OpenMed/multicare-articles huggingface dataset:
Left Inferior Vena Cava and Right Retroaortic Renal Vein
Authors: Alberto Nania, Fabio Capilli, Eugenia Longo
Journal: Case Rep Radiol (2016)

Nowadays, incidental anatomical variants are frequent findings, due to the widespread diffusion of cross-sectional imaging. This case report illustrates a fairly uncommon anatomical variant, that is, the copresence of left inferior vena cava and retroaortic right renal vein reported in a 46-year-old lady, undergoing a staging CT for breast cancer. Although the patient was asymptomatic, the authors highlight potential risks related to the above-mentioned condition and the importance of correct identification and diagnosis of the findings.
Innovative Method of Traction in a Bilateral Diaphyseal Femur Fracture in a Polytrauma Below-Knee Amputee
Authors: Stefan Mitrasinovic, Georgios Kiziridis, Shauni Wellekens, Charline Roslee, Syed Neshat Anjum
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

While diaphyseal femoral shaft fractures are common, it is uncommon to see this injury in leg amputees. Traditionally, these fractures are internally fixed using a fracture table with reduction obtained by traction and adequate rotation exerted on a slightly abducted extremity. Special considerations need to be given in the management of patients with leg amputations. We report the case of a 24-year-old gentleman with bilateral diaphyseal femoral shaft fractures and a previous right below-knee amputation, who was transferred to our centre following a road traffic collision. We highlight important planning that needs to be undertaken for appropriate positioning, ease of reduction, and fracture fixation. We have reviewed the literature to highlight the methods that have been previously described and our use of skeletal traction through the amputation stump that can be utilised by other surgeons in challenging situations like this.
A Case of Chronic Ectopic Pregnancy Manifested by Rectal Bleeding
Authors: Nina Vukas Radulovic, Maria Bullarbo, Erling Ekerhovd
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Ectopic pregnancy resulting in perforation of the rectum and rectal bleeding is clinically rare. We report an extremely rare case of chronic ectopic pregnancy with decreasing low levels of serum β-HCG resulting in rectal bleeding. A 31-year-old woman, gravida 3, para 3, with moderate abdominal pain and rectal bleeding was diagnosed with a tubal pregnancy. The tube was adherent to the rectum. Following salpingo-oophorectomy, the perforation of the rectum was sutured. Biopsies from the rectum as well as the tube confirmed chronic ectopic pregnancy. This case illustrates that diagnosing ectopic pregnancy is sometimes extremely challenging and it underlines the importance of follow-up consultations when the final diagnosis has not yet been reached.
Case Series: Cancer-Related Facial Pain Treated with Stellate Ganglion Block
Authors: Raheleh Rahimi Darabad, Jerry P Kalangara, Anna Woodbury
Journal: Palliat Med Rep (2020)
Keywords: cancer, orofacial pain, stellate ganglion block, sympathetic ganglia
MeSH terms: Case Reports

Stellate ganglion block (SGB) is believed to modify the pathologic sympathetic pain response and has been commonly used to treat complex regional pain syndrome. We report successful treatment of cancer-related facial pain with SGB in three patients, suggesting a possible sympathetic pain-related mechanism. All patients exhibited clinically significant improvement of pain 12 weeks following the procedure. SGB should be considered a palliative pain treatment option in cancer-related facial pain.
The Pitfalls of Utilizing "Goals of Care" as a Clinical Buzz Phrase: A Case Study and Proposed Solution
Authors: Adrienne Klement, Sean Marks
Journal: Palliat Med Rep (2020)
Keywords: consultation, goal-concordant care, goals of care, standardization, unified definition
MeSH terms: Case Reports

Assistance with discussing goals of care is one of the most common reasons clinicians seek out palliative care consultation. In practice though, the phrase "goals of care" is often utilized as a buzz phrase that lacks a shared understanding of its clinical relevance. We present a case example in which breakdowns in communication occurred between a patient and clinicians due to misunderstandings of the meaning of the phrase "goals of care." Subsequently, we review the literature to propose a unified definition of "goals of care" in hopes to minimize differences in what this phrase implies in clinical practice. We also seek to introduce a standardized process for establishing goals of care that may offer a more reliable and measurable method to promote goal-concordant care.
Case report: Optical coherence tomography for monitoring biologic therapy in psoriasis and atopic dermatitis
Authors: Linh Ha-Wissel, Handan Yasak, Robert Huber, Detlef Zillikens, Ralf J Ludwig, Diamant Thaçi, Jennifer E Hundt
Journal: Front Med (Lausanne) (2022)
Keywords: atopic dermatitis, biologic therapy, in vivo imaging, optical coherence tomography (oct), psoriasis, skin inflammation
MeSH terms: Case Reports

