ABSTRACT
Congenital pulmonary airway malformations (CPAMs) are a heterogeneous group of hamartomatous cystic and noncystic lung lesions that result from early airway maldevelopment. Usually they are distinguished according to Stocker's classification in type 0, 1, 2, 3 and 4. We present the case of a 2 weeks old baby who was admitted to hospital with RDS symptoms and left pleural effusion: X rays and CT were suggestive for a pulmonary cystic lesion with pleural complications. Because of the persistence of pleural empyema and the development of a pneumothorax the baby underwent surgery. The histological examination revealed a type 3 CPAM associated with pleural loculated empyema. According to this case, in newborns with RDS loculated pleural empyema may mimick pulmonary cystic lesions; a treatment-resistant pleural empyema or pyopneumothorax in a newborn can recognize a CPAM 3 as a probable underlying condition, even in the absence of lung suppurative changes; CPAM 3 involving only two lung segments can have an excellent prognosis after surgical excision.
ABSTRACT
Although in most cases the diagnosis of acute appendicitis is straightforward, not all patients experience typical symptoms and other conditions may mimic appendicitis. In fact, 15-25% of appendectomies involve the removal of a normal appendix. To date, there is no literature evidence that herniation pit (HP) may mimic acute appendicitis. We report a case of a 30 year old woman admitted to the Emergency Department for severe, acute pain developing a few hours earlier in the lower right fossa, with irradiaton to the right thigh. She did not present any fever, nausea or vomiting, Blumberg's sign was absent but the psoas sign and obturator sign were both positive. WBC count was 16,000/mm3 and the Alvarado score was 4. Biochemistry profile was normal. US was unclear and transvaginal ultrasound did not show any gynecological disease. CT scan showed only an herniation pit of the right femoral neck. The patient was admitted to an orthopedic ward and treated with anti-inflammatory therapy. She was discharged after 2 days without any pain and in good conditions. Our case demonstrates that herniation pits of the right femoral neck should be considered a potential cause of right lower abdominal pain mimicking acute appendicitis, particularly if the psoas sign and obturator sign are positive and the patient is physically active.
Subject(s)
Appendicitis/diagnostic imaging , Femur Neck/diagnostic imaging , Femur Neck/pathology , Tomography, X-Ray Computed , Adult , Diagnosis, Differential , Female , HumansABSTRACT
Twenty-six patients affected with Crohn's disease were studied by means of CT. The method demonstrated transmural fistulas in 2 cases, and bowel wall thickening in all patients. In our series of cases, the advantages of CT over conventional radiology lay in the fact that the former allowed the evaluation of associated mesenteric pathologies (e.g. fibrofatty proliferation, and adenopathies) and demonstrated the presence of abscesses in 4 case. CT findings were in agreement with those from conventional contrast studies in the demonstration of entero-enteric fistulas, whereas they yielded additional information in the study of entero-muscular fistulas. Associated pathologies in other organs were found in 5 patients--i.e. fatty infiltration of the liver and cholelithiasis. CT is not useful in demonstrating early mucosal damage in Crohn's disease, but it should be regarded as a complementary method to conventional barium studies. As a matter of fact, CT is fundamental in the evaluation of associated mesenteric pathologies and of other complications which can affect therapeutic management.
