Left-sided unilateral hematuria: an unusual association with tropical splenomegaly--a case report and review of literature

A 35-year-old woman presented with chronic intermittent left-sided hematuria. A massively enlarged spleen caused displacement of the left kidney and compression of the left renal vein, leading to pyelovenous congestion and subsequent hematuria. Splenectomy along with release of fibrous adhesions around the renal hilum cured the hematuria.     

Botryoid Wilms tumor: case report and review of literature

A rare case of botryoid Wilms tumor is presented. The main clinical manifestations were persistent low-grade fever, malaise, and proteinuria associated with microhematuria. Ultrasonography revealed an echogenic mass in the right kidney, and a contrast-enhanced mass was found in the dilated collecting system by contrast-enhanced computed tomography. The surgically resected tumor was a polypoid, light-yellow, glistening mass that occupied a large part of the renal pelvis and originated from the pelvicaliceal wall. Part of the tumor extended to the proximal ureter, resulting in hydronephrosis in the involved kidney. No parenchymal lesion was observed. Microscopic examination revealed epithelial, stromal, and blastemal components, which indicated Wilms tumor. Infection had occurred in the hydronephrotic kidney, which presumably had caused the major presenting symptoms. The prognosis of our patient and previously reported cases of botryoid Wilms tumor was good compared with that of typical Wilms tumor, since the botryoid type can be detected at an early stage. Received: 28 August 1998 / Revised: 13 January 1999 / Accepted: 13 January 1999     

创伤性髂动脉假性动脉瘤输尿管瘘一例报告及文献复习

目的 总结分析创伤性假性动脉瘤输尿管瘘的发病机理及诊治方法。方法 复习文献，对1例创伤性髂动脉假性动脉瘤输尿管瘘患者的临床资料进行分析。患者，男，49岁，临床表现反复大量肉眼血尿，经过数字减影血管造影(DSA)和输尿管镜检查确诊。结果 行右髂外动脉球囊扩张、右髂内动脉栓塞和带膜支架管右髂动脉瘤腔内隔绝术。患者痊愈，随访18个月未见复发。结论 创伤性假性动脉瘤输尿管瘘临床罕见，以大量血尿为特点，DSA及输尿管镜检是重要的诊断方法，血管内支架腔内隔绝术安全、有效。     

Hematuria: an unusual presentation for mucocele of the appendix. Case report and review of the literature.

Mucocele of the appendix is a nonspecific term that is used to describe an appendix abnormally distended with mucus. This may be the result of either neoplastic or non-neopleastic causes and may present like most appendiceal pathology with either mild abdominal pain or life-threatening peritonitis. Urologic manifestations of mucocele of the appendix have rarely been reported. Laparoscopy can be used as a diagnostic tool in equivocal cases. Conversion to laparotomy may be indicated if there is a special concern for the ability to remove the appendix intact or if more extensive resection is warranted, as in malignancy. We here report our experience with a woman presenting with hematuria whose ultimate diagnosis was mucocele of the appendix, and we review the appropriate literature. This case highlights the mucocele as a consideration in the differential diagnosis of appendiceal pathology and serves to remind the surgeon of the importance for careful intact removal of the diseased appendix.     

An unusual cause of hematuria; primary epiploic appendagitis

INTRODUCTION

Primary epiploic appendagitis (PEA) is self limiting inflammatory disease of colonic epiploic appendices.

PRESENTATION OF CASE

Herein, a 40 years old patient describing abdomino-inguinal pain with clotty hematuria having PEA was presented. At first, the patient was thought to have a primary bladder pathology, but after a meticioulus examination, he found to have PEA and managed by conservative measures.

DISCUSSION

Although PEA does not require surgical intervention, it may mimic other acute abdominal disorders which can be difficult to differentiate. Appendices overlying the sigmoid colon and cecum are more prone to be affected as they are more elongated and wider in size. The patient is usually admitted due to sudden onset of abdominal pain accompanied with fever, abdominal tenderness and leucocytosis.

