Case Reports in Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Bilateral Spontaneous Perirenal Hemorrhage due to Initial Presentation of Polyarteritis Nodosa Tue, 01 Sep 2015 06:51:25 +0000 Spontaneous perirenal hemorrhage (SPH) is uncommon but can be a life-threatening condition which is associated with flank or abdominal pain and hypovolemia. The etiologies of SPH include tumor, vascular disease, and infection. Among the vascular diseases, polyarteritis nodosa (PAN) is common cause of the SPH. However, patients with PAN usually complain of nonspecific symptoms and the incidence of PAN is relatively rare. So, diagnosis is difficult even though tissue biopsy and angiography help to confirm the PAN. Particularly bilateral perirenal hemorrhage is very rare complication in patients with PAN. We reported a case of bilateral perirenal hemorrhage in the patients with PAN who have continued to take exogenous sex hormone. Hyung-Il Choi, Yang-Gyun Kim, Se-Yun Kim, Da Wun Jeong, Ki-Pyo Kim, Kyung-Hwan Jeong, Sang-Ho Lee, and Ju-Young Moon Copyright © 2015 Hyung-Il Choi et al. All rights reserved. Sinus of Valsalva Aneurysm: A Rare Cause of Dyspnea Mon, 24 Aug 2015 07:36:58 +0000 Sinus of Valsalva aneurysm (SOVA) is a rare clinical entity. Clinical manifestations can vary from an incidental finding on an imaging study to a life-threatening emergency. We report a case of a 51-year-old female with a large symptomatic left SOVA. Echocardiogram and computed tomography angiography (CTA) of the chest revealed marked dilatation of the left sinus of Valsalva, measuring 7.5 cm. This resulted in superior displacement of the left main coronary artery. Surgical repair of the aneurysm with reimplantation of the right and left coronary arteries was performed in addition to aortic valve replacement (Bentall procedure). The patient had an uneventful postoperative course and remains asymptomatic at the three-month follow-up visit. Aiman Smer, Osama Elsallabi, Mohamed Ayan, Haitam Buaisha, Hamza Rayes, Yazeid Alshebani, Hamza Tantoush, and Mohsin Salih Copyright © 2015 Aiman Smer et al. All rights reserved. Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World? Wed, 19 Aug 2015 09:46:22 +0000 Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early. Mohammed Qaisi, Matthew Loeb, Lindsay Montague, and Ron Caloss Copyright © 2015 Mohammed Qaisi et al. All rights reserved. Diffuse Calcifications of the Spleen in a Woman with Systemic Lupus Erythematosus Mon, 17 Aug 2015 08:47:58 +0000 Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease, which affects a wide variety of organs including the spleen. Splenic involvement in SLE includes conditions such as splenomegaly, hyposplenism, infarction, and spontaneous rupture. However, only a few cases of splenic calcifications in patients with SLE have been reported. Herein, we present a case of a 24-year-old female diagnosed with SLE, in which we found diffuse splenic calcifications. The unique pattern of splenic calcifications in SLE contributes to the differential diagnosis from other conditions such as infections and other connective tissue diseases, which also cause calcifications in the spleen. Aristeides G. Vaiopoulos, Meletios A. Kanakis, Kyriaki Katsouri, Stavroula Kyriazi, George A. Vaiopoulos, and Phaedon Kaklamanis Copyright © 2015 Aristeides G. Vaiopoulos et al. All rights reserved. Cooccurrence of Multiple Sclerosis and Idiopathic Basal Ganglia Calcification Sun, 16 Aug 2015 11:14:38 +0000 Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of central nervous system that affects both white and gray matter. Idiopathic calcification of the basal ganglia is a rare neurodegenerative disorder of unknown cause that is characterized by sporadic or familial brain calcification. Concurrence of multiple sclerosis (MS) and idiopathic basal ganglia calcification (Fahr’s disease) is very rare event. In this study, we describe a cooccurrence of idiopathic basal ganglia calcification with multiple sclerosis. The association between this disease and MS is unclear and also maybe probably coincidental. M. Abedini, N. Karimi, and N. Tabrizi Copyright © 2015 M. Abedini et al. All rights reserved. Inflammatory Pseudotumor of the Liver with Escherichia coli in the Sputum Wed, 12 Aug 2015 11:13:00 +0000 Inflammatory pseudotumor is a nonmalignant lesion that mimics malignant lesions and has been reported to occur at various sites throughout the body. Though it has been reported as a reaction to infection, the true etiology of the lesion is unknown. In this report, we present the case of a patient with a liver lesion of unknown origin. Through a series of imaging studies, we were able to observe the locally aggressive nature of this lesion as it rapidly eroded into the lung. Sputum cultures showed growth of E. coli, indicating E. coli infection as a possible etiology of this lesion. Pathology was consistent with inflammatory pseudotumor. Sreenath Narayan, Ashwini Nayak, and Chris L. King Copyright © 2015 Sreenath Narayan et al. All rights reserved. Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy Wed, 12 Aug 2015 07:15:49 +0000 Diffuse alveolar hemorrhage (DAH) is a life-threatening clinical pathologic syndrome caused by a variety of diseases. We report a case of DAH related to therapy of warfarin use. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin. Bülent Kaya, Ibrahim Yildiz, Reshat Mehmet Baha, Neslihan Ebru Eryaşar Zeytun, and Azize Yetisgen Copyright © 2015 Bülent Kaya et al. All rights reserved. Reconstruction of Elbow by Free Fibular Graft in a Case of Osteoclastoma of Proximal Ulna: A Rare Case Report Wed, 12 Aug 2015 06:30:33 +0000 Giant cell tumour is a benign aggressive bone tumour. Most commonly, it is seen in epiphysiometaphyseal region around knee and distal radius. Proximal ulna is a rare location for giant cell tumour. According to reports, only 4 such cases have been reported in English literature. We report one such case of giant cell tumour of proximal ulna. Patient presented with painless, progressive swelling around right elbow since 4 months. Proximal ulna along with tumour was resected and elbow was reconstructed using nonvascularized free fibular graft. At two years of follow-up, patient is tumour-free and has functional range of movement in elbow. We are reporting the case because of its rare location and for the indigenous treatment modality of using free fibular graft for elbow reconstruction. Kiran Kalaiah, S. G. Thejaswi, and Marula Siddappa Copyright © 2015 Kiran Kalaiah et al. All rights reserved. Pulmonary Embolism in a Sarcoidosis Patient Double Heterozygous for Methylenetetrahydrofolate Reductase Gene Polymorphisms and Factor V Leiden and Homozygous for the D-Allele of Angiotensin Converting Enzyme Gene Tue, 11 Aug 2015 11:35:06 +0000 Sarcoidosis is a multisystem granulomatous disease of unknown etiology and pathogenesis. It presents in patients younger than 40 years of age. The lungs are the most commonly affected organ. Till the present day, there is no single specific test that will accurately diagnose sarcoidosis; as a result, the diagnosis of sarcoidosis relies on a combination of clinical, radiologic, and histologic findings. Patients with sarcoidosis have been found to have an increased risk of pulmonary embolism compared to the normal population. MTHFR and factor V Leiden mutations have been reported to increase the risk of thrombosis in patients. We hereby present a case of a middle aged man with sarcoidosis who developed a right main pulmonary embolism and was found to be double heterozygous for methylenetetrahydrofolate reductase gene polymorphisms and factor V Leiden and homozygous for the D-allele of the angiotensin converting enzyme gene. Nadim El-Majzoub, Rami Mahfouz, and Nadim Kanj Copyright © 2015 Nadim El-Majzoub et al. All rights reserved. A Fetus with Iniencephaly Delivered at the Third Trimester Thu, 06 Aug 2015 11:26:49 +0000 Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele) and iniencephaly clausus (without encephalocele). Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1–5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination. Esra Cinar Tanriverdi, Ilhan Bahri Delibas, Zeynep Kamalak, Berrin Goktug Kadioglu, and Rukiye Ada Bender Copyright © 2015 Esra Cinar Tanriverdi et al. All rights reserved. Gabapentin Treatment for Neuropathic Pain in a Child with Sciatic Nerve Injury Tue, 04 Aug 2015 11:20:23 +0000 There are a restricted number of studies about usage of gabapentin for neuropathic pain treatment of pediatric patients. We shared a 12-year-old male case with severe neuropathic pain that hindered the rehabilitation programme for the loss of muscle power and movement limitation. Neuropathic pain developed after peripheral sciatic damage due to firearm traumatisation did not respond to other medical treatments but healed nearly completely after gabapentin usage. Halil Ekrem Akkurt, Haluk Gümüş, Hamit Göksu, Ömer Faruk Odabaşı, and Halim Yılmaz Copyright © 2015 Halil Ekrem Akkurt et al. All rights reserved. Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use Mon, 03 Aug 2015 06:07:40 +0000 Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity. Anupam Kotwal and Sarah L. Cutrona Copyright © 2015 Anupam Kotwal and Sarah L. Cutrona. All rights reserved. Histopathologic Finding of Both Gastric and Respiratory Epithelia in a Lingual Foregut Cyst Thu, 30 Jul 2015 11:25:34 +0000 Foregut cysts are uncommon, mucosa-lined congenital lesions that may occur anywhere along the gastrointestinal or respiratory tract and typically present within the first year of life. Although infrequent, these cysts may generate feeding or respiratory difficulties depending on the size and location of the lesion. Foregut cysts of the oral cavity are rarely seen and of those cases localized to the tongue are even more uncommon. We describe a 4-month-old girl with a foregut cyst involving the floor of mouth and anterior tongue. Subsequent histologic analysis demonstrated a cyst lined with both gastric and respiratory epithelia. This case represents an extremely rare finding of both gastric and respiratory epithelia lined within a single cystic structure in the tongue. Although a very rare finding, a foregut cyst should be on the differential diagnosis of any lesion involving the floor of mouth or tongue in an infant or child. Yangfan Luo, Nick Shillingford, and Jeffrey A. Koempel Copyright © 2015 Yangfan Luo et al. All rights reserved. First Case of Tricuspid Valve Endocarditis Caused by Gemella bergeri Thu, 30 Jul 2015 09:44:33 +0000 Gemella bergeri is a Gram-positive cocci species arranged in pairs and composes the normal flora of oral cavity, digestive and urinary tract. Several species of Gemella are known to cause endocarditis. Here, we report the first case in Thailand of G. bergeri endocarditis whose blood culture was negative using routine methods but was positive by PCR identification of bacteria in the affected valve. A 37-year-old male presented with prolonged fever, weight loss, and dyspnea on exertion. By transthoracic echocardiography, he was suspected of having infective endocarditis of the tricuspid valve. The patient underwent tricuspid valve repair and vegetectomy. Routine hospital blood cultures were negative but G. bergeri was identified by PCR/sequencing of the heart valve tissue. Orathai Pachirat, George Watt, and Burabha Pussadhamma Copyright © 2015 Orathai Pachirat et al. All rights reserved. Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Patient with Myasthenia Gravis: A Review of the Management Wed, 29 Jul 2015 15:36:30 +0000 Myasthenia gravis, a disorder of neuromuscular transmission, presents a unique challenge to the perioperative anesthetic management of morbidly obese patients. This report describes the case of a 27-year-old morbidly obese woman with a past medical history significant for myasthenia gravis and fatty liver disease undergoing bariatric surgery. Anesthesia was induced with intravenous agents and maintained with an inhalational and balanced intravenous technique. The nondepolarizing neuromuscular blocker Cisatracurium was chosen so that no reversal agents were given. Neostigmine was not used to antagonize the effects of Cisatracurium. The goal of this approach was to reduce the risk of complications such as postoperative mechanical ventilation. The anesthetic and surgical techniques used resulted in an uneventful hospital course. Therefore, we can minimize perioperative risks and complications by adjusting the anesthetic plan based on the patient’s physiology and comorbidities as well as the pharmacology of the drugs. Megana Ballal and Tracey Straker Copyright © 2015 Megana Ballal and Tracey Straker. All rights reserved. Baclofen-Induced Encephalopathy in End Stage Renal Disease Wed, 29 Jul 2015 10:00:37 +0000 Baclofen is a highly used centrally acting GABA agonist that continues to be an effective therapy for spasticity and chronic hiccups. The renally dependent excretion determines the circulating concentrations and guides effective dosing to decrease adverse reactions. Caution should be considered in administering