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Kunz S, Bergsma P, Brand Y. Varicella mimicking complications of acute rhinosinusitis in an infant. BMJ Case Rep 2024; 17:e246379. [PMID: 38684354 DOI: 10.1136/bcr-2021-246379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Varicella is the manifestation of primary infection with the varicella-zoster virus, mainly affecting preschool and school-aged children. The children suffer from a generalised, vesicular rash and fever. Despite the infection's typically non-threatening course, a variety of severe complications have been described.The authors present the case of a female infant suffering from varicella and developing preseptal cellulitis with a frontal abscess while being treated with intravenous antibiotics. Otorhinolaryngology consultation was sought since the clinical image was highly suggestive for sinusitis complications, namely orbital cellulitis and frontal bone osteomyelitis (Pott's puffy tumour). However, the child was below the age of frontal sinus development and there was no other apparent sign of sinonasal involvement. Ultrasonography revealed a mid-frontal collection without signs of abscess formation preseptally or postseptally, leading to the diagnosis of cutaneous superinfection of varicella lesions. The frontal abscess was drained, and the child fully recovered under antibiotic treatment.
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Affiliation(s)
- Seraina Kunz
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Patrick Bergsma
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Yves Brand
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- University of Basel, Basel, Switzerland
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2
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Jamshaid S, Rotimi O, Tanna R, Elmiyeh B. Complicated penetrating foreign body neck injury. BMJ Case Rep 2024; 17:e259396. [PMID: 38677718 PMCID: PMC11057282 DOI: 10.1136/bcr-2023-259396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Penetrating neck injury is associated with significant morbidity due to the several structures (neurological, vascular and aerodigestive) within close proximity to one another. This case highlights an uncommon presentation of an embedded foreign body following penetrating neck trauma and the decision-making required during management.
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3
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Amar Z, Uddin S, Ahmed Y. Oral ulcer and miliary pulmonary nodules are a rare manifestation of histoplasmosis infection. BMJ Case Rep 2024; 17:e260020. [PMID: 38670571 PMCID: PMC11057194 DOI: 10.1136/bcr-2024-260020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Zain Amar
- St John Medical Center, Tulsa, Oklahoma, USA
| | - Salah Uddin
- Transplant Nephrology, St John Medical Center, Tulsa, Oklahoma, USA
| | - Yasir Ahmed
- Infectious Diseases, St John Medical Center, Tulsa, Oklahoma, USA
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4
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Sagar M, Sunar D, Konkimalla A, Das S. Rare presentation of solitary fibrous tumour in the floor of the mouth. BMJ Case Rep 2024; 17:e258608. [PMID: 38649243 PMCID: PMC11043717 DOI: 10.1136/bcr-2023-258608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
A male in his 20s, a tobacco chewer, presented to the outpatient department with a history of painless, slowly progressive swelling in the floor of the mouth. After a thorough history and clinical examination, MRI was done and the tumour was completely excised. Histopathological examination revealed the mass to be a solitary fibrous tumour, confirmed with immunohistochemical markers. On subsequent follow-ups, the patient was found to be asymptomatic with no clinical signs of recurrence.
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Affiliation(s)
- Milind Sagar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Diwash Sunar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Abhilash Konkimalla
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sumanta Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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5
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Karanth T, Lal N. Herpes zoster of posterior division of mandibular branch of trigeminal nerve. BMJ Case Rep 2024; 17:e259276. [PMID: 38642932 PMCID: PMC11033655 DOI: 10.1136/bcr-2023-259276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
Herpes zoster is a disease caused by the reactivation of dormant varicella zoster virus present in the sensory root ganglion. It presents with a vesicular rash on an erythematous base similar to that seen in classical varicella, however, with only a single dermatomal distribution. The rash is usually seen throughout the affected dermatome as the dorsal root ganglia for each dermatome are clustered together. We present a case of an otherwise healthy male who developed a vesicular rash confined to the distribution of the posterior division of the mandibular nerve. Though the entire mandibular nerve arises from a single ganglion, the skin area supplied by the anterior division of the mandibular nerve was spared. This case provides evidence to show that there is anatomic segregation of cell bodies of nerves traversing anterior and posterior divisions of mandibular division in the trigeminal ganglion and that partial involvement of a sensory root ganglion is possible in immunocompetent patients.
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Affiliation(s)
- Tulasi Karanth
- Department of ENT-HNS, Military Hospital Prayagraj, Prayagraj, India
| | - Neetu Lal
- Department of ENT-HNS, Military Hospital Prayagraj, Prayagraj, India
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6
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Carreira A, Muna S, Grossman AB, Korbonits M. Beware of epistaxis: fatal pseudoaneurysm rupture 30 years after treatment of acromegaly. BMJ Case Rep 2024; 17:e258533. [PMID: 38642934 PMCID: PMC11033645 DOI: 10.1136/bcr-2023-258533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes of mild epistaxis. A week later, he presented at his local hospital's emergency department with severe epistaxis and altered consciousness. He was diagnosed with a ruptured internal carotid artery (ICA) pseudoaneurysm, but unfortunately died before treatment could be attempted.ICA pseudoaneurysms are rare complications of surgery or radiotherapy and can present with several years of delay, often with epistaxis. This case highlights the importance of life-long monitoring in patients with previous pituitary interventions and early recognition of epistaxis as a herald sign of a potentially catastrophic event, thus leading to timely treatment.
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Affiliation(s)
- Ana Carreira
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Endocrinology, Diabetes and Metabolism, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Solomon Muna
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ashley B Grossman
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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7
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Sagar M, Dharmavaram Rajasekhar P, Singh CA, Khandkar H. Juvenile trabecular ossifying fibroma of the inferior turbinate. BMJ Case Rep 2024; 17:e259397. [PMID: 38627043 PMCID: PMC11029416 DOI: 10.1136/bcr-2023-259397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Nasal obstruction is a commonly reported issue in the Otorhinolaryngology Outpatient Department. In this case, an early adolescent boy with a long-standing problem of right-sided nasal obstruction since childhood sought consultation. Diagnostic nasal endoscopy revealed a deviation of the nasal septum to the left, coupled with right inferior turbinate hypertrophy, all overlying healthy mucosa. A CT scan of the nose and paranasal sinuses further identified a bony hyperdense lesion with ground glass attenuation, confined to the right inferior turbinate. Subsequent biopsy confirmed juvenile trabecular ossifying fibroma (JTOF). The patient underwent endoscopic right medial maxillectomy, and the final histology affirmed the diagnosis of JTOF.
