Pyolaryngocele: Case report

INTRODUCTION AND IMPORTANCE

Pyolaryngocele is a very rare and serious complication of laryngocoele. The clinical presentation can be extremely severe acute epiglottitis with laryngeal dyspnea and major dysphagia. The treatment of choice is surgical excision. Our aim is to attract the intention of the surgeon to this unusual entity and describe its clinical features.

CASE PRESENTATION

We report a case of a 70-year-old male patient with a five-day history of left neck swelling, sore throat, and low-grade fever. An urgent CT scan showed a mixed pyolaryngocele. The management consisted of high-dose antibiotics and excision of the residual laryngocoele via an external approach.

CLINICAL DISCUSSION

A pyolaryngocele is an unusual complication of laryngocoele that becomes secondarily infected causing serious symptoms. The management consists of administrating broad-spectrum antibiotics and aspiration of purulent material to decompress the sac. At a later stage, after relieving the acute symptoms we performed an external approach with formal excision of the laryngocele.

CONCLUSION

Pyolaryngocele is a rare complication of laryngocele and can present with serious complaints like dyspnea and sepsis. Excision of the laryngocoele is still the best treatment option to prevent this complication and recurrence.

An atypical Esthesioneuroblastoma of the sphenoid sinus: a case report

Esthesioneuroblastoma (ENB) is a rare tumor, arising from the olfactory epithelium. It manifests as an aggressive tumor in the superior aspect of the nasal cavity. Sinonasal symptoms are the most common. The cervical lymph nodes ensue in nearly 10% of cases and hematogenous metastases are rare. The diagnosis is histological. This tumor is staged using the Kadish et al System. The imaging techniques, using both computed tomography (CT) and MRI provides all the important information required for treatment modality. Today, the standard multimodal treatment combining external craniofacial resection, radiotherapy, and chemotherapy has improved long-term survival.

Case presentation

A 27-year-old male patient with no medical history, complained of a headache, a unilateral right nasal obstruction, epistaxis, and anosmia for 2 months. Nasal endoscopy showed a pinkish-gray mass filling the right nasal cavity. An enhanced-contrast CT scan was performed and objectified a mildly enhancing extensive mass of the sphenoid sinus with bone erosion of the left wall of the sinus and intracranial involvement. An intranasal biopsy was performed, resulting in a histopathological diagnosis of olfactory neuroblastoma. Our case was staged as stage C according to the Kadish staging. The tumor was inoperable, the patient had chemotherapy, radiotherapy, and pain management.

Clinical discussion

ENB is an aggressive malignant tumor derived from the specialized olfactory neuroepithelium of the upper nasal cavity. Several published reports confirm ectopic cases of ENB throughout the nasal cavity and the central nervous system. Because sinonasal malignant lesions are rare and difficult to distinguish from their benign counterparts. ENBs appears as a soft, glistening, polypoidal, or nodular mass covered by intact mucosa or as friable masses with ulceration and granulation tissue. A radiological, CT scan through the skull base and paranasal sinuses with intravenous contrast should be performed. ENBs are solid, enhancing nasal cavity masses that may manifest erosion into nearby osseous. MRI provides better discrimination between tumor and secretions and optimal assessment of orbital, intracranial, or brain parenchymal involvement. The biopsy is the next important step in securing a diagnosis. Classic treatment strategies of ENB are based on surgery or radiotherapy as unique modalities or a combination of surgery and radiation therapy. More recently, chemotherapy has been introduced in the therapeutic armamentarium since ENB has proven to be chemosensitive. The elective neck dissection remains controversial. Long-term follow-up is mandatory for patients with ENB.

Conclusion

While most ENBs originate in the superior nasal vault and present with typical symptoms of nasal obstruction and epistaxis in the late stages of the disease, uncommon manifestations should be considered as well. Adjuvant therapy should be considered in patients with advanced disease and unresectable disease. A continuing follow-up period is needed.

Primary tuberculosis of the pyriform sinus: A case report

Introduction

Tuberculosis is a chronic bacterial infection caused by the Mycobacterium tuberculosis. Extrapulmonary tuberculosis (EPTB) accounts for about 20% of cases in immunocompetent patients and 50% of cases in HIV-positive individuals (7). Except for the cervical lymph nodes location, head and neck tuberculosis is rare.

