Multinodular goiter compressing the trachea following open heart surgery

Acute hemorrhage into an adenomatous goiter following cardiac surgery is a rare cause of acute upper airway obstruction. We report an unusual presentation of respiratory distress in a patient with goiter recovering from open heart surgery, which was successfully treated by left hemithyroidectomy. A mandatory evaluation of the upper trachea in patients with long-standing benign goiter is recommended prior to cardiac surgery.     

Multinodular goiter and parotid carcinoma : a new case of Cowden's disease

Cowden's Disease is an autosomal dominant genodermatosis associated with abnormalities of the breast, thyroid gland, gastrointestinal tract. We describe a 23-year-old girl who was diagnosed with this disease when she consulted for evaluation of a multinodular goiter. Further investigations revealed breast lesions, gastric polyposis and parotid cancer. Recognizing Cowden's disease is important for prompt screening for malignancies. Skin lesions are markers of precancerous development.     

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.     

Left atrial angiosarcoma: an unusual presentation and location

Primary sarcomas are aggressive tumors with a predilection for the right side of the heart. The case is reported of a patient with a highly aggressive angiosarcoma occupying the entire left atrium, who presented with a rapidly progressive history of dyspnea. The tumor was resected surgically and found to be invading the left pulmonary veins. Unfortunately, the patient had a recurrence within three months of surgery and died one year after the first presentation. A brief review of the relevant literature is also provided.     

PET detection of recurring rectal adenocarcinoma in an unusual location. Case report

A rare pattern of colon cancer recurrence is presented. A 63-year-old man underwent surgical resection after diagnosis of colon cancer. The postsurgical-pathologic examination showed a stage II colon cancer (MAC B2). Six courses of adjuvant chemotherapy (Mayo protocol) were started within four weeks of surgery. During follow-up, serial serum carcinoembryonic antigen levels became progressively elevated in an otherwise asymptomatic patient who showed no signs of recurrence in any of the conventional imaging tests performed (chest X-ray, abdominal ultrasound, and abdominal CT-scan). Positive findings suggesting lymph node mediastinal metastases were present in the PET scan. Surgical resection and pathologic examination demonstrated metastases of colon adenocarcinoma.     

Toxic intrathoracic goiter and mediastinal lymphadenopathy: an unusual presentation of systemic primary AL amyloidosis

Mediastinal lymphadenopathy and goiter have been associated with primary amyloidosis, although not in the same patient. One previous case report described the association of an amyloid goiter and hyperthyroidism (due to Graves' disease) with primary amyloidosis. Till now no case reports of patients presenting simultaneously with mediastinal lymphadenopathy, intrathoracic amyloid goiter and hyperthyroidism as the first manifestation of systemic primary (idiopathic) amyloidosis have been described. The present case report describes the clinical, biological radiological and histological features in such a male patient.     

Case report: peritoneal sarcoidosis in an unusual location

A 48-year-old woman underwent surgery for a lesion seen on ultrasound and interpreted as a uterine myoma. The surgery revealed multiple nodules that had seeded on the omentum, peritoneum, and ovaries. The macroscopic interpretation was either metastasis or tuberculosis. The biopsy showed noncaseating granulomas, and a diagnosis of peritoneal sarcoidosis was reported. The AFB (acid fast bacillus) and L?wenstein-Jensen culture were negative. She was treated with methylprednisolone for 1 year for pulmonary sarcoidosis progression, with a resulting decrease in her DLCO (diffusing lung capacity for carbon monoxide). Computed tomography showed only a slight decrease in the multiple nodules and cysts. She is currently symptom-free.     

Acute endocarditis of the patch caused by Staphylococcus capitis in treated tetralogy of Fallot. An unusual location by an unusual bacterium

We present the case of a 46 year-old male, HCV infected, treated with corrective surgery for tetralogy of Fallot (TOF) immediately after percutaneous closure of the Blalock Taussig shunt. Four months later, the patient had infective endocarditis by Staphylococcus capitis localised on the right side of the patch, treated by oxacillin and gentamycin. The particularity of our report is the unusual location of the acute endocarditis and the bacterium involved: the pulmonary valve is much more likely to be involved in endocarditis in TOF patients and the patch endocarditis has rarely been reported. Moreover, Staphylococcus capitis has never been reported as a cause of acute endocarditis in corrected TOF patients. We believe that antibiotic therapy should be instituted as soon as possible even though an aggressive surgical treatment is mandatory to achieve complete recovery, mainly when clinical condition and inflammation markers do not improve.     

Substernal goiter: an unusual cause of respiratory failure after coronary artery bypass grafting

Substernal goiter can cause extrathoracic upper airway obstruction. Since cardiopulmonary bypass results in a systemic inflammatory response syndrome characterized by an increase in capillary permeability and edematous changes in many tissues including the thyroid gland, an existing nonobstructive substernal goiter may become obstructive postoperatively. We describe the case of a patient with an asymptomatic substernal goiter who required urgent thyroidectomy for tracheal obstruction after elective coronary artery bypass grafting. To the best of our knowledge, ours is the 1st such case reported in the English-language medical literature. This case illustrates that, in cases of acute postoperative respiratory failure after open heart surgery, tracheal obstruction caused by enlarged substernal goiter should be considered in the differential diagnosis.     

An unusual location of leproma of bone; a case report

A hyperactive leproma, stimulating osteoclastoma, was excised from the distal metaphysis of the left ulna in an 18-year-old girl with borderline-lepromatous leprosy of short duration.     

Anaerobic deep abscesses with unusual location: report of 5 cases

OBJECTIVE: Anaerobic deep abscesses are rare and may have unusual location leading to severe outcome due to delayed diagnosis and treatment. In order to improve their diagnosis, we report and analyse 5 new cases. METHODS: Patients were seen from 1999 to 2003 in a single department of internal medicine of the university hospital of Marseille. RESULTS: Five new cases were diagnosed consisting in 3 females and 2 males with a medium age of 56,8 years, with unusual location in 4 cases: epidural (2), psoas (1) and sub-diaphragmatic (1) or circumstances in one case of pulmonary abscess unrelated to inhalation. Predisposing conditions thought to compromise resistance to infection were found in all cases: social poverty (4/5), alcoholism (3/5), smoking (4/5), teeth and periodontal disease (4/5), neoplasia (2/5), iatrogenic disease (2/5). Symptoms were insidious (5/5) and unspecific but were always related to the abscess location. Abscesses were frequently found distant from the initial focus of infection because of frequent hematogenous spread (4/5). Drainage of the collection led to bacterial identification in all cases (4/4), although blood cultures could be positive (3/5) and helpful in one case in which drainage was not possible (1/5). The isolated organisms always corresponded to the suspected initial focus (oropharynx 4/5 and digestive 1/5). Finally, combination of surgical drainage and double prolonged antibiotherapy (penicillin+metronidazole) was the elected treatment. CONCLUSION: Since hematogenous diffusion is frequent, anaerobic infection should be suspected in any case of deep abscess affecting patients with predisposing conditions such as poverty, severe teeth disease or iatrogenic procedure.