Unilateral hypoplasia of the trapezius muscle in a 10-year-old boy: a case report

We present a 10-year-old boy with a partial absence of or a hypoplastic right trapezius. At present, his only concern is shoulder asymmetry. No family history of significance and no history of trauma exist. His radiographs confirm changes in bony anatomy secondary to the altered balance of muscle forces on the skeleton. We have not identified any other clinical report of a partial or total absence of the trapezius although it has been defined in cadaveric cases. Similarly, some papers have described an absence of trapezius in combination with other abnormalities. In these cases, an abnormal blood supply has been described in contrast to the normal neurovascular anatomy identified in the cadaveric cases with partial absence. If this patient develops painful disability, the Eden-Lange procedure may be an appropriate treatment as for patients with spinal accessory nerve palsies.     

Spontaneous rupture of the extensor carpi radialis brevis in a 51-year-old man: case report

Dorsal hand osteophytes are common findings in the general population, frequently presenting with dorsal pain and treated with surgical excision. We report the spontaneous rupture of the extensor carpi radialis brevis in association with a previously asymptomatic dorsal scaphoid spur. Following conservative management, surgical excision of dorsal hand osteophytes should be considered for both resolution of pain and prevention of attritional tendon rupture.     

Spontaneous tracheal rupture: a case report

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. Risk factors, diagnosis and principles of treatment of this lesion are discussed.     

Spontaneous retroperitoneal hematoma: a case report

The A.A. present a case report of retroperitoneal spontaneous hematoma and put in evidence the difficulties in making an etiopathogenetic diagnosis of spontaneous renal cyst rupture. The patient was a 72 years old man admitted to the hospital in emergency for a painful ipogastric syntomatology and biliary vomit. The ecography showed a distanced gallbladder and the endoscopy evidenced a duodenal stenosis with compression of the gastric posterior wall, so that we were initially directed towards a pancreatic tumor even if the modest increase of the serum bilirubinemy and mostly the fact that direct component was almost normal, gave us strong doubts. The spiral TC gave finally the diagnosis of retroperitoneal hematoma and the presence of a bilateral polycystic kidney with several subcapsular cyst, let us suggest, as well as the anamnestic report of a physical stress, a renal origin of the bleeding. A wild literature review did not evidence other similar cases, but the ecclusion of other possible causes of retroperitoneal hematoma, suggested this conclusion.     

Spontaneous peripelvic extravasation: a case report

A case of spontaneous peripelvic extravasation is reported and discussed. A 41-year-old woman visited our hospital with the chief complaint of right flank pain. There was tenderness on the right side of the abdomen. Enhanced computed tomographic scan of the kidney showed peripelvic extravasation of right kidney. Single J ureteral catheter was inserted for 7 days. The excretory urogram obtained after its removal showed no extravasation.     

Spontaneous ruptured pheochromocytoma: a case report

We present a rare case of intra-abdominal hemorrhage due to a ruptured pheochromocytoma. Our patient presented with signs of shock. By emergency surgery, an hemorrhagic pheochromocytoma of the left adrenal gland was removed. Recovery was uneventful. In cases of suspected hemorrhagic pheochromocytoma with severe shock, prompt surgery is mandatory and catecholamines administration may be crucial to resolve hypotension and guarantee an uneventful recovery.     

A posterior ring apophyseal fracture and disc herniation in a 21-year-old competitive basketball player: a case report

Objective:

To describe the diagnosis and management of a competitive male basketball player with discogenic low back pain and presence of an old posterior ring apophyseal fracture (PRAF). This case will highlight the importance of early recognition and considerations regarding patient management for this differential of radiating low back pain.

Clinical Features:

A 21-year-old provincial basketball player presented with recurrent radiating low back pain into the left groin and lower limb. After several weeks of persistent symptoms including pain, muscle weakness, and changes in the Achilles deep tendon reflex, imaging was obtained that revealed a large disc extrusion with an old posterior ring apophyseal fracture. In collaboration with a spine surgeon and family physician, the patient was treated using a conservative, multimodal approach. Treatment consisted of graded mobilizations, spinal manipulative therapy, interferential current, and soft tissue therapy to the lumbar spine. Rehabilitation exercises focused on centralizing symptoms and improving strength, proprioception and function of the lower limb. After a period of 8 weeks, the patient was able to complete all activities of daily living without pain in addition to returning to basketball practice.

Summary:

PRAF is a unique condition in the immature spine and recent evidence suggests that those involved in sports requiring repetitive motion of the lumbar spine may be at increased risk. The astute clinician must consider this differential in young populations presenting with discogenic low back pain, as a timely diagnosis and necessary referral may allow for effective conservative management to reduce symptoms. Equally as important, one must be aware of the complications from PRAF as a contributing source of low back pain and dysfunction into adulthood. Knowing when to refer for advanced imaging and/or a surgical consult given the variable clinical presentation and prognosis is an essential component to care.     

