Hérnia muscular: relato de caso diagnosticado pela ultrassonográfico / Muscular herniation: case report diagnosed by ultrasonography / Herniación muscular: reporte de caso diagnosticado por ultrasonografía

A hérnia muscular em extremidades é uma condição incomum e subdiagnosticada. A maioria das massas é indolor e assintomática. No entanto, em alguns casos, podem se tornar dolorosas após exercícios físicos prolongados. Neste relato de caso temos um paciente de 18 anos, queixando-se de abaulamento na perna esquerda após atividade física, com suspeita inicial de lipoma de extremidade A ultrassonografia identificou uma hernia muscular, destacando a importância de uma detecção precoce para que haja um tratamento adequado sem complicações, gastos desnecessários e diagnósticos equivocados.

Muscular hernia in extremities is an uncommon and underdiagnosed condition. Most masses are painless and asymptomatic. However, in some cases, muscle hernia can become painful after prolonged physical exercise. In this case report, we present an 18-year-old patient complaining of bulging in the left leg after physical activity, with initial suspicion of lipoma of the extremity. Ultrasonography identified a muscle hernia, highlighting the importance of early detection and leading adequate treatment without complications, unnecessary expenses, and misdiagnoses.

La hernia muscular en extremidades es una patología poco frecuente e infradiagnosticada. La mayoría de las masas son indoloras y asintomáticas. Sin embargo, en algunos casos, la hernia muscular puede volverse dolorosa después de un ejercicio físico prolongado. En este reporte de caso, presentamos a un paciente de 18 años que consulta por abultamiento en la pierna izquierda después de la actividad física, con sospecha inicial de lipoma de la extremidad. La ecografía identificó una hernia muscular, destacando la importancia de la detección temprana y conducir un tratamiento adecuado sin complicaciones, gastos innecesarios y diagnósticos erróneos.

Sonographic Demonstration of a Gastrocnemius Fascial Defect: A Rare Cause of Calf Pain / Demostración sonográfica de un defecto fascial del gastrocnemio: una causa rara del dolor de pantorrilla

ABSTRACT Fascial defects with muscular herniation are an uncommon, treatable cause of calf pain. Differential diagnosis includes deep vein thrombosis, compartment syndrome, soleus strain/tear, and muscle or subcutaneous tumour. In this case, sonography was more sensitive for diagnosis than magnetic resonance imaging.

RESUMEN Los defectos fasciales con herniación muscular son una causa poco frecuente y tratable del dolor de pantorrilla. El diagnóstico diferencial incluye trombosis venosa profunda, síndrome compartimental, distensión o desgarro del sóleo, y tumor subcutáneo o muscular. En este caso, la sonografía resultó más sensible para el diagnóstico que la tomografía por resonancia magnética.

Idiopathic Spinal Cord Herniation­Case Report

Idiopathic spinal cord herniation is a rare cause of progressivemyelopathy, especially in the absence of a history of spinal or surgical trauma. The radiological diagnosis ismade through a myelography or an MRI exam. The spinal cord is pushed anteriorly, buffering the dural defect and leading inmost cases to Brown-Séquard syndrome. The present study describes the case of a male patient with a clinical picture of progressive thoracicmyelopathy. In the clinical and radiological investigation, an idiopathic spinal cord herniation on the chest level was identified. During the surgery, the spinal cord was reduced to the natural site, taking its usual elliptical shape, and the dural defect was repaired with a dural substitute. The numbness of the patient improved, and the shocks in the lower limbs disappeared. A postoperative MRI confirmed the surgical reduction of the herniation and the restoration of the anterior cerebrospinal fluid (CSF) column to the spinal cord. The authors describe the clinical, radiological, intraoperative, and postoperative evolution.

Imaging in the Diagnosis of Symptomatic Forearm Muscle Herniation.

