OpenMed/multicare-articles huggingface dataset:
Pyoderma Gangrenosum as a Presenting Feature of Undifferentiated Spondyloarthropathy with Erosive Inflammatory Arthritis
Authors: Jaspreet Kaler, Sandra Sheffield, Myint Thway, Karishma Ramsubeik, Gurjit Kaeley
Journal: Case Rep Rheumatol (2020)
MeSH terms: Case Reports

Pyoderma gangrenosum is a rare inflammatory condition with varying clinical presentations and severity. It is commonly seen in association with an underlying condition, most common of which is inflammatory bowel disease. We report a case of a 26-year-old male who came to the emergency department with increasing lower extremity ulcers, intermittent hematochezia, and pain in the small joints of his hands. After excluding a broad list of differentials for lower extremity ulcers, the diagnosis of pyoderma gangrenosum was made. He was also found to have erosive changes at multiple proximal interphalangeal joints and jug-like syndesmophytes at T12 and L1 on CT scan. Although there was evidence of a spondyloarthropathy, there was no evidence of inflammatory bowel disease on colonoscopy, psoriasis, or sexually transmitted infections. After multiple failed trials of medications including azathioprine and sulfasalazine, 4 weeks of Adalimumab resulted in rapid healing of pyoderma gangrenosum lesions and improvement in his synovitis. Coupled together, this suggests a diagnosis of pyoderma gangrenosum associated with undifferentiated spondyloarthropathy and erosive inflammatory arthritis. This case is suggestive of spondyloarthropathy going underdiagnosed and untreated in other patients with pyoderma gangrenosum as lower extremity ulcerations can be the primary complaint for seeking treatment. Although rare, axial spondyloarthropathy associated with pyoderma gangrenosum should be kept as an associated differential diagnosis when faced with pyoderma gangrenosum.
Postoperative Airway Obstruction by a Bone Fragment
Authors: Patrick Schober, K Hakki Karagozoglu, Stephan A Loer, Lothar A Schwarte
Journal: Case Rep Anesthesiol (2017)
MeSH terms: Case Reports

Postoperative airway obstructions are potentially life-threatening complications. These obstructions may be classified as functional (sagging tongue, laryngospasm, or bronchospasm), pathoanatomical (airway swelling or hematoma within the airways), or foreign body-related. Various cases of airway obstruction by foreign bodies have previously been reported, for example, by broken teeth or damaged airway instruments. Here we present the exceptional case of a postoperative airway obstruction due to a large fragment of the patient's maxillary bone, left accidentally in situ after transoral surgical tumor resection. Concerning this type of airway obstruction, we discuss possible causes, diagnosis, and treatment options. Although it is an exceptional case after surgery, clinicians should be aware of this potentially life-threatening complication. In summary, this case demonstrates that the differential diagnosis of postoperative airway obstructions should include foreign bodies derived from surgery, including tissue and bone fragments.
Case Report: Evaluation strategies and cognitive intervention: the case of a monovular twin child affected by selective mutism
Authors: Micaela Capobianco, Luca Cerniglia
Journal: F1000Res (2018)
Keywords: selective mutism, twins, assessment, intervention