CONCLUSION

The present case demonstrated that PEA located close to the lower urinary tract especially urinary bladder might present with urinary symptoms such as hematuria. dysuria, pollakuria and inguinal pain.     

Cerebellar hemorrhage after spinal surgery: case report and review of the literature

Recent reports indicate that cerebellar hemorrhage after spinal surgery is infrequent, but it is an important and preventable problem. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanisms are unknown. This report details the case of a 48-year-old woman who developed remote cerebellar hemorrhage after spinal surgery. The patient presented with a herniated lumbar disc, spinal stenosis, and spondylolisthesis, and underwent multiple-level laminectomy, discectomy, and transpedicular fixation. The dura mater was opened accidentally during the operation. There were no neurologic deficits in the early postoperative period; however, 12 h postsurgery the patient complained of headache. This became more severe, and developed progressive dysarthria and vomiting as well. Computed tomography demonstrated small sites of remote cerebellar hemorrhage in both cerebellar hemispheres. The patient was treated medically, and was discharged in good condition. At 6 months after surgery, she was neurologically normal. The case is discussed in relation to the ten previous cases of remote cerebellar hemorrhage documented in the literature. The only possible etiological factors identified in the reported case were opening of the dura and large-volume cerebrospinal fluid loss.     

Hemorrhagic prepatellar bursitis: a rare case report and review of the literature

Bursitis is a common cause of lower extremity pain in patients presenting to primary care physicians. However hemorrhagic prepatellar bursitis is considered to be one of the rare differential diagnoses of swellings around the knee and its diagnosis both clinically and radiologically can be difficult. We present a rare case report of a 50-year-old female patient with complaints of swelling and pain over her right knee for past one year. An initial diagnosis of prepatellar bursitis was made and aspiration of the swelling was done which revealed blood. After further investigations a final diagnosis of hemorrhagic prepatellar bursitis was made which was treated with complete excision and the patient was completely relieved of her symptoms.     

Nephrogenic adenoma of the urethra: an unusual cause of hematuria in the child

The authors describe a 9-year-old boy who had an accident with his bicycle. He presented with hematuria a few weeks later, and cystoscopy results showed a polypod lesion near the veru montanum. The lesion was resected, and histologic examination showed a nephrogenic adenoma (NA), which recurred 6 years later with hematuria. NA is a rare lesion in a child's urethra and can be a source of hematuria.     

An unusual case of tumor-to-cavernoma metastasis. A case report and literature review

BACKGROUND: Metastases of systemic neoplasia to preexisting intracranial mass lesions are uncommon phenomena. Tumor-to-intracranial cavernoma metastases are even more unusual and rarely reported. We describe here a case of melanoma to intracranial cavernoma metastasis. CASE DESCRIPTION: A 39-year-old woman presented after an episode of generalized tonic-clonic seizure on a background of infrequent epilepsy. She was found to have a left parieto-occipital hemorrhagic lesion on imaging studies. The lesion was surgically removed and histopathology showed a metastatic melanoma within a cavernoma. CONCLUSION: This case report represents the third recorded case of tumor-to-intracranial cavernoma metastasis and the first melanoma to intracranial cavernoma metastasis. An extensive literature review of tumor-to-intracranial tumor metastases was conducted and disclosed an increase in reporting of the uncommon phenomenon of metastasis into preexisting intracranial lesions. It should therefore be considered as a differential diagnosis in patients with history of systemic cancer who present with progression of preexistent intracranial lesions.     

Pigmented villonodular synovitis. A literature review and unusual case report

The literature contains various nomenclature and classifications regarding the pigmented villonodular pathology that have proven to be quite confusing. This article clarifies this and emphasizes the fact that there is a spectrum of inflammatory pathologies that may affect synovial tissue. The primary focus of this article is pigmented villonodular Synovitis (PVNS) which refers to joint pathology.     

Cervical cord compression by hereditary multiple exostosis: case report and review of literature

Background

Hereditary multiple exostosis (HME) is an hereditary disease, characterized by the presence of multiple osteochondromas; 7% of patients with HME have a spinal disease. Through this observation, the authors discuss the diagnostic and therapeutic aspects of this rare lesion.

