Floating Thrombus in the Aortic Arch: Rare Images.

Aortic floating thrombus is a rare, life-threatening disease. Most cases of aortic thrombus are diagnosed after embolic events; however, on rare occasion we may diagnose this condition incidentally during routine examinations as in our case.

Diagnostic Challenges in Adult Intestinal Malrotation: A Case Report and Literature Review.

Adult intestinal malrotation is a rare anatomical anomaly that typically manifests during infancy but can also present in adulthood. Symptoms are mainly digestive, with a long history of intermittent abdominal pain and epigastralgia. It often presents a diagnostic challenge due to the varied and nonspecific nature of clinical symptoms. Radiological evaluations reveal diverse patterns of malrotation, including incomplete rotation, mesenteric base abnormalities, and associated malformations. Computed tomography (CT) scans consistently identify characteristic anatomical distortions, aiding in accurate diagnosis. In this context, we present a unique case in which contrast-enhanced CT of the abdomen, initially conducted to investigate a suspected episode of acute pancreatitis accompanied by epigastralgia, fortuitously revealed the presence of intestinal malrotation. Once the diagnosis has been made, the therapeutic approach is based on monitoring or managing complications such as intestinal obstruction. Early recognition and accurate radiological assessment of intestinal malrotation play an essential role in establishing the diagnosis and guiding appropriate management strategies. Increased awareness among clinicians and radiologists is essential to avoid delays in diagnosis and the potential complications associated with this entity.

Low-grade endometrial stromal sarcoma, a rare uterine tumor: Case report.

This case report describes a 45-year-old woman presenting with abnormal uterine bleeding and a cervical mass. Imaging and biopsy revealed low-grade endometrial stromal sarcoma (LGESS), emphasizing the importance of comprehensive evaluation for uterine masses. The report underscores the role of MRI and pathology in diagnosis, with immunohistochemical analysis helping confirmation. A multidisciplinary approach and vigilant follow-up are crucial for optimal management. The rarity of LGESS and its challenging diagnosis highlight the need for continued research to improve diagnostic and therapeutic strategies. Surgical intervention remains primary, but the optimal management approach is debated. This report indicates the necessity of a comprehensive approach to uterine mass evaluation and ongoing research for enhanced patient care.

Rare case of inguinal cystic lymphangioma diagnosed and treated in elderly patient.

Cystic lymphangioma develops due to the interruption of lymphatic-venous connections during embryogenesis, leading to the formation of a cystic lesion containing lymph. These lesions fall under the ISSVA classification of vascular malformations. The first documented case dates back to 1828, with further elucidation provided by Sabin in 1909 and 1919. Cervicofacial region is the most common site, often showing early-stage symptoms. Inguinal location is rare, but if complications arise, it may present as a strangulated inguinal hernia. The tumor's severity lies in its compression and invasion of the aerodigestive tract and adjacent organs. Diagnosis relies on imaging techniques such as ultrasound and computed tomography, which help determine the mass's nature, boundaries, and relationship with neighboring structures. Asymptomatic lesions are generally monitored, while symptomatic ones require complete surgical excision to minimize the risk of recurrence. At Cheikh Khalifa University Hospital, we present a case highlighting our urology department's experience in diagnosis, patient care, and surgical treatment.

Intestinal Spontaneous Intramural Hematoma Secondary to Anticoagulation Therapy: A Case Report.

A common complication of anticoagulation therapy is bleeding, especially in patients receiving long-term vitamin K antagonists. Spontaneous intramural hematoma is a rare etiology among life-threatening major bleeds. An 80-year-old female patient presented with diffuse abdominal pain. Her history included ischemic heart disease and chronic atrial fibrillation treated with 3 mg of acenocoumarol per day. Three days before her admission, she developed diffuse abdominal pain with fecaloid vomiting, bloating, and not passing gas. Palpation of the abdomen revealed asymmetrical distension and pain, with no signs of peritoneal irritation or bleeding. Investigations showed anemia with a hemoglobin level of 9.2 g/dL, a white blood cell count of 14200/mm3, a C-reactive protein of 112.6 mg/L, and a prothrombin time of 75.1 seconds with an international normalized ratio (INR) of 8.5. Abdominal contrast-enhanced computed tomography (CT) showed segmental parietal thickening, luminal narrowing, and partial small bowel obstruction secondary to an intramural jejunum hematoma responsible for a gallbladder occlusion with infiltration of the mesenteric fat in front. The patient recovered two days after conservative treatment. In this case, we report an unusual small bowel intramural hematoma of the jejunum secondary to anticoagulant therapy. Physicians should be aware of this unusual cause of abdominal pain. Early diagnosis may avoid unnecessary surgical exploration.