The present work describes the assessment process, evaluation strategies, and cognitive intervention on a 9 years old child with selective mutism (SM), a monovular twin of a child also affected by mutism. Currently, the cognitive behavioral multimodal treatment seems the most effective therapeutic approach for children diagnosed with selective mutism (Capobianco & Cerniglia, 2018). The illustrated case confirms the role of biological factors involved in mutacic disorder but also highlights the importance of environmental influences in the maintenance of the disorder with respect to relational and contextual dynamics (e.g. complicity between sisters, family relationships). The article discusses furthermore the importance of an early diagnosis as a predictor of positive treatment outcomes.
Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound
Authors: Emanuelle J Best, Cecelia M O'Brien, Wendy Carseldine, Aniruddh Deshpande, Rebecca Glover, Felicity Park
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Background:
Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis.
Case description:
We present a case of fetal ileal volvulus suspected on third trimester ultrasound, complicated by premature labour, small bowel necrosis, and meconium peritonitis. Progressive dilatation and decreased peristalsis of echogenic bowel were noted in the early part of the third trimester. Daily surveillance ultrasound was performed and spontaneous labour occurred at 32 weeks' gestation. A proactive postnatal approach guided by prenatal sonographic findings allowed prompt treatment and an urgent laparotomy was performed for an ileal volvulus with necrosis and meconium peritonitis. A segment of small bowel volvulus was resected and an end-to-end anastomosis was performed with uneventful recovery.
Discussion:
Clinically signs of fetal midgut volvulus are not pathognomonic, such as intestinal dilatation, abdominal mass, ascites, peritoneal calcifications, or polyhydramnios; thus, the diagnosis is often challenging. Complications reported in the literature include perforation and haemorrhagic ascites, which may lead to anaemia, hypovolemia, heart failure, and fetal demise.
Conclusion:
This case highlights the importance of assessing the fetal bowel as a part of routine third trimester ultrasound. The case describes the complexity of diagnosis in the fetus, important considerations along with multidisciplinary team approach to management.
Delayed active bleeding after radical evacuation of injected polyacrylamide hydrogel and immediate implant based breast reconstruction
Authors: Min-Ling Chen, Jin-Lan Liu, Shen-Jung Hsu, Chang-Cheng Chang
Journal: Springerplus (2016)
Keywords: breast reconstruction, delayed active bleeding, polyacrylamide hydrogel

Background:
Polyacrylamide hydrogel (PAAG) was used in breast augmentation surgery in China during 1997-2006. Its application has led to increasing complications such as localized lumps, asymmetry, diffuse stiffness, infections, and localized tenderness or myalgia. Hence, many patients have sought for surgical gel evacuation in the following years.
Case presentation:
A 37-year-old G2P0A2 slim (BMI = 18.3) woman who had received injected PAAG bilateral breast augmentation in China 15 years ago, visited our hospital for gel removal due to left upper quadrant breast tenderness with burning sensation. We performed simple mastectomy and immediate breast augmentation with silicone prostheses. Her postoperative course was uneventful. However, subcutaneous hematoma formed right after she started breast massage on the day 14 post operatively. The patient promptly received a CT-guided drainage followed by exploratory surgery with coagulation of the lesion located at the second intercostal space 2 cm to the right of the sternum.
Discussion:
Delayed bleeding in our patient might be contributed to below reasons. First, the usage of PAAG might cause degeneration of muscle tissue structure which made it more fragile than normal muscle tissue. Secondly, the lack of sufficient coverage, cushion and protection of the muscle tissue in slim patient in addition to the external compression and shearing force of massage.
Conclusion:
In slim patients, we suggest that the postoperative breast massage should be postponed for months until the tissue is recovered, or delayed breast reconstruction could also be considered.
Tubocutaneous fistula
Authors: Krishnaveni Nayini, Clive Gie
Journal: Case Rep Obstet Gynecol (2015)

Introduction. Tubocutaneous fistula is a very rare condition; most cases described in the literature are secondary to endometriosis, tuberculosis, and complications of child birth and gynecological operations. Case Presentation. We report a case of 40-year-old woman who presented with tubocutaneous fistula secondary to pelvic inflammatory disease which was diagnosed in the setting of persistent discharging wound in the right groin. Conclusion. Tubocutaneous fistula is a rare condition. Salpingectomy and resection of fistulous tract is the treatment of choice as is treating the underlying cause. Early diagnosis and treatment of these patients are essential for avoiding long term complications.
Asymptomatic Dysplasia Epiphysealis Hemimelica of the Shoulder in a Skeletally Mature Patient with Normal Function
Authors: Vincenzo Giordano, Marcos Giordano, Carolina Giordano, José Giordano, Renato Mendonça, Hilton Augusto Koch
Journal: Case Rep Radiol (2019)
MeSH terms: Case Reports