Clinical presentation

A 32-year-old man presented with chronic and progressive sore throat and dysphagia lasting for 4 months. The clinical examination revealed a lesion in the left piriform sinus confirmed by CT. a biopsy was performed and the histological results showed a chronic and granulomatous inflammatory process composed of epithelioid and giganto-cellular follicles centered by large areas of caseous necrosis, concluding tuberculosis of the pyriform sinus.

Discussion

Primary tuberculosis of the hypopharynx is very rare. In most cases, is revealed by odynophagia, dysphagia, but it can also mimic the signs of a malignant tumor, hence, the difficulty in diagnosing this localization. Few articles have been reporting cases of hypopharyngeal tuberculosis, in these articles, the main symptom was dysphagia, as was the case with our patient. Given the rarity of hypopharyngeal tuberculosis, several differential diagnoses are to consider: squamous cell carcinoma, which is has a similar clinical manifestation to tuberculosis. There is also, rarely, oropharyngeal lymphoma, minor salivary gland tumors, neurogenic tumors, and Wegener's disease. The Diagnosis of EPT is established when Mycobacterium tuberculosis bacillus is isolated and the epithelioid and giganto-cellular follicles centered by large areas of caseous necrosis is found in the histopathological examination of the endoscopic biopsy specimen. The Treatment is medical, by Anti bacillar chemotherapy, however the period is longer the pulmonary tuberculosis, it extends from of six to twelve months.

Through this study, the main lesseons and are that Malignant lesion is always to rule out when a suspicious lesion of the hypopharynx is found, we also come to conclude that the ndoscopic and clinical aspect between tumoral and tuberculosis of the hypopharynx are very similar The diagnosis is confirmed with biopsy of the lesion.

Conclusion

primary tuberculosis of the pyriform sinus is very rare. it's mandatory to rule out malignant pharyngeal lesions and consider hypo-pharyngeal tuberculosis as one of the differential diagnoses in lesions especially in the countries where tuberculosis is endemic.

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Emphasize the challenge confronted in diagnosing clinically and by imaging.

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Its mandatory to rule out malignant lesion first.

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The diagnosis is retained by pathological examination of the lesion sample.

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The treatment is medical, with Anti bacillar chemotherapy.

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Monthly follow up for at least one year is obligatory.

Sars-Cov-19 associated with aspiration pneumonia in a patient with Parkinson disease: A case report

Coronaviruses can cause multiple systemic infections respiratory complications are the most recognizable symptoms similar to severe acute respiratory syndrome coronavirus (SARS-CoV). Aspiration pneumonia was the most common reason for the Emergency admission of patients with PD.Here we report the case a patient with Parkinson’s disease admitted for respiratory insufficiency secondary to Covid-19 and aspiration pneumonia.

A 78-years- old male patient, treated for Parkinson’s disease, was admitted to the emergency department with symptoms of acute respiratory insufficiency. Four days before his admission, the patient suffered from solid dysphagia. On physical examination, the patient was obnibulated, febrile at 39 °, with clinical signs of respiratory insuffisiency. Computed tomography of the neck and Chest showed patchy areas of subpleural ground glass opacities with vascular dilatation associated with bilateral posterobasal and anterior consolidations with air overlapping imaging characteristics of aspiration and covid 19 pneumonia. The CT scan also showed an oesophageal hypodensity consistant with endoluminal foreign body.

Reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 was positive.The diagnosis of Sars-cov 19 associated with aspiration pneumonia were retained. An esophagoscopy was realized, a foreign body visualized in the upper sphincter of the esophagus and an impacted food bolus was retracted.

We would like to emphasize the challenging differential diagnosis of pneumonia caused by aspiration of different materials and Sars-cov 19. Definite discrimination of the two diagnoses might be impossible. Some radiologic features may suggest one diagnos over the other. While lobar or segmental pneumonia, lung abscess, and empyema have been reported as Complications of aspirations pneumonia these outcomes are rarely Considered Complications of COVID-19 pneumonia. Centrilobular nodules and tree-in-bud sign are commonly seen in cases with aspiration. Interestingly, these CT findings are not frequent in COVID-19 pneumonia and have been categorized as “Atypical” by the Radiological Society of North America (RSNA), and therefore could be of some Value in proposing a differential diagnosis. Bilateral subpleural patches of ground-glass opacity (GGO), especially in basal distribution, have been described as typical for the diagnosis of COVID-19 pneumonia in suspected Cases. Such a presentation is also fairly common in aspiration Pneumonia.