Radiological diagnosis of severe appendicitis in 4 months infant with possible microperforation: A rare case report.

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention; however, it is extremely rare in infants. Its diagnosis and treatment are challenging due to nonspecific clinical signs and symptoms. As a result, delayed or missed diagnosis is common in young children and is associated with an increased risk of perforation and peritonitis. We reported a case of a 4-month-old healthy male child. The patient presented with abdominal distention and fever. After ruling out other possible causes, he was diagnosed with acute appendicitis, which was confirmed by a CT scan. A gangrenous appendix, dilated bowel loops, and free fluid in the abdomen were discovered during surgery. An appendectomy was performed. The appendix in infants has an average length of 4.5 cm compared with 9.5 cm in adults. Infantile appendicitis is considered rare but cases have been documented also in neonates, misdiagnosis rates are high due to rarity in this age group in addition to nonspecific signs and symptoms, which led to a high perforation rate. Ultrasonography can diagnose appendicitis in children with a sensitivity and specificity of 90%-95% without subjecting the child to radiation. A physician should always keep the diagnosis of appendicitis in mind in the infant age group, even though it is rare, as a delay in diagnosis and treatment has been associated with an increased risk of complications including appendicular perforation and peritonitis.

Bullous pemphigoid in a previously healthy adolescent: a case report and literature review.

Introduction: Bullous pemphigoid (BP) is considered the most common bullous autoimmune disorder, characterized by autoantibodies directed against hemidesmosomes in the skin and mucous membranes. It usually affects elderly individuals in the sixth through eighth decades of life, with an average age at onset of 65 years. Only a few cases have been reported in children and teenagers. Case presentation: Herein, we report a 17-year-old boy who presented with a pruritic vesicular rash on his arms and legs accompanied by erythema. He was treated at the beginning with topical lotion and acyclovir, but the rash kept deteriorating and eventually bullae appeared, involving also his mouth. A dermatologist was consulted and diagnosed him with BP, and he was treated accordingly. Discussion: BP is the most prevalent autoimmune bullous illness, caused by autoantibodies against hemidesmosomes in the basement membrane of skin and mucosal surfaces, which in turn attract immune cells, including T-cells and neutrophils, and activate them, which causes damage to and separation of keratinocytes, resulting in the bullous formation. Diagnosis can be accomplished by recognizing clinical symptoms supported by histopathological and immunofluorescence testing. Steroids, whether topical or systemic, are the cornerstone treatment; depending on the extent of the disease, other immunosuppressant drugs can be used as a second line. Conclusion: BP manifestations are polymorphic; physicians should keep in mind that they may present with non-bullous, pruritic lesions, which may persist for some days to several months before bullae appear. Although this disease is rare in the young population, it should be considered in the differential diagnosis of bullous lesions.

Testicular adrenal rest tumor in a pediatric patient with congenital adrenal hyperplasia: A case report.

Testicular adrenal rest tumors (TARTs) are benign intratesticular tumors that occur mostly in male patients with congenital adrenal hyperplasia (CAH), their prevalence in these populations can reach up to 94%. We hereby report a male child with known CAH, presented with bilateral irregular testicular masses which were diagnosed as TARTs. TARTs were first reported in 1940, They were named due to their resemblance to adrenal tissue, they are almost always benign but can blunt spermatogenesis and endocrine function of the testis leading to infertility, they are diagnosed by a combination of clinical history, physical exam, and imaging studies, MRI and U/S are equally good for diagnosis and follow-up, treatment includes surgical resection or observation depending on tumor size, symptoms, and fertility goals. TARTs are benign testicular tumors that are strongly associated with CAH, they can be completely asymptomatic or can cause pain and infertility, diagnosis can be done by imaging modalities like MRI or U/S, and treatment options include observation or surgical removal.

Nerve sheath myxoma masqueraded as intramuscular myxoma: an extremely rare tumor with unusual location - a case report and literature review.

