A Case of Cutaneous Botryomycosis of the Lower Leg in a Young Adult Male.

We present a case of cutaneous botryomycosis of the lower leg in a young adult male. Botryomycosis is a chronic granulomatous response to bacterial infection. As a cutaneous lesion, it can easily be mistaken for a malignant, autoimmune or inflammatory mass. We were able to successfully treat our patient with primary surgical excision, vacuum-assisted closure (V.A.C.™) dressing and subsequent split thickness skin graft (STSG). Use of a V.A.C. dressing with subsequent grafting has not previously been reported in the literature.

Large Intermuscular Lipoma Presenting as a Groin Hernia.

Lipomas are the commonest benign mesenchymal tumours, commonly seen as a subcutaneous lump. However, intermuscular lipomas are uncommon and can remain asymptomatic until they attain larger sizes. We discuss a rare case of a large symptomatic intermuscular lipoma in a 34-year-old woman who presented with acute on chronic groin pain. Clinical examination findings were consistent with an incarcerated inguinal hernia and imaging confirmed a large intermuscular lipoma of the anterior abdominal wall, the tip of which herniated into the inguinal canal. She underwent open primary repair of the hernia along with excision of the lipoma. An intermuscular lipoma presenting as an incarcerated inguinal hernia at the first instance is an uncommon finding. Due to lack of obvious clinical findings, uncomplicated intermuscular lipomas can be challenging to diagnose until they become symptomatic, and a high degree of suspicion in patients reporting atypical abdominal and groin pain, or abdominal wall fullness is required.

Successful non-operative management of a traumatic thyroid haematoma in a goitrous gland.

Traumatic haemorrhage of the thyroid is an uncommon injury, especially in patients without pre-existing thyroid disease. Goitrous glands have an increased risk of haemorrhage following trauma due to their increased size and vascularity. Traditionally, traumatic thyroid haematomas were indiscriminately managed with neck exploration. Over time, the role of the close observation in the management of these injuries was explored, and it became common for patients with traumatic haematomas in otherwise normal thyroid glands to be managed non-operatively if no signs of ongoing bleeding or airway compromise manifested. However, patients with known goitrous glands continued to undergo neck exploration and resection of the affected gland. Herein we discuss the case of a traumatic thyroid haematoma managed non-operatively in a patient with a goitrous gland and discuss its implications for the management of similar future cases.