Linfangioma hipofaríngeo en adulto: presentación de un caso clínico / Hypopharyngeal lymphangioma in adults: Presentation of a case report

Los linfangiomas son malformaciones linfáticas benignas infrecuentes; se manifiestan principalmente en la infancia. Pueden desarrollarse en cualquier zona del cuerpo, más frecuentemente cabeza y cuello, siendo su compromiso faríngeo extremadamente poco común. Dada su clínica inespecífica se requiere un análisis anatomopatológico preciso para concretar un correcto diagnóstico. Presentamos el caso de una mujer de 40 años con historia de disfagia y odinofagia de un año de evolución cuyo estudio imagenológico y con nasofibroscopía evidenció un tumor redondeado alojado en seno piriforme derecho, la biopsia excisional confirmó el diagnóstico de linfangioma. Se debe considerar el diagnóstico de linfangioma dentro de los diagnósticos diferenciales de tumores en faringe y concientizar su presencia en pacientes adulto, para ofrecer el manejo óptimo basado, ya sea en escisión quirúrgica completa, para evitar la recurrencia asociado, o al uso de sustancias esclerosantes.

Lymphangiomas are infrequent benign lymphatic malformations, with clinical manifestations mainly at birth or in childhood. They can develop in any area of the body, most frequently the head and neck, and their pharyngeal involvement is extremely rare. Given its nonspecific symptoms, it requires a precise pathological analysis to make a correct diagnosis. We present the case of a 40-year-old woman with a 1-year history of dysphagia and odynophagia whose imaging study and nasofibroscopy revealed a rounded tumor lodged in the right pyriform sinus. The excisional biopsy confirmed the diagnosis of lymphangioma. The diagnosis of lymphangioma should be considered within the differentials of tumors in the pharynx and awareness of its presence in adults to offer optimal management based on complete surgical excision to avoid recurrence or management with use of sclerosing substances.

Clinical Signs and Symptoms Associated with COVID-19: A Cross Sectional Study

ABSTRACT: Covid-19 is a viral disease that has spread throughout the world, becoming a pandemic. Dysgeusia and anosmia are some of its most frequent symptoms. The aim of the study was to determine the frequent signs and symptoms associated with COVID-19 patients. A cross-secional study from 370 patients with acute respiratory illness admitted by emergenc y services of a hospital in Acapulco. An institutional survey was applied to all patients as a data collection instrument, and a SARS-CoV-2 test, by RT-PCR processed by a certified laboratory. Statistical analysis was performed using the STATA V13 program. The numerical variables without normality were reported in medians, 25th and 75th percentiles, and the Mann W ithney U test was performed for differences between groups. The categorical variables were presented in percentages and differences between groups with Chi-square test. A generalized linear models (GLM) analysis was carried out to determine the most frequent symptoms and signs associated with COVID-19. Clinical signs and symptoms associated to COVID-19 in the bivariate análysis were dysgeusia, odynophagia, anosmia, arthralgia, myalgia, conjunctivitis, and age older than 40 years. In the final multivariate model only age older than 40 years (OR) 2.2; CI 95 % 1.3,3.8) and dysgeusia (OR 2.1; CI95 % 1.2,3.6) kept significance. Dysgeusia, odynophagia, anosmia, arthralgia, myalgia and conjunctivitis are clinical signs and symptoms that can appear in the early stages of the disease, so they could be important for an early diagnosis.

