Granuloma eosinofílico cervical en el adolescente: reporte de un caso y revisión de la literatura / Cervical eosinophilic granuloma in adolescents: case report and literature review

INTRODUCCIÓN El granuloma eosinofílico (GE) es una patología infrecuente, sobre todo en adultos, que puede afectar la columna cervical. A pesar de la vasta literatura, esta enfermedad afecta principalmente a la población infantil, y no hay un consenso sobre el manejo en adultos. Con el objetivo de aportar conocimiento respecto a esta patología poco frecuente, se presenta un caso clínico de GE cervical en un paciente de 16 años, a quien se trató de manera conservadora, con buenos resultados y retorno completo a sus actividades. CASO CLÍNICO Un hombre de 16 años, seleccionado de rugby, consultó por dolor cervical axial persistente y nocturno de 6 semanas de evolución, sin trauma evidente. Al examen, destacó dolor a la compresión axial sin compromiso neurológico asociado. Los exámenes de tomografía computarizada (TC) y resonancia magnética (RM) revelaron lesión lítica en el cuerpo de C3 de características agresivas, de presentación monostótica en tomografía por emisión de positrones-tomografía computada (TEP-TC) compatible con tumor primario vertebral. Se decidió realizar biopsia percutánea bajo TC, para definir el diagnóstico y manejo adecuado, la cual fue compatible con células de Langerhans. Al no presentar clínica ni imagenología de inestabilidad ósea evidente o compromiso neurológico, se manejó con tratamiento conservador, inmovilización cervical, analgesia oral, y seguimiento estrecho. A los cuatro meses de evolución, se presentó con una TC con cambios reparativos del cuerpo vertebral y sin dolor, y logró retomar sus actividad habituales. CONCLUSIONES El diagnóstico de GE es infrecuente a esta edad, y se debe plantear entre diagnósticos diferenciales de lesiones líticas agresivas primarias vertebrales. Es necesario el uso de imágenes, y la biopsia vertebral es fundamental para confirmar el diagnóstico. Su manejo va a depender de la sintomatología, del compromiso de estructuras vecinas, y de la estabilidad de la vértebra afectada. El manejo conservador con seguimiento clínico e imagenológico es una opción viable.

INTRODUCTION Eosinophilic granuloma (EG) is a rare, tumor-like lesion, infrequently affecting the cervical spine, particularly in adults. Although vastly described in literature, this pathology mainly affects children, and there is still no consensus on its treatment in older patients. With the goal of contributing to increase the knowledge regarding this infrequent pathology, we present a case of a C3 eosinophilic granuloma in a 16-year-old patient, who was treated conservatively, with good results, including complete return to his previous activities. CLINICAL CASE a 16-year-old male, elite rugby player, presented with a history of persistent neck pain, mainly at night, with no previous trauma. Upon physical examination, he reported neck pain with axial compression of the head, without neurological impairment. Both computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed an aggressive lytic lesion in the C3 vertebral body, a with monostotic presentation on positron emission tomography-computed tomography (PET-CT) compatible with a primary spine tumor. A CT-guided percutaneous biopsy was obtained to establish the diagnosis and provide the proper management. The results were compatible with Langerhans cells. As he presented no symptoms or imaging findings of evident bone instability, as well as no neurological impairment, the patient was treated conservatively, with a cervical brace, oral pain medication and close followup. A CT obtained after four months of treatment showed reparative changes of the C3 vertebral body; at this point, the patient reported no neck pain, so he was able to return to his previous activities. CONCLUSIONS Although an EG is rare at this age, it should be considered in the differential diagnosis of primary vertebral aggressive lytic lesions. Imaging and a vertebral biopsy are paramount to confirm the diagnosis. The treatment modality depends on the symptoms, the involvement of adjacent structures, and the stability of the affected vertebra. Conservative management including clinical and imaging followup is a viable option.