Labyrinthine sequestrum: four case studies

Labyrinthine sequestrum, a rare form of labyrinthitis, is highly distinct from the more commonly encountered labyrinthitis ossificans based on its unique clinical, radiologic, and histologic characteristics. The study included 4 such patients who had undergone clinical and laboratory investigations, computed tomography (CT), and magnetic resonance imaging (MRI) assessments followed by surgical procedures and pathological evaluation. Their major symptoms were otorrhea, otalgia, tinnitus, and profound hearing loss. Imaging studies showed an osteolytic soft mass with calcified debris in the inner ear, and the bony labyrinth was eroded partly or completely by granulation mass, with loss of bony morphology. Further pathological examination was coincident with inflammatory granulation tissue with some calcification or osseous tissue. The disease process is attributed to chronic osteomyelitis due to the presence of osteonecrosis. Prompt CT and MRI examinations and optimal therapeutic management facilitate definitive diagnosis and protect against fatal complications.     

自发性脊柱硬膜下血肿1例报告

脊柱硬膜下血肿（SSDH）是一种罕见且危险的椎管内血肿，可表现为神经根痛、截瘫、自主神经功能障碍等脊髓横贯性损伤，极少数表现为单侧病变。好发于胸椎，腰椎少见。2021年4月5日，本院收治1例自发性SSDH患者，疗效满意，现报告如下。     

Spontaneous bilateral extradural hematomas: a case report

A rare case of spontaneous bilateral extradural hematomas probably due to hypofibrinogenemia is reported. On April 17, 1983, a 21-year-old woman was referred to our hospital because of her comatose state. She has complained of her longer duration of menstrual bleeding lasting 10 days to 2 weeks, but has had no history of hemorrhagic diseases. At the last night, she complained of headache and vomited several times, after drinking some beer but she went to bed without therapy. We cannot see a history of her head injury several days before admission. On admission, she was comatose with bilateral dilated pupils and flexed her upper extremities against painful stimuli. There was a tendency for subcutaneous hematomas to form immediately in places where the stimuli were applied. Skull fracture was not found on craniogram and CT scan showed bilateral extradural hematomas (60 ml on the right side and 130 ml on the left side). Laboratory data showed leukocytosis (14800), longer prothrombin time (15.2 seconds with a control of 11.9 seconds), markedly elongated activated partial thromboplastin time (90 seconds with a control of 15-45 seconds) and decreased fibrinogen concentration (114 mg/dl with a control of 200-400 mg/dl). At the bilateral decompressive craniectomies with infusion of 5 gram of fibrinogen and 300 ml of fresh blood, we found neither scalp hemorrhage nor skull fracture and after removal of coagulated hematomas no dural anomaly was found. After operation she improved gradually and laboratory re-examination was normal including bone marrow puncture. Now, 5 months after operation she is clear with slight tetraparesis on her rehabilitating course.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spontaneous chylous cardiac tamponade: a case report

Background  

Chylous cardiac tamponade is a rare condition with little known cause.     

Spontaneous renal artery dissection: a case report

A 65-year-old female was admitted to our hospital complaining of left upper abdominal pain. Although the symptom improved with observation, serum creatinine rose to 2.0 mg/dl. Slight atrophy of the left kidney was seen on abdominal plain computed tomography. In order to examine the possibility of renal infarction from thrombosis with angiography, we consulted the department of cardiovascular medicine. Even though we did not detect thrombosis with left renal angiography or intravascular ultrasound, there was a dissection finding localized at the left renal artery. Based on this finding, we made a diagnosis of spontaneous renal artery dissection and performed stent placement. Spontaneous renal artery dissection is extremely rare and the frequency of occurrence is reported to be less than 0.05%. Recently, however the frequency of detection has risen with the development of clinical imaging. We must keep in mind that the condition has the possibility of leading to renal blood circulation disorders.     

Spontaneous rectus sheath hematoma: a case report

Spontaneous rectus sheath hematoma is an uncommon condition which usually presents as acute abdomen, mimicking other abdominal disorders. Management must be initially conservative, but surgery is indicated in progressive hematomas. We present a case report of rectus sheath hematoma conservatively managed.     

Metanephric adenoma in a 59-year-old female: a case report

We report a case of metanephric adenoma in a 59-year-old female. The tumor was incidentally detected on computed tomography (CT) and ultrasound (US), and diagnosed as left renal cell carcinoma by radiological examination. Left nephrectomy was performed. The tumor measuring 4 x 3 x 3 cm had a clear margin and was encapslated with thick fibrous tissue. The cut surface was yellow-white and the boundary of renal parenchyma was clear. Histopathologically, the tumor showed a characteristic composition of small uniform cells with regular nuclei that formed a tubular pattern. Immunohistologically, they were positive for Leu-7 and vimentin. Pathological diagnosis was metanephric adenoma. We discuss the radiological findings of metanephric adenoma.