ABSTRACT
We report a case of classic HSE with early neurological relapse 7 days after onset of acyclovir treatment secondary to cerebral venous thrombosis (CVT). The development of CVT after meningoencephalitis has been described with neurotropic viruses such as HSV, HIV, or enteroviruses and also bacterial or fungal agents. CVT is probably the consequence of the inflammation secondary to these infections. A diagnosis of CVT, although rarely described, should be systematically suspected in patients with HSE who present no or only moderate improvement, or early relapse of symptoms despite adapted acyclovir treatment.
Subject(s)
Encephalitis, Herpes Simplex/complications , Sinus Thrombosis, Intracranial/virology , Acyclovir/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Encephalitis, Herpes Simplex/drug therapy , Female , Humans , Middle Aged , Sinus Thrombosis, Intracranial/drug therapy , Warfarin/therapeutic useABSTRACT
INTRODUCTION: The Proteus syndrome is a rare genetic disease which is characterized by the overgrowth of tissues, especially bone, connective and adipose tissue. This condition is related to a somatic mosaic activating mutation in the AKT1 oncogene. CASE REPORT: We report the case of a 25-year-old man, diagnosed with the Proteus syndrome at the age of 6 months. He exhibited an asymmetric overgrowth of the extremities leading to bilateral amputation of the legs at the age of 10 years. He was hospitalized for acute respiratory failure due to a bronchopulmonary infection. Severe bullous pulmonary emphysema, predominantly on the left, with mediastinal deviation, was diagnosed. The patient recovered with antibiotics. An assessment 2 months later revealed mild hypoxaemia (PaO2=75 mmHg) and severe airflow limitation (FEV1=1260 mL [28% th.], FEV1/V C=69%) with hyperinflation (TLC=7840 mL [107% th.], RV=6010 mL [253% th.]). CONCLUSION: The Proteus syndrome is a very rare cause of pulmonary emphysema. The pathophysiology of emphysema in this syndrome is unknown. It can be hypothesized that the development of pulmonary cysts leading to emphysema may share the same AKT1 activation pathway with lymphangioleiomyomatosis.
Subject(s)
Proteus Syndrome/diagnosis , Pulmonary Emphysema/diagnosis , Adult , Humans , Male , Proteus Syndrome/complications , Pulmonary Emphysema/etiologyABSTRACT
Schoenlein-Henoch purpura is a systemic vasculitis involving the small vessels. In adults it is rare and is sometimes associated with malignancies such as bronchial carcinoma. We report the case of a 74-year-old male ex smoker who was admitted with necrotic skin lesions associated with a nephrotic syndrome, and was found to have a right upper lobe squamous cell bronchial carcinoma. The renal biopsy led to a diagnosis of IgA nephropathy related to Schoenlein-Henoch purpura. Curative surgical resection of the bronchial carcinoma (ypT2N0M0) was associated with remission of the purpura. The synchronous diagnosis of bronchial carcinoma and Schoenlein-Henoch purpura suggests a potential relationship between these two pathologies. Our observation and other published data strongly suggest a direct link on account of: the synchronous diagnosis, the clinical and biological remission of the Schoenlein-Henoch purpura after curative treatment of the bronchial carcinoma. It is important to recognise both the therapeutic and prognostic significance of this connection.
