Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound.

Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.

Excellent response to combined radioiodine and enoxaparin in the setting of tumor venous thrombosis from differentiated thyroid carcinoma involving internal jugular and subclavian veins.

A striking clinical, radiological and tumor marker response obtained with a combined approach of radioiodine (I-131; single fraction) coupled with subcutaneous enoxaparin (a low-molecular-weight heparin) in the setting of differentiated thyroid carcinoma with jugular vein tumor thrombosis and metastatic pulmonary disease is described in this article. Pulmonary metastases, a frequent accompaniment in this group of patients, also demonstrated remarkable response with a single fraction of I-131. The proposed approach of combining targeted I-131 therapy with the antithrombotic effect of low-molecular-weight heparin in patients with thyroid cancer with documented tumor venous thrombosis is likely to produce a synergistic effect, with a dramatic clinical response that requires a minimal I-131 dose. The noninvasive nature and ease of the approach, which has an impressive response and findings, calls for administering this therapeutic option more in such patients in the future. This could lead to the development of an effective treatment strategy in these patients based upon generated evidence.