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Affiliation(s)
- Milind Sagar
- ENT, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head-Neck Surgery, AIIMS, New Delhi, Delhi, India
| | - Hena Khandkar
- Department of Pathology, AIIMS, New Delhi, Delhi, India
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8
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Hsue VBC, Wong YT, Wu A, Tang D. Reconstruction of an obliterated Eustachian tube: transnasal lighted guidewire catheter stenting. BMJ Case Rep 2024; 17:e256748. [PMID: 38490712 PMCID: PMC10946367 DOI: 10.1136/bcr-2023-256748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
An obliterated Eustachian tube (ET) is a rare occurrence that can lead to chronic otitis media (OM) and aural fullness even with treatment. Our study presents a review of the literature on methods of stenting the ET. We additionally present a case of a man with mucoepidermoid carcinoma of the ET who underwent a radical nasal pharyngectomy with reconstruction and adjuvant radiation, and who had symptoms of intolerable otorrhea after tympanostomy tube placement to treat aural fullness and mucoid OM. We used a novel method of stenting the ET using a transnasal lighted guidewire catheter and steroid eluting stents placed along the entire medial ET. Previously described methods in the literature were unable to be used due to the complex middle ear anatomy filled with granulation tissue and the lack of a visible nasopharyngeal ET ostium available for straightforward placement of the stent. The procedure was successful, and postoperatively, the patient experienced decreased otorrhea.
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Affiliation(s)
| | - Yu-Tung Wong
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Arthur Wu
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis Tang
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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9
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Butler D, Moylett E. Pseudoparalysis in an infant with otitis media: an evolving presentation of scapular osteomyelitis. BMJ Case Rep 2024; 17:e256833. [PMID: 38471705 PMCID: PMC10936462 DOI: 10.1136/bcr-2023-256833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
A female infant presented to an Irish hospital with a 4-day history of fever, irritability and reduced oral intake. Initial inflammatory markers were significantly elevated, an erythematous tympanic membrane was noted on examination and an initial diagnosis of acute otitis media was made. By the third hospital day, the infant was noted to be irritable when being lifted up; pseudoparalysis of the right upper limb was observed. A radiograph of the right shoulder was normal; MRI identified acute scapular osteomyelitis with subperiosteal abscess formation. The child underwent 3 washout procedures and received 6 weeks of antibiotic therapy, with full clinical recovery at 3 months. This case highlights the importance of remaining flexible in the context of an evolving presentation and recognising hallmarks of musculoskeletal infection, fever, localised pain and pseudoparalysis. Additionally, we review the literature to highlight clues in diagnosis, treatment and outcome for paediatric acute scapular osteomyelitis.
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Affiliation(s)
| | - Edina Moylett
- Paediatrics, University College Hospital Galway, Galway, Ireland
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10
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Marques DL, Rato C, Miguéis A, Miguéis J. Descending necrotising mediastinitis: a rare entity in children. BMJ Case Rep 2024; 17:e258304. [PMID: 38453221 PMCID: PMC10921524 DOI: 10.1136/bcr-2023-258304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
We present a case of descending necrotising mediastinitis (DNM) originating from a retropharyngeal abscess in a healthy early childhood patient. The patient had a history of fever, odynophagia and refusal to eat, followed by rapid deterioration of the clinical state. Cervicothoracic CT was performed, which revealed a right parapharyngeal abscess, extending to the mediastinum and occupying the retropharyngeal/visceral space, with gaseous content throughout this collection, associated with bilateral pleural effusion, aspects compatible with DNM. She started broad-spectrum antibiotic therapy and transoral drainage of the parapharyngeal and retropharyngeal collections was performed under general anaesthesia. She was admitted to the intensive care unit. The patient showed clinical, analytical and imaging improvement, having been transferred to the ear, nose and throat department, with favourable evolution. Early diagnosis of DNM by cervicothoracic CT and multidisciplinary approaches, including intensive care, broad-spectrum antibiotics and surgical intervention, are crucial to minimise the morbidity and mortality.
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Affiliation(s)
| | - Catarina Rato
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - António Miguéis
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jorge Miguéis
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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11
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Tan JL, Dhepnorrarat C, Wong D, De Sousa JL. Transorbital and endonasal resection of a rare orbital ectopic atypical meningioma. BMJ Case Rep 2024; 17:e257490. [PMID: 38429059 PMCID: PMC10910577 DOI: 10.1136/bcr-2023-257490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
A female patient in her early 20s presented with increasing proptosis of her left eye over 2 months. She had no other signs of diplopia, pain or visual loss on initial presentation. Subsequent imaging of her orbits revealed a medial rectus tumour. A transorbital open biopsy of this tumour was non-diagnostic/inconclusive, hence a combined transorbital and endonasal resection of this tumour was performed. Histopathology of the resected tumour revealed an unusual inflammatory-rich spindle cell neoplasm, which was determined to be a primary orbital ectopic atypical meningioma. These tumours are exceedingly rare, with only case reports/series reported in the literature. Complete surgical resection with margins is the proposed treatment. The role of radiotherapy is still controversial. More studies are required to improve our knowledge of this condition.
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Affiliation(s)
- Jian Li Tan
- ENT, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Tan Tock Seng Hospital, Singapore
| | | | - Daniel Wong
- Pathology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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12
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Hu H, Hulse K, Iyer A. Management of recurrent pinna haematoma following rugby injury: a surgical approach. BMJ Case Rep 2024; 17:e256375. [PMID: 38429058 PMCID: PMC10910642 DOI: 10.1136/bcr-2023-256375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
A young adult male developed a left-sided pinna haematoma after a rugby injury. The haematoma reaccumulated after multiple attempts at drainage under local anaesthetic in emergency rooms and required incision and drainage in the theatre under general anaesthetic. Intraoperatively, multiple venous bleeding points were identified and these were controlled with bipolar diathermy. The wound was closed and dressed with bolster and crepe bandage. On day 7 postoperatively, the sutures and dressings were removed and the haematoma had not recurred. He returned to playing rugby on day 21 postoperatively and sustained another blunt impact to his left ear. He noticed new swelling over the posterior aspect of the same ear. This was drained via needle aspiration and there was no further reaccumulation of the pinna haematoma.
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Affiliation(s)
| | - Kate Hulse
- Ear, Nose and Throat, Monklands General Hospital, Airdrie, North Lanarkshire, UK
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13
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Jeganathan C, Tan JL, Dhepnorrarat C. Rare case of p16-positive oropharyngeal cancer metastasis to the orbit. BMJ Case Rep 2024; 17:e257679. [PMID: 38417943 PMCID: PMC10900310 DOI: 10.1136/bcr-2023-257679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
We describe a case of a man in his 70s who was diagnosed with a p16-positive base of tongue squamous cell carcinoma (SCC) and presented with deteriorating vision and exophthalmos. Imaging revealed medial rectus hypertrophy, and surgery confirmed metastatic p16-positive SCC. Literature reveals that orbital metastasis from any malignancy is a rare occurrence, and even that of p16-positive oropharyngeal SCC has only been reported once in English literature previously. The case highlights the importance of maintaining a wide differential and not being narrowed into a diagnosis or treatment, and given the increasing incidence of human papillomavirus-related cancers, it is important to preserve a high index of suspicion.
