BMJ Case Reports最新文献

Kienböck's disease, an uncommon avascular necrosis of the lunate, remains challenging to manage, particularly in young adults. We report a woman in her 20s with early-stage disease (Lichtman stage II) and positive ulnar variance, but without lunate collapse. She underwent a distal radial osteotomy with autologous cancellous bone grafting, stabilised with a volar locking plate, along with intraosseous lunate decompression. Postoperative recovery was uneventful, with complete union at the osteotomy site, restoration of wrist motion and return to unrestricted activity at 1 year. This case illustrates the role of combined distal radial osteotomy and lunate decompression as a joint-preserving strategy in early Kienböck's disease with positive ulnar variance.

A woman in her early 60s with a remote history of lung cancer presented with severe hypercortisolism, bilateral pulmonary consolidations and progressive cognitive decline. Extensive imaging and biopsies failed to identify a definitive adrenocorticotropic hormone (ACTH)-secreting tumour, but pulmonary nocardiosis was diagnosed, reflecting profound cortisol-induced immunosuppression. Management was further complicated by limited social supports and a history of unstable housing, raising concerns about access to advanced imaging and reliable follow-up. Despite medical therapy, hypercortisolism persisted, and she ultimately underwent bilateral adrenalectomy with marked improvement. This case illustrates the challenges of occult ectopic ACTH syndrome and underscores the importance of multidisciplinary management.

We report the case of a teenaged girl presenting with progressive orthopnoea, exertional dyspnoea, non-radiating right-sided chest pain and loss of appetite, for the last 6 months. Chest radiograph revealed complete opacification of the right hemithorax with contralateral tracheo-mediastinal shift. A contrast-enhanced CT scan of the thorax showed a massive fat-containing anterior mediastinal mass extending into both hemithoraces, without invasion of adjacent structures. Ultrasound-guided biopsy of the lesion suggested a neoplastic aetiology of thymic origin. Based on the clinicoradiological and pathological findings, a provisional diagnosis of thymolipoma was made. The mass was completely excised via a midline sternotomy approach. Postoperative histopathology confirmed the diagnosis as thymolipoma. After surgical excision of the tumour, the patient showed complete clinicoradiological improvement and is asymptomatic at 3-year follow-up.

Extracorporeal membrane oxygenation (ECMO) technology has relative contraindications in haemorrhagic disease but remains an effective therapeutic option for the treatment of pulmonary haemorrhage associated with respiratory failure. We report a critically ill case of a child with pulmonary haemorrhage and respiratory failure due to unintentional injury that was successfully treated with ECMO running at a low dose of heparin. An anticoagulation strategy with appropriate doses of heparin may improve the success of ECMO techniques in the treatment of severe pulmonary haemorrhage.

Myoma uteri is the most common benign tumour in women, but myomatous erythrocytosis syndrome (MES) is rare. MES is characterised by erythrocytosis, a myomatous uterus and blood normalization after hysterectomy or myomectomy. It increases the risk of thromboembolic events, making early recognition crucial.A premenopausal, nulliparous woman in her 50s with dyslipidaemia and obesity presented with a 20-week-sized abdominopelvic mass but no abnormal uterine bleeding. CT imaging revealed a large right adnexal mass. Lab tests showed isolated erythrocytosis with normal tumour markers and serum erythropoietin (Epo). Hysterectomy and bilateral salpingo-oophorectomy confirmed multiple uterine myomas, the largest measuring 19.5 cm, along with a right ovarian haemorrhagic cyst. Postoperatively, her blood levels normalised, confirming MES.The exact mechanism remains unclear but may involve Epo production. While Epo is often linked to myomas, some cases, like ours, show normal levels, highlighting the need for further research to understand MES and develop targeted treatments.

The subspecialty of interventional bronchoscopy has grown exponentially in recent times, and airway stenting is a frequently performed procedure. It is a therapeutic bronchoscopic intervention for both benign and malignant conditions, being mostly performed with a palliative intent, especially in cases of malignant central airway obstruction (CAO).We report a previously undocumented complication of airway stenting-disintegration of a self-expanding metallic stent (SEMS) and its spontaneous expectoration. A man in his late 40s with newly diagnosed squamous cell carcinoma of the lung presented with CAO and respiratory failure. Rigid bronchoscopy with tumour debulking and Y-SEMS placement was performed, resulting in clinical stabilisation. Four-and-a-half months post-stenting, the patient presented with expectoration of metallic fragments. Bronchoscopy revealed extensive disintegration of the posterior wall of the tracheal limb of the stent, with the bronchial limbs intact. The disintegrated stent was carefully removed under rigid bronchoscopy without any complications. Given adequate airway patency, no replacement stent was inserted. The patient continued systemic chemotherapy and remained stable, with no recurrence of airway compromise. This case highlights an unusual delayed complication of airway stenting.

Chronic lung disease in preterm infants is not a homogenous diagnosis. We highlight the case of a preterm infant with persistent respiratory distress complicated by diaphragm dysfunction, neurologic dysfunction and pulmonary interstitial glycogenosis requiring long-term positive pressure ventilation.

Schwannoma is usually a solitary, slowly progressing, benign tumour. It arises from the Schwann cells of peripheral, cranial and autonomic nerve sheaths and rarely affects the external female genitalia. We treated a patient in her late 30s with vulvar schwannoma with complete excision. A histological examination showed an encapsulated proliferation of bland spindle cells positive for S100 and SOX10 on immunohistochemistry, negative for desmin. A diagnosis of vulvar schwannoma was made. It carries a good prognosis with complete excision.

The Canal of Nuck cyst is a rare developmental anomaly in females resulting from the failure of obliteration of the processus vaginalis that can lead to inguinal hernias. We present the case of a woman in her late 30s with a concomitant right inguinal hernia and Canal of Nuck cyst, managed successfully with laparoscopic total extraperitoneal repair and cyst excision. This report highlights the importance of considering this rare entity in the differential diagnosis of female groin swellings and discusses the comparative considerations between open and laparoscopic surgery.

Retropharyngeal abscesses are rare in adults and often associated with immunocompromised states or complications from foreign body ingestion. This case report highlights an unusual presentation of acute retropharyngeal abscess that subsequently led to cervical vertebral osteomyelitis and focal neurological deficit. We describe a middle-aged man who presented with a 10-day history of progressive dysphagia, right upper limb weakness and respiratory distress, culminating in stridor. Examination revealed a bulge in the posterior pharyngeal wall and motor weakness in the right upper limb (3/5 power). Imaging studies confirmed the diagnosis of retropharyngeal abscess with cervical vertebral osteomyelitis. The management involved surgical drainage of the abscess, antibiotic therapy and supportive care. In the absence of prior symptoms suggestive of a chronic vertebral infection, it was concluded that the osteomyelitis and monoparesis were secondary to the acute retropharyngeal abscess. This case underscores the importance of considering retropharyngeal abscess in adults presenting with progressive dysphagia and respiratory distress, particularly when associated with neurological deficits for prompt intervention. Diagnostic methods, management strategies and follow-up care are discussed to emphasise the complexities involved in such cases.