Dysplasia epiphysealis hemimelica is a rare osteocartilaginous overgrowth syndrome of bone epiphysis, mostly encountered in the lower limbs of immature skeleton patients. We report a case of proximal humerus presentation in an adult male, with neither articular involvement nor clinical dysfunction. This case highlights the importance of stratification into intra- and extra-articular lesions, as this distinction ultimately influences both symptoms and treatment outcome. In addition, the case highlights the importance of specific imaging modalities, such as CT and MR images, which provide excellent anatomic location of the lesion, adequate extension of cartilaginous components, exact status of articular cartilage, and accurate assessment of neighboring structures, such as vessels, nerves, ligaments, tendons, and muscles. The imaging features are described, the relevant literature is reviewed, and salient features are discussed.
Right atrial cardiac lipoma with distinctive imaging characteristics. A rare case report and literature review
Authors: Qiqing Chen, Dayan Yang, Lili Liu, Xiangxiang Jing
Journal: Front Cardiovasc Med (2022)
Keywords: cardiac lipomas, contrast-enhanced ultrasonography, diagnosis, multimodal imaging, transthoracic echocardiography
MeSH terms: Case Reports

Cardiac lipomas are rare primary cardiac tumors that are often only detected incidentally during other examinations. Lipomas of the right atrium are particularly rare. In this report, we describe the case of a patient presenting with a mixed cystic-solid lipoma in the right atrium. The symptoms, imaging findings, and treatment strategies associated with this case are discussed herein. This 65-year-old female patient reported to our hospital due to exertional chest tightness, shortness of breath, and occasional chest pain for over 1 year. She subsequently underwent transthoracic echocardiography and contrast-enhanced ultrasonography, both of which revealed a cystic-solid mass in the right atrium. The transthoracic computed tomography scan showed a dense patchy shadow in the right atrium. The mass was completely excised from the atrial septum, and subsequent histopathological examination confirmed its identity as a lipoma. Surgical resection remains the primary treatment approach for cardiac lipomas, and multimodal imaging is of key importance for the diagnosis and follow-up monitoring of affected patients.
Breast Implant-Associated Anaplastic Large Cell Lymphoma: Case Report and Review of the Literature
Authors: Eva Berlin, Kunwar Singh, Christopher Mills, Ilan Shapira, Richard L Bakst, Manjeet Chadha
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

We are reporting the case of a 58-year-old woman with history of bilateral silicone breast implants for cosmetic augmentation. At 2-year interval from receiving the breast implants, she presented with swelling of the right breast with associated chest wall mass, effusion around the implant, and axillary lymphadenopathy. Pathology confirmed breast implant-associated anaplastic large cell lymphoma (stage III, T4N2M0, using BIA-ALCL TNM staging and stage IIAE, using Ann-Arbor staging). The patient underwent bilateral capsulectomy and right partial mastectomy with excision of the right breast mass and received adjuvant CHOP chemotherapy and radiation to the right breast and regional nodes. Since completion of multimodality therapy, the patient has sustained remission on both clinical exam and PET/CT scan. We report this case and review of the literature on this rare form of lymphoma.
Iatrogenic Fistula in Hemodialysis Patients: An Alternative Approach to Thrombectomy of Arteriovenous Graft (AVG) Thrombosis
Authors: Ramanath Dukkipati, Alexandre M Benjo, Antonio Jimenez, Ivo Lukitsch, Gift C Echefu, Damodar R Kumbala
Journal: Case Rep Vasc Med (2022)
MeSH terms: Case Reports

Arterial venous (AV) fistula is the first choice of vascular access to perform hemodialysis in the vast majority of suitable patients followed by arteriovenous grafts (AVG). An iatrogenic fistula can occur when a second vein adjacent to the graft is punctured and the needle traverses the vein. In normal circumstances, this has no clinical repercussions and does not need correction, and in prior reports, it has helped to maintain the patency of partially occluded grafts but rarely can lead to thrombosis of the graft due to reduced flow and pressure in the graft lumen. We report here what we believe is a unique approach to perform thrombectomy of an occluded graft in a 71-year-old patient on hemodialysis to avoid placement of tunneled hemodialysis catheters and complications associated with catheters. When the outflow of basilic vein in this patient was thrombosed and could not be traversed, we successfully used an iatrogenic fistula as main outflow vein for the graft and created an alternative vein for drainage thus avoiding placement of a tunneled catheter for hemodialysis.
CASE REPORT Penetrating Injury of the Orbit by a Needlefish
Authors: Miho Ohtsubo, Kenya Fujita, Kazuhiro Tsunekawa, Shunsuke Yuzuriha, Kiyoshi Matsuo
Journal: Eplasty (2013)

