centred approach: shared decision-making, preoperative desensitisation, topical anaesthesia for intravenous access and emotional support. Surgery proceeded without complications or psychological distress postoperatively or at 6-day follow-up. This case highlights the risk of psychological harm from forced anaesthesia and supports trauma-informed care to prevent retraumatisation and reduce long-term mental health consequences.

Herpesviruses are double-stranded DNA viruses that belong to the Herpesviridae family and are capable of infecting both humans and animals. A defining feature of these viruses is their ability to establish lifelong latency within host cells, with the potential to reactivate in response to triggers such as immunosuppression or physiological stress. Among the eight identified human herpesviruses, the Varicella-Zoster Virus (VZV), also known as human herpesvirus type 3, is responsible for causing chickenpox during the initial infection and shingles on reactivation. In the case we observed, VZV manifested primarily with neurological symptoms such as headache, elevated intracranial pressure, cerebrospinal fluid (CSF) pleocytosis and unilateral papilloedema in the absence of fever or a skin rash. Treatment with intravenous acyclovir produced a marked improvement in the clinical condition and CSF findings.

An adolescent female presented with acute cholecystitis associated with obstructive choledocholithiasis. As she was being prepared to undergo urgent endoscopic retrograde cholangiopancreatography and cholecystectomy, it was noted that she was profoundly bradycardic with resting heart rate as low as 33 beats per minute. Though her body mass index was within normal limits at presentation, her bradycardia prompted review of her growth curve which showed almost 100 pounds of weight loss in the previous year. History revealed severe disordered eating behaviours and led to a diagnosis of atypical anorexia nervosa. Rapid weight loss likely caused her acute biliary presentation, cardiac compromise and a high risk of refeeding syndrome that needed to be addressed before she could safely undergo surgery. This case highlights the severity of medical complications of malnutrition and eating disorders in youth presenting with normal or high weight, and the importance of early recognition for good prognosis.

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disorder of uncertain aetiology that often mimics advanced ovarian or peritoneal malignancy, both clinically and radiologically. The majority of reported cases have been associated with prior laparoscopic uterine myomectomy, particularly when uncontained morcellation was used. Here, we present a case of a nulliparous woman in her 20s who presented with a large abdominopelvic mass and radiological findings suggestive of ovarian carcinoma. However, further history-taking revealed a laparoscopic myomectomy with morcellation performed 2 years earlier for primary infertility due to a large intramural fibroid. Subsequent ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis of disseminated peritoneal leiomyomatosis (DPL). The objective of this case report is to highlight the diagnostic challenge DPL poses by mimicking malignancy and to emphasise the importance of eliciting prior surgical history-particularly involving morcellation-as a crucial clue in correctly identifying this benign entity.