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Affiliation(s)
- Chaithanya Jeganathan
- Otolaryngology, Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jian Li Tan
- Otolaryngology, Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Tan Tock Seng Hospital, Singapore
| | - Chris Dhepnorrarat
- Otolaryngology, Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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14
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Cukman M, Luzaic K, Krstanovic K, Stevanovic S. Management of a rapidly enlarging supraclavicular mass of unknown aetiology. BMJ Case Rep 2024; 17:e255774. [PMID: 38383129 PMCID: PMC10882406 DOI: 10.1136/bcr-2023-255774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Intramuscular haemangiomas are benign tumours showing an extremely rare occurrence and making up less than 1% of all haemangiomas. The goal of this case report is to share our experience in treating a patient with an extremely rare intramuscular haemangioma, which occurred in the supraclavicular region VB level of the neck and extended towards the infraclavicular space, localised within and inferior to the trapezius muscle. The lesion was diagnosed by using multimodal imaging and a wide excision was performed with intraoperative feeding vessel ligation and a good postoperative result. The main difficulties regarding diagnosis and treatment include a lack of evidence-based guidelines, due to limited publications on this topic, the nature of the lesion frequently showing obscure anatomic localisation deep within muscles and unclear delineation, various anatomic origin requiring an individual treatment approach, inconclusive radiologic signs as well as non-specific symptoms.
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Affiliation(s)
- Mateo Cukman
- University of Zagreb School of Medicine, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Karla Luzaic
- University of Zagreb School of Medicine, Zagreb, Croatia
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15
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Kusunoki T, Wada R. Case with translating to multiple myeloma at 8 years after radiation therapy for extramedullary plasmacytoma of the larynx. BMJ Case Rep 2024; 17:e256747. [PMID: 38373810 PMCID: PMC10882452 DOI: 10.1136/bcr-2023-256747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
We report a case of extramedullary plasmacytoma of the larynx that was eradicated by radiotherapy; however, 8 years later, the disease had progressed to multiple myeloma. A mid -60s Japanese woman presented with a right-sided arytenoid mass in the larynx who underwent biopsy at another hospital. Based on the biopsy results, the patient was diagnosed with extramedullary plasma cell tumour and was referred to the Department of Otorhinolaryngology at our hospital. She received radiotherapy (50.4 Gy) and the laryngeal tumour was eradicated. Positron emission tomography/CT (PET-CT) revealed no abnormal accumulation in the larynx or whole body. After radiotherapy, the department of otorhinolaryngology, in consultation with Ddepartment of haematology performed follow-ups using laryngoscope, blood examination and PET-CT. Five years after the end of radiotherapy, the patient had no local recurrence or transition to multiple myeloma. However, 8 years later, blood examination and PET-CT revealed multiple myeloma. Laryngoscopy did not reveal any recurrent laryngeal tumour. Therefore, chemotherapy for multiple myeloma was administered at the department of haematology. Three months after the initiation of chemotherapy, the accumulation had disappeared in PET-CT. Three years have passed since chemotherapy initiation. At present, no recurrence or metastasis was observed in the larynx or whole body.
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Affiliation(s)
- Takeshi Kusunoki
- Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital, Izunokuni-shi, Shizuoka, Japan
| | - Ryo Wada
- Department of Pathology, Juntendo University of Medicine, Shizuoka Hospital, Izunokuni, Shizuoka, Japan
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16
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Tsang W, Meghji S, Masterson L, Fish B. Successful use of sclerotherapy in giant supraglottic vascular malformation. BMJ Case Rep 2024; 17:e256195. [PMID: 38359957 PMCID: PMC10875521 DOI: 10.1136/bcr-2023-256195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
A young male patient presented with an incidental finding of a large supraglottic vascular lesion. The lesion was initially noted during intubation 4 years ago. Although originally listed for elective excision, there was a significant delay and at the time of surgery, the lesion proved too large to remove and a significant threat to the patient's airway. An emergency tracheostomy was performed, followed by two consecutive treatments with sclerotherapy agents to reduce the size of the lesion. It was then successfully excised using a Thunderbeat ultrasound and bipolar dissection and cautery device.
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Affiliation(s)
- William Tsang
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sheneen Meghji
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Liam Masterson
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian Fish
- ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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17
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Akhavan-Mofrad A, Gupta KK, Jolly K. Carolyn's window approach for spontaneous frontal sinus meningoencephalocele. BMJ Case Rep 2024; 17:e258886. [PMID: 38355205 PMCID: PMC10868238 DOI: 10.1136/bcr-2023-258886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Spontaneous meningoencephaloceles (MECs) are sparsely documented in the literature. Those occurring in the frontal sinus are an exceedingly rare entity. MECs are commonly associated with cerebrospinal fluid (CSF) rhinorrhoea. CSF rhinorrhoea is frequently misdiagnosed, causing delays in diagnosis and management. The subsequently increased risk of bacterial meningitis can be life-threatening to patients. We report the case of a woman in her late 70s with a spontaneous frontal sinus MEC, presenting with a 6-month history of CSF rhinorrhoea. The patient was successfully treated using the novel Carolyn's window approach endoscopically; 9-month follow-up revealed no skull-base breach. Our case emphasises the importance of considering MEC as a differential diagnosis for clear rhinorrhoea and demonstrates successful repair through a novel surgical approach.
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Affiliation(s)
| | - Keshav Kumar Gupta
- ENT and Skull Base Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karan Jolly
- ENT and Skull Base Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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18
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Shiraki Y, Takahashi T, Ogi M, Horii A. Changes in CT values of wood in the body: pitfalls in detecting a wooden foreign body. BMJ Case Rep 2024; 17:e259348. [PMID: 38320817 PMCID: PMC10859975 DOI: 10.1136/bcr-2023-259348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Yuya Shiraki
- Otolaryngology, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Takeshi Takahashi
- Otolaryngology, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Manabu Ogi
- Otolaryngology, Niigata prefectural central hospital, Joetsu, Japan
| | - Arata Horii
- Otolaryngology, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
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19
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Rajpal N, Saxena R, Meher R, Dabas A. Sentinel ear bleed as a presenting sign for carotid artery blowout due to aspergillus abscess in parapharyngeal space in an immunocompetent infant. BMJ Case Rep 2024; 17:e256753. [PMID: 38320828 PMCID: PMC10859982 DOI: 10.1136/bcr-2023-256753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Parapharyngeal abscesses leading to complications, although rare after the advent of antibiotics, can lead to serious complications. One such complication is carotid erosion that can lead to a potentially fatal carotid artery blowout. We report a case of a previously healthy infant who presented with fever, ear bleed and progressively increasing swelling in the right side of his neck that led to airway compromise. The child required immediate securing of the airway at presentation. Imaging revealed lobulated abscess with multiple bleeding points eroding the carotid vessels, along with internal jugular venous thrombus. Surgical exploration was done and abscess debulked. Histopathology revealed aspergillus, which was treated with antifungals. He was discharged on oral warfarin after 40 days of hospital stay and remains well on follow-up. Sentinel ear bleed warrants close observation for possibility of carotid artery blowout in children with parapharyngeal abscesses.
