Trauma: an unusual aetiology of pulmonary pseudocyst

Traumatic pulmonary pseudocyst due to blunt chest trauma is rare. It is a clinical entity that manifests itself with minor clinical and major radiological signs. We report a case of a 16-year-old girl, who during an attack by a violent cow sustained a chest impact that resulted in a traumatic pulmonary pseudocyst, confirmed with a computed tomographic (CT) scan of the chest. The patient recovered with conservative management.     

An unusual case of rounded atelectasis

An unusual case of rounded atelectasis (RA) is described. This entity is likely to develop as a consequence of asbestos-induced pleural disease. The sine qua non of RA is a curvilinear tail extending from the inferior medial surface of a peripheral mass. Recognition of this "comet tail" prevents the necessity for surgery.     

Ileo-anal j-pouch cancer: an unusual case in an unusual location

Restorative proctocolectomy with ileal pouchanal anastomosis (IPAA) is the surgical treatment of choice for complicated ulcerative colitis. Development of ileal pouch-related cancer is a rare event and usually occurs in association with backwash ileitis or chronic pouchitis. We report a case of adenocarcinoma at the inlet of an ileal pouch in a 68-year-old Caucasian male, 14 years after restorative proctocolectomy for ulcerative colitis in the absence of severe chronic pouchitis or backwash ileitis. The operative technique is described, with a review of the literature on ileal pouch cancer.     

Round atelectasis in an elderly man: the role of thoracotomy

In summary, a case of round atelectasis appearing subsequent to a pleural effusion in an elderly man 6 months after open heart surgery is reported. Although plain roentgenograms and linear and computerized tomography could help the physician make the diagnosis with confidence, a needle biopsy of the lesion at the very least or exploratory thoracotomy may sometimes still be justified for the properly selected patient.     

Eosinophilic oesophagitis: an unsuspected aetiology for dysphagia in an HIV-positive patient

Patients with HIV/AIDS are often afflicted with oesophageal disorders. Opportunistic infections such as candidiasis, herpes simplex, cytomegalovirus, mycobacterial infections, Kaposi sarcoma or lymphoma involving the oesophagus, motility disorders and reflux oesophagitis are the usual culprits. Eosinophilic oesophagitis (EE), a recently recognized entity, is an important cause of dysphagia, food impaction and chest discomfort. We report the case of an HIV-infected man who had persistent dysphagia for six months despite treatment with proton pump inhibitor. He was diagnosed with EE after having endoscopic evaluation and biopsy of his oesophagus and was successfully treated with swallowed fluticasone. This case represents the first reported case of EE in an HIV-infected individual.     

Subgaleal abscess: an unusual presentation

We report a case of subgaleal abscess formation in a 16-year-old boy with varicella and minor head trauma. He presented four weeks after injury with left-sided scalp swelling and periorbital edema. There was no break in the skin over the involved area. Diagnosis was made on the basis of prolonged swelling, an elevated erythrocyte sedimentation rate, and computed tomography that showed a subgaleal fluid collection. Aspirated material grew Group A beta-hemolytic Streptococcus. Subgaleal abscess formation without an overlying wound is previously unreported. Management of subgaleal abscess usually requires operative debridement and IV antibiotics. However, in our patient, needle aspiration and oral antibiotics sufficed.     

Trichomonas vaginalis: an unusual presentation

We report a case of Trichomonas vaginalis (TV) presenting as vulval ulceration in a 41-year-old woman. There was complete resolution of her symptoms only after oral tinidazole. The delayed diagnosis and importance of using the correct tests for the diagnosis of TV are discussed.     

Hepatic cystadenoma: an unusual presentation

A 53-yr-old woman with a history of hepatic cystadenoma 25 yr before presented with a simple hepatic cyst, which evolved over 9 yr into a complex cystadenoma with septations and internal bleeding. She was treated with a left hepatectomy. Review of the literature shows that hepatic cystadenomas, although rare, frequently can recur years later and have potential for malignant transformation. Histologic similarities of one variant with ovarian stroma raises interesting possibilities regarding the origin of these lesions. The best treatment results are obtained with radical excision.     

Congenital laryngoptosis: an unusual case

Laryngoptosis is a rare anomaly of the larynx. The larynx is localized in a position lower than its normal position. A 15-year-old boy presented with hoarseness of voice. Physical examination showed that the larynx was in an abnormal position. There were no palpated tracheal rings. A low-pitched monotonic voice was the only symptom of laryngoptosis. Magnetic resonance imaging showed that the larynx was almost localized on the manibrium sterni, and the diagnosis was laryngoptosis.     

Gastric cancer: an unusual presentation

We want to introduce the case of an 18 year old male patient who consulted us because of proctorrhage, straining and rectal tenesmus. Diagnosis was rectal tumor which pathological anatomy revealed an adenocarcinoma of cells in seal ring shape, suggesting a probable gastric origin. The high endoscopy evidenced multiple polyps, less than a centimeter wide found in the cardiac orifice, body and antrum, with the same histology. All these findings were confirmed during the exploratory laparotomy. We thought it was interesting to report this case because of the clinical presentation, unusual in this type of gastric cancer.     

Mycobacterium szulgai: an unusual pathogen

Mycobacterium szulgai is an unusual pathogen that accounts for less than 1% of all cases of non-tuberculosis mycobacterial infection. Infections with this organism usually involve the lung but may involve soft tissues. Although similar to tuberculosis in its clinical presentation, infection due to M. szulgai requires different management, and it is therefore important to distinguish disease caused by M. szulgai from that caused by M. tuberculosis. Isolation of M. szulgai implies the presence of clinical disease, and when the organism is identified, treatment based on sensitivity testing should be initiated. Although no standard recommendations for treatment exist, most infections due to M. szulgai have been treated with combined high doses of isoniazid, ethambutol, and rifampin for 18-24 months. M. szulgai has been isolated worldwide; the first case of infection reported from Canada is described, and the clinical presentation, microbiologic diagnosis, and therapeutic management of M. szulgai infections are reviewed.