RESUMEN: El Covid-19 es una enfermedad viral que se ha extendido por todo el mundo, convirtiéndose en una pandemia. La disgeusia y la anosmia son algunos de sus síntomas más frecuentes. El objetivo del estudio fue determinar los signos y síntomas frecuentes asociados con los pacientes con COVID-19. Estudio transversal de 370 pacientes con enfermedad respiratoria aguda ingresados por los servicios de emergencia de un hospital de Acapulco. A todos los pacientes se les aplicó una encuesta institucional como instrumento de recolección de datos, y una prueba de SARS-CoV-2, por RT-PCR procesada por un laboratorio certificado. El análisis estadístico se realizó utilizando el programa STATA V13. Las variables numéricas sin normalidad se reportaron en medianas, percentiles 25 y 75, y se realizó la prueba U de Mann Withney para diferencias entre grupos. Las variables categóricas se presentaron en porcentajes y diferencias entre grupos con la prueba de Chi-cuadrado. Se realizó un análisis de modelos lineales generalizados (GLM) para determinar los síntomas y signos más frecuentes asociados a la COVID-19. Los signos y síntomas clínicos asociados a COVID-19 en el análisis bivariado fueron disgeusia, odinofagia, anosmia, artralgia, mialgia, conjuntivitis y edad mayor de 40 años. En el modelo multivariado final solo la edad mayor de 40 años (OR) 2,2; IC 95 % 1,3,3,8) y la disgeusia (OR 2,1; IC95 % 1,2,3,6) mantuvieron significanca estadística. Disgeusia, odinofagia, anosmia, artralgias, mialgias y conjuntivitis son signos y síntomas clínicos que pueden aparecer en etapas tempranas de la enfermedad, por lo que podrían ser importantes para un diagnóstico precoz.

Caracterización clínica, epidemiológica y anatómica del cáncer de esófago / Clinical, Epidemiological and Anatomical Characterization of Esophagus Cancer

Introducción: El cáncer de esófago es una enfermedad muy frecuente con tasas de supervivencia desalentadoras, debido a su naturaleza extremadamente agresiva. Objetivo: Caracterizar clínica, epidemiológica y anatómicamente a los pacientes con cáncer de esófago. Método: Se realizó un estudio descriptivo de casos clínicos que acudieron al servicio de Gastroenterología del Hospital Dr. Juan Bruno Zayas Alfonso, en el período comprendido entre junio -noviembre del año 2018. El universo de estudio estuvo conformado por el total de los pacientes de ambos sexos cuya cifra ascendió a 35. Resultados: El grupo de edad que predominó en ambos sexos fue el de 70 años y más, con 37,1 por ciento entre los hombres y 17,1 por ciento en las mujeres. Los hombres fueron los más afectados (68,6 por ciento). La localización anatómica que prevaleció fue a nivel del tercio inferior en un 37,1 por ciento entre los hombres y un 17,1 por ciento entre las féminas. El 57,1 por ciento resultó encontrarse bajo peso, en su mayoría presentaron el esófago de Barret como antecedente patológico personal, acompañado de odinofagia en el 88,6 por ciento de los pacientes. Conclusiones: El estudio permitió caracterizar a los pacientes con cáncer de esófago según variables clínicas, epidemiológicas y anatómicas. Aparece con mayor frecuencia en las últimas décadas de la vida y en etapas avanzadas de la enfermedad, se localiza con mayor frecuencia en el tercio inferior y asociados a antecedentes patológicos personales(AU)

Introduction: Esophageal cancer is a very frequent disease. Due to its extremely aggressive nature, it presents poor survival rates. Objective: To characterize clinically, epidemiologically and anatomically patients with esophageal cancer. Method: A descriptive study was carried out with clinical cases that attended the gastroenterology service at Dr. Juan Bruno Zayas Alfonso Hospital, in the period between June and November 2018. The study population was made up of the total number of patients of both sexes, whose number amounted to 35. Results: The age group that predominated in both sexes was 70 years and over, accounting for 37.1 percent among men and for 17.1 percent among women. Men were the most affected (68.6 percent). The anatomical location that prevailed was the level of the lower third, accounting for 37.1 percent among men and for 17.1 percent among women. 57.1 percent turned out to be underweight; most of them presented Barrett esophagus as a personal pathological history, accompanied by odynophagia in 88.6 percent of the patients. Conclusions: The study allowed characterizing patients with esophageal cancer according to clinical, epidemiological and anatomical variables. It appears more frequently in the last decades of life and in advanced stages of the disease. It is most frequently located in the lower third and associated with a personal pathological history(AU)

Tendinitis calcificante del musculo largo del cuello: presentación de un caso clínico / Calcific tendinitis of the longus colli muscle: a case report / Tendinite calcificante do músculo longo do pescoço: apresentação de um caso clínico