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Affiliation(s)
- Neha Rajpal
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Romit Saxena
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- ENT, Maulana Azad Medical College, New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
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20
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Mckinnon K, Jardine C, Barclay G, Thrippleton MJ, Abel S, Wardlaw JM, Bastin ME, Whalley HC, Richardson H, Boardman JP. An unexpected ferromagnetic foreign body in a paediatric research participant undergoing 3T MRI. BMJ Case Rep 2024; 17:e258969. [PMID: 38272527 PMCID: PMC10826474 DOI: 10.1136/bcr-2023-258969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Metallic foreign bodies (FBs) are a safety risk during MRI. Here, we describe a boy in early childhood with an unexpected ferromagnetic FB discovered during a research brain MRI. Safety precautions included written and oral safety screening checklists and visual check during a structured safety pause. During introduction to the scanner, he was lifted to look at the bore. Staff became aware of an object flying into the bore. The child reached for his ear, and a 5 mm diameter ball bearing was found in the bore. The child had no external injury. We have introduced a 0.1 T handheld magnet to check for metallic FBs not known to the parent. FBs are a common paediatric emergency department presentation, particularly in younger children or those with cognitive or behavioural problems. This case highlights the importance of safety screening in paediatric MRI scanning, along with its fallibility.
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Affiliation(s)
- Katie Mckinnon
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | | | - Gayle Barclay
- Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, UK
| | - Michael J Thrippleton
- Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Selina Abel
- School of Philosophy, Psychology, and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Heather C Whalley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Hilary Richardson
- School of Philosophy, Psychology, and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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21
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D'Mello K, Cevik J, Wong DJY, Hart C. Therapeutic challenges in small cell carcinoma of the larynx. BMJ Case Rep 2024; 17:e258269. [PMID: 38262714 PMCID: PMC10826497 DOI: 10.1136/bcr-2023-258269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Primary small cell neuroendocrine carcinoma (SCNC) of the larynx is a rare subtype of laryngeal cancer, accounting for less than 1% of all laryngeal tumours. It most commonly affects smokers in their fifth to sixth decade of life and is characterised by a high incidence of advanced disease at presentation and an aggressive clinical course. Here we present a case of SCNC of the larynx, presenting initially with dysphonia, and an associated literature review collating current knowledge regarding therapeutic approaches. After review of 260 cases in the literature we determined a disease-specific survival of 33.1%. Combined chemoradiotherapy is currently the recommended first-line treatment option.
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Affiliation(s)
- Kimberly D'Mello
- Otolaryngology, Head & Neck Surgery, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Jevan Cevik
- Otolaryngology, Head & Neck Surgery, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Daniel Jun Yi Wong
- Otolaryngology, Head & Neck Surgery, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Cameron Hart
- Otolaryngology, Head & Neck Surgery, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
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22
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Dodhia VH, Penny F, Shanmugasundaram R, Patel N. De-escalating radiotherapy in HPV-positive oropharyngeal squamous cell carcinoma: how much is too little? BMJ Case Rep 2024; 17:e257078. [PMID: 38262720 PMCID: PMC10826500 DOI: 10.1136/bcr-2023-257078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) had a rapidly increasing incidence rate in high-income countries, with a significant increase in cases related to human papilloma virus (HPV). HPV-positive (HPV+) OPSCC has shown better survival rates compared with HPV-negative (HPV-) cases, prompting investigations into de-escalation strategies to reduce or change chemoradiotherapy protocols. We present a case of a patient with HPV+ OPSCC who discontinued chemoradiotherapy after 2 weeks, effectively receiving a de-escalated dose of 18 Gy over nine fractions and only one cycle of cisplatin, subsequently undergoing curative surgical resection with no residual disease in the radiotherapy field 14 years later. This case challenges the concept of standard radiotherapy dosing in HPV+ OPSCC and discusses the implications on future de-escalation trials.
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Affiliation(s)
| | - Fiona Penny
- Department of ENT, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Ramkumar Shanmugasundaram
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Nimesh Patel
- Department of ENT, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
- University of Southampton, Southampton, Hampshire, UK
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23
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D'Mello K, Cevik J, Wong DJY, Goh A, Hart C. Primary pulmonary enteric adenocarcinoma presenting as a solitary skull mass. BMJ Case Rep 2024; 17:e258535. [PMID: 38238167 PMCID: PMC10806858 DOI: 10.1136/bcr-2023-258535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Pulmonary enteric adenocarcinoma (PEAC) is a rare, aggressive variant of lung adenocarcinoma with early metastatic potential. We present the case of a male smoker in his 50s who presented with right-sided numbness, pain and headache. Imaging revealed a destructive skull base mass invading the right sphenoid sinus. Histopathology was consistent with PEAC. The diagnosis was metastatic PEAC with a distant spread to the skull and represents the first case reported in the literature. We present an associated literature review of the clinical presentation, histological features and management of PEAC with skull metastasis. Metastasis should be considered when evaluating any persistent cranial lesion. Diagnosis requires thorough clinical, radiological and pathological assessment. Treatment involves surgical resection, chemoradiation and targeted therapy. Prognosis directly correlates with clinical stage at presentation. This case highlights the importance of careful evaluation of skull lesions, even in patients without known primary malignancy. Early diagnosis and multimodal therapy may improve outcomes.
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Affiliation(s)
- Kimberly D'Mello
- Department of Otolaryngology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jevan Cevik
- Department of Otolaryngology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Daniel Jun Yi Wong
- Department of Otolaryngology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Asher Goh
- Department of Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Cameron Hart
- Department of Otolaryngology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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24
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Barreto J, Cunha-Cabral D, Duarte D, Viana M. Nasal polyps causing airway obstruction. BMJ Case Rep 2024; 17:e258638. [PMID: 38233002 PMCID: PMC10806845 DOI: 10.1136/bcr-2023-258638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Affiliation(s)
- Joana Barreto
- Otorhinolaryngology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Diogo Cunha-Cabral
- Otorhinolaryngology, Hospital Pedro Hispano, Matosinhos, Portugal
- Department of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Delfim Duarte
- Otorhinolaryngology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Miguel Viana
- Otorhinolaryngology, Hospital Pedro Hispano, Matosinhos, Portugal
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25
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Ooi KM, Saniasiaya J, Kulasegarah J, Ong DBL. Cervical bronchogenic cyst in a toddler. BMJ Case Rep 2024; 17:e256699. [PMID: 38216171 PMCID: PMC10806961 DOI: 10.1136/bcr-2023-256699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Bronchogenic cyst is a congenital abnormality arising from the tracheobronchial system. Localisation of such cysts in the head and neck region is rare. We report a girl in her early childhood with a painless enlarging right lateral neck mass diagnosed with a branchial cleft cyst based on clinical and radiological MRI findings. An incidental finding of a cervical bronchogenic cyst was made on the final histopathological specimen. Although rare, bronchogenic cysts should be considered as differential diagnoses for paediatric patients' lateral and midline cervical masses.