Criptococosis vertebral: comunicación de un caso y revisión bibliográfica / Vertebral cryptococosis: case report and literature review

Resumen La criptococosis es una micosis sistémica producida por un hongo levaduriforme encapsulado denominado Cryptococcus neoformans. Es una enfermedad universal, que ocurre con mayor frecuencia en pacientes inmunocomprometidos, manifestándose principalmente como una enfermedad diseminada con compromiso meníngeo o pulmonar. Sin embargo, la osteomielitis ocurre solo en 5-10% de los casos, siendo el compromiso vertebral el más frecuente. Presentamos un caso de criptococosis vertebral aislada y una búsqueda bibliográfica sobre el tema. Se recomienda realizar una terapia antifúngica de inducción intravenosa y continuar con una fase de consolidación, vía oral, de duración variable. La indicación quirúrgica se considera en lesiones que comprometen la estabilidad vertebral y aquellas que presentan un compromiso neurológico, producen deformidad y para reducir el inóculo infeccioso.

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.

Radiographic implications of the surgical waiting list for the treatment of spinal deformity / Implicações radiográficas da lista de espera cirúrgica para tratamento de deformidade da coluna vertebral / Implicaciones radiográficas de la lista de espera quirúrgica para el tratamiento de deformidad de la columna vertebral

ABSTRACT Objective: The aim of this study was to evaluate the implications of long waiting times on surgery lists for the treatment of patients with scoliosis. Methods: Radiographs of 87 patients with scoliosis who had been on the waiting list for surgery for more than six months were selected. Two surgeons answered questionnaires analyzing the radiographs when entering the waiting list and the current images of each patient. Results: Data from 87 patients were analyzed. The mean waiting time for surgery was 21.7 months (ranging from seven to 32 months). The average progression of the Cobb angle in the curvature was 21.1 degrees. Delayed surgery implied changes in surgical planning, such as greater need of instrumentation, osteotomies, and double approach. Conclusions: Long waiting lists have a significant negative impact on surgical morbidity of patients with scoliosis, since they increase the complexity of the surgery. Level of evidence: IV. Type of study: Descriptive study.

RESUMO Objetivo: A meta desse estudo foi avaliar as implicações das longas listas de espera de cirurgia no tratamento dos pacientes portadores de escoliose. Métodos: Foram selecionados radiografias de 87 pacientes portadores de escoliose que estavam na lista de espera por cirurgia há mais de seis meses. Dois cirurgiões responderam questionários, analisando as radiografias de entrada na lista de espera e as imagens atuais de cada paciente. Resultados: Dados de 87 pacientes foram analisados. A média de espera pela cirurgia foi de 21,7 meses (variando de sete a 32 meses). A média de progressão do ângulo de Cobb na curvatura foi de 21,1 graus. A demora pela cirurgia implicou em alterações no planejamento cirúrgico, como maior necessidade de instrumentação, osteotomias e dupla via de acesso. Conclusão: As longas listas de espera tem um significativo impacto negativo na morbidade cirúrgica dos pacientes com escoliose, por aumentar a complexidade da cirurgia. Nível de evidência: IV. Tipo de estudo: Estudo descritivo

RESUMEN Objetivo: El objetivo de este estudio fue evaluar las implicaciones de los largos tiempos de espera en las listas de cirugía para el tratamiento de pacientes con escoliosis.. Métodos: Se seleccionaron radiografías de 87 pacientes con escoliosis que habían estado en la lista de espera para cirugía durante más de seis meses. Dos cirujanos respondieron cuestionarios analizando las radiografías al entrar en la lista de espera y las imágenes actuales de cada paciente. Resultados: Se analizaron los datos de 87 pacientes. El tiempo promedio de espera para la cirugía fue de 21,7 meses (variando de siete a 32 meses). La progresión promedio del ángulo de Cobb en la curvatura fue de 21,1 grados. La demora de la cirugía implicó cambios en la planificación quirúrgica, como mayor necesidad de instrumentación, osteotomías y doble vía de acceso. Conclusiones: Las largas listas de espera tienen un impacto negativo significativo en la morbilidad quirúrgica de los pacientes con escoliosis, ya que aumentan la complejidad de la cirugía. Nivel de evidencia: IV. Tipo de estudio: Estudio descriptivo.

