Cervical spinal abscess: an insidious presentation and unusual pathology

Spinal abscess is a rare condition. Its presentation can often be subtle and insidious. This report describes the diagnosis and management of an 87-year-old man who presented to our orthopaedic clinic. We would like to emphasise the importance of rapid diagnosis and prompt treatment in such cases.     

Spontaneous rupture and emergency repairment of the renal pelvis

A case of spontaneous rupture of the renal pelvis is very rare and unusual occurrence. Our case was a young woman who did not present with any disease that was a factor for pelvic rupture. The diagnosis was confirmed by abdominopelvic CT, and emergency repair of the renal pelvis was performed and a ureteral stent was inserted. Appropriate antibiotherapy was ordered, and the recovery was rapid. The differential diagnosis of this ease is discussed and the literature is reviewed:     

自发性膀胱破裂

目的：提高对自发性膀胱破裂的认识。方法：回顾性分析３９例自发性膀胱破裂患者的临床资料。结果：引起自发性膀胱破裂的原因：泌尿系结核１０例，前列腺增生及膀胱颈梗阻９例，肿瘤７例，其他原因者１３例。３３例行膀胱修补术，其中腹膜内型膀胱破裂者２５例，腹膜外型膀胱破裂者８例。６例行保守治疗，其中５例治愈，４例因病程长死于败血症及水电解质紊乱。结论：Ｂ超为首选检查手段，膀胱造影对腹膜内型膀胱破裂诊断意义较大，     

Spontaneous rupture of the third ventricle in obstructive hydrocephalus: A radiographic diagnosis

Summary Two cases of posterior fossa tumours with spontaneous rupture of the third ventricle are presented. In the first case there was dramatic relief of symptoms of raised intracranial tension. Rupture of the supra-pineal recess was demonstrated by Conray ventriculography in both cases.     

自发性髂静脉破裂:病例报告兼文献复习

目的:分析自发性髂静脉破裂的诊断与外科治疗。方法:报告本院2003年收治的1例左髂外静脉自发性破裂病例,并检索国内外相关文献,取其中资料完整的24篇文献,共26例病人(包括本例病人),对其临床表现、影像学检查、病理学检查、手术方式和预后进行分析。结果:女24例,男2例。突发下腹部疼痛或饱胀(25/26)、下肢肿胀(8/26)为主要症状,24例存在休克。发生于左侧髂静脉(24/26),仅2例发生于右侧髂外静脉。影像学检查显示为髂窝混合性肿块。22例接受破裂静脉壁修补,4例行髂静脉结扎。8例病理学检查无明显异常。21例存活,5例死亡。结论:突发下腹部肿块或疼痛、休克且无外伤史的女性病人,为该病的诊断要点。积极复苏、及时剖腹探查和破裂静脉壁修补可取得较好预后。     

Spontaneous rupture of both flexor tendons within a digit

Summary A case of closed rupture of both flexor tendons in a little finger is reported. This rare event is discussed in relation to previous similar reports.     

Spontaneous retroperitoneal abscess as the first clinical manifestation of a non-functioning retroperitoneal paraganglioma

We demonstrate a novel clinical presentation of paraganglioma not described in the literature. The paraganglioma is a catecholamine secretory, or non-secretory, neuroendocrine tumour that derives from chromaffin cells. Its frequency, with regard to pheochromocytoma, is low, and the abdominal region is the most frequent localisation site, followed in importance by the cervical region. We report the case of a 54-year-old woman diagnosed with a retroperitoneal abscess; after drainage of the lesion, samples indicated necrotic paraganglioma cells, so it was decided to conduct a survey to determine catecholamine levels in urine, and carry out a MIBG gammagraphy, which described a non-functioning retroperitoneal paraganglioma that underwent surgical removal. There was no residual disease after 3-month follow-up.     

An unusual first presentation of hypopharyngeal carcinoma as thyroid abscess: Case report of a diagnostic challenge

BackgroundHypopharyngeal carcinoma can involve thyroid gland due to their close proximity. However, an initial presentation as a thyroid abscess is rare in this malignancy. To our knowledge, this is the second reported case in the English literature.Case presentationWe described a 45-year-old female who presented with dysphagia, hoarseness and anterior neck swelling. The initial CT scan revealed a right thyroid abscess which was incised and drained with no malignancy found in the biopsy of the thyroid tissue. Patient presented one month later with worsening dysphagia, weight loss and a fungating anterior neck mass. Further investigation revealed a locally advanced hypopharyngeal squamous cell carcinoma extending to the right thyroid, upper oesophagus, prevertebral muscles and bilateral cervical lymph nodes (T4bN2cM0). Unfortunately, the patient passed away prior to initiation of treatment.ConclusionClinicians should have raised index of suspicion of a possible underlying hypopharyngeal carcinoma in patients presenting with thyroid abscess and proceed to further investigations in order to ensure early diagnosis and treatment of the malignancy.     

