RESUMO
Although intrinsic pituitary lesions are the most common cause of hypopituitarism, suprasellar masses can produce similar symptoms. The differential diagnosis of a suprasellar mass includes cystic lesions, tumors, granulomatous disease, and infection. The etiology is not always obvious, and despite extensive work-up, may remain elusive. A 28-year-old Mexican man presented with complaints of headache and weakness for two weeks duration. He became increasingly lethargic and an MRI revealed a two centimeter suprasellar mass. Testing of the hypothalamic-pituitary axis suggested panhypopituitarism. He was prescribed treatment with hydrocortisone, DDAVP, and levothyroxine. Open craniotomy and biopsy of the hypothalamus revealed marked inflammation with plasma cells, histiocytes, and small lymphocytes. Light microscopy revealed macrophage-contained leishmania-like organisms although results were not immediately available. Pathological data was consistent with acute infection by Trypanasoma cruzi. Despite supportive efforts, the patient expired two months after presentation. This case illustrates the difficulty of diagnosing and the potential rapid mortality of a suprasellar mass. Because of the wide consideration of etiologies, a tissue diagnosis is needed. However, as this case illustrates, a definitive tissue diagnosis is not always possible, even following biopsy during open craniotomy.
Assuntos
Cistos do Sistema Nervoso Central/etiologia , Doença de Chagas/diagnóstico , Hipopituitarismo/etiologia , Adulto , Animais , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/parasitologia , Doença de Chagas/patologia , Desamino Arginina Vasopressina/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Hipopituitarismo/diagnóstico , Hipopituitarismo/parasitologia , Masculino , Tiroxina/uso terapêutico , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
Facial trauma is a commonly encountered injury in the emergency department. Facial fractures can be categorized into limited, transfacial, and smash fractures. Limited fractures may involve one or two adjacent facial supporting struts. Transfacial fractures are classically the Le Fort fractures. Smash fractures are comminuted fractures that do not follow classical facial fracture patterns. Depending on the severity of injury, treatment may be conservative or surgical. [figure: see text] Computed tomography is superior to conventional radiography, tomography, and MRI in detecting facial fractures, defining their direction, extent, and displacement.