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BACKGROUND: This is a unique case of neuropraxia of femoral nerve seen after resection of retroperitoneal liposarcoma which has not been reported before in the literature. INTRODUCTION: Neuropraxia, a transient paralysis due to blockage of nerve conduction, commonly associated with athletes and orthopedic procedures, has not been previously reported as a complication following resection of retroperitoneal sarcoma. CASE: This is an 81-year-old female who, on CT for evaluation of her atherosclerosis, was found to have an incidental right-sided retroperitoneal mass extending from the right renal capsule inferiorly through the inguinal canal. At this point, the patient reported mild right sided abdominal pain and right lower back pain, but reported no neuromotor deficits of the right lower extremity. Given the symptoms of the patient as well as the size, location and the density of the lesion, surgical intervention was pursued. On exploration, the lipomatous lesion, suggestive of liposarcoma, was invading the right genitofemoral nerve and ilioinguinal nerve which were sacrificed to ensure a complete oncologic resection. Following complete removal of the mass, she developed right side femoral nerve neuropraxia, suffering complete loss of motor function in the femoral distribution. Pathology revealed the mass to be a low grade liposarcoma. DISCUSSION: The patient required only physical therapy and oral prednisone following surgery for treatment of the neuropraxia. She responded well and has regained significant neuromotor function of the affected limb. Cases presenting with post-resection neurological sequelae without any known intraoperative nerve injury may respond very well to conservative treatment. Hence, it is very important to collaborate with Neurology and Physical Therapy to achieve best possible outcome.
RESUMO
INTRODUCTION: This case presents a painful ectopic thyroid, an unusual presentation, in an atypical location. The patient's history of an ingested fish bone, her acute presentation, and inconclusive imaging, made this case a diagnostic dilemma. PRESENTATION OF CASE: 61-year-old female presented with acutely worsening history of left throat pain and dysphagia after swallowing a fish bone. CT scan showed a foreign body in the anterior wall of the cervical esophagus. EGD studies were inconclusive. Surgical exploration identified and excised a multinodular cystic lesion without connection to esophageal lumen. Pathology described multinodular thyroid parenchyma with chronic inflammation and no evidence of malignancy. No foreign body was located. DISCUSSION: Based on the patient's history, imaging, and acute presentation, an esophageal perforation with abscess formation was the most likely diagnosis. Surgical exploration was the necessary intervention for this patient's acute symptoms as both a diagnostic and therapeutic tool. The diagnosis of ectopic thyroid tissue from pathology of the excised cystic lesion was unexpected, as the location of tissue and the painful presentation are not typical characteristics of ectopic thyroid tissue. Management of the this case illustrates the dilemma faced in determining the appropriate work up for a patient, without compromising the patient's safety. CONCLUSION: Though painful presentation and this case's location are rare, ectopic thyroid tissue should be included in the differential diagnosis of point tenderness with an associated lesion on imaging.
