Pyogenic liver abscess in Crohn's disease

We describe six cases of pyogenic liver abscess occurring among 1227 Crohn's disease patients admitted to The Mount Sinai Hospital from 1960 through 1982, and review the features of the seven similar cases that have been previously reported. Mechanisms of formation of liver abscess in these 13 patients included direct extension of intraabdominal abscess (three cases), propagation via the portal vein (eight cases), biliary complications (one case), or metastatic cancer (one case). Five of the 13 patients died. All five deaths occurred among the eight patients with multiple abscesses; all five patients with solitary abscess survived. The mean age of the patients who died was 56 years, versus 37 years for the survivors. Three of the four patients treated with antibiotics only died; only two of the nine patients who underwent some form of drainage succumbed. Mortality was usually attributable to failure in making the diagnosis, especially as liver function test abnormalities were often subtle. Furthermore, the generally nonspecific clinical signs and symptoms were often obscured by underlying bowel disease. If a high index of suspicion is maintained, CT scanning and ultrasonography should reveal the lesion at an early stage, so that the necessary drainage procedure can be carried out, with or without concomitant resection of affected bowel and drainage of intraabdominal abscess.     

Prostate abscess presenting as priapism

Abscesses of the prostate are infrequently encountered now as a result of effective antibiotics. The clinical diagnosis remains difficult. Herein we report an unusual case of a prostate abscess presenting as priapism. The diagnosis and management of the case is discussed, and the literature is reviewed.     

Crohn's disease presenting as a recurrent perianal fistula: a case report

Crohn's disease (CD) is a multifactorial polygenic disease characterized by chronic inflammation of the gastrointestinal tract (GIT), often complicated by the development of intestinal strictures and/or formation of fistulas. Several diagnostic criteria have been proposed, usually relying on clinical, endoscopic, radiological or histological features. report a case of Crohn's disease of the entire colon with rectal sparing presenting with recurrent perianal fistula that had earlier on been misdiagnosed and treated for other things. The patient was treated successfully with corticosteroids and aminosalicylates and had since remained stable.     

Percutaneous drainage of iliopsoas abscess in Crohn's disease

Iliopsoas abscess is a rare but serious complication of Crohn's disease. Initial treatment by surgical drainage of the abscess alone or in combination with bowel resection has been recommended. Percutaneous catheter abscess drainage (PAD) has not been described. We report 3 patients with this uncommon complication of Crohn's disease in whom PAD was attempted. It was successful in 2 cases but failed in 1, who went on to have the abscess drained surgically. We suggest that PAD can be a useful initial treatment to improve the patient's condition prior to definitive surgical resection.     

Subclavian mycotic aneurysm presenting as mediastinal abscess

A 60-year-old man was admitted to a hospital for evaluation of intermittant fever, dysphagia, hoarseness, and general chest discomfort. Great vessel mycotic aneurysm was suspected when antibiotic trials failed and chest X-ray showed paraaortic mass with pleural effusion mimicking mediastinitis. Although the correct diagnosis of mycotic aneurysm of innominate artery was made thereafter and vigorous treatment was initiated immediately, this patient succumbed to overwhelming sepsis, probably due to a 2-week delay in another hospital. This case is reported to remind readers of the possibility of this unusual location of mycotic aneurysm. A high index of suspicion should be maintained to make an earlier diagnosis and obtain better prognosis. Computed tomography and 3D magnetic resonance angiography also significantly improve the diagnosis when mycotic aneurysm location is unusual and presentation is equivocal.     

Anal tuberculosis presenting as refractory perianal abscess

Although most cases occur in immunocompromised individuals, anal tuberculosis can occur in the absence of HIV infection. Anal tuberculosis should be considered in the differential diagnosis of chronic or recurrent anal fistulas.     

Diverticular abscess presenting as prostate abscess and missed by abdominal CT scan

This is a case report of sigmoid diverticular abscess presenting as prostate abscess. Helical computed tomography (CT) scan revealed the prostate abscess but failed to demonstrate the underlying diverticular abscess. Colonic diverticular abscess can have many unusual presentations, and multiple imaging modalities may be required to reveal the underlying pathology. Abdominal CT scan is not always a definitive and absolute imaging modality for abdominal pain evaluation and cannot supplant clinical judgment in the evaluation of confusing cases.     

Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess

Perinephric abscesses often present with flank pain and signs of sepsis, and are known to discharge to the skin. We report a case of a young patient presenting with a 48-hour history of painful swelling in her right renal angle following a urinary tract infection and no overt signs or symptoms of sepsis. Plain abdominal films showed a perinephric abscess secondary to a staghorn calculus in the upper pole of the right kidney. On incision and drainage, 700 mL of pus was drained freely. The patient recovered well but required partial nephrectomy. Subcutaneous abscess as a result of intra-abdominal pathology is a recognized but rare complication. This case illustrates that subcutaneous abscesses may have underlying intra-abdominal pathology without overt signs of sepsis.     

Isolated obturator externus muscle abscess presenting as hip pain

The case of a 20-year-old diabetic male with 2 weeks of hip pain, diagnosed with an isolated obturator externus muscle abscess, is reported. Pyomyositis, or abscess formation deep within a large striated muscle, is a rare but potentially life-threatening disease.     

Ruptured left subclavian artery aneurysm presenting as upper airway obstruction in von Recklinghausen's disease

Aneurysms arising from the subclavian artery are very rare vascular abnormalities in von Recklinghausen's disease, which often have a silent clinical presentation and are difficult to diagnose before rupture. We report a case of von Recklinghausen's disease with life-threatening upper airway obstruction caused by spontaneous rupture of the left subclavian artery aneurysm in a 46-year-old woman. The diagnosis was eventually confirmed by a reconstructed enhanced computed tomography of aorta. We emphasise the importance of it as a differential diagnosis because life-threatening upper airway obstruction may develop in such patient.     

First branchial cleft anomaly presenting as a recurrent post-auricular abscess

Failure to recognise these unusual cases may result in misdiagnosis, inadequate treatment, and subsequent recurrence. Further definitive surgery may thus be complicated. A case is reported of a patient who attended accident and emergency on three occasions with an infected post-auricular cyst, which was treated by incision and drainage. It was subsequently found to be a first branchial cleft anomaly.     

Prostatic abscess in young males: a rare complication of Crohn's disease

We report a rare case of prostatic abscess with Crohn's disease in a 21-year-old male. Computed tomography showed a typical prostatic abscess. Moreover, filling of the abscess cavities with contrast medium was demonstrated after micturition, which represented the rupturing of the abscess into the urethra. Crohn's disease should be included in the differential diagnosis of prostatic abscesses even in young males.     

Hiatal hernia presenting as a left atrial mass

Cardiac masses pose diagnostic challenges. We present a 62‐year‐old woman presented for evaluation of chest pain and palpitations. Transthoracic echocardiography showed left atrial mass, which was subsequently identified as hiatal hernia by cardiac magnetic resonance imaging.     

Femoral neck stress fracture presenting as gluteal pain in a marathon runner: case report

A case is described of a 50-year-old man with a femoral neck stress fracture presenting as gluteal pain. An operative pinning procedure of the femoral neck was performed for stabilization. Femoral neck stress fractures are often misdiagnosed early in their presentation. The signs and symptoms can mimic those of more commonly seen disorders. Appropriate physiatric history and physical examination, along with indicated studies, will help prevent misdiagnosis and potentially serious complications associated with musculoskeletal pathology.