Case report

A 45-year-old woman, operated 10 years ago for an exostosis of the right fibula and left femur. She has since few years paresthesia of all four limbs with distal predominance, walking fatigability kind of spinal claudication. The MRI shows a voluminous osteoma at the second cervical vertebra compressing the spinal cord. The patient was operated with macroscopically complete resection of the exostosis and C2 laminectomy.

Conclusion

The cervical exostosis associated with HME is a rare disease. The clinical symptomatology is dominated by spinal cord compression and surgical treatment allows excellent clinical results.     

An unusual case of gluteal pain - Case report and review of literature

Numerous pathologies of the spine, pelvis and hips can present with gluteal pain and pose a challenge to orthopaedic surgeons. We report a unique Case of tuberculous osteomyelitis of the ischium in a young immunocompetent individual presenting as gluteal pain. A high index of suspicion, early diagnosis and prompt management is mandatory to promote early and complete healing and prevent complications.     

Blunt myocardial disruption: report of an unusual case and literature review.

Blunt cardiac injury is frequently noted among trauma patients. They may demonstrate few signs and symptoms or may be in profound shock. A unique case of left ventricular disruption in a young soldier who sustained blunt torso trauma is reported. A paucity of clinical findings led to a delay in diagnosis. He ultimately underwent successful repair 12 days after injury.     

Mucusuria--an unusual manifestation of ileal adenocarcinoma: a case report and review of the literature

Primary adenocarcinoma of the ileum is an uncommon gastrointestinal malignancy, the symptoms of which are often insidious in onset. This case history highlights the previously unreported finding of ileal adenocarcinoma presenting with mucusuria, caused by local invasion of the bladder in a 44-year-old male. A review of the literature is included to highlight the incidence, risk factors, clinical presentation, investigation, and current management of adenocarcinoma of the small bowel.     

Pulmonary sequestration. A report of an unusual case and a review of the literature

A case of extralobar sequestration with findings indicating a pulmonary origin is reported. The literature has been reviewed and evidence presented that intra- and extralobar sequestration are variants of the same abnormality and that the systemic artery is an associated anomaly. From the evidence available at present the pathogenesis of this anomaly is best explained as an abnormality of bronchial and foregut budding resulting from failure of normal embryonic organizer control.     

The evaluation and management of hematuria in women

This review outlines an efficient diagnostic work-up for hematuria in women. An English-language MEDLINE database search and a bibliographic review of the relevant articles was conducted. The evaluation includes a detailed history, physical examination, invasive and non-invasive testing. An algorithm for laboratory tests, procedures and follow-up recommendations is presented.     

An unusual case of duodenal perforation caused by a blister pack: A case report and literature review

IntroductionIngestion of foreign bodies is a relatively common clinical problem. Blister packs have been known to be a causative agent of gastrointestinal perforation. We report a rare case of duodenal perforation caused by a blister pack, which was complicated by retroperitoneal abscess and having a poor outcome.Presentation of caseA 72 year-old man with a history of dementia presented to the emergency department with a 2-day history of backache. Upon radiological findings, perforated peptic ulcer was suspected. However, emergency laparotomy revealed a blister pack protruding from the posterior wall of the third portion of the duodenum. It was complicated by a widespread retroperitoneal abscess. After removal of the foreign body, the perforation was treated with primary suture repair and an omental patch. However, the patient died two days after operation due to sepsis.DiscussionAccording to a literature review, the ileum is the most common site of perforation caused by blister packs. To our knowledge, duodenal perforations have not been documented to date. Curative treatment often involves emergent surgery. However, duodenal perforation in the third portion may lead to retroperitoneal abscess, which can result in severe sepsis and have a poor outcome. As there is no consensus about an ideal surgical approach, retroperitoneal abscess is one of the clinical challenges for surgeons. Even with prompt management, duodenal perforation may become fatal.ConclusionUnnoticed ingestion of blister packs can cause duodenal perforation. Although prompt management is necessary, duodenal perforation, especially in the third portion, may be potentially fatal.