La tendinitis calcificante del músculo largo del cuello es una patología subdiagnsoticada, de baja frecuencia, autolimitada. Se presenta clínicamente como una de las causas de odinofagia en la consulta médica. Se produce debido al depósito de cristales de hidroxiapatita en espacio retrofaríngeo, desencadenándose una respuesta inflamatoria local. En la TMLC el principal diagnóstico diferencial es el absceso retrofaríngeo, ya que puede presentarse clínicamente con odinofagia, disfagia , disminución de la movilidad del cuello y cervicalgia. En nuestro trabajo se analiza un caso clínico sobre dicha patología, en un hombre de 45 años; realizando un análisis de la sintomatología, diagnóstico y tratamiento de esta entidad.

Calcific tendinitis of the long neck muscle is an underdiagnosed, low frequency, self-limited pathology. It is clinically presented as one of the causes of odynophagia in the medical consultation. It occurs due to the deposit of hydroxyapatite crystals in the retropharyngeal space, triggering a local inflammatory response. On This patholgy, the main differential diagnosis is retropharyngeal abscess, since it can present clinically with odynophagia, dysphagia, decreased mobility of the neck, and neck pain. In our work, a clinical case of this pathology is analyzed, in a 45-year-old man; performing an analysis of the symptoms, diagnosis and treatment of this entity.

A tendinite calcificante do músculo longo do pescoço é uma patologia subdiagnsoticada, de baixa frequência, autolimitada. Apresenta-se clinicamente como uma das causas de odinofagia na consulta médica. Ocorre devido ao depósito de cristais de hidroxiapatita em espaço retrofaríngeo, desencadeando-se uma resposta inflamatória local. Na TMLC o principal diagnóstico diferencial é o abscesso retrofaríngeo, já que pode apresentar-se clinicamente com odinofagia, disfagia , diminuição da mobilidade do pescoço e cervicalgia. Em nosso trabalho analisa-se um caso clínico sobre essa patologia, em um homem de 45 anos; realizando uma análise da sintomatologia, diagnóstico e tratamento desta entidade.

Causa infrecuente de odinofagia: angiolipoma laríngeo / Uncommon cause of odynophagia: laryngeal angiolipoma

Laryngeal angiolipoma is a benign and rare tumor at this level. It is a type of unique lipoma, which is located in aritenoepiglottic retraction, epiglottis, and postcricoid region, and it is usually diagnosed after surgical exeresis. It is usually silent until it reaches a large size, causing dysphagia as the most common symptom; so it should be part of the differential diagnosis of odynophagia. We present a case in a male patient of supraglottic angiolipoma as an unusual cause of odynophagia

El angiolipoma laríngeo es un tumor benigno e infrecuente a este nivel. Es un tipo de lipoma único, que se localiza en el repliegue aritenoepiglótico, la epiglotis y la región poscricoidea, y suele diagnosticarse tras su exéresis quirúrgica. Suele ser silente hasta que alcanza gran tamaño, ocasionado odinofagia como síntoma más frecuente; de ahí que deba formar parte del diagnóstico diferencial de la odinofagia. Presentamos un caso en un paciente varón de angiolipoma supraglótico, como causa inusual de odinofagia

Clinical and Imaging Features of Longus Colli Calcific Tendinitis: An Analysis of Ten Cases