Symptomatic muscle herniations are an unusual cause of upper extremity pain that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion6. Dynamic ultrasound and Dynamic MRI test are the very good tool for diagnosis of muscle herniation, FNAC and biopsy are rarely needed. This article describes a successful repair of a 22yr old manual worker’s ventral forearm herniation with polypropylene mesh. Prevalence Muscle herniation in an extremity is a well-known cause of pain, even though there have been extremely few documented cases. In a 2009 report published by the “Journal of Hand and Microsurgery,” only 200 cases of herniated muscles of the extremities had been reported since the mid-1800s, and only 17 cases of muscle herniation in the upper limb have been described10. Characteristics A herniated muscle in the forearm can cause mild to severe localized pain, affect grip, cause nerve pain or have no physical symptoms at all. Causes of documented cases include sporting or occupational activities, or an unrelated primary medical condition. Patients usually have a swollen mass that increases in size when the affected muscle is engaged and decreases when the muscles are relaxed. One differential diagnosis for a herniated forearm muscle is a tumor. Muscle herniation in the forearm typically affects males in their adolescent or young-adult years1. We report a case of a disappearing forearm nodule that appeared with muscle contraction. This is characteristic of a transfascial muscle hernia. Ultrasound and MRI are the key to identifying an area of fascial alteration. Treatment alternatives of this unusual condition are discussed.

Diagnostic computerized tomography sign in Petersen's space hernia after laparoscopic roux-en-Y gastric bypass

Petersen's space hernia [PSH] is a well-known complication of laparoscopic roux-en-Y gastric bypass [LRYGB] in up to 7% of cases. This led the surgeons to close this defect during surgery. We report the case of a young lady, 25 years old with a body mass index [BMI] of 55 kg/m[2] who had LRYGB in October 2004 with antecolic roux limb, without closing the Petersen's space [PS]. Two years later she presented with vague abdominal complaints, which drew our attention to the occurrence of this type of internal bowel herniation through the PS. routine laboratory investigation and upper endoscopy failed to reveal the problem. However, computerized tomography [CT] scan of the abdomen showed one of the major signs of internal herniation, namely, rotation by 180 degrees of the superior mesenteric vein [SMV] counterclockwise upon the superior mesenteric artery [SMA]. This hernia was reduced surgically through small laparotomy wound after a failed trial to do it laparoscopically. The PS defect was repaired and closed

Role of transabdominal ultracound in para-umbilical hernia

In a hospital-based study, over a period of six months, 17 patients were diagnosed to have para umbilical hernia on abdominal Ultrasonography. Fourteen patients underwent surgery, which confirmed the diagnosis. Ultrasound was able to document the size of the defect which ranged from 1.0 cm to 2.9 cm. Contents of the sac were evaluated and it was found that 10 patients had omentum and seven patients had gut in the sac. Out of the seven patients containing gut loops, four patients were diagnosed as strangulation. Reducibility was also documented with certainty in 4 out of 17 patients. The results showed that ultrasonography, being a non invasive easily available modality, can be used not only for detection of para umbilical hernias but also for marking the sites on skin and determining the contents of para umbilical hernias

Herniography: a useful diagnostic tool for occult groin hernia in adult patients with obscure groin pain

20 adult patients [mean age of 39.8 years] with established groin pain of duration of 8.9 months and normal physical examination underwent herniography. All patients had a history of medical evaluation on several occasions by other physicians. The pain was described as an ache in most patients and was unilateral in 17. Apart from 2 cases of brief syncope, no serious herniographic complications were recorded in the present series. In the presence of bilateral hernial sacs, the larger sac was found at the painful side. 18 patients [90%] were found to have 26 occult groin hernias. 4 were direct and 6 were bilateral. Exploration of the painful side confirmed the herniographic findings in all patients. Three months follow-up after operation revealed resolution of the patients' symptoms. The technique of herniography and the normal herniogram were described

The missing eyeball--CT evaluation (a case report).

A case of blow out fracture of the medial wall and floor of the orbit with herniation of the eyeball into the ethmoid sinus diagnosed on CT scan is reported. To the best of our knowledge there is no previous report of prolapse of eyeball into the ethmoid sinus.