Biologic therapies are increasingly used to treat chronic inflammatory skin diseases such as psoriasis and atopic dermatitis. In clinical practice, scores based on evaluation of objective and subjective symptoms are used to assess disease severity, leading to evaluation of treatment goals with clinical decisions on treatment initiation, switch to another treatment modality or to discontinue current treatment. However, this visual-based scoring is relatively subjective and inaccurate due to inter- and intraobserver reliability. Optical coherence tomography (OCT) is a fast, high-resolution, in vivo imaging modality that enables the visualization of skin structure and vasculature. We evaluated the use of OCT for quantification and monitoring of skin inflammation to improve objective assessment of disease activity in patients with psoriasis and atopic dermatitis. We assessed the following imaging parameters including epidermal thickness, vascular density, plexus depth, vessel diameter, and vessel count. A total of four patients with psoriasis or atopic dermatitis were treated with biologic agents according to current treatment guidelines. OCT was used to monitor their individual treatment response in a target lesion representing disease activity for 52 weeks. Psoriatic and eczema lesions exhibited higher epidermal thickness, increased vascular density, and higher vessel count compared to uninvolved skin. An upward shift of the superficial vascular plexus accompanied by smaller vessel diameters was seen in psoriasis in contrast to atopic dermatitis, where larger vessels were observed. A response to biologic therapy was characterized by normalization of the imaging parameters in the target lesions in comparison to uninvolved skin during the observation period of 52 weeks. Optical coherence tomography potentially serves as an instrument to monitor biologic therapy in inflammatory skin diseases. Imaging parameters may enable objective quantification of inflammation in psoriasis or atopic dermatitis in selected representative skin areas. OCT may reveal persistent subclinical inflammation in atopic dermatitis beyond clinical remission.
Malignant fibrous histiocytoma, now referred to as Undifferentiated Pleomorphic Sarcoma: A Case Report of an unexpected histology of a subcutaneous lesion
Authors: Karishma Seomangal, Nezar Mahmoud, Joseph P McGrath
Journal: Int J Surg Case Rep (2019)
Keywords: case report, malignant fibrous histiocytoma, myxoid, sarcoma, storiform, subcutaneous mass, undifferentiated pleomorphic

Introduction:
An 85year old male presented to his General Practitioner with a vague history of a lump on his back that was mobile and non tender. He had a previous history of advanced prostate cancer and radiotherapy treatment.
Presentation:
We present an unexpected diagnosis of malignant fibrous histiocytoma of a subcutaneous lesion removed from the patient's back.
Discussion:
Excisions of subcutaneous lesions along with cutaneous lesions form the majority of cases on a usual minor operations list. All lesions are sent for histopathological analysis and most are confirmed benign sebaceous cysts or lipomas. However the entity of malignant fibrous histiocytoma, now referred to as undifferentiated pleomorphic sarcoma (UPS) should be kept in mind. Patients will usually present late with advanced local disease or metastasis, usually to lungs and lymph nodes. Treatment is surgical with wide local excision and neoadjuvant/adjuvant radiotherapy has been advocated as well.
Conclusion:
Undifferentiated pleomorphic sarcoma should be a differential in subcutaneous lesions in older adults with a previous history of malignancy, radiation therapy and a mass in the subcutaneous tissue of the back.
Severe Rhabdomyolysis due to Presumed Drug Interactions between Atorvastatin with Amlodipine and Ticagrelor
Authors: Iouri Banakh, Kavi Haji, Ross Kung, Sachin Gupta, Ravindranath Tiruvoipati
Journal: Case Rep Crit Care (2017)
MeSH terms: Case Reports

Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness. A muscle biopsy was performed to exclude myositis which confirmed extensive myonecrosis, consistent with statin associated rhabdomyolysis. After a prolonged ventilatory course in the intensive care unit, patient's condition improved with recovery from renal and liver dysfunction. The patient slowly regained her upper and lower limb function; she was successfully weaned off the ventilator and was discharged for rehabilitation. To our knowledge, this is a second case of statin associated rhabdomyolysis due to interaction between atorvastatin and ticagrelor. However, our case differed in that the patient was also on amlodipine, which is considered to be a weak cytochrome P450 3A4 inhibitor and may have further potentiated myotoxicity.
Desmoplastic ameloblastoma: a case report
Authors: Soheyl Sheikh, Shambulingappa Pallagatti, Isha Singla, Aman Kalucha
Journal: J Dent Res Dent Clin Dent Prospects (2011)
Keywords: desmoplastic ameloblastoma, odontogenic tumor, stromal desmoplasia
MeSH terms: Case Reports

Desmoplastic ameloblastoma is a rare variant of ameloblastoma. Up until now, less than 150 patients have been reported in the literature. We report a case of desmoplastic ameloblastoma in a 45-year-old female with a painless swelling in the left anterior maxillary region. Fine needle aspiration yielded no fluid. Periapical and panoramic radiographs as well as computer tomography scan showed a mixed lesion with multilocular appearance. The present case deserves special importance be-cause of its unfamiliar appearance, potentially aggressive nature and high chances of misdiagnosis. Moreover, the radio-graphic features of this lesion rarely point towards ameloblastoma. A partial maxillectomy for tumor resection was per-formed and the involved teeth were removed. This report is an attempt to help the dental community in developing familiarity with the clinical presentation and at the same time advocating to develop a high index of suspicion in recognizing such cases.
Pericardial Effusion/Cardiac Tamponade Induced by Peripherally Inserted Central Catheters in Very Low Birth Weight Infants: A Case Report and Literature Review
Authors: Ana Hou, Jianhua Fu
Journal: Front Pediatr (2020)
Keywords: peripherally inserted central catheter, cardiac tamponade, complication, pericardial effusion, very low birth weight
MeSH terms: Case Reports

Background: Although pericardial effusion/cardiac tamponade (PCE/CT) is a rare complication of peripherally inserted central catheters (PICCs), with an incidence of 0. 07-2%, it is associated with high mortality and is often life threatening. We sought to improve understanding of PICC-induced PCE/CT among pediatricians. Case presentation: The clinical data of PICC-associated PCE/CT in a very low birth weight (VLBW) infant were summarized, and the relevant literature was also reviewed. Conclusions: In VLBW infants with a PICC, if unstable respiratory circulatory system states are observed that cannot be explained, such as tachycardia, bradycardia, apnea, hypotension, and metabolic acidosis, PICC-induced PCE/CT should be considered. Early diagnosis and pericardial puncture are key to saving infants' lives.
Full-body x-ray imaging to facilitate triage: a potential aid in high-volume emergency departments
Authors: S P Whiley, H Alves, S Grace
Journal: Emerg Med Int (2013)

The levels of traumatic injury seen in South African emergency departments (EDs) are epidemic. This is coupled with a severe lack of resources and adequately trained emergency staff. The Lodox Statscan (LS) is an X-ray scanner capable of producing rapid, low-dose, and full-body X-ray images. In this paper, a new trauma protocol-the Johannesburg trauma protocol-that implements LS scanning on entry to the ED as a triage tool is reported. A case study illustrating the use of LS to triage 63 patients in a single Saturday shift at a level 1 Trauma Centre is also presented. Because of the ability to rapidly and safely provide X-ray imaging information to support clinical decision making, the LS could be a useful tool to aid in resource allocation to improve treatment of the high levels of trauma patients that present to South African EDs daily.
Case report: MELAS and concomitant presumed antiphospholipid antibody syndrome in an adult woman
Authors: Sirisha Nouduri, Rajiv Padmanabhan, Richard Hicks, Mary-Alice Abbott, Dennis O'Brien, Gottfried Schlaug
Journal: Front Neurol (2022)
Keywords: melas, mri, mrs, anticardiolipin antibodies, antiphospholipid antibodies, heteroplasmy
MeSH terms: Case Reports

Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes, and other features (short stature, headaches, seizures, and sensorineural hearing loss) constitute characteristics of MELAS syndrome. MELAS is a rare condition due to mutations in maternally inherited mitochondrial DNA with levels of heteroplasmy possibly related to late adulthood presentation. A previously reported MELAS case coexisted with presumed Antiphospholipid Antibody Syndrome (APLAS), but the connection between MELAS and a potential APLAS is unclear. A 29-year-old woman presented with mild right-sided sensorimotor symptoms and mixed aphasia in November 2021. She presented again in May 2022 for unrelenting headaches and was found to have a new right hemisphere syndrome with mild left-sided sensorimotor symptoms, hemineglect, and anosognosia. Characteristic lab and imaging studies were obtained. During the first presentation (October 2021), the discovery of anticardiolipin IgM antibodies (aCL) (and their replication 3 months later) led to a diagnosis of APLAS, and Warfarin was initiated. During the second admission (May 2022), a new stroke-like lesion on the right hemisphere with characteristic features not suggestive of ischemia was detected, which led to a diagnosis of MELAS (m3243A > G mutation). Although MELAS and APLAS could co-exist, alternatively, it is possible that antiphospholipid antibodies might be generated when the strongly anionic Cardiolipin-Hydroperoxide from the inner mitochondrial membrane is exposed to immune component cells upon cell lysis. Thus, the presence of aCL in patients with stroke-like lesions might masquerade as an APLAS, but should probably be questioned if only aCL are repeatedly found and imaging findings are not characteristic for ischemic lesions.
Case report: A rare case of acute myeloid leukemia with CPSF6-RARG fusion resembling acute promyelocytic leukemia
Authors: Junmei Zhao, Wentao Wang, Li Yan, Xi Chen, Wen Li, Wanying Li, Tingting Chen, Lunhua Chen
Journal: Front Oncol (2022)
Keywords: cpsf6-rarg fusion, acute myeloid leukemia, acute promyelocytic leukemia, homoharringtonine, resistance to atra
MeSH terms: Case Reports

Retinoic acid receptor gamma (RARG) gene rearrangement has been reported in several acute myeloid leukemia (AML) patients. They resemble classical acute promyelocytic leukemia (APL) patients in clinical features, morphology, and immunophenotype but do not carry the promyelocytic leukemia (PML)-RARA fusion gene. Importantly, almost all these APL-like AML patients show resistance to all-trans retinoic acid (ATRA), and no effective treatment is recommended for them. Here, we identified a case of AML resembling APL in clinical presentation and experimental findings carrying a rare cleavage and polyadenylation-specific factor 6 (CPSF6)-RARG fusion gene. The patient was insensitive to ATRA and ATO but responded well to homoharringtonine and cytarabine.
Severe Hyponatremia Precipitated by Acute Urinary Retention in a Patient with Psychogenic Polydipsia
Authors: C M H Hilton, L Boesby, K E Nelveg-Kristensen
Journal: Case Rep Nephrol (2020)
MeSH terms: Case Reports

A woman in her late sixties presented with severe hyponatremia and acute kidney injury (AKI) as consequence of psychogenic polydipsia and acute urinary retention due to urinary tract infection. Urinary catheterization promptly drained 5.5 L of urine with resulting polyuria, leading to an initial swift raise in plasma (P) sodium concentration, disregarding the course of fluid resuscitation. After the polyuric phase, normal range P-sodium levels were reestablished by oral water restriction. Treatment with psychoactive drugs, e.g., zuclopentixol, may have contributed to the severity of the condition. There are few published reports regarding water intoxication and urinary retention, but none reflecting severe hyponatremia precipitated by acute urinary retention in a patient with polydipsia. By this report, we illustrate the detrimental consequences on water and electrolyte homeostasis of urinary retention and polydipsia resulting in acute water intoxication. The purpose of presenting this case is firstly to draw attention to the potentially fatal combination of polydipsia and postrenal acute kidney injury, where the kidneys are unable to correct the enormous excess water, then to focus on the difficulty in correcting hypervolemic hyponatraemia in the context of polyuria after relief of urinary retention, and finally, to point out that patients in treatment with antipsychotics may have further worsening of electrolyte derangement.
Atypical Findings of Focal Nodular Hyperplasia with Gadoxetic Acid (Gd-EOB-DTPA)-Enhanced Magnetic Resonance Imaging
Authors: Jung-Hee Yoon, Ji-Yeon Kim
Journal: Iran J Radiol (2014)
Keywords: dtpa, focal nodular hyperplasia, liver neoplasms
MeSH terms: Case Reports