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Affiliation(s)
- Kar Mun Ooi
- Otorhinolaryngology, University of Malaya Faculty of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jeyasakthy Saniasiaya
- Otorhinolaryngology, University of Malaya Faculty of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jeyanthi Kulasegarah
- Otorhinolaryngology, University of Malaya Faculty of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Diana-Bee Lan Ong
- Pathology, University of Malaya Faculty of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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26
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Thomas AS, Trupthi MC, Ponmar M, Issac R. Misdiagnosed long-standing unilateral nasal obstruction: ossifying fibroma of the inferior turbinate. BMJ Case Rep 2024; 17:e255881. [PMID: 38199659 PMCID: PMC10806964 DOI: 10.1136/bcr-2023-255881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
A man in his 20s presented with complaints of unilateral nasal obstruction for the past 6 years that progressively worsened leading to irrational use of over-the-counter nasal decongestants. With the worsening of symptoms, a non-contrast CT was done. It showed a dense expansile sclerotic lesion of the right inferior turbinate, which was excised endoscopically. Cemento-ossifying fibromas of the inferior turbinate are rare and require assessment and surgical excision to relieve the symptom of nasal obstruction. It derives its name from the variable proportions of fibrous and mineralised tissue present in it and exclusively develops in the craniofacial region. It can be surgically managed by an endoscopic, an endonasal non-endoscopic (with a speculum) or an open approach (lateral rhinotomy, sublabial approach or mid-facial degloving). Here, we present how such a case was detected and managed surgically by the endoscopic approach, which is a minimally invasive option with shorter hospital stay and early recovery.
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Affiliation(s)
- Akhila Sarah Thomas
- Department of ENT, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Menuskodige C Trupthi
- Department of ENT, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Madhurima Ponmar
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rijo Issac
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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27
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Saniasiaya J. Intermittent unilateral neck bulge on Valsalva manoeuvre in an adolescent. BMJ Case Rep 2023; 16:e255231. [PMID: 38154861 PMCID: PMC10759044 DOI: 10.1136/bcr-2023-255231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
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28
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Saniasiaya J, Kulasegarah J. Acute labyrinthitis: a manifestation of COVID-19 in a teenager. BMJ Case Rep 2023; 16:e258290. [PMID: 38154869 PMCID: PMC10759023 DOI: 10.1136/bcr-2023-258290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Audiovestibular symptoms following COVID-19 have been long acknowledged, especially in adults. However, acute labyrinthitis presenting as an early manifestation of COVID-19 has not been reported in children. We report COVID-19-induced acute labyrinthitis in a teenager. We report on a boy in his early adolescence with a sudden onset of spinning sensation, imbalance and unilateral hearing loss with a positive SARS-CoV-2 test. Vestibular investigations point towards right labyrinthine hypofunction, and an audiometry test revealed right-sided severe hearing loss. Symptoms improved gradually with steroids and vestibular rehabilitation therapy. However, the long-term repercussions of post-COVID-19 acute labyrinthitis are unknown and must be followed up closely. To our knowledge, this is the first reported case of acute labyrinthitis secondary to COVID-19 in paediatrics. Additionally, we conducted a literature search to elucidate the outcome of COVID-19-induced acute vestibular syndrome in children.
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Affiliation(s)
| | - Jeyanthi Kulasegarah
- Otorhinolaringologi, Fakulti Perubatan, Universiti Malaya, Kuala Lumpur, Malaysia
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29
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De Brito Garcia Sousa Ferro I, Girbal I, Lopes M. Diagnosing congenital hypochromic patches. BMJ Case Rep 2023; 16:e258827. [PMID: 38123319 DOI: 10.1136/bcr-2023-258827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
| | - Inês Girbal
- Pediatrics, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
| | - Miguel Lopes
- Pediatrics, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
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30
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Pervaiz A, Brimioulle M, Qureishi A, Royston D. Nasopharyngeal myeloid sarcoma as a manifestation of acute monomyelocytic leukaemia. BMJ Case Rep 2023; 16:e251681. [PMID: 38123315 DOI: 10.1136/bcr-2022-251681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This case report describes the case of a man in his seventies presenting with a nasopharyngeal deposit of myeloid sarcoma associated with acute monomyelocytic leukaemia. He presented with right nasal obstruction associated with unilateral pulsatile tinnitus. CT and MRI scans of sinuses identified a moderately restricting mucosal swelling of the right torus tubarius, and a biopsy of the lesion diagnosed a nasal deposit of myeloid sarcoma.
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Affiliation(s)
| | | | - Ali Qureishi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel Royston
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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31
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Byrne C, Flynn L, Carroll C. Unstable bradycardia induced by posterior nasal packing: a rare activation of the Trigeminocardiacreflex. BMJ Case Rep 2023; 16:e258537. [PMID: 38114292 DOI: 10.1136/bcr-2023-258537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
A woman in her 40s presented to the emergency department with epistaxis. Anterior nasal packing was unsuccessful in achieving haemostasis. After the exchange of devices and insertion of a posterior nasal pack, the patient developed a junctional rhythm and progressively unstable bradycardia. The rhythm and bradycardia immediately improved following the removal of the posterior nasal pack. This case describes a rare occurrence of Trigeminocardiac reflex (TCR), following an insertion of a posterior nasal pack. Only one other such case has been reported and published. This case highlights the importance of raising awareness of this rare reflex and the need for prompt removal of the triggering cause in such scenarios. TCR can induce a junctional rhythm, which progresses to unstable bradycardia and may lead to asystole in susceptible individuals. The removal of the stimulus resolves the reflex and can result in prompt resolution of the bradycardia and hypotension induced via the TCR.
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Affiliation(s)
- Carl Byrne
- James Connolly Hospital Emergency Department, Blanchardstown, HSE, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Lisa Flynn
- University College Dublin, Dublin, Ireland
| | - Carthage Carroll
- James Connolly Hospital Emergency Department, Blanchardstown, HSE, Dublin, Ireland
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32
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Chrysouli K, Karamagkiolas S. Venous malformation phleboliths mimicking submandibular sialadenitis in children. BMJ Case Rep 2023; 16:e257971. [PMID: 38087492 PMCID: PMC10728921 DOI: 10.1136/bcr-2023-257971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
To report one paediatric patient who presented with a rare venous vascular malformation as a mass in the left submandibular region with a clinical picture compatible with sialadenitis. Phleboliths are a specific feature of venous malformations due to venous stasis and may mimic sialoliths on various imaging modalities. Thus venous malformations are often misdiagnosed as sialadenitis due to sialolithiasis. Sialoliths are extremely rare in paediatric patients. In an early adolescent presenting with a submandibular mass and suspected sialadenitis arising from sialoliths, a detailed history, clinical examination and careful review of the radiological findings will allow the diagnosis of venous vascular malformation and provide the complete surgical resection. Our patient was initially referred with a presumed diagnosis of submandibular sialadenitis, and instead a venous malformation with phlebolith was diagnosed.