BACKGROUND: Longus colli calcific tendinitis (LCCT) exhibits characteristic clinical features; thus, misidentification can be avoided once it is learned. There is a lack of reports on this disease. In this study, we analyzed the imaging and clinical features of LCCT in 10 patients. METHODS: We retrospectively reviewed the radiolographic findings, laboratory data and clinical features of 10 patients diagnosed with LCCT between January 2015 and June 2017. All patients were treated with medical treatment consisting of intravenous methylprednisolone 125 mg twice and oral nonsteroidal anti-inflammatory drug administration. RESULTS: On clinical findings, all 10 patients complained of severe posterior neck pain and cervical motion limitation. Odynophagia was present in nine patients. The mean time from symptom onset to hospital visit was 2.9 days. The mean time to symptom relief was 4.6 days. Of the 10 patients, three patients were admitted through the emergency room. There were five patients in the medical records who were transferred from another hospital. On the laboratory data, the mean value of C-reactive protein and erythrocyte sedimentation rate were 2.08 mg/dL (reference range, < 0.30 mg/dL) and 36.9 mm/hr (reference range, < 20 mm/hr), respectively. Leukocytosis was found in only two patients and fever was not present all patients. On radiographic findings, calcification was present on computed tomography images of all patients. The calcification was located at the lower part of the C1 arch, except for one case where calcification occurred in the anterolateral aspect of the C4–5 disc space. The mean value of the retropharyngeal space was 7.2 mm. CONCLUSIONS: LCCT, a rare disease, has characteristic radiographic findings and clinical features. Understanding such characteristics of this disease can prevent unnecessary testing and misdiagnosis.

Misconceived Retropharyngeal Calcific Tendinitis during Management of Myofascial Neck Pain Syndrome

Differential diagnosis of posterior neck pain is very challenging based on symptoms and physical examination only. Retropharyngeal calcific tendinitis is a rare and frequently misdiagnosed entity in various causes of neck pain. It results from calcium hydroxyapatite deposition in the longus colli muscle which is characterized by severe neck pain, painful restriction of neck movement, dysphagia, and odynophagia. We herein report a case of a patient with acute retropharyngeal calcific tendinitis, who complained of posterior neck pain, initially diagnosed and treated as a myofascial neck pain syndrome.

Caso de intoxicación en Venezuela, por el uso de la planta de Estropajo o Tusa (Luffa cylíndrica ) / Case of intoxication by the use of the loofah sponge or tusa (Luffa cylindrica) in Venezuela

En algunas regiones del mundo, las plantas originan importantes problemas clínicos, causando gran morbilidad y mortalidad, principalmente después de la intoxicación no intencional. Este trabajo tiene como objetivo principal describir un caso clínico presentado en el Servicio de Toxicología Médica, Hospital “Doctor Leopoldo Manrique Terrero”, Caracas, Venezuela (2012), de una intoxicación con la planta de estropajo (Luffa  cylindrica), perteneciente a la familia de las Cucurbitáceas, usada inadecuadamente como instilación nasal. El análisis clínico otorrinolaringológico permitió evidenciar un cuadro agudo, grave con obstrucción de vías aéreas superiores, producido por el uso tópico de extracto de la planta de estropajo (Luffa  cylindrica), como medicamento nasal para tratar una sinusitis crónica. El paciente presentó 2 horas después de la instilación,  una disfonía,  con un intenso edema de úvula; se encontraba confundido, con cefalea, así como acentuada odinofagia y dificultad respiratoria. Tras la revisión de la literatura se permite plantear que se trata del primer caso referido o publicado de esta inusual intoxicación y daño de vías aéreas superiores ocasionado por esta planta. El paciente fue tratado con oxígeno (SOS), hidrocortisona y clorfeniramina recuperándose después de 48 h de tratamiento sintomático.

In some world regions, plants originate important clinical problems, causing significant morbidity and mortality, mainly after unintentional poisoning. This paper aims to describe a case seen at the Medical Toxicology Service, "Dr. Leopoldo Manrique Terrero " Hospital, Caracas, Venezuela (2012), which was a loofah plant poisoning (Luffa cylindrica), belonging to Cucurbitaceae family, used inappropriately as nasal instillation. The otorhinolaryngology clinical analysis demonstrated an acute, severe upper airway obstruction produced by the topical use of loofah (Luffa cylindrica) plant extract as nasal medication to treat chronic sinusitis. The patient developed 2 hours after instillation, a dysphonia, with intense uvula edema, confusion, headache and sore throat and accentuated respiratory distress. After literature review it is suggested that this is the first referred or published case in this unusual intoxication and upper airway damage caused by this plant. The patient was treated with oxygen (SOS), hydrocortisone and chlorpheniramine recovering after 48 h of symptomatic treatment.