We report two cases of focal nodular hyperplasia in patients following gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging confirmed with histopathology. These cases showed an atypical pattern during the delayed-hepatobiliary phase after the injection of gadoxetic acid. One case showed a total defect, and the other showed a peripheral ring-like enhancement without a visible central scar, mimicking hepatocellular carcinoma. The pathologic examination demonstrated that the two lesions were focal nodular hyperplasia.
Case report: Onyx embolization of tentorial dural arteriovenous fistula via the meningohypophyseal trunk and medial tentorial artery of Bernasconi-Cassinari
Authors: Kun Hou, Jinlu Yu
Journal: Front Neurol (2022)
Keywords: onyx, embolization, medial tentorial artery of bernasconi-cassinari, meningohypophyseal trunk, tentorial dural arteriovenous fistula
MeSH terms: Case Reports

For tentorial dural arteriovenous fistula (TDAVF), the meningohypophyseal trunk (MHT), and medial tentorial artery (MTA) of Bernasconi-Cassinari are rarely used as transarterial paths to perform the successful endovascular treatment (EVT). We reported a TDAVF mainly fed by the MHT. Onyx-18 casting in the MTA of Bernasconi-Cassinari under the assistance of coil embolization in proximal MHT was performed. The technique was reported in case 1. At the same time, case 2 with a similar TDAVF was chosen as a control. In case 1, a 52-year-old man suffered a cerebellar hemorrhage. A TDAVF was confirmed by computed tomography angiography and digital subtraction angiography. The feeding arteries included the MHT, middle meningeal artery (MMA), and the artery of Wollschlaeger and Wollschlaeger of the superior cerebellar artery. The MHT and MTA of Bernasconi-Cassinari were hypertrophied. First, a Marathon microcatheter was placed in the MTA to wait for Onyx casting, and then an Echelon-10 microcatheter was placed in the proximal MHT trunk with an aneurysmal dilation to perform coiling to prevent Onyx reflux. Then, Onyx casting obliterated the TDAVF. Case 2 was a 75-year-old woman with TDAVF, and the MTA of Bernasconi-Cassinari was the main feeder. First, the TDAVF experienced incomplete EVT with Onyx casting via the MTA under no assistance of coil embolization in the proximal MTA. The second EVT had to be performed via MMA. Then, Onyx casting obliterated the TDAVF. Therefore, for selected TDAVFs with hypertrophied MHT, under the assistance of coil embolization in proximal MHT, Onyx casting via MHT can finish the complete EVT.
Jones Fractures in Sumo Wrestlers: Three Case Reports
Authors: Takashi Hoshino, Tomohiko Tateishi, Tsuyoshi Nagase, Arata Yuki, Teruhiko Nakagawa, Masamitsu Tsuchiya
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Jones fractures sometimes occur in athletes and are known to have complications, such as nonunion, delayed union, and recurrence, even with treatment. We describe three cases of Jones fractures in sumo wrestlers with treatment-related difficulties. All patients discontinued treatment at their own discretion. The two conservative cases had nonunion or delayed union, and the operative case had a broken screw. However, all patients continued sumo wrestling, with little impact on their careers. The risk factors of Jones fractures in sumo wrestling may be heavy weight, and training or competition characteristics unique to sumo wrestling. In cases of a complete Jones fracture, operative treatment is most commonly selected, as the risk for nonunion or refractures is less than that for conservative treatment. However, in the case of sumo wrestlers, there are risks of infection and problems with treatment compliance. As taking a rest may result in a lowered rank, completing a sufficient duration of treatment is difficult. Treatment is difficult and controversial in sumo wrestlers; all three patients discontinued treatment of their own accord. These cases suggest that it is important to thoroughly inform sumo wrestlers of the treatment options, and to decide the most appropriate treatment method for each patient.
Forced Eruption: Alternative Treatment Approach to Restore Teeth with Subgingival Structure
Authors: Hamid Kermanshah, Elmira Najafrad, Sara Valizadeh
Journal: Case Rep Dent (2022)
MeSH terms: Case Reports

The management of teeth with deep caries, fracture, or perforation in the cervical third of the root is an integral part of dental practice. Orthodontic extrusion preserves the natural root system and may convert the tooth indicated for extraction into useful tooth with good prognosis and a low risk of failure. Orthodontic tooth eruption can be an alternative to treatment such as surgical crown lengthening, especially in esthetic areas, and provides more favorable conditions for prosthodontic coronal restorations by guaranteeing proper sealing and esthetics and preserving periodontal tissue health. The aim of this case report was to explain a multidisciplinary approach that successfully preserve and treat the teeth with subgingival carious lesion. This innovative method is cost-effective and can be easily done with the equipment available in any office.