Haemorrhage in pre-existing adrenal masses. A case series.

INTRODUCTION: Adrenal haemorrhage in the context of a pre-existing adrenal mass is a rare, underestimated and potentially fatal surgical emergency. It is a rare cause of acute abdominal pain. PRESENTATION OF CASES: Data from 13 patients with adrenal haemorrhage in a pre-existing adrenal mass were prospectively collected during a 9 year period from a single institution. All patients underwent CT imaging which formed the basis of diagnosis and a complete endocrinological evaluation. Seven out of 13 patients underwent an elective surgical procedure and 2 patients underwent emergency laparotomy. Five out of 13 patients were diagnosed with metastatic disease. One patient was diagnosed with pheochromocytoma. DISCUSSION: The likelihood of an undiagnosed pheochromocytoma renders emergency surgery extremely precarious. Complete patient evaluation includes testing for hormonally active adrenal tumors and malignancy. Emergency surgery is reserved for cases where conservative management fails. CONCLUSION: Haemorrhage of an adrenal mass constitutes a diagnostic and therapeutic challenge. Most patients respond well to initial resuscitation efforts. When feasible, patients should undergo a complete hormonal and oncologic evaluation before surgical intervention is considered.

Anatomical Variations of the Left Subclavian Artery and Their Significance in Clinical Practice.

We study variations of the aortic arch (AA) and its first branches, the brachiocephalic, common carotid, and subclavian arteries. Specifically, we describe anatomical variations of the left subclavian artery (LSA) and their significance in clinical practice. Such variations are commonly associated with congenital anomalies of the right-sided AA (RAA) and/or great vessels. A systematic search of the PubMed online database for studies of LSA variations and RAA, published between 2000 and 2020, produced a total of 73 articles for our study (n = 258 cases). Three of the most common variants were aberrant LSA (32.9%), RAA with mirror-image branching (49.6%), and isolated LSA (17.4%). Although RAA and LSA variations are rare, they may give rise to symptoms during the first stages of life or adulthood and may require surgical repair. Patients can remain asymptomatic, but incidental findings on imaging studies may lead to surgical interventions in areas of the neck or thorax. In such cases, planning the surgical procedure can be challenging, and possible implications must be considered.

Variation of Marginal Mandibular Nerve in a Caucasian Male Cadaver: A Study Using the Anatomage Table.

Anatomage (Anatomage, Inc., San Jose, CA) is a modern method for studying anatomy. It is a state-of-the-art method used for the representation of the structure of the human body. In our study, we examined the seventh cranial nerve of a male Caucasian cadaver using an Anatomage Table in the Anatomy Department of the School of Medicine, National and Kapodistrian University, Athens, Greece. After exiting the skull from the stylomastoid foramen, the facial nerve divided into the temporofacial and cervicofacial main branches. The cervicofacial branch divided into its own branches, including the marginal mandibular nerve (MMN), which ran within the investing (superficial) layer of the deep cervical fascia. We found a variation of the course of the marginal mandibular branch of the facial nerve. In the area of the lower border of the mandible, where the MMN actually crossed the facial artery and vein, it appeared to run deeper than both of those vessels, rather than running superficially. This seemed to be a rare variation of the location of the MMN relative to the facial vessels, which suggested that extra care is essential in surgical approaches within this area.

Acro-osteolysis.

Acro-osteolysis is an osteolysis of the distal phalanges of the hands and feet and can affect the terminal tuft or the shaft of the distal phalanx (transverse or band acro-osteolysis). It is often associated with distal digital ischemia, digital calcinosis, or severe sensory neuropathy. Acro-osteolysis has been associated with a heterogeneous group of disorders, including occupational activities, infections, rheumatic disorders (systemic sclerosis, psoriatic arthritis), endocrinopathies, genetic disorders, and lysosomal storage disorders. Plain radiography is the gold standard for the detection of acro-osteolysis.