A RCT study on oral lidocaine plasmagel on improvement of the postoperative odynophagia in patients receiving trans-oesophageal echocardiography examination for cardiac surgery / 中国实用护理杂志

Objective To investigate the effect of oral lidocaine plasmagel on the postoperative odynophagia in patients receiving trans-oesophageal echocardiography (TEE) examination for cardiac surgery.Methods Sixty patients for cardiac surgery were divided randomly into the control group (C group) and the oral lidocaine plasmagel group (L group) with 30 cases in each group.Patients in L group received 2％ oral lidocaine plasmagel 20 ml before anesthesia,while C group did not.The incidence of postoperative odynophagia was compared between two groups.Results Postoperative odynophagia pain score were significantly higher in C Group than that in L Group.Conclusions Oral lidocaine plasmagel can alleviate the postoperative odynophagia in patients receiving trans-oesophageal echocardiography examination for cardiac surgery.

Retrospective study of postoperative odynophagia in elderly patients undergoing intraoperative transoesophageal echocardiography examination for cardiac surgery / 中华老年医学杂志

Objective To evaluate the influencing factors for postoperative odynophagia in elderly patients undergoing intraoperative transesophageal echocardiography (TEE) examination for cardiac surgery.Methods A total of 96 patients with intraoperative TEE examination for cardiac surgery was divided into two groups:the elderly group (patients aged ≥65 years,n=60) and the young group (patients aged ＜ 65 years,n =36).Clinical data were retrospectively analyzed.Postoperative odynophagia was assessed by number rating scale (NRS) scores.Characteristics of postoperative odynophagia were compared between the two groups.Influencing factors for postoperative odynophagia were analyzed by multivariable logistic regression analysis.Results The incidence of postoperative odynophagia and the average NRS score were higher in the elderly group thanin the young group [88.3％ vs.66.7％,(2.6±1.7) vs.(1.4±0.9),P＜0.05 or 0.01].Multivariate logistic regression analysis showed that preoperative oral lidocaine plasmagel,oropharyngeal mucosal injury and duration of TEE insertion were independent influencing factors for postoperative odynophagia (all P＜0.01).Conclusions The incidence of postoperative odynophagia is higher and the degree of odynophagia is more serious in elderly patients undergoing intraoperative TEE examination for cardiac surgery.Postoperative odynophagia can be relieved by applying the preoperative oral lidocaine plasmagel,reducing oropharyngeal mucosal injury and shortening the duration of TEE insertion.

Tuberculosis of Larynx: A case report.

A case of tuberculosis of larynx in a 45-year-old male patient has been described here. Usually, the signs and symptoms of laryngeal tuberculosis resemble with malignant diseases of larynx. The diagnosis was made here by the microscopic examination of sputum smear for Acid Fast Bacilli, chest x-ray, direct laryngoscopy and biopsy from the laryngeal lesion.

Odinofagia em paciente com pênfigo vulgar de esôfago sem alterações dermatológicas. relato de caso / Odynophagia in patient with esophageal pemphygus vulgaris without dermatological changes. case report

JUSTIFICATIVA E OBJETIVOS: Pênfigo refere-se a um grupo de doenças bolhosas intraepidérmicas imunomediadas,caracterizadas pela perda de coesão entre as células epidérmicas. As lesões bolhosas podem envolver pele e mucosas. O acometimento esofágico, quando ocorre, pode ser acompanhado de sintomas como odinofagia e disfagia. O objetivo deste estudo foi relatar o caso de um paciente com odinofagia e dor retroesternal em queimação que recebeu o diagnóstico de pênfigo vulgar esofágico e foi tratado com prednisona.RELATO DO CASO: Paciente do sexo masculino, 53 anos, procurou atendimento com odinofagia grave para líquidos, associada à dor retroesternal contínua, em queimação,de média intensidade, havia sete dias, com piora acentuada há 12h. Foi solicitada uma endoscopia digestiva alta, que mostrava áreas hiperemiadas ou hemorrágicas aol ongo do esôfago, com áreas de descamação espontânea. A impressão diagnóstica foi de esofagite dissecante superficial,com lesões descamativas, sugestivas de pênfigo.CONCLUSÃO: Sugere-se que a suspeita de pênfigo vulgar esofágico seja imperativa diante do quadro clínico compatível, a fim de que o diagnóstico e o tratamento possam ser feitos o mais breve possível.