Nerve sheath myxoma (NSM) is a very rare benign nerve sheath tumor that mostly affects young adults, with a peak incidence in the 30s. Patients usually present with an asymptomatic swelling commonly affecting the dermis and subcutaneous tissues of the head, neck, and upper extremities. Lower extremities are a much rarer location, and when this occurs, the knee/pretibial region is the most common location. NSM has not been reported within the anterior tibialis muscle. Case Presentation: The authors present the first reported case of NSM in the anterior tibialis muscle in a 39-year-old man presented as deep swelling in the left leg. Discussion: NSM is difficult to diagnose clinically or using standard imaging techniques; MRI and ultrasonography cannot differentiate it from other anomalies. Histopathology alone is not enough to distinguish NSM from neurothekeomas, which were considered synonymous in the past. They can be distinguished by using immunohistochemical markers. Conclusion: Soft tissue tumors in lower extremity muscles are somewhat difficult to diagnose. Excision of the tumor by a specialized orthopedic surgeon and histopathological/immunohistochemical analysis were the only avenues to correctly diagnose the NSM.

Ewing sarcoma in calcenous presented as chronic osteomyelitis: a case report and literature review.

Ewing's sarcoma (ES) is an uncommon primary malignant tumor of the bone, mostly affecting 5-20 years of age with male predominance. It commonly affects the diaphysial region of long bones, while the small bones of hands and feet are extremely rare (3-5%) to be affected. The authors report a case of calcaneal ES which was misdiagnosed as bacterial chronic osteomyelitis and treated inappropriately. A high index of suspicion is required in diagnosing tumors at rare sites to avoid undue delay in initiating appropriate therapy. As the overall prognosis of ES of the calcaneum is lower compared to other sites, these tumors should have an extensive radiological evaluation and histological confirmation, as misdiagnosis and treatment delays will have detrimental outcomes.

Rapidly enlarging axillary cystic hygroma in a 6-year-old male patient: A case report and literature review.

INTRODUCTION: Cystic hygromas are relatively uncommon tumors of lymphatic origin, it appears most of the time, approximately 90 % before age of 2 years, and it is caused by abnormal development of lymphatic vessels. CASE PRESENTATION: Here we report a case of axillary cystic hygroma in a 6-year-old healthy boy, which presented with the rapid development of a right axillary mass during 3 days, without any predisposing factor. DISCUSSION: Cystic hygromas occur due to complete or partial obstruction of lymphatic vessels, which leads to lack of communication with the venous system, this results in the accumulation of lymphatic fluid and swelling, it occurs in the cervicofacial region most of the time 75 %, but it can arise anywhere in the body, it classically presents as painless, soft mass, diagnosis can be done using ultrasound, CT, MRI, each of which has its advantages, surgical treatment is routinely favored, but other options are also available. CONCLUSION: Axillary cystic hygromas are quite rare, few cases have been reported in fetuses and adults, but only one case in the pediatric age group, thus, in light of these cases, cystic hygromas should be considered in the differential diagnosis of any cystic axillary swelling.

Extreme Oncoplastic Breast Surgery: A case series of three patients from a lower-middle income country.

Introduction: Oncoplastic breast surgery has become a major player in modern breast surgery.It broadens the indications for breast-conserving surgery. More challenging cases are being treated more with what so-called "extreme oncoplastic breast surgery" which is defined as a breast-conserving operation, using oncoplastic techniques, in a patient who, in most physicians' opinions, requires a mastectomy. Methods: Replacement and/or displacement oncoplastic techniques with contralateral symmetrization to three female patients with breast cancer were done by an oncoplastic breast surgeon. Outcomes: The three patients had smooth recoveries with good aesthetic,oncologic and psychological outcomes. Conclusion: Oncoplastic breast surgery can be a better option than mastectomy with good oncologic, Psychological and aesthetic outcomes, even with extreme cases, yet long-term studies are needed.

Emergency repair of traumatic avulsion of the right main stem bronchus using biliary stent in a 6-year-Old girl: A case report.