Unusual presentation and rupture of left sinus of Valsalva into mitral-aortic intervalvular fibrosa

Ruptured sinus of Valsalva aneurysm from the left coronary sinus communicating through the mitral-aortic intervalvular fibrosa is rare. We report a 35-year-old patient who presented with only hemoptysis without any other cardiac complaint. The patient with this unusual diagnosis and presentation was managed successfully.     

Primary melioidotic prostatic abscess: presentation,diagnosis and management

Introduction: In South‐East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community‐acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare. Methods: The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study. Results: The mean age at presentation was 53 years (range: 29?69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re‐resection while another patient developed severe septic shock requiring intensive care and ­inotropic support. There was no mortality in our series. Conclusions: Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome.     

Spontaneous rupture of a pancreatic acinar cell carcinoma presenting as an acute abdomen

INTRODUCTIONPancreatic acinar cell carcinoma is a rare malignant pancreatic neoplasm. To the best of our knowledge, there has been no report on spontaneous rupture of acinar cell carcinoma.PRESENTATION OF CASEA 39-year-old Azari male presented with a history of sudden onset, acute epigastric pain of 12-h duration. Eight hours later the patient's general condition rapidly deteriorated, blood pressure was decreased to 90/70 mm/Hg and heart rate was increased to 120 beat/min. Emergent abdominal computed tomography scan showed a well-defined hypo-dense, necrotic mass, measured 12 cm × 12 cm that was originating from the uncinate process of pancreas with marked free peritoneal fluid and extensive haziness of retroperitoneal and mesenteric fat compatible with marked bleeding. Emergent abdominal operation was performed and histopathology revealed acinar cell carcinoma of the pancreas.DISCUSSIONPancreatic acinar cell carcinoma (ACC) usually presents with abdominal pain, nausea and vomiting. To best of our knowledge, no report has been made of spontaneous rupture of ACC.CONCLUSIONPancreatic carcinoma may present as acute abdomen due to rupture of underlying neoplasm.     

Spontaneous rupture of splenic hematoma in a malaria patient: Case report and review of literature

IntroductionBlunt abdominal trauma is the most common cause of splenic rupture. Malaria is the most frequent tropical infectious cause of spontaneous splenic rupture. The exact mechanism is not well-defined.Case reportWe report a case of thirty-year-old male patient known to have malaria who presented with spontaneous splenic rupture. A trial of conservative treatment failed and splenecomy was done to control bleeding.ConclusionSpontaneous splenic rupture should be kept in mind in malaria patients presenting with left upper quadrant pain and signs of hypovolemia. Early diagnosis and treatment is essential.     

Spontaneous liver hematoma and a hepatic rupture in HELLP syndrome: report of two cases

Subcapsular liver hematomas and ruptures are unusual fatal complications of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (HS). We present two cases of a spontaneous rupture of subcapsular liver hematoma occurring in HS and review the literature on this subjects. One case demonstrated a secondary rupture of a subcapsulary liver hematoma due to HS in one patient and HS associated with preeclampsia in another. The defects were on the medial and lateral sectors of the left lobe in one patient and on the medial sector of the right lobe in the other patient. In case 1 deep mattress sutures and omentoplasty were performed, and in the other case a defective area was closed with an absorbable gelatin sponge with a hemostatic effect. In addition, the liver was compressed by abdominal towels. A high index of suspicion and immediate recognition are keys to proper diagnosis and management of affected patients. The multidisciplinary approach to the management of these patients led to a remarkable decrease in the mortality rates. Less aggressive treatment is preferable to aggressive intervention such as a hepatic resection in such patients with coagulopathy. Received: May 8, 2001 / Accepted: November 20, 2001     

Spontaneous splenic rupture: report of three new cases and review of the literature

This study reports 3 new cases of spontaneous (or atraumatic) splenic rupture of the spleen, including two with massive hemoperitoneum and one with a secondary rupture of splenic infarct, and reviews the literature about this rare disease. These spontaneous ruptures are rare and potentially fatal. They result from infectious diseases (mainly mononucleosis and and paludism) and hematological diseases (mainly malignant hemopathies) in more than 50% of cases. Mortality is close to 20%, and includes some deaths occurring before diagnosis was established and postoperatives deaths, which can result from delayed management and bad general condition of the patients. Splenectomy is usually mandatory. Non-surgical treatment can be indicated only in young and stable patients.