Linfadenitis cervical por Salmonella no Typhi en una paciente diabética / Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient

Resumen La infección por Salmonella no Typhi es una de las enfermedades transmitidas por alimentos más común y ampliamente extendida en el mundo. Aunque la mayoría de los casos se limitan al tracto gastrointestinal, el compromiso extraintestinal no es infrecuente. Sin embargo, la adenitis como manifestación aislada, es una forma inusual de presentación de la enfermedad. Comunicamos el caso clínico de una mujer de 67 años de edad con diagnóstico de diabetes mellitus y una linfadenitis cervical por Salmonella no Typhi tratada con ciprofloxacina y y que requirió resección quirúrgica.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

Neumoquiste vertebral en columna lumbar: reporte de un caso y revisión de la literatura / Vertebral body pneumatocyst in lumbar spine: a case report and review of the literature

Los neumoquistes intraóseos, son lesiones cavitadas de contenido gaseoso, las cuales generalmente son encontradas como hallazgos incidentales en exámenes imagenológicos a nivel sacroiliaco, pubis, sacro, clavícula, cabeza humeral, columna cervical, torácica y en menor medida, en la columna lumbar. La tomografía computarizada es el examen de elección para realizar la confirmación diagnóstica y descartar diagnósticos diferenciales, y su patrón característico se describe como una lesión de aspecto quística con atenuación por gas intralesión con rangos entre -950 y -580 H. El diagnóstico diferencial debe incluir otras posibles causas de gas intraóseo como osteomielitis, osteonecrosis, quistes óseos o subcondrales, entre otros. Si bien la progresión natural del neumoquiste intraoseo es desconocida, distintos autores han descrito que en seguimientos radiológicos hasta 4 años, el tamaño de las lesiones se mantiene estable, e incluso en otros casos se han resuelto de manera espontánea, sin embargo, en otros se ha reportado un crecimiento progresivo en seguimiento de 16 meses. En cuanto al manejo del neumoquiste intraóseo, en la mayoría de los casos reportados se ha observado una evolución benigna, con manejo conservador de las lesiones, sin embargo frente a lesiones de gran tamaño con riesgo de fractura patológica se debe plantear la posibilidad de manejo quirúrgico con corpectomía e injerto óseo. Debido a la escasa evidencia respecto de esa lesión, es que se reporta un caso de neumoquiste vertebral lumbar, describiendo su estudio, evolución y manejo.

The intraosseous pneumatocyst, is a rare condition in which there is gas-filled cystic lesion in the bone which is incidentally discovered on imaging studies and has been observed in relation to iliosacral joint, the humeral head, medial end of the clavicle, cervical spine, and thoracolumbar spine. The computer tomography (CT) is the most useful radiological tool for the diagnosis of the pneumatocyst and the pathognomonic finding is a cystic-like lesion with attenuation that ranges from 950 to 580 Hounsfield units, indicating gas, surrounded by a sclerotic rim. Main differential diagnosis includes other possible causes of intraosseous gas such as infectious osteomyelitis, osteonecrosis, solitary bone cysts, and subchondral cysts. The natural progression of the intraosseous pneumatocyst is unclear. Some authors suggest that these lesions remained unchanged up to 4 years of follow up with CT, and even spontaneous resolution of the pneumatocyst have been reported, but others authors found progressive growth of the lesions in few weeks, months or years. Surgical treatment could be indicated in symptomatic patients or with progressive growth of the lesion at CT follow up that could increase the potential risk of vertebral fracture. We report a case of vertebral body intraosseous pneumoatocyst in lumbar spine describing the diagnosis process and management.

Spinal subarachnoid haematoma after spinal anaesthesia: case report / Hematoma espinhal subaracnoideo após raquianestesia: relato de caso

Abstract Subarachnoid haematoma after spinal anaesthesia is known to be very rare. In the majority of these cases, spinal anaesthesia was difficult to perform and/or unsuccessful; other risk factors included antiplatelet or anticoagulation therapy, and direct spinal cord trauma. We report a case of subarachnoid haematoma after spinal anaesthesia in a young patient without risk factors.

Resumo Hematoma subaracnoideo após anestesia espinal é conhecido por ser muito raro. Na maioria desses casos, a anestesia espinal foi difícil de executar e/ou malsucedida; outros fatores de risco incluem terapia anticoagulante ou antiplaquetária e trauma medular direto. Relatamos um caso de hematoma subaracnoideo após raquianestesia em paciente jovem sem fatores de risco.

