Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report

INTRODUCTION

Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain.

CLINICAL CASE REPORT

A 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium.

CLINICAL CONCLUSION

A successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.

Best management modality of trichobezoar: A case report

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Laparotomy is the best treatment method for trichobezoare.

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Psychiatric management should be done for any patient with trichotillomania to avoid trichobezoar.

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Endoscopic treatment can only be successful for small trichobezoar.

Introduction

Trichobezoar is a rare condition, usually diagnosed in children and young female especially with psychiatric illness. Diagnosis of trichbezoar is usually dependent on the disease history, examination, diagnostic modality including CT scan. Generally this condition can be treated by endoscopy, laparoscopy or laparotomy. Here, we have presented a rare case of trichobezoar which has failed to be treated endoscopically but was eventually treated successfully by laparotomy.

Case report

A 17 years old girl was presented with the initial complaint of epigastric pain for about 9 months duration with symptoms including vomiting and weight loss. Clinical examination showed tenderness and hard mass over epigastric area and it was extending towards the right hypochondrial area. CT scan results also showed that the stomach was filled with large intra-luminal abnormal mass like contents with mottled air pattern extended to fill the pylorus and first part of the duodenum. These findings were the proofs for possible trichobezoar. Endoscopic surgery failed significantly and hence laparotomy was performed, as a result, trichbezoar was removed successfully.

Discussion

Trichobezoar can be treated by using endoscopy for removal of hair, laparoscopy or Laparotomy. Laparotomy had 100% successful rate while 5% for endoscopy and 75% for laparoscopy.

Conclusion

Laparotomy is the best treatment method for trichobezoare. Psychiatric management should be done for any patient with trichotillomania to avoid trichobezoar.

Mediastinal ectopic thyroid mass with normal thyroid function and location: Case report

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Ectopic Thyroid Tissue in the mediastinum is very rare.

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ETT can be associated with normal thyroid function and normal thyroid anatomical location.

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ETT should be differentiated from substernal goiter.

Introduction

Mediastinal Ectopic Thyroid Gland is a rare entity, accounting for 1% of all mediastinal tumours. Here, we present a rare case of mediastinal mass that was proved to be an ectopic thyroid with normal thyroid function tests and normal thyroid gland in the cervical location.

Case Presentation

A 32-year-old lady had a road traffic accident, with the incidental discovery of a mediastinal mass on chest radiography. Thyroid function tests were normal. CT scans of the neck and chest revealed a large mediastinal mass compressing the trachea from the left side and extending to the superior part of the anterior mediastinum with normal thyroid gland in the cervical position. Midline Partial Sternotomy was done with complete surgical excision of the mass. It was well circumscribed, multinodular, had firm inconsistency, and grossly looked like a thyroid tissue. Histopathology revealed ectopic thyroid tissue negative for malignancy. Postoperative thyroid ultrasound showed normal thyroid lobes in the neck.

Discussion

Ectopic thyroid tissue (ETT) occurs due to failure of the thyroid gland to migrate from foramen ceacum to its normal position in the cervical region in front of the trachea. The most common site of ETT is lingual thyroid and accounts for about 90% of all cases reported in the literature. ETT in the mediastinum is very rare, with only a few cases reported in the literature.

Conclusion

ETT in the mediastinum is very rare and can be associated with normal thyroid function and normal thyroid anatomical location. It should be differentiated from substernal goiter.

Hodgkin's Lymphoma as a Multiloculated Lung Cavity Lesion

BACKGROUND

Pulmonary manifestation of Hodgkin's lymphoma is common, and recently, single and/or multiple lung cavities with air-fluid levels has been reported as a primary manifestation of Hodgkin's lymphoma. However, the unusual presentation of the lung cavity itself has not been previously reported for Hodgkin's lymphoma, especially as the first presentation of the disease.

CASE PRESENTATION

We report a 16-year-old male who presented to the emergency department with chief complaints of fever, unintentional 10-kilogram weight loss, a productive cough and pulmonary cavity for investigation. The patient's CT scan indicated multiloculated cavity lesions in the middle lobe with an air-fluid level and multiple enlarged mediastinal lymph nodes, which have not been previously reported as a primary presentation for Hodgkin's lymphoma or in the histopathology of the nodular sclerosing type of classical Hodgkin's lymphoma.

CONCLUSION

Pulmonary manifestation of Hodgkin's lymphoma has already been reported and must be part of the differential diagnosis of lung cavity lesions, even if the likelihood is low based on previous reports, especially in younger individuals. Multiloculated lung cavities can be the first presentation of Hodgkin's lymphoma.

Is Cronbach's alpha sufficient for assessing the reliability of the OSCE for an internal medicine course?

Background

The number of medical students accepted into medical programs is increasing, which has made the traditional long/short case style of examination difficult to conduct. At Dammam University, the program is shifting to the use of the Objective Structural Clinical Examination (OSCE), which may solve some of these difficulties, including issues with reliability, validity index and exam duration.

Results

A pilot study was conducted over one semester. A total of 207 examinees in three groups took the OSCE and written exams. The OSCE consisted of 18 clinical stations and required 3–4.3 h/day. The written exam contained 80 multiple-choice questions. The Cronbach’s alpha for each group was 0.7, 0.8, and 0.9. Correlations for all stations ranged from 0.7 to 0.8, which indicated good stability and internal consistency with minor differences in the progression of the indexes. The reliability of the written exam was 0.79, and the validity of the OSCE was 0.63, as assessed using Pearson’s correlation.

Conclusion

No single reliability index can be considered a perfect assessment tool to solve this issue. Thus, at least two to three indexes should be used to ensure the reliability of the OSCE.