Disseminated peritoneal leiomyomatosis: A case report.

Disseminated peritoneal leiomyomatosis (DPL) or leiomyomatosis peritonealis disseminata is a sporadic benign disease characterized by several solid peritoneal smooth muscle nodules that proliferate along the abdominopelvic cavity. The source of the condition is undetermined, although suspected causes include iatrogenic and hormonal stimulation. It primarily affects women of reproductive age. Imaging investigations are important in determining the extent of lesions and the presence of malignancy. There are no conventional therapeutic guidelines for the therapy of DPL, hence the risk of malignant transformation is low. We discuss the case of a 41-year-old woman who had a previous laparoscopic hysterectomy and presented 4 years later with numerous peritoneal tumors the diagnosis of DPL was suspected by computed tomography and magnetic resonance imaging, and confirmed by histology.

Pituitary hyposignal characteristic of hemochromatosis on MRI.

Pituitary haemochromatosis is an endocrine disorder caused by the accumulation of iron due to a lack of absorption during haemochromatosis. The characteristic appearance on MRI is a T2 and T2* hyposignal of the anterior pituitary gland without enhancement, respecting the pituitary stalk and the posterior pituitary gland.

Retroperitoneal paraganglioma.

Paragangliomas are rare tumors of the neuroendocrine system that form near certain blood vessels (paraaortic and carotid) and nerves, often presenting heterogeneous parenchyma and displaying strong contrast enhancement on computed tomography. Underdiagnosis and misdiagnosis of this tumor are suspected as they can be silent, of small size, or confused with other structures.

Incidental discovery of intercostal pulmonary hernia: A case report.

Lung hernias are rare. They are defined by the protrusion of lung parenchyma through a defect in the chest wall. A distinction is classically made between supraclavicular, thoracic or diaphragmatic hernias and congenital or acquired hernias. The latter can be classified by etiology as post-traumatic, postoperative, or pathological but can be spontaneous (even rarer) caused mainly by coughing efforts. The diagnosis is guided by the clinical presentation and confirmed by radiographic analysis, especially CT scan. The management, by conservative or surgical approach, depends on the clinical condition of the patient, the characteristics of the hernia and the existence or not of complications. We report the case of a 58-year-old patient, chronic smoker with no history of trauma, who presented with a chronic cough not improved by symptomatic treatment and in whom the clinical examination was without particularities. Chest CT scan showed discrete pulmonary emphysema with an intercostal pulmonary herniation at the level of the right fifth intercostal space associated with a bony outgrowth at the level of the middle arch of the right fifth rib. The pulmonary protrusion occurred through a parietal defect between the fifth rib and the bony protrusion. The management consisted of conservative treatment of the hernia with close clinical and radiological follow-up and medical treatment of the pulmonary emphysema and chronic cough associated with smoking cessation and hygienic and dietary rules.

Polysplenia syndrome in adulthood: a case report.

Polysplenia syndrome mainly described in pediatrics; rarely and incidentally in adulthood. Most patients had their diagnosis done during childhood due to the frequent association to cardiac anomalies that speak for themselves earlier in life. Multiple spleens, cardiac defect and vascular malformation of the inferior vena cava with azygos or hemiazygos continuation are the most frequent observed malformations. Our patient was one this rarest adulthood incidental diagnosis, who presented in the emergency department for nephritic colic, and while imaging for this, multiples spleens and other visceral malformations were diagnosed. Hopefully, cardiac ultrasound hadn't showed any cardiac malformation and the patient was discharged aware of this condition. Through this publication we report the possible incidental diagnosis of polysplenia condition and highlight the fact that people with such important malformation can lead a normal life, and only awareness should be given for future surgeries, instrumental treatment or else.

An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome.

BACKGROUND: Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. CASE PRESENTATION: A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel's syndrome. Due to failure of ERCP, the patient underwent surgical derivation. CONCLUSION: Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn't be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.