Subject(s)
Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , IgA Vasculitis/etiology , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Aged , Carcinoma, Squamous Cell/surgery , Glomerulonephritis, IGA/etiology , Humans , Lung Neoplasms/surgery , Male , Prognosis , Risk Factors , Smoking/adverse effects , Treatment OutcomeABSTRACT
Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Liposarcoma, Myxoid/diagnosis , Liposarcoma, Myxoid/drug therapy , Liposarcoma, Myxoid/radiotherapy , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/drug therapy , Mediastinal Neoplasms/radiotherapy , Mediastinal Neoplasms/therapy , Neoadjuvant Therapy , Thoracotomy , Disease-Free Survival , Female , Humans , Liposarcoma, Myxoid/pathology , Magnetic Resonance Imaging , Mediastinal Neoplasms/pathology , Radiotherapy, Adjuvant , Young AdultABSTRACT
INTRODUCTION: Sarcoidosis is a systemic granulomatous disease of unknown origin. We report an unusual case associated with alveolar haemorrhage. CASE REPORT: An 18-year-old caucasian man was admitted for recent dyspnea. He reported regular tobacco- and occasional cannabis smoking. Lung CT scan revealed mediastinal lymphadenopathy and lung nodules in both fields. Bronchoalveolar lavage recovered bloody alveolar fluid containing many siderophages. Because of rapid deterioration leading to acute respiratory failure, intravenous corticosteroid treatment was started. Improvement was obtained in few days and a diagnosis of sarcoidosis was established based on lymph node biopsy performed under mediastinoscopy. CONCLUSION: This unusual case and those reported in the literature give us the opportunity to describe the characteristics of alveolar haemorrhage associated with sarcoidosis.
Subject(s)
Hemorrhage/etiology , Lung Diseases/etiology , Sarcoidosis/complications , Adolescent , Hemorrhage/diagnostic imaging , Humans , Lung Diseases/diagnostic imaging , Male , Pulmonary Alveoli , Sarcoidosis/diagnosis , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Pulmonary artery stump thrombosis has been reported after pneumonectomy. The prevalence of risk factors for and outcome associated with this condition remain to be clearly evaluated. CASE REPORT: We describe three cases of pulmonary artery stump thrombosis occurring after pneumonectomy. No pulmonary embolism was observed despite the absence of anticoagulation therapy. The prevalence of arterial stump thrombosis after pneumonectomy has been estimated as 12%. It is often detected by CT scanning performed systematically as part of the routine follow up of lung cancer. Thrombus was identified as a filling defect with concave or convex margins, located at the bottom of the stump. DISCUSSION: Only one case of pulmonary embolism associated with pulmonary artery stump thrombosis has been described. The absence of complications associated with thrombus in this site suggests that anticoagulant therapy is not likely to be of benefit.
Subject(s)
Pneumonectomy/adverse effects , Pulmonary Artery , Thrombosis/etiology , Adult , Aged , Female , Humans , Male , Middle Aged , Thrombosis/diagnosis , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Follicular bronchiolitis (FB) is a rare type of cellular bronchiolitis characterised by the presence of hyperplastic lymphoid follicles with reactive germinal centres, distributed along the bronchovascular bundles. OBSERVATION: A non-smoking 36 year old woman was seen because of progressive exertional dyspnoea for 2 years. Chest x-ray and lung CT scan were normal. Pulmonary function tests revealed irreversible airflow obstruction. Exercise testing showed a ventilatory limitation of aerobic capacity with limitation of volume recruitment. The diagnosis of FB was obtained by surgical biopsy. A deficiency of immunoglobulins G4 and M was found. CONCLUSION: The main clinical manifestation of FB is exertional dyspnoea in a young patient. The lung CT scan frequently shows peripheral micronodules but a normal scan does not exclude the diagnosis. The main causes of FB are collagen vascular diseases (especially rheumatoid arthritis) and immunodeficiency syndromes. The treatment of FB is not well defined.
Subject(s)
Bronchiolitis/diagnosis , Adult , Biopsy , Dyspnea/etiology , Female , Humans , IgG Deficiency/diagnosis , Immunoglobulin M/deficiency , Lung/pathologyABSTRACT
Acute Disseminated Encephalomyelitis is a serious demyelinating disorder of childhood that typically occurs following vaccination or a viral prodrome. Some etiologies remain unrecognized, and multiple mechanisms of immune response may explain the pathophysiology of this syndrome. Based on a report of two adult cases presenting with neurologic deficit and ataxia, we report our experience with this syndrome that may affect adults without evident infectious disorder. Prompt treatment is important to avoid rapid progression.
