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Ruptured Ovarian Artery Pseudoaneurysm in a Postmenopausal Patient Treated with Transcatheter Embolization
Ovarian artery pseudoaneurysms are relatively rare entities, usually associated with pregnancy or the early postpregnancy period. Occurrence in older females is even less common. We present a case of ruptured ovarian artery pseudoaneurysm in an older postmenopausal patient, successfully treated with transcatheter embolization.
Ruptured Obturator Internus Muscle Abscess Causing Extensive Retroperitoneal Necrosis
Obturator internus muscle (OIM) abscess occurs rarely in adults. Accurate diagnosis is often hindered and delayed due to the deep location of the abscess and the nonspecific clinical features. Even of rarer occurrence is rupture of the obturator internus muscle abscess into the perirectal space and retroperitoneum causing extensive retroperitoneal necrotizing soft tissue infection. We present a case of ruptured left OIM abscess, which initially presented with clinical features, which were suspected as acute pancreatitis. Contrast-enhanced multidetector computed tomography (MDCT) of the abdomen and pelvis revealed ruptured left OIM abscess with extensive fat stranding, fluid collections, and pockets of gas throughout the perirectal space, perisigmoid space, and bilateral posterior pararenal and anterior pararenal spaces as well as thickening of bilateral anterior renal fascia, posterior renal fascia, and lateral conal fascia. These CT findings were consistent with extensive retroperitoneal necrotizing soft tissue infection secondary to ruptured left obturator internus muscle abscess. Broad-spectrum antibiotics were instituted immediately, and the patient was urgently worked up for drainage of the abscess and debridement of the necrotic material. However, the patient’s condition deteriorated quickly before the surgical interventions were performed and slipped into septic shock. Emergency resuscitative measures were unsuccessful, and unfortunately, the patient died. The case represents a rare pathology with an unusual presentation, which can be fatal if diagnosis and treatment is delayed.
Magnetic Apposition across the Epiglottis: Radiographic and Operative Correlation of a Rare Hypopharyngeal Foreign Body
Background and Aim. Rare-earth magnet ingestions are a subset of foreign body ingestions and can result in significant morbidity secondary to pressure necrosis. These magnets are best visualized radiographically, typically located in the gastrointestinal tract. However, unusual locations of magnetic adherence may include the hypopharynx along the epiglottis, where only 2 previous cases have been reported. Clinicians should be aware of the potential dangers of rare-earth magnet ingestion and consider atypical locations of attachment in the appropriate clinical setting. Case Presentation. We present an interesting case of a fourteen-year-old female patient who presents with witnessed ingestion of multiple rare-earth magnets. Soft-tissue neck radiographs demonstrate two adjacent rounded radiopaque densities in the hypopharynx. Intraoperative images confirmed the radiographic findings and identified two magnetic balls stuck along the dorsal and ventral aspect of the epiglottis without evidence of pressure necrosis. Conclusion. This is the first published case of magnetic foreign body adherence to the epiglottis in the Radiology literature. Awareness and recognition of the unique radiographic findings of this rare entity can help clinicians streamline timely management.
Mirizzi Syndrome with Cholecystobiliary Fistula: Observation of Development from Asymptomatic Cholecystolithiasis to Surgery
Despite a considerable number of reports of Mirizzi syndrome, none have described the process of its development from simple cholecystolithiasis. We report an extremely rare case of Mirizzi syndrome in which it was possible to observe the process of development of cholecystobiliary fistula from asymptomatic cholecystolithiasis until unavoidable surgical intervention 4 years later. A 68-year-old woman presented at our hospital with right upper quadrant pain. She had been diagnosed as having asymptomatic cholecystolithiasis 4 years previously. Diagnostic abdominal computed tomography (CT) had revealed a 1.9 cm radiopaque stone, and thereafter, the patient had been monitored by imaging alone. CT conducted 6 months before the present admission revealed that the gallbladder stone was compressing the common hepatic duct, although the patient remained asymptomatic. On admission, abdominal CT showed that the gallbladder stone was obstructing the common bile duct with dilatation of the intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a round filling defect at the confluence of the common bile duct and the image of the cystic duct; therefore, the patient was categorized as having Mirizzi syndrome type III, according to the Csendes classification. Intraoperative findings revealed a cholecystobiliary fistula involving up to two-thirds of the circumference of the common bile duct.
Vertebral Erosion Secondary to Aortic Aneurysm
We report the case of a patient who presented for back pain with paresthesia, and the CT showed vertebral lysis of aneurysmal origin. The aneurysm of the thoracic aorta compresses the anterior surface of the dorsal vertebrae and by mechanical effect is responsible for the destruction of the opposite bone. The knowledge of this cause is very important considering the frequency of other tumoral and infectious causes of this affection.
Bilateral Bochdalek Hernias Associated with Arnold-Chiari I Malformation
A Bochdalek hernia is a posterolateral diaphragmatic defect that is either congenital or acquired. The contents of the hernia range from fat to intra-abdominal organs. They are primarily pathologies of neonates and most commonly occur unilaterally. These hernias have been described in isolation and as one part of a group of malformations. There have been reports of Bochdalek hernias in association with myelomeningocele and other neural tube defects. We present a unique case of bilateral Bochdalek hernias in a 35-year-old female with an Arnold-Chiari I malformation.