baclofen to patients with decreased renal function. We present a patient with end stage renal disease on hemodialysis with recent baclofen ingestion who presented with toxic encephalopathy that was resolved with additional dialysis sessions. Andrew Meillier, Cara Heller, and Shyam Patel Copyright © 2015 Andrew Meillier et al. All rights reserved. Papillary Thyroid Cancer and Lung Adenocarcinoma Presenting as Two Primary Malignancies in a Patient with Symptomatic Goiter Tue, 28 Jul 2015 12:45:01 +0000 In rare instances, patients may be diagnosed with two different primary malignancies. Though such synchronous malignancies have been documented in sporadic case reports, the overwhelming majority of malignancies involving multiple organs can be attributed to a primary source. Papillary thyroid carcinoma and lung adenocarcinoma are rarely diagnosed within the same year. Our case report presents a patient who was diagnosed with these two malignancies during her same hospital visit. Biopsies results proved that the two malignancies were in fact separate entities and not a consequence of metastasis from a primary source. Deepu Daniel, Leah Delumpa, and Natasha Bray Copyright © 2015 Deepu Daniel et al. All rights reserved. Walking with Neuropathic Pain: Paradoxical Shift from Burden to Support? Tue, 28 Jul 2015 11:28:49 +0000 Baclofen 5% cream can be used for the treatment of neuropathic pain. We describe an unusual case of a neuropathic pain patient with spinal cord injury. A 71-year-old woman with a partial spinal cord injury lesion at L4 complained of tingling, pins and needles, and burning in her legs. She scored her pain as 6 before adding baclofen 5% cream to her pain medication (pregabalin 450 mg, acetaminophen 3000 mg, and diclofenac 150 mg daily). One month later she experienced complete pain relief, though experienced increased difficulties in walking, leading to frequent falls. Her steadier walking without stumbling and falling was more important to her than pain reduction. Thus she decided to stop using baclofen. This unusual case report discusses two important issues that relate to pain medicine and rehabilitation in patients with painful spinal cord lesions: (1) the presence of wide areas of sensory loss “covered” by the presence of painful sensations and (2) pathological sensations that can be used and integrated in the body schema to create an improved spatiovisual orientation and thus mobility. Both these aspects have to be taken into account when treating pain and design rehabilitation programs. David J. Kopsky, Jan M. Keppel Hesselink, and Roberto Casale Copyright © 2015 David J. Kopsky et al. All rights reserved. Brodie’s Abscess in a Patient Presenting with Sickle Cell Vasoocclusive Crisis Tue, 28 Jul 2015 09:02:11 +0000 First described by Sir Nicholas Brodie in 1832, Brodie’s abscess is a localized subacute or chronic infection of the bone, typically seen in the metaphases of long bones in children and adolescents. The diagnosis can prove to be enigmatic due to absence of clinical signs and symptoms of systemic disease. We report a very interesting case of Brodie’s abscess masquerading as sickle cell vasoocclusive crisis in a 20-year-old female with sickle cell disease and review the literature. Onyekachi Henry Ogbonna, Yonette Paul, Hasan Nabhani, and Adriana Medina Copyright © 2015 Onyekachi Henry Ogbonna et al. All rights reserved. 16 Y/O Female with “Watermelon Stomach”? Tue, 21 Jul 2015 09:14:28 +0000 Background. Gastric antral vascular ectasia (GAVE) also known as “watermelon stomach” (WS) is an uncommon cause of gastrointestinal (GI) blood loss. It typically presents in middle aged females. We are presenting a case of GAVE at an unusually early age with atypical symptoms. Case. A previously healthy 16 y/o Caucasian female presented to the ER with a one-month history of upper abdominal pain. Physical examination was benign except tenderness in the epigastric region. There were no significant findings on laboratory data. Upper endoscopy showed incidental findings of linear striae in the antrum indicative of GAVE but histology was equivocal. Discussion. GAVE is a poorly understood but treatable entity and an increasingly identifiable cause of chronic iron deficiency anemia or acute or occult upper GI bleeding. The pathophysiology of GAVE remains unclear. It is an endoscopic finding characterized