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Affiliation(s)
| | - Sotirios Karamagkiolas
- Department of Otorhinolaryngology, Panepistemiako Geniko Nosokomeio Attikon, Athens, Attica, Greece
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33
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Misirovs R, Hoey G, Carruthers C, Majumdar S. Spontaneous tracheal perforation following a sneeze. BMJ Case Rep 2023; 16:e255633. [PMID: 38050389 PMCID: PMC10693861 DOI: 10.1136/bcr-2023-255633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Rasads Misirovs
- Scottish Centre For Respiratory Research, University of Dundee School of Medicine, Dundee, UK
- Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Gary Hoey
- Ninewells Hospital and Medical School, Dundee, UK
| | - Calum Carruthers
- Emergency Department, Ninewells Hospital and Medical School, Dundee, UK
| | - Samit Majumdar
- Otorhinolaryngology, Ninewells Hospital and Medical School, Dundee, UK
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34
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Martis W, Chahal R. Expedited awake tracheal intubation using ropivacaine topicalisation for the evacuation of a postoperative neck haematoma in the presence of lignocaine allergy. BMJ Case Rep 2023; 16:e256695. [PMID: 38050394 PMCID: PMC10693857 DOI: 10.1136/bcr-2023-256695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Progressive airway compromise from a neck haematoma is a feared complication of head and neck surgery that can rapidly lead to death if not urgently intervened upon. We report a case of a patient developing a progressively expanding neck haematoma on the first postoperative night after parotidectomy and neck dissection for malignancy. Although he did not have respiratory compromise or stridor, ultrasound examination of his airway revealed marked tracheal deviation, and flexible nasoendoscopy showed significant supraglottic swelling. The decision was made for an awake fibreoptic intubation; however, a complicating factor was a history of lignocaine allergy. This case report describes the unconventional use of atomised ropivacaine in a concentration of 0.5% for topicalisation of the airway. Along with conscious sedation with remifentanil, ropivacaine provided excellent conditions for awake intubation, following which a significant amount of blood was evacuated from the face and neck.
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Affiliation(s)
- Walston Martis
- Department of Cancer Anaesthesia, Perioperative and Pain medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rani Chahal
- Department of Cancer Anaesthesia, Perioperative and Pain medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
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35
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Goulioumis A, Fouzas S, Xenofontos EM, Gyftopoulos K. Nasopharyngeal cyst in an adolescent boy: differential diagnosis - embryological and anatomical considerations. BMJ Case Rep 2023; 16:e256945. [PMID: 37993143 PMCID: PMC10668190 DOI: 10.1136/bcr-2023-256945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
In the current article, we present a case of an adolescent boy with a nasopharyngeal cyst that induced nasal and Eustachian tube obstruction. Nasopharyngeal cysts can be found incidentally during imaging examinations such as MRI; however, a symptomatic nasopharyngeal cyst is a rare finding in the paediatric population. The cyst was treated successfully by marsupialisation, and the histological diagnosis revealed an adenoidal retention cyst. The differential diagnosis of a nasopharyngeal cyst is always challenging since developmental cysts such as Rathke's pouch cysts, Torwaldt's and branchial cleft cysts may be encountered at the nasopharynx. The current article also intends to present the diagnostic and therapeutic approach to a nasopharyngeal cyst, emphasising anatomical and embryological considerations that address its differential diagnosis.
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Affiliation(s)
- Anastasios Goulioumis
- Otorhinolaryngology, Karamandanio Children's Hospital, Patras, Greece
- Anatomy, University of Patras School of Health Sciences, Patras, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras, Patra, Greece
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36
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Bhardwaj V, Gautam V, Verma H, Bhutada MD. Lost and found: foreign body in submandibular gland. BMJ Case Rep 2023; 16:e257564. [PMID: 37977847 PMCID: PMC10660160 DOI: 10.1136/bcr-2023-257564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
A young adult male patient presented with the history of a retained foreign body in the oral cavity. The object in question was a stapler pin that got accidentally lodged while the patient tried removing food particles from his mouth 28 days earlier. Aside from intermittent pain upon digital palpation on the right side of the floor of his mouth, he was asymptomatic. Clinical examination was unremarkable. Plain radiography and a computed tomogram revealed a linear foreign body in the right submandibular gland. The patient underwent a submandibular gland excision, during which a 2 cm long stapler pin was retrieved. This case highlights that not all foreign bodies cause inflammatory reactions as a telltale sign of their presence.
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Affiliation(s)
- Viny Bhardwaj
- Otorhinolaryngology, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Vimmi Gautam
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Hitesh Verma
- ENT and Hand and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mayank Dilip Bhutada
- Otorhinolaryngology, All India Institute of Medical Sciences, Delhi, Delhi, India
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37
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Bramati C, Galli A, Salerno E, Giordano L. Challenging management of an enlarged tracheoesophageal fistula in an irradiated patient. BMJ Case Rep 2023; 16:e255770. [PMID: 37977831 PMCID: PMC10661048 DOI: 10.1136/bcr-2023-255770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Speech restoration after total laryngectomy may be achieved in different ways, the gold standard being tracheoesophageal puncture (TPE) with the positioning of a speech prosthesis. TPE is not immune to complications, the most common of which being leakage through or around the prosthesis. When dealing with an enlarged tracheoesophageal fistula, the management can be either conservative or surgical. In the following case report, we present a particularly challenging case, in which every conservative strategies failed and a major surgery was required to close the fistula.
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Affiliation(s)
- Chiara Bramati
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Andrea Galli
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Emilio Salerno
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Leone Giordano
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
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Shah KD, Ezzy MK, Patekar SK, Bradoo R. Chondrosarcoma of the maxilla. BMJ Case Rep 2023; 16:e253143. [PMID: 37963659 PMCID: PMC10649627 DOI: 10.1136/bcr-2022-253143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
A woman in her 70s reported to the outpatient department of our tertiary care hospital with chief complaints of painless swelling in the right cheek and palatal area. The patient was a known case of diabetes mellitus and hypertension on medications with controlled sugars and blood pressure. The swelling was 10×8 cm in size extending from right infraorbital region up to the lower mandible. CT demonstrated a permeative lytic pattern of bone destruction noted involving the hard palate and maxillary bone.Using the Weber Ferguson approach, a surgical resection was carried out under general anaesthesia. Resection included from right total maxillectomy (excluding roof of maxilla), nasal septum up to left medial maxillectomy including hard palate and the tumour was resected en bloc. The palatal obturator was fixed. On the basis of histopathology, grade 1 well-differentiated chondrosarcoma was diagnosed. The patient received postoperative radiotherapy and had a good recovery.