Subject(s)
Encephalomyelitis, Acute Disseminated/diagnosis , Magnetic Resonance Imaging/methods , Adrenal Cortex Hormones/therapeutic use , Adult , Diagnosis, Differential , Encephalomyelitis, Acute Disseminated/drug therapy , Female , Humans , Middle AgedSubject(s)
Biopsy , Lung Diseases, Interstitial/pathology , Lung/pathology , Biopsy/methods , Bronchiolitis/diagnosis , Bronchoscopy , Decision Trees , Diagnosis, Differential , Humans , Lung Diseases, Interstitial/classification , Lung Diseases, Interstitial/diagnosis , Medical History Taking , Physical Examination , Prognosis , Thoracic Surgery, Video-Assisted , Tomography, X-Ray ComputedABSTRACT
A nephrotic syndrome with focal sclerosis associated with Kimura's disease is reported in a young asiatic man. The nephrotic syndrome started three years prior to the usual skin tumors and lymph nodes involvement. Epidemiological, clinical and nosological characteristics of Kimura's disease are discussed. Renal manifestations are the only visceral localisations of the disease. Thirteen Kimura's disease associated with documented nephrotic syndromes have been reported in german-english literature. They display a wide variety of histologic patterns. Their clinical course do not differ from the primary form of nephrotic syndrome with identical histology.
Subject(s)
Angiolymphoid Hyperplasia with Eosinophilia/complications , Nephrotic Syndrome/complications , Adult , Angiolymphoid Hyperplasia with Eosinophilia/drug therapy , Angiolymphoid Hyperplasia with Eosinophilia/immunology , Glucocorticoids/therapeutic use , Humans , Male , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/immunology , Prednisone/therapeutic useABSTRACT
Clinical, mammographic, and sonographic preoperative size measurements were correlated with the values obtained at pathologic examination in a series of 31 patients with pathologically T1 (n = 23) and T2 (n = 8) breast carcinomas. Sonographic measurements demonstrated the highest correlation coefficient (r = 0.84), with the lowest residual standard deviation calculated in relation to the regression line. As a result, real-time sonography yielded the most accurate determination of breast cancer size in this series. Sonographic tumor size determination has proved valuable when mammography failed to delineate the tumor, particularly in patients with dense breasts. It may also be recommended in the evaluation of tumor response to nonsurgical conservative treatment.
Subject(s)
Breast Neoplasms/diagnosis , Mammography , Ultrasonography , Breast Neoplasms/pathology , Female , Humans , Neoplasm Staging/methods , PalpationABSTRACT
The authors report a case of traumatic bilateral carotid-cavernous fistula successfully treated by inflatable and detachable balloon.
Subject(s)
Arteriovenous Fistula/therapy , Carotid Arteries , Cavernous Sinus , Embolization, Therapeutic/methods , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/etiology , Carotid Artery Injuries , Cavernous Sinus/injuries , Female , Humans , Middle Aged , RadiographyABSTRACT
We report 4 cases of post-traumatic enthesopathy occurring later after rupture of rectus femoris tendon from the anterior superior iliac spine. Radiographic feature and clinical picture are typical of diagnosis.
Subject(s)
Athletic Injuries/diagnosis , Ossification, Heterotopic/etiology , Tendon Injuries/diagnosis , Adult , Athletic Injuries/diagnostic imaging , Diagnosis, Differential , Humans , Male , Ossification, Heterotopic/diagnostic imaging , Radiography , Rupture , Tendon Injuries/diagnostic imaging , ThighABSTRACT
Two patients with true synovial cysts in atypical sites (internal compartment of knee and inguinal hollow) were investigated by radioarthrography, ultrasound and computed tomography imaging. The cyst in the hip region originated from a dilated serous bursa of the iliopsoas muscle that did not communicate or was no longer in communication with the joint. In contrast, the cyst of the knee appeared to be a lateral synovial capsule hernia. Positive diagnosis in both cases was dependent on combined ultrasound-CT scan imaging, this eliminating a tumor (sarcoma) of soft tissues. However, affirmation of the synovial origin (mesothelial covering of the wall) of the lesion was obtained by histology only, this allowing differentiation from a "capsular" (fibrous wall) cyst, which probably provokes similar ultrasound and CT scan images.