Hydatid cyst of the uterus: Very rare location.

The involvement of the genital tract of a hydatid cyst is rare and the occurrence in the uterus is an extreme rarity. The diagnosis of this localization is difficult because the clinical and radiological findings are often misleading and the diagnosis is often worn during surgery and after histopathological examination of the surgical specimen. We report the case of a patient who consulted for primary infertility, with a clinical finding as the only anomaly significantly large uterus, and imaging pointing strongly toward an ovarian multilocular cyst, and in which the discovery of hydatid cyst was accidental intraoperative with double localization uterine and omental. Radical treatment cannot be discussed in this young patient of 32 years and gravid 0. The removal of the cyst wall completely and excision of the mass epiploic seemed reasonable. The patient was placed under Mebendazol and is always under the supervision of a possible recurrence.

Exophytic hepatic hemangioma: a case report.

Hepatic hemangiomas may rarely arise outside the extra-hepatic capsule. It appears as a pedunculated mass. We report the case of a 58-year-old female presenting with abdominal chronic pain. Incidental diagnosis of a pedunculated hepatic hemangioma was suggested by ultrasonography confirmed by typical imaging features on computed tomography. Dynamic contrast- enhanced computed tomography and MR scan are relevant to approach the diagnosis of hemangioma, showing its origin from the liver edge and typical radiological features Surgical removal of the mass was performed to prevent volvulus along the pedicle. Pathological analysis confirmed the diagnosis of pedunculated benign hepatic hemangioma.

A Unique Case of Radiologically Isolated Syndrome Diagnosed During a Follow-up of Cytomegalovirus Meningoencephalitis.

Radiologically isolated syndrome (RIS) refers to an entity in which an MRI of the brain, spine, or both demonstrates incidental white matter lesions that are characteristic of a demyelinating disease in morphology and location. High-risk RIS may require disease-modifying treatment (DMT). A complex interaction among genetic and environmental factors leads to self-reactive immune mechanisms, which are believed to have a pivotal role in the pathogenesis of demyelinating diseases. Viruses are possible triggers to this mechanism. Unlike Epstein-Barr virus (EBV) infection, which is a well-known risk factor for multiple sclerosis (MS), the association between cytomegalovirus (CMV) infection and MS remains uncertain, with some studies indicating a protective effect of CMV on autoimmune diseases. We report a unique case of RIS diagnosed during the follow-up of CMV meningoencephalitis in a patient who presented with generalized seizure onset.

Gallstone ileus: An unusual cause of intestinal obstruction.

Gallstone ileus is an infrequent cause of intestinal obstruction. It is typically the result of cholecystoduodenal fistula, computed tomography scan is the best modality for the diagnosis. Surgical removal of the gallstone is the pillar of treatment to relieve intestinal obstruction. We report the case of a 77-year-old male with features of a small bowel obstruction. Computed tomography scan of the abdomen showed pneumobilia, a cholecystoduodenal fistula, and small bowel obstruction features suspicious for gallstone ileus. The patient had a laparotomy and removal of two gallstones via an enterotomy without postoperative complications.

[Bilateral adrenal tuberculosis: about a case]. / Tuberculose surrénalienne bilatérale: à propos d'un cas.

Isolated adrenal tuberculosis accounts for less than 2% of adrenal incidentalomas. This is the most frequent infectious cause of adrenal insufficiencies. We report the case of a 53-year old patient with no previous medical history presenting with adrenal insufficiency with slow progression over six months. Physical examination didn't show any mass or hepatosplenomegaly. Blood pressure was 120/60 mmHg. Laboratory tests didn't show inflammatory syndrome. LDH level was normal. CT scan showed bilateral hypertrophy of the adrenal glands characterized by calcifications. Intradermo tuberculin reaction was positive at 25mm. The analyses to detect Koch's bacillus in the sputum and in the urine were negative. Quantiferon® test was positive. Trial antibacillar treatment was started with clinical improvement and 5kg weight gain in 12 months. Hormonal assays were low.