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Affiliation(s)
- Kshitij D Shah
- ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Mustafa Kamruddin Ezzy
- ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Shivali K Patekar
- ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Renuka Bradoo
- ENT, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Raviprasad AG, Malaty J, Wynne B, Orlando FA. Incidental seromucinous hamartoma of the anterior nasal cavity presenting after episode of vestibular neuritis. BMJ Case Rep 2023; 16:e254889. [PMID: 37914165 PMCID: PMC10626906 DOI: 10.1136/bcr-2023-254889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
A woman in her 70s presented to primary care clinic complaining of acute onset dizziness for 1 day that was initially diagnosed as vestibular neuritis and treated with steroids. The next day, she presented to the emergency department with worsening symptoms. Imaging revealed no intracranial process; however, non-contrast CT imaging revealed a soft-tissue mass in the posterior ethmoid sinus. The vertigo completely resolved before an otolaryngologist surgically removed the nasal mass, which actually originated from the right cribriform plate and extended to the anterior middle turbinate head. The final pathology was consistent with seromucinous hamartoma.
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Affiliation(s)
| | - John Malaty
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brianna Wynne
- Division of Geriatrics, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Frank A Orlando
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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40
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Rekha HS, Paramasivam S, Raja K, Bharadwaj B. Voriconazole-induced psychosis in rhino-orbital invasive aspergillosis. BMJ Case Rep 2023; 16:e254790. [PMID: 37821144 PMCID: PMC10583028 DOI: 10.1136/bcr-2023-254790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Aspergillosis is a challenging fungal infection. Voriconazole is an antifungal drug belonging to the triazole group, commonly used for treating invasive aspergillosis, Cryptococcus neoformans and candida infections. We present a case of a man in his late 70s diagnosed with rhino-orbital invasive aspergillosis who developed voriconazole-induced psychosis as an idiosyncratic, adverse drug reaction (ADR); however, he responded to the cessation of intravenous voriconazole and, after starting on an oral antipsychotic, haloperidol. Clinicians need to be cognizant of this rare, idiosyncratic and iatrogenic ADR to voriconazole.
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Affiliation(s)
- H Swarna Rekha
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
| | - Sabharisan Paramasivam
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kalaiarasi Raja
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balaji Bharadwaj
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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41
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Balaraj S, Sridhar A, Sajith M, Channegowda C. Transnasal endoscopic drainage of neonatal orbital abscess. BMJ Case Rep 2023; 16:e255145. [PMID: 37802596 PMCID: PMC10565282 DOI: 10.1136/bcr-2023-255145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Neonatal orbital complications are rare and potentially fatal, demanding prompt diagnosis and adequate treatment. A 25-day-old neonate presented with rapidly progressive orbital complications as evidenced by proptosis, chemosis, lid oedema and restricted eye movements, developing within 3 days. There was no significant medical history or risk factors for developing infection. An initial conservative approach with antimicrobial therapy failed to show any resolve. An MRI brain, orbits and paranasal sinuses demonstrated that there were features suggestive of right orbital cellulitis with possibility of abscess formation with right ethmoidal mucoinflammatory disease and mass effect on the optic nerve causing stretching and compression by the surrounding inflammation.The patient was treated successfully with transnasal endoscopic drainage and decompression. Endoscopic access was challenging owing to the restrictive anatomy. Postoperatively, the patient showed improvement, with gradual decrease in proptosis and resolve in eye movements.
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Affiliation(s)
| | | | - Milu Sajith
- ENT, MS Ramaiah Medical College, Bangalore, Karnataka, India
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42
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Lloyd A, Lloyd S, Reilly BK. Paediatric subepidermal calcified nodule of the ear. BMJ Case Rep 2023; 16:e255106. [PMID: 37802595 PMCID: PMC10565165 DOI: 10.1136/bcr-2023-255106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Subepidermal calcified nodules are benign entities that can be seen in the head and neck region and are part of a family of calcifying disorders known as calcinosis cutis, in which calcium is deposited in subcutaneous tissue. We describe a middle aged childhood boy with a rapidly enlarging ear mass of unknown aetiology who presents for otolaryngologic evaluation. In this case, surgical excision provided both definitive diagnosis and sufficient treatment. Although uncommon, it is important to recognise these lesions in order to appropriately counsel patients on management options and rule out underlying disorders that may be responsible for the pathology.
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Affiliation(s)
- Ashley Lloyd
- Department of Otolaryngology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shannon Lloyd
- University of Virginia, Charlottesville, Virginia, USA
| | - Brian K Reilly
- Department of Otolaryngology, Children's National Hospital, Washington, DC, USA
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43
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Fogang D C, Martin G, Boehlen F, Savoldelli GL. Anaesthetic management for caesarean section in a patient with hereditary haemorrhagic telangiectasia and severe epistaxis during pregnancy. BMJ Case Rep 2023; 16:e255530. [PMID: 37788916 PMCID: PMC10551871 DOI: 10.1136/bcr-2023-255530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
A primigravida patient, with a history of hereditary haemorrhagic telangiectasia (HHT) manifesting as nasal angiodysplasia and hepatic arteriovenous malformations (AVM), presented for delivery planning and anaesthetic evaluation at 29 weeks of gestation. She was hospitalised several times during the second and third trimester for serious recurrent epistaxis, leading to severe anaemia. In total, she required the transfusion of 20 units of packed red blood cells during her pregnancy as well as surgical nasal haemostasis under general anaesthesia (GA). The patient was referred to our tertiary centre for delivery. In the context of recurrent severe epistaxis and high cardiac output (due to hepatic AVM) in the third trimester, a multidisciplinary decision was made to plan an elective caesarean section at 35 4/7 weeks combined with nasal packing under GA. This report discusses the implications of HHT, the multidisciplinary planning of the caesarean section, intraoperative anaesthetic management and patient follow-up.
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Affiliation(s)
- Claudie Fogang D
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gallice Martin
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Françoise Boehlen
- Division of Angiology and Hemostasis, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Georges L Savoldelli
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Faculty of Medicine, Geneva, Switzerland
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44
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Assiri SA, Altwairqi RG, Alotaibi R, Ibrahim M. External auditory canal sebaceous carcinoma. BMJ Case Rep 2023; 16:e255038. [PMID: 37775279 PMCID: PMC10546117 DOI: 10.1136/bcr-2023-255038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
The incidence of sebaceous carcinoma (SC) in the outer one-third of the external auditory canal is considered extremely rare, and only eight case reports have been published. We present a case of a male patient in his late 70s known case of hypertension on indapamide. His medical history included a postspinal tumour that had been treated with surgery and radiation more than 40 years ago and current complaints of right ear pain and purulent discharge. A right ear soft granular tissue mass was found. Complete debulking of the right ear mass was done in conjunction with middle ear exploration, moderately differentiated SC diagnosis was made based on the histopathological analysis. The patient was free of recurrence but then died of an unrelated pulmonary infection. SC should be suspected in elderly patients who present with long-term complaints of a mass with or without otalgia, and these patients should be examined for the presence of such tumours especially if they report a history of radiation. Additionally, more research is warranted to investigate the association of diuretics with SC.
