Pulmonary Embolism in an Adolescent With May-Thurner Syndrome: A Case Report.

May-Thurner syndrome (MTS) is a pathological variant where the left iliac vein is compressed by the right iliac artery. Usually common in females between the third and fourth decades of life, this case report is about MTS in an adolescent girl. The patient was overweight and had a sedentary lifestyle. She developed a sudden onset of unilateral left leg deep venous thrombosis (DVT), leading to low-risk pulmonary embolism (PE) within a week of the symptoms starting. The patient received a heparin infusion for one week, after which she was switched to subcutaneous low-molecular-weight heparin. Apart from the initial high D-dimer, the rest of the thrombophilia workup was unremarkable. The whole exome sequencing (WES) study was negative. An inferior vena cava (IVC) filter was not advised for her due to the small size of the clot and her age. The patient responded well to heparin alone and was discharged home on enoxaparin.

Primary Basidiobolomycosis of the Cecum in Immunocompetent Patients: Two Case Reports.

Colonic basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. Primary cecal basidiobolomycosis is an exceptionally rare condition. The study describes two cases of primary basidiobolomycosis of the cecum in immunocompetent male and female patients (one each). The patients presented with fever, abdominal pain, weight loss, eosinophilia, and high erythrocyte sedimentation rates. Computed tomography revealed wall thickening and mass lesions involving the cecum, suggesting malignancy. Right hemicolectomies were performed to relieve the intestinal obstruction. On microscopy, there were destructive, transmural eosinophil-rich pyogranulomatous reactions with thin-walled, pauci-septated fungal elements surrounded by Splendore-Hoeppli bodies. The patients received antifungal drugs, with no evidence of dissemination or recurrence on follow-up. Primary cecal basidiobolomycosis in immunocompetent hosts is a rare occurrence. It oftentimes clinically masquerades malignant neoplasms and therefore its identification mandates its inclusion in the differential diagnosis of a colonic mass, equally both on the part of the clinicians and pathologists.

Incidence of Gastrointestinal Neuroendocrine Tumor: Case Series, Armed Forces Hospital Southern Region, Hospital-Based Tumor Board Registry.

Neuroendocrine tumors are aggressive and rare tumors which can occur almost everywhere in the body. The annual incidence of neuroendocrine tumors is 2.5-5 per 100000. We report seven cases of gastrointestinal neuroendocrine tumors which were diagnosed and treated at our hospital from the time period of 2016-2018 knowing that the total number of our hospital tumor board cases registry during the same period was 444 cases.

Ipsilateral reduced olfactory bulb volume in patients with unilateral nasal obstruction.

OBJECTIVES: To evaluate the effect of unilateral nasal obstruction (by nasal polyps of different histopathology) on olfactory bulb volume using MRI technique. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary university hospitals, Departments of Otolaryngology and Radiology. SUBJECTS AND METHODS: Eleven patients with a few months of complete unilateral nasal obstruction of different pathological etiologies were selected. MRI assessment of olfactory bulb volume was performed using planimetric manual contouring. The contralateral olfactory bulb was used as a comparative control for the same patient. Eleven healthy controls constituted the control group. RESULTS: Mean olfactory bulb volume ± SD of obstructed side = 14.3 ± 3.7 mm(3), mean olfactory bulb volume ± SD of nonobstructed side = 43.49 ± 10.7 mm(3). The difference between the 2 sides was significant (P = .003). The difference in olfactory bulb volume between normal subjects and nonobstructed nasal side was statistically nonsignificant (t = .9118, P = .3727), while the difference between normal subjects' olfactory bulb volume and obstructed nasal side olfactory bulb volume in our patients was extremely statistically significant (t = 9.7320, P < .0001). A strong negative correlation was found between duration of obstruction and olfactory bulb volume (R = -0.9761). CONCLUSION: This study shows that unilateral nasal obstruction may be associated with a lateralized ipsilateral difference of olfactory bulb volume.

Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta.

OBJECTIVE: To analyze the value of ultrasound followed by magnetic resonance imaging (MRI) in doubtful cases for antenatal detection of placenta accreta. DESIGN: A prospective observational study. SETTING: Hospital in the southern region, Saudi Arabia. SAMPLE: Patients with a low-lying placenta or placenta previa. METHODS: The placentas of all included cases were scanned in a systematic fashion using both gray-scale and color Doppler (transabdominal and transvaginal). MAIN OUTCOME MEASURES: Explicit ultrasound criteria for placenta accreta were carefully applied, and any case with two or more criteria was labeled as highly suspicious. If only one criterion was detected, then the case was labeled as suspicious and MRI was applied. RESULTS: Five hundred and seventy seven women had a diagnosis of low-lying placenta or placenta previa. Of these, 42 had placenta accreta confirmed after delivery by pathological examination, and 39 of these were diagnosed prenatally. Ultrasound accurately predicted placenta accreta in 33 of 39 of women and correctly ruled out placenta accreta in 512 of 514 without placenta accreta (sensitivity 95.1% and specificity 95.5%). Twenty (20) women underwent MRI because of suspicion of placenta accreta by ultrasonography. MRI accurately predicted placenta accreta in six of 20 cases and correctly ruled out placenta accreta in 10 of 20 cases (sensitivity 85.7% and specificity 76.9%). CONCLUSION: Placenta accreta can be successfully detected prenatally using ultrasound. MRI can provide additional information in doubtful cases.