Introduction: Pediatric thoracic trauma is a rare condition, but results in high levels of morbidity and mortality. These injuries are often more devastating in the pediatric population due to differences in children's anatomy and physiology relative to adult patients. Tracheobronchial injuries secondary to blunt trauma are difficult to diagnose compared to penetrating trauma. So, a high index of suspicion is of utmost importance. Case presentation: We report a case of a 6-year-old girl who experienced complete avulsion of the right main bronchus. The patient presented with extensive emphysema and severe respiratory distress with bilateral tension pneumothorax. Endotracheal intubation and two thoracostomy tubes were applied. Pneumothorax and a massive air leak persisted on the right side. After thoracotomy, right main bronchus avulsion was present and then repaired by end-to-end anastomosis and muscle flap. minimal air leaks from right chest tubes and partially expanding right lung on chest X-ray are seen after that. So, reinforcement by biliary (instead of bronchial) stent was performed because unavailability of bronchial stent with the desired size at that time. Discussion: Traumatic tracheobronchial damage occurs in just 0.05-3% of all pediatric thoracic traumas. It's fatal condition especially in first hour. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma. Conclusion: Biliary stent placement could be a reasonable treatment option for tracheobronchial damage.

Significant response to Pembrolizumab for metastatic cutaneous squamous cell carcinoma in patient with Netherton syndrome.

Background: Netherton syndrome is a rare autosomal recessive disease that presents with a triad of symptoms which include atopic diathesis, ichthyosis linearis circumflexa, and hair shaft abnormality termed "Bamboo Hair". Netherton syndrome patients can develop cutaneous squamous cell carcinoma (cSCC) in unusually young age. Pembrolizumab is the first line treatment for locally advanced and recurrent/metastatic cSCC. Case presentation: A 44-year-old man with a history of Netherton syndrome and multiple skin squamous cell carcinoma was diagnosed with locally advanced and recurrent/metastatic cSCC two years ago. He was started on Pembrolizumab as a treatment for his cSCC. The immunotherapy course was well tolerated with no significant side effects including the expected immune related adverse events seen in patients treated with this medication. PET/CT scan showed significant regression of his disease consistent with partial response according to the response evaluation criteria in solid tumors. Discussion: Incurable and recurrent cSCC tends to metastasize, leading to an extremely poor long-term prognosis, and the treatment options for locally advanced or metastatic disease are few. Pembrolizumab, an immune checkpoint inhibitors (ICIs) showed a benefit in patients with various tumors including squamous cell carcinoma, but using this drug which is working by enhancing the immunity against tumor in patient with altered immunity like Netherton syndrome was a bit of a challenge, in terms of both effectiveness and safety. Conclusion: Pembrolizumab had a effective and safe treatment profile when it was used as a monotherapy for treating a Netherton syndrome patient diagnosed with locally advanced and recurrent/metastatic cSCC.

Surgical management of bilateral scapular winging in a previously healthy 10-year-old boy: A case report.

Introduction: Scapular winging is a pathological condition that occurs due to dysfunction of any scapulothoracic muscles, most commonly the serratus anterior which is innervated by long thoracic nerve. Case presentation: Herein, we report a 10-year-old boy presented with bilateral scapular winging for a few months, associated with vague discomfort upon shoulder movements. After taking history and performing physical examination and tests as electromyography, he was diagnosed with idiopathic bilateral scapular winging as there was no obvious cause or risk factor for his bilateral scapular winging. Discussion: Scapular winging causes decrease strength and range of motion of the shoulder, the usual complain of patients is discomfort or the unpleasant cosmetic appearance of scapular prominence, this condition, if left untreated, can cause various negative consequences on the shoulder joint, detailed history and physical exam reinforced by electromyography are crucial in determining the cause of winging, as it has many causes, initial management can be conservative, but various surgical approaches have been described for more severe cases which compromise shoulder function, choice of the surgical approach depends on the underlying cause and overall clinical picture of the patient. Conclusion: bilateral scapular winging is rare condition, only 26th cases were reported in literature, it occurs due to multiple causes, treatment can be conservative at early stages, but surgical option should be considered when shoulder function and strength become compromised.

A child diagnosed with midaortic syndrome and inherited thrombophilia after presenting with a stroke: A case report.

A 5-year-old female patient presented to the emergency room with right upper limb weakness, inability to speak and left side deviation of the mouth. Computed tomography (CT) scan was done and she was diagnosed with ischemic stroke. During her medical evaluation she was found to have high blood pressure (186/104 mm Hg). Investigations done to evaluate for secondary causes of hypertension and stroke revealed that she has inherited thrombophilia and abdominal aortic coarctation. Balloon angioplasty was done that lowered her elevated blood pressure, which was not responding well to antihypertensive medications, to near normal value for her age.