by longitudinal columns of tortuous red ectatic vessels (watermelon stripes), pathognomonic for WS. Treatment options include endoscopic, pharmacologic, and surgical approaches. Failure to recognize GAVE can result in delayed treatment for years. Our patient with GAVE was unusually young and was diagnosed incidentally. Due to lack of anemia on laboratory examination we elected to monitor her clinically for any future development of anemia. Amandeep Singh, Anwaar A. Khan, Robert Krall, and Zafar K. Mirza Copyright © 2015 Amandeep Singh et al. All rights reserved. First Reported Case of Methicillin-Resistant Staphylococcus aureus Vertebral Osteomyelitis with Multiple Spinal and Paraspinal Abscesses Associated with Acupuncture Wed, 15 Jul 2015 10:49:13 +0000 Acupuncture is one of the oldest medical procedures in the world and originated in China about 2,000 years ago. Acupuncture is a form of complementary medicine and has gained popularity worldwide in the last few decades. It is mainly used for the treatment of chronic pain. Acupuncture is usually considered a safe procedure but has been reported to cause serious complications including death. It has been associated with transmission of many viruses and bacteria. Two cases of Methicillin-Resistant Staphylococcus aureus have been reported recently following acupuncture therapy. We are reporting a case of a 57-year-old Korean female who developed vertebral osteomyelitis and intraspinal and paraspinal abscesses as a complication of acupuncture. Blood cultures, skin lesion culture, and body fluid culture yielded Methicillin-Resistant Staphylococcus aureus (MRSA). Good anatomical and medical knowledge, good hygiene standards, and proper acupuncture techniques should be followed to prevent the complications. Acupuncturists should consistently review the infection control guidelines to acupuncture. This case should raise awareness of such condition and hazards of presumably benign procedures such as acupuncture. Sandeep Singh Lubana, Mostafa Alfishawy, Navdeep Singh, and Debra J. Brennessel Copyright © 2015 Sandeep Singh Lubana et al. All rights reserved. Lemierre’s Syndrome: A Neglected Disease with Classical Features Wed, 15 Jul 2015 07:27:57 +0000 We report the case of a previously healthy, immunocompetent 23-year-old male who presented to the Emergency Department with general malaise, difficulty in breathing, fever, and chest pain. He reported a two-week history of progressively worsening sore throat that he presumed to be a viral infection and thus initially neglected. However, when his condition deteriorated, he was admitted to hospital acutely unwell and in respiratory distress. He quickly developed septic shock requiring intensive care admission for inotropic support. Ultrasound and CT imaging revealed internal jugular vein thrombosis with associated septic emboli reaching the lungs to form bilateral cavitations and consequently pleural effusions. Blood cultures were positive for Fusobacterium necrophorum. Based on these findings, a diagnosis of Lemierre’s syndrome was made. The patient was treated with appropriate antibiotics and anticoagulation and gradually recovered. He was discharged 20 days after admission with advice to complete a six-week course of antibiotics. Andreas V. Hadjinicolaou and Yiannis Philippou Copyright © 2015 Andreas V. Hadjinicolaou and Yiannis Philippou. All rights reserved. Transhepatic Embolization of Congenital Intrahepatic Portosystemic Venous Shunts with Associated Aneurysms Tue, 14 Jul 2015 09:12:47 +0000 Intrahepatic shunts between the portal and systemic venous systems with associated aneurysms are extremely rare. A middle aged woman presented with hepatic encephalopathy and was found to have two intrahepatic portosystemic venous shunts with associated aneurysms. Diagnosis was made by duplex ultrasound and was confirmed with contrast enhanced MRI. Treatment was performed percutaneously with an Amplatzer vascular plug. Kalyan Paudel and Eric K. Hoffer Copyright © 2015 Kalyan Paudel and Eric K. Hoffer. All rights reserved. An Unusual Case: Salmonella UTI and Orchitis in HIV Patient Tue, 14 Jul 2015 08:40:27 +0000 Salmonellosis is a major cause of gastroenteritis in the United States; however, nontyphoidal strains of Salmonella have also been known to cause urinary tract infections, usually transmitted via the fecal-urethral route. This can lead to critical illness in those patients with immune deficiencies, especially HIV, cancer patients, and those with diabetes mellitus. However, the spread of the infection from the urinary tract to involve the testicles and epididymis is very rare. Here, we present the first documented case of an immune-compromised young male with a urinary tract infection with orchitoepididymitis. Sabrina Arshed, Hongxiu Luo, John Middleton, and Abdalla Yousif Copyright © 2015 Sabrina Arshed et al. All rights reserved. Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm Sun, 12 Jul 2015 09:37:16 +0000 Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others. A. Gungor, N. Gokkaya, A. Bilen, H. Bilen, E. M. Akbas, Y. Karadeniz, and S. Eren Copyright © 2015 A. Gungor et al. All rights reserved. Congenital Vallecular Cyst Causing Airway Compromise in a 2-Month-Old Girl Thu, 09 Jul 2015 13:40:24 +0000 Congenital vallecular cyst is a rare entity and may present with acute airway obstruction. This is a case of congenital vallecular cyst presenting with airway compromise requiring immediate management. The epidemiology, pathogenesis, and clinical presentation of vallecular cysts are discussed as well as the diagnosis and management. Amal Faisal AlAbdulla Copyright © 2015 Amal Faisal AlAbdulla. All rights reserved. Pericarditis Epistenocardica or Dressler Syndrome? An Autopsy Case Thu, 09 Jul 2015 08:28:40 +0000 Postinfarction pericarditis can be classified as “early,” referred to as pericarditis epistenocardica, or “delayed,” referred to as Dressler syndrome. The incidence of postinfarction pericarditis has decreased to <5% since the introduction of reperfusion therapies and limitation of infarct size. We report on a 57-year-old man who suffered sudden cardiac death as a result of acute myocardial infarction. Autopsy revealed an area of previous infarction and fibrinous pericarditis related to the previous infarction, leading to a diagnosis of Dressler syndrome. Alessandro Feola, Noè De Stefano, and Bruno Della Pietra Copyright © 2015 Alessandro Feola et al. All rights reserved. Unusual Extramedullary Plasmacytoma: A Rare but Possible Cause of Lymphadenopathy in Chronic Lymphocytic Leukemia Tue, 07 Jul 2015 12:37:50 +0000 Cervical bilateral lymphadenopathy is a frequent event during chronic lymphocytic leukemia (CLL) natural history. However, lymph node biopsy is generally not required as long as transformation into an aggressive lymphoma (Richter syndrome) is not suspected. We present here a rare case of CLL patient who developed progressive bilateral cervical lymph node and bilateral tonsillar hypertrophy. CLL front-line therapy was ineffective leading to adenectomy and diagnosis of concomitant extramedullary plasmacytoma. Radiotherapy did not result in the disappearance of lymphadenopathy. Adenectomy should be performed in CLL cases to avoid misdiagnosis. S. P. Chantepie, Q. Cabrera, J. B. Mear, V. Salaun, E. Lechapt-Zalcman, and M. Macro Copyright © 2015 S. P. Chantepie et al. All rights reserved. Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man Tue, 07 Jul 2015 05:52:25 +0000 Introduction. Unruptured sinus of valsalva aneurysm (SVA) is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD) and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema. Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD. Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status. Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery. Pouya Nezafati, Mohammad Hassan Nezafati, and Hamid Hoseinikhah Copyright © 2015 Pouya Nezafati et al. All rights reserved. Intramucosal Signet Ring Cell Gastric Cancer Diagnosed 15 Months after the Initial Endoscopic Examination Mon, 06 Jul 2015 08:10:13 +0000 The size and shape of intramucosal signet ring gastric cancer in this case remained endoscopically unchanged for 15 months. Laparoscopy-assisted distal gastrectomy was performed, and immunohistochemical analysis revealed Ki-67 and p53 mutations to be negative in this case. Signet ring gastric cancer has long been thought to confer a worse prognosis than other forms of gastric cancer; however, our case did not progress to advanced gastric cancer for 15 months. Keisuke Taniuchi, Koji Ookawauchi, Kento Kumon, Tatsuaki Sumiyoshi, Jun Iwata, Mutsuo Furihata, Toshio Nakamura, and Junko Uchiumi Copyright © 2015 Keisuke Taniuchi et al. All rights reserved.