Objective:
We present a very rare case of penetrating injury into the orbit by a needlefish. The patient underwent extirpation twice at another hospital.
Methods:
We performed foreign body removal from a right subbrow incision under general anesthesia.
Results:
The foreign body was successfully removed and the patient's diplopia recovered gradually after surgery.
Conclusions:
Treatment was similar to that used for penetrating injury. As there is a risk of secondary infection, it is important to completely remove the fish body, followed by vigorous irrigation and debridement.
An Atypical Presentation of Sinonasal Tract Alveolar Rhabdomyosarcoma in a Young Male Patient Submitted to Multimodality Treatment
Authors: Wilber E Bernaola-Paredes, Sergio Leonardo Favareto, Valdener Bella Filho, Eloah Pascuotte Filippetti, Walkiria Pantoja Bellotto, Henrique Rocha Mazorchi Veronese, Lucas Neves de Martins Moraes, Felipe D'Almeida Costa, Antonio Cassio Assis Pellizzon
Journal: Case Rep Oncol Med (2021)
MeSH terms: Case Reports

Rhabdomyosarcoma (RMS), a malignant tumor derived from the neoplastic proliferation of striated skeletal muscle cells, is the most common pediatric soft tissue sarcoma. Its treatment is mainly based on neoadjuvant chemotherapy (QT+), surgical resection, and adjuvant radiotherapy (RT+). RT+ has shown satisfactory results for locoregional control of the disease, in spite of promoting local side effects. The present case report was aimed at describing the clinical and therapeutic characteristics and the management of complications resulting from multimodal therapy in a patient with an atypical presentation of RMS in the sinonasal tract. A 20-year-old Afro-descendant man complained of an expansive tumor lesion, with left eye proptosis that reduced visual acuity and caused severe regional pain. Imaging analysis showed an extensive and infiltrative lesion in the periorbital region, sinonasal tract, left maxilla, and orbital roof. According to the histopathological analysis, the diagnosis was established corresponding to parameningeal alveolar RMS that was unresectable. Treatment was initiated with three cycles of QT+ which showed partial response and later RT+. After completing half of the RT+ sessions, the patient showed a complete response with reduction in tumor volume and improvement in pain and local conditions. Side effects such as alopecia and dermatological changes induced by radiation were observed. Moreover, painful erythematous areas were observed in the region of the hard and soft palate, uvula, and oropharynx, compatible with Grade 2 mucositis lesions. After the cytological swab test, some of them were diagnosed as herpes simplex lesions; thickening and decrease in salivary flow were also found. A local drug therapy approach was instituted, and photobiomodulation was performed to manage oral complications. RT+ was shown to be effective in locoregional control of the disease; however, the early management of its undesirable effects on the surrounding tissues was required.
Contrast-induced encephalopathy and permanent neurological deficit following cerebral angiography: A case report and review of the literature
Authors: Yujing Zhang, Jiancheng Zhang, Shiying Yuan, Huaqing Shu
Journal: Front Cell Neurosci (2023)
Keywords: cerebral angiography, contrast-induced encephalopathy, neurological deficit, prognosis, risk factor
MeSH terms: Review

Contrast-induced encephalopathy (CIE) is an uncommon complication associated with contrast exposure during angiographic procedures that is usually transient but occasionally leads to permanent complications or death. Due to the low incidence of CIE, there are still insufficient reports. This study was used to summarize the clinical features of CIE through a case report and systematic review. We summarized and reviewed 127 patients with CIE, and we found that the total incidence of CIE between men and women had no difference (49.61 and 50.39%, respectively), but the average age in female patients with CIE was older than that in male patients (62.19 and 58.77 years, respectively). Interestingly, the incidence of female patients with CIE in the poor prognosis group was significantly higher than that in the good prognosis group (62.50 and 36.51%, respectively), and the average age of these female patients in the poor prognosis group was younger than that in the good prognosis group (61.39 and 62.82 years, respectively). The contrast medium types were mainly nonionic (79.69 and 73.02%, respectively) and low-osmolar (54.69 and 71.43%, respectively) in both groups. Importantly, the total contrast media administrated in patients with poor prognoses was greater than that administrated in patients with good prognoses (198.07 and 188.60 ml, respectively). In addition, comorbidities in both groups included hypertension (55.91%), diabetes mellitus (20.47%), previous contrast history (15.75%), renal impairment (11.81%), and hyperlipidemia (3.15%). The percentage of patients with cerebral angiography was significantly higher in the poor prognosis group than that in the good prognosis group (37.50 and 9.52%, respectively), whereas the percentage of patients with coronary angiography in both groups had the opposite results (35.94 and 77.78%, respectively). In conclusion, CIE may not always have a benign outcome and can cause permanent deficits. Female gender, younger age, the higher dose of contrast medium, and the procedure of cerebral angiography may be related to the patient's poor prognosis.
Maxillary Fungal Osteomyelitis Mimicking and Treated as Endodontic Pathosis
Authors: Sarang Suresh Hotchandani, Feroze Ali Kalhoro, Priya Rani Harjani, Mahwish Memon
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