Subject(s)
Synovial Cyst/diagnosis , Aged , Arthrography , Female , Humans , Male , Middle Aged , Synovial Cyst/diagnostic imaging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
We report the C.T. findings of a dermoid cyst communicating with ventricular system and ruptured in the subarachnoid space. A fat-fluid level and calcifications were present on the plain skull X rays.
Subject(s)
Brain Neoplasms/diagnostic imaging , Dermoid Cyst/diagnostic imaging , Tomography, X-Ray Computed , Female , Humans , Middle Aged , Rupture, Spontaneous , Time FactorsABSTRACT
The authors report a case of intracranial fungal aneurysm and brain abscesses. The compromised host was a young drowned woman. Scedosporium Apiospermum was isolated in fungal culture from abscess. Radiological and clinical pictures are typical of the hyphal form.
Subject(s)
Aneurysm, Infected/microbiology , Brain Abscess/microbiology , Mitosporic Fungi , Mycoses/diagnosis , Adult , Aneurysm, Infected/diagnostic imaging , Brain Abscess/diagnostic imaging , Female , Humans , Immunologic Deficiency Syndromes/microbiology , Mycoses/microbiology , Mycoses/pathology , Tomography, X-Ray ComputedABSTRACT
The authors report a case of spondylitis Th11-Th12 occurred 1 month after embolization of an intraspinal extramedullary arteriovenous fistulae; this fistulae was fed by 11th left intercostal artery. The infecting organism isolated from the affected intervertebral disc was streptococcus sanguis a common agent of dental abscess.
Subject(s)
Arteriovenous Malformations/therapy , Embolization, Therapeutic/adverse effects , Spinal Canal/blood supply , Spondylitis/etiology , Streptococcal Infections/etiology , Humans , Intervertebral Disc/diagnostic imaging , Male , Middle Aged , Radiography , Spondylitis/diagnostic imaging , Streptococcal Infections/diagnostic imaging , Streptococcus sanguis , Thoracic Vertebrae/diagnostic imagingABSTRACT
The authors report two cases of extramedullary arteriovenous fistulas in the spinal canal with venous return into the spinal cord veins. Both patients were middle-aged men who presented with multiple nerve root involvement of the lower extremities for one year and three months respectively. Myelography demonstrated an indentation at the level of the conus medullaris by a dilated vein in both cases. Arteriography of the spinal cord demonstrated an arteriovenous malformation from the dura mater with venous return into the ascending spinal cord veins, located in both cases at T11. Unlike typical angiomas of the spinal cord, these arteriovenous fistulas do not arise from spinal cord arteries. Only the venous return is into the spinal cord system. Initial clinical manifestations are progressive and often misleading, with pseudoradicular pain of the lower extremities or intermittent claudication which was observed in both patients. Only good quality myelography enabled visualization of the dilated vein at the level of the conus medullaris which lead to localization of the arteriovenous malformation and its afferent arteries outside of the spinal cord itself. Treatment is either surgical, or neuroradiological (embolization). Similar results are obtained by both methods, in a condition which would otherwise progress to paraplegia.
Subject(s)
Arteriovenous Malformations/diagnosis , Spinal Canal/blood supply , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/therapy , Embolization, Therapeutic , Humans , Male , Middle Aged , Paraplegia/etiology , RadiographyABSTRACT
Subperiosteal chondroma (juxta-cortical) is unusual benign cartilaginous neoplasm with characteristic radiographic features. We report two cases occurring in uncommon location: the hand. Radiologic differential diagnosis with others bone tumors is easy but it could be difficult with some soft-tissue tumors, especially chondrosarcoma and extraarticular chondromatosis.