Diaphragm Disease of the Terminal Ileum: The Great Imitator.

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an array of intestinal injuries: erosions, ulcers, enteropathy, strictures and diaphragm disease. The diagnosis of diaphragm disease is challenging. Diaphragm disease can cause thin, concentric and stenosing strictures, which can induce intermittent or complete bowel obstruction. NSAID-induced lesions are reversible following discontinuation of the offending agent. Treatment of diaphragm disease can be conservative, endoscopic or surgical through stricturoplasty and/or segmental resection. We report a case of a 59-year-old female presenting with intermittent right lower quadrant pain diagnosed with diaphragm disease upon combined ileo-colonoscopy and histopathological analysis. Her diaphragm disease was successfully treated conservatively through drug cessation, avoiding more invasive procedures like endoscopic and surgical interventions. LEARNING POINTS: The incidence of diaphragm disease has been soaring due to the widespread use of non-steroidal anti-inflammatory drugs (NSAIDs).Diaphragm disease is characterized by diaphragm-like mucosal projections and annular constrictions that induce luminal narrowing and result in bowel obstruction.Physicians should get acquainted with diaphragm disease and include it in their differential diagnosis when approaching a patient with obstruction-like symptoms or non-specific and vague abdominal pain in the setting of chronic NSAIDs usage.

Migrating foreign material mimicking metastatic soft tissue sarcoma in a patient with history of synthol injection.

Injecting substances like Synthol for cosmetic muscle enhancement is known, but its potential for causing severe systemic complications is less documented. This case highlights the risks of foreign material migration, initially presenting as a suspected malignancy. A 47-year-old male presented with dyspnea and bilateral diffuse airspace opacities on chest X-ray, initially raising suspicions for metastatic disease. The patient's medical history was unremarkable until further detailed questioning revealed the use of Synthol injections. Initial imaging suggested metastatic soft tissue sarcoma with bilateral lung and various soft tissue masses detected on PET-CT scans. However, subsequent detailed examinations, including a CT-guided biopsy of the lung lesions, revealed no evidence of malignancy but instead chronic inflammation and fibrosis indicative of a reaction to foreign material. This finding prompted a re-evaluation of the initial diagnosis, leading to the identification of Synthol migration as the underlying cause of the patient's symptoms. This case underscores the importance of considering foreign substance migration in the differential diagnosis for patients presenting with unexplained tissue masses and emphasizes the need for thorough history-taking in elucidating the etiology of atypical radiologic findings. Early detection and accurate diagnosis can prevent unnecessary invasive procedures and facilitate appropriate management.

Psoas muscle sequestered disc mimicking an intramuscular abscess: A rare case report.

This report documents a rare case of a sequestered disc in the psoas muscle mimicking an intramuscular abscess, notable for its lack of systemic infection indicators and resolution without surgical intervention. Such cases emphasize the need for accurate differential diagnosis and highlight potential conservative management pathways for sequestered disc herniations. A 57-year-old male presented with acute low back pain following minor weight lifting, unresponsive to NSAIDs. MRI and CT imaging, followed by CT-guided aspiration and cultures, were employed to investigate a nodular structure within the right psoas muscle. Initial imaging suggested an infectious etiology; however, aspiration yielded no material, and cultures were negative. Follow-up MRIs demonstrated improvement and eventual resolution of the lesion, supporting a diagnosis of sequestered disc herniation. This case underscores the importance of considering differential diagnoses for psoas abscess-like presentations and suggests that conservative management may be sufficient in certain cases of sequestered disc fragments.

An Intimate Relationship Lies Between the Appendix and the Colon: A Case Report of Colitis Cystica Profunda Post-Laparoscopic Appendectomy.

Cystica profunda is a rare benign finding of mucous-filled cysts in the submucosa of the gastrointestinal tract, more commonly found in the rectum and colon. Risk factors include rectal prolapse, inflammatory bowel diseases, pelvic radiation and being post-appendectomy. We present a case of a female patient presenting with rectorrhagia, found to have sigmoidal colitis cystica profunda (CCP) six months post-appendectomy. This case is one of the few in medical literature to highlight the direct association between laparoscopic appendectomy and CCP, previously discussed in the literature as a complication post-appendectomy in the American Journal of Gastroenterology. LEARNING POINTS: Physicians should have a high index of suspicion to rule out colitis cystica profunda (CCP) when approaching a patient with rectorrhagia following laparoscopic appendectomy.It is pivotal to make a prompt diagnosis for CCP in the context of rectorrhagia and initiate timely management.It is important to differentiate CCP from other aetiologies of lower gastrointestinal tract bleed as it is coined 'the great imitator'.

Case series of rhomboid ligament degeneration, mimicking a supraclavicular adenopathy.

A case series of 3 different patients showing very rare costoclavicular ligament increased SUV uptake on PET\CT with history of different types of cancer. This finding has not been described before especially that it corresponds to benign degenerative rather than sinister process. This is supported by low SUV and stability over months of follow up. Furthermore, even in degenerative joint diseases we have found very rare cases of such uptake. Experienced radiologists need to be always involved in the multidisciplinary team approach and be very cautious when approaching such findings to avoid any unnecessary medical interventions.