BACKGROUND AND OBJECTIVES: Pemphygus refers to a group of bullous intradermal and immune-mediated diseases, characterized by loss of cohesion among epidermal cells. Bullous injuries may involve skin and mucosa. Esophageal involvement, when it occurs, may be followed by symptoms such as odynophagia and dysphagia.This study aimed at reporting a case of odynophagia and burning retrosternal pain, diagnosed as esophageal pemphygus vulgaris and treated with prednisone.CASE REPORT: Male patient, 53 years old, who looked for assistance with severe odynophagia for fluids,associated to continuous burning retrosternal pain of intermediate intensity for seven days, with marked worsening for 12h. High digestive endoscopy was performed and showed hyperemic or hemorrhagic areas along the esophagus, with spontaneous peeling areas. Diagnostic impression was superficial esophagitis dissecans, with peeling lesions suggesting pemphygus.CONCLUSION: It is suggested that the suspicion of esophageal pemphygus vulgaris be mandatory when there is a compatible clinical presentation so that diagnosis and treatment are achieved as soon as possible.

Doença de Behçet e a visão do otorrinolaringologista / Behçet’s disease as viewed by the otorhinolaryngologist

A doença de Behçet é um distúrbio inflamatório autoimune, que acomete pequenos vasos sanguíneos. O diagnóstico da síndrome é clínico e necessita a presença de úlceras orais recorrentes, úlceras genitais e desordens oculares. No entanto, diversos sistemas podem ser afetados. Na avaliação otorrinolaringológica, as lesões orais são os sintomas mais frequentes da doença. O paciente do caso desenvolveu odinofagia no pósoperatório de cirurgia para correção de aneurisma. Ao exame, foram identificadas úlceras orais e lesão ulcerada na base peniana. Foi aventada hipótese diagnóstica de doença de Behçet e iniciado terapia com corticoide e colchicina. Embora a doença de Behçet não seja frequente na prática diária, os profissionais médicos devem estar atentos a sua apresentação

Behçet’s disease is an inflammatory autoimmune disorder that affects small blood vessels. The diagnosis of the syndrome is clinical and requires the presence of recurrent oral ulcers, genital ulcers, and ocular disorders. However, several systems may be affected. On otorhinolaryngological evaluation oral lesions are the most frequent symptoms of the disease. The patient described here developed postoperative odynophagia after surgery for aneurysm. On examination oral ulcers and ulcerated lesion on the penile base were found. A diagnosis of Behcet’s disease was hypothesized and therapy with corticosteroids and colchicine was initiated. Although Behcet’s disease is rare in everyday practice, medical professionals should be aware of its presentation

Retropharyngeal Abscess: A Seven-Year Review - Clinical Presentation, Diagnosis and Management

This was a retrospective study of operative records between 2000 – 2007 from two ear, nose and throat (ENT) referral centers in Malaysia to review demographic patterns, clinical presentations and management of retropharyngeal abscess (RPA). Our case series comprised of eight patients with five females and three males with a median age at presentation of 47 years. Comorbid factor in this series was diabetes mellitus, with four patients having diabetes. There were three cases of fish bone ingestion. The commonest presentation was dysphagia or odynophagia. None of them had fever. All patients were treated with broad spectrum intravenous antibiotics (IV) and drainage was performed for the abscess. Four patients underwent transoral drainage with three having the cervical approach and one having spontaneous rupture. All patients recovered well from the infection and only one patient passed away due to septicaemia. In conclusion, patients with retropharyngeal abscess may present with vague symptoms of sore throat, odynophagia without fever due to partial antibiotics treatment. A correct diagnosis should be made so that adequate treatment can be given to prevent mortality.