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Affiliation(s)
- Sara A Assiri
- Otolaryngology-Head and Neck Surgery Department, King Faisal Medical Complex, Taif, Makkah, Saudi Arabia
| | - Rahaf Ghazi Altwairqi
- Otolaryngology-Head and Neck Surgery Department, Al Hada Military Hospital, Taif, Makkah, Saudi Arabia
| | | | - Mohammed Ibrahim
- Otorhinolaryngology-Head and Neck Surgery Department, Al Hada Military Hospital, Taif, Makkah, Saudi Arabia
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45
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Marak JR, Chauhan A, Anand N, Khurana R. Primary Small Cell Neuroendocrine Carcinoma of nasopharynx with metastatic cervical lymph nodes: an exceedingly rare entity with review of literature. BMJ Case Rep 2023; 16:e255695. [PMID: 37758655 PMCID: PMC10537850 DOI: 10.1136/bcr-2023-255695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Small cell neuroendocrine carcinoma of nasopharynx is extremely rare and displays aggressive nature with a poor prognosis. Neuroendocrine tumours rarely arise from the head and neck region and pose a diagnostic and management challenge. In English literature, only 16 cases of primary small cell neuroendocrine carcinoma of nasopharynx have been reported so far; and to the best of our knowledge, this is the seventeenth case and second in the younger age group. Here, we report the case of an adolescent male patient who presented with nasal blockage, repeated episodes of epistaxis and neck swellings. After proper diagnostic workup, the diagnosis of small cell neuroendocrine carcinoma of nasopharynx was made. The patient was treated with chemotherapy, followed by radiotherapy. Imaging investigation executed after the end of the treatment exhibited complete remission of the disease. The patient is kept under active surveillance with no signs of relapse at present.
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Affiliation(s)
- James R Marak
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Abhishek Chauhan
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Nidhi Anand
- Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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46
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Abdul Razak SF, Gendeh HS, Idris A. Submandibular nodal schwannoma: where did it come from? BMJ Case Rep 2023; 16:e253868. [PMID: 37640417 PMCID: PMC10462965 DOI: 10.1136/bcr-2022-253868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
SummarySchwannoma, a type of benign neurological tumour arising from Schwann cells, is commonly seen in the head and neck region. However, the incidence of cervical lymph node schwannoma is extremely rare, with only two cases reported in the literature. Schwannomatosis is a disease characterised by a constellation of multiple schwannomas seen in a patient, guided by at least one confirmational histological diagnosis. This is a case of a painless progressively enlarging submandibular swelling which is confirmed as a schwannoma based on histology. The patient is also diagnosed with schwannomatosis as the patient has multiple neurological tumours. Nodal schwannoma has a good prognosis and no documentation of recurrence in the literature. It may arise from sympathetic nerves located within the lymph node.
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Affiliation(s)
- Siti Farhana Abdul Razak
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Hardip Singh Gendeh
- Department of Otorhinolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
- Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Anuar Idris
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
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47
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Wang RL, Tavárez B, Amaro-Barron J, Iqbal A, Mesola R. Cranial nerve VI palsy in chronic sphenoid sinusitis. BMJ Case Rep 2023; 16:e253773. [PMID: 37620105 PMCID: PMC10450123 DOI: 10.1136/bcr-2022-253773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Sphenoid sinusitis is a rare disease associated with life-threatening complications that can be avoided with early recognition and timely treatment. Here, we present a case of a woman in her 80s admitted for symptomatic anaemia likely secondary to a gastrointestinal bleed with left cranial nerve (CN) VI palsy incidentally discovered on physical examination. CT and MRI were suggestive of chronic left sphenoid sinusitis with possible involvement of the left cavernous sinus. Surgical treatment was deferred due to high cardiac risk for perioperative mortality and recent ischaemic stroke. Despite antibiotic treatment, the patient's CN VI palsy remained unchanged. This report contributes to the current understanding of sphenoid sinusitis by presenting a complex case of chronic sphenoid sinusitis in which urgent surgical intervention was deferred due to the patient's multiple comorbidities. Furthermore, it highlighted the importance of the CN examination and imaging modalities in diagnosing sphenoid sinusitis.
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Affiliation(s)
- Ruoyu Luie Wang
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Bertilia Tavárez
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jonathan Amaro-Barron
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Arooj Iqbal
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Rovie Mesola
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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48
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Hota BP, Behera SK, Karakkandy V, Chappity P. Outcome of cochlear implantation in a case of cochlear aplasia with cochlear nerve deficiency. BMJ Case Rep 2023; 16:e253079. [PMID: 37591623 PMCID: PMC10441050 DOI: 10.1136/bcr-2022-253079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Cochlear nerve deficiency in cochlear aplasia is a contraindication for cochlear implantation (CI) anticipating poor auditory response. Few authors have reported auditory outcomes even without nerves following CI. This study outlines the audiological outcomes of a patient in early childhood with cochlear aplasia and cochlear nerve deficiency who underwent CI. Auditory and speech-language development were assessed using the Categories of Auditory Performance (CAP) scale, Speech Intelligibility Rating (SIR) scale and Ling-6 sound test; at the time of switch-on, after 6 and 12 months of auditory verbal therapy. Significant differences across CAP, SIR and Ling-6 sound detection scores were noted, with the highest mean scores at the 12th-month postimplantation, indicating substantial improvement in auditory and speech-language skills. In cochlear aplasia cases, residual cochlear elements and nerve fibres cannot be ruled out. Our report emphasises the need for research, as this has the potential to impact the existing guidelines for CI candidacy.
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49
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Thongpiya J, Eshak N, Yingchoncharoen P, Abdelnabi M. IgG4-related disease presents as a nasopharyngeal mass. BMJ Case Rep 2023; 16:e256043. [PMID: 37524512 PMCID: PMC10391819 DOI: 10.1136/bcr-2023-256043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Affiliation(s)
- Jerapas Thongpiya
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Nouran Eshak
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | | | - Mahmoud Abdelnabi
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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50
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Bhardwaj A, Sood R, P S S, Malhotra M. Empirical overview of a delayed diagnosis of bilateral congenital choanal atresia in an adolescent male: management with 'coblation-assisted surgery'. BMJ Case Rep 2023; 16:e254865. [PMID: 37491123 PMCID: PMC10373672 DOI: 10.1136/bcr-2023-254865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Bilateral choanal atresia (CA) is a congenital anomaly consisting of an imperforated choana that leads to newborn fatalities but, if unilateral, may go unnoticed for many years. Bilateral CA occurring without significant symptoms and remaining undiagnosed for many years is rare. This case report identifies an adolescent male with bilateral CA who remained undiagnosed till adolescence. The patient presented with isolated complaints of chronic nasal obstruction and discharge and was diagnosed with bilateral CA by endoscopic and radiological evaluation. The patient underwent a coblation-assisted endoscopic CA repair, with a crossover mucoperiosteal flap technique, without stenting and with a successful outcome.
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Affiliation(s)
- Abhishek Bhardwaj
- Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Rachit Sood
- Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Science, New Delhi, Delhi, India
| | - Suji P S
- Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Manu Malhotra
- Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
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