Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

Sean Donovan

Joseph Cernigliaro

Nancy Dawson

Pneumatosis Intestinalis: A Case Report and Approach to Management

Schwannomas arise from Schwann cells of the peripheral nerve sheath. The most common locations include the head, neck, and extensor surfaces of the extremities. Intramammary schwannomas are very rare and account for only 2.6&#x0025; of schwannomas. A review of the English literature reveals 27 such cases of breast schwannoma. In this paper we describe another such rare case.

Vandana Dialani

Neely Hines

Yihong Wang

Priscilla Slanetz

Breast Schwannoma

Painful thyroid has a limited differential diagnosis. In rare cases, no clear cause can be found after careful clinical, biochemical, and radiological analysis. This may lead to extensive patient morbidity and frustration when symptomatic treatment proves insufficient. Hemithyroidectomy or total thyroidectomy may then be the last resort for doctor and patient. Three cases of unexplained painful thyroid which were successfully treated with hemi or total thyroidectomy are presented. In two cases extensive histological evaluation did not yield a satisfactory explanation for the extreme thyroid pain. In one case histological evaluation of the thyroid revealed Hashimoto's thyroiditis. Review of the literature does not mention surgical treatment for unexplained painful thyroid, and only 15 cases of surgical treatment for painful Hashimoto's thyroiditis are presented. Surgical therapy is a successful final option in the treatment of unexplained painful thyroid and painful Hashimoto's thyroiditis.

Jan van Schaik

Olaf M. Dekkers

Eleonora P. M. van der Kleij-Corssmit

Johannes A. Romijn

Hans Morreau

Cornelis J. H. van de Velde

Surgical Treatment for Unexplained Severe Pain of the Thyroid Gland: Report of Three Cases and Concise Review of the Literature

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier&#39;s gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier&#39;s gangrene is characterized by high mortality rates, ranging from 15&#x0025; to 50&#x0025; and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

Ioannis Papaconstantinou

Anneza I. Yiallourou

Nicolaos Dafnios

Irini Grapsa

George Polymeneas

Dionysios Voros

Successful Treatment of a Severe Case of Fournier&#39;s Gangrene Complicating a Perianal Abscess

Hydatid disease (HD) continues to be a significant health problem in areas where animal husbandry is common but no proper veterinary control exists. The involvement of the spleen in HD is rare, and isolated splenic involvement is even less common. In this case report, we present isolated splenic HD in a 26-year-old female with complaint of abdominal pain, and we discuss some of the clinical aspects of HD. Evaluation of the patient with ultrasonography, computed tomography, and magnetic resonance imaging revealed the presence of an isolated splenic HD as a multivesicular cystic mass located near splenic hilus, measuring <svg style="vertical-align:-0.3135pt;width:48.325001px;" id="M1" height="11.075" version="1.1" viewBox="0 0 48.325001 11.075" width="48.325001"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.075)">
		<g transform="translate(72,-63.14)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">1</tspan>
				<tspan style="font-size: 12.50px; " x="6.2515001" y="0">2</tspan>
				<tspan style="font-size: 12.50px; " x="15.278666" y="0">×</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">1</tspan>
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</svg>&#x2009;cm. No other organ or system involvement could be demonstrated.

Alper Dilli

Idil G&#xfc;ne&#x15f; Tatar

Umit Yasar Ayaz

Baki Hekimoglu

Isolated Splenic Hydatid Disease

Dysphagia is a common problem in elderly patients and a rare manifestation of Graves&#39; disease. We report a case of an 82-year-old male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves&#39; disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia.

Konstantinos Parperis

Ramona Dadu

Sheikh Hoq

Vivian Argento

Thyrotoxic Dysphagia in an 82-Year-Old Male

We report the case of a patient with a huge interatrial septal aneurysm as an intraoperative coincidental finding that led to a fatal outcome. The patient was admitted to our hospital in order to undergo elective coronary artery bypass grafting because he suffered from severe coronary artery disease. We intraoperatively diagnosed by transesophageal echocardiography a huge interatrial septal aneurysm mimicking a right atrial tumor. The aneurysm was initially resected and then coronary artery bypass grafting was successfully performed but the patient never achieved a successful separation from cardiopulmonary bypass probably because of massive embolic events.

Petros Tzimas

Georgios Papadopoulos

Huge Interatrial Septal Aneurysm: A Coincidental but Rather Fatal Finding

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<p><em>Case Reports in Medicine</em> publishes case reports and case series in all areas of clinical medicine.</p>


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Case Reports in Medicine - Table of contents 2011

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Case Reports in Medicine publishes case reports and case series in all areas of clinical medicine.

Case Reports in Medicine