Fungal osteomyelitis is a lethal opportunistic infection that affects only a small percentage of patients present to endodontists. It is a highly contagious infection that requires urgent treatment. We discuss three cases in which endodontic pathology was initially recognized but subsequent follow-up revealed severe osteolytic fungal infection of the maxilla manifesting as acute apical abscesses in the maxillary canine region. CBCT demonstrated osteolytic abnormalities, and further histology confirmed the illness was caused by mucormycosis in patients with uncontrolled diabetes mellitus and exposure to COVID-19.
Resistant Ventricular Arrhythmia and the Role of Overdrive Pacing in the Suppression of the Electrical Storm
Authors: Mohamed Magdi, Mahmood Mubasher, Hakam Alzaeem, Tahir Hamid
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Ventricular arrhythmia storm is a state of cardiac instability characterized by multiple ventricular arrhythmias or multiple ICD therapies within a 24-hour duration. Management of this life-threatening state depends on the reversal of the cause besides either electrical or medical management of the arrhythmia. We report a case of a 54-year-old male who underwent a percutaneous coronary intervention following massive acute myocardial infarction. Afterwards, he developed frequent life-threatening ventricular arrhythmias that required multiple shocks and antiarrhythmic medications. Despite all these interventions, it was very difficult to control the electrical instability, but after overdrive ventricular pacing, the storm subsided and within a few days the case was stabilized. Overdrive pacing is an easy temporary modality to control the resistant arrhythmia following myocardial infarction.
Revascularisation of iatrogenic superior mesenteric artery injury by end to end anastomosis during robot assisted nephrectomy
Authors: Sunil Kumar, Shiv C Navariya, Deepak P Bhirud, Satish K Ranjan, Ankur Mittal, Kim J Mammen
Journal: Int J Surg Case Rep (2019)
Keywords: end to end anastomosis, robot assisted laparoscopic nephrectomy, superior mesenteric artery injury

Introduction:
Superior mesenteric artery (SMA) injury is very peculiar to left sided renal surgery. Although it is rare only, most of it is unreported. We report a case of SMA injury during robot assisted laparoscopic nephrectomy, which was managed successfully by end to end anastomosis.
Case presentation:
A 19-year-old male patient was undergoing robot assisted laparoscopic simple nephrectomy for pyelonephritic kidney. Because of dense adhesion, SMA was inadvertently clipped and cut. It was recognised intraoperatively and an end to end anastomosis was done by laparotomy.
Discussion:
SMA injury is rarely encountered in surgical practice. Most of it occurs following trauma. Iatrogenic SMA injury occurs in case of distorted local anatomy either due to adhesion or bulky tumor in left renal fossa and vicinity.
Conclusion:
One should be cautious about proximity of SMA and its possible injury during left nephrectomy and it should be repaired as soon as possible.
Extensive Superior Vena Caval Territory Thrombosis and Pulmonary Embolism: A Rare Clinical Entity of Haemorrhagic Pancreatitis
Authors: P Thineskaran, K Abiramy, T Kumanan, V Sujanitha, N Suganthan, G Selvaratnam
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

Acute haemorrhagic pancreatitis is a severe form of pancreatitis often encountered in ethanol abuse. Extensive venous thrombosis resulting in pulmonary embolism is a rare presenting clinical entity of acute haemorrhagic pancreatitis. Here, we report a young male with an extensive deep vein thrombosis involving superior vena caval territory associated with haemorrhagic pancreatitis presented with pulmonary embolism managed supportively. Prompt recognition and appropriate intervention of this rare complication would improve the outcome in patients with acute pancreatitis.