Forensic identification for 16 cases with lumbar sacralization and lumbarization / 法医学杂志

Lumbar sacralization and lumbarization are congenital spine malformation. 16 cases with lumbar sacralization or lumbarization were reviewed. Through studying the etiopathogenisis and clinical manifestation we analyze the relationship between injury and disease. 6 cases of 16 have lumbar sacralization. 10 cases are attributed to lumbarization. Most of this cases have backleg pain more or less. As a forensic doctor we suggest that pay more attention to this problem in our identify practice and locate the sequence of vertebral body more exactly.

Unusual location of eosinophilic granuloma

Eosinophilic granuloma EG is a well-recognized benign form of Langerhans cell histiocytosis, most commonly involving the skull bones. In this paper, we report an 8-year-old girl with EG of posterior element of vertebra; she had complete resolution with surgical curettage and bone grafting

Myelography in spinal disorders - experience of 1400 cases

To evaluate the diagnostic importance of myelography in spinal disorders, in correlation with clinical presentation of the patients. Patients selected for myelography had presented with history of various spinal disorders such as low backache, neurogenic claudication, paraparesis or paraplegia, quadriparesis or quadriplegia, trauma to spinal region and infective spondylitis. Patients excluded were those with history of allergies to iodinated contrast agents, seizures coagulopathy and pregnant women. Contrast agent was water soluble non ionic agent - Iohexol. Spinal Needles used were of 20,22 and 25 gauge. X-Ray machine with tilltable table was used for myelography. There were 1400 patients of whom 935 were males and 465 females with male to female ratio of 2.1. Age range was 8 to 65 years. Spinal disorders diagnosed on myelography were lumbar disc prolapse 866 [60%] cases, lumbar canal stenosis 113 [8%], thoracic disc protrusions 15 [1%], infective spondylitis 53 [4%] cases, spinal tumors 36 [2.5%], spinal dysraphism 28 [2%] and traumatic spine in 85 [6%] cases. Free flow of contrast agent with no block was found in 149 [10.64%] cases. These were subjected for MRI scan which revealed significant pathological lesion of surgical importance in 23 cases [1.64%] only. Myelography is the least expensive valuable diagnostic test in spinal disorders specially in lumbar disc prolapses and lumbar canal stenosis

Prenatal Sonographic Diagnosis of Focal Musculoskeletal Anomalies

Focal musculoskeletal anomalies vary, and can manifest as part of a syndrome or be accompanied by numerous other conditions such as genetic disorders, karyotype abnormalities, central nervous system anomalies and other skeletal anomalies. Isolated focal musculoskeletal anomaly does, however, also occur; its early prenatal diagnosis is important in deciding prenatal care, and also helps in counseling parents about the postnatal effects of numerous possible associated anomalies. We have encountered 50 cases involving focal musculoskeletal anomalies, including focal limb dysplasia [radial ray abnormality (n=3), mesomelic dysplasia (n=1) ]; anomalies of the hand [polydactyly (n=8), syndactyly (n=3), ectrodactyly (n=1), clinodactyly (n=6), clenched hand (n=5) ]; anomalies of the foot [clubfoot (n=10), rockerbottom foot (n=5), sandal gap deformity (n=1), curly toe (n=2) ]; amniotic band syndrome (n=3) ; and anomalies of the focal spine [block vertebra (n=1), hemivertebra (n=1) ]. Among these 50 cases, five [polydactyly (n=1), syndactyly (n=2) and curly toe (n=2) ] were confirmed by postnatal physical evaluation, two (focal spine anomalies) were diagnosed after postnatal radiologic examination, and the remaining 43 were proven at autopsy. For each condition, we describe the prenatal sonographic findings, and include a brief review.

Primary multiple intramedullary and intradural extramedullary hydatid cysts of lumbar spinal canal

A rare case is reported of a 42 year old male farmer who developed gradual paraparesis and incontinence following a radicular pain for which myelography at the L4- L5 interspace revealed complete block at L3. With a presumptive diagnosis of intradural spinal cord tumor he was operated and turned out to be a case of primary intramedullary and intradural extramedulary hydatid cyst of the terminal 2.5 cm of spinal cord and cauda equina. postoperatively he completely recovered and after seventeen years he is without neurological deficit or further manifestations of echinococcosis