Brucellosis presenting as piriformis myositis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Myositis is a rare bacterial muscle infection. Involvement of the piriformis muscle has been rarely reported in the literature. In this report we describe a case of piriformis myositis due to <it>Brucella melitensis</it>, which to the best of our knowledge is the first such case presented in the literature.</p> <p>Case presentation</p> <p>We report the case of a 19-year-old Caucasian man who presented to our institution with fever and right hip pain. Brucellosis was suspected, but the clinical suspicion was for spondylodiscitis. A pelvic magnetic resonance imaging scan allowed prompt diagnosis of inflammatory involvement of the right piriformis muscle. Blood culture results were positive for <it>B. melitensis</it>. Our patient was treated with antibiotics, and follow-up magnetic resonance imaging scans showed resolution of the inflammation.</p> <p>Conclusion</p> <p>Brucellosis can present as piriformis myositis. The clinical diagnosis of piriformis myositis is difficult, as it can mimic other common entities such as referred back pain from spondylodiscitis. Magnetic resonance imaging is the method of choice for establishing the diagnosis in the early stages of the disease, as late diagnosis can lead to abscess formation and the need for drainage.</p

The role of Diffusion-Weighted Imaging in better delineating the extent of Diffuse Axonal Injury in a pediatric patient: A case report and brief review of the literature

Introduction: Diffuse axonal injury (DAI) is a major cause of disability in the pediatric patient. Herein we describe the MRI/DWI findings in a case with DAI. We also discuss the current role of CT and MRI with DWI in the evaluation of DAI. Aim of the study: To stress the role of diffusion-weighted imaging in diffuse axonal injury. Methods: A pediatric patient, who was hospitalized in the ICU, was submitted to MRI with DWI for the evaluation of brain lesions. The patient was scanned with T1-weighted images, T2-weighted images, FLAIR, T2*-weighted images and diffusion weighted images. Result: Brain lesions caused by DAI were more conspicuous on diffusion-weighted images compared to FLAIR images. T2*-weighted images were a helpful adjunct in showing micro-hemorrhages. Conclusion: T2*-weighted images and FLAIR images alone underestimate the true extent brain lesions in DAI compared to DWI

Frequent Benign, Nontraumatic, Noninflammatory Causes of Low Back Pain in Adolescents: MRI Findings

Introduction. Low back pain (LBP) is common in children and adolescents. There are many factors that cause LBP, including structural disorders, degenerative changes, Scheuermann’s disease, fractures, inflammation, and tumors. Magnetic Resonance Imaging is the gold standard for diagnosing spinal abnormalities and is mandatory when neurological symptoms exist. The study focuses on common MRI findings in adolescents with persistent LBP, without history of acute trauma or evidence of either inflammatory or rheumatic disease. Materials and Methods. Eleven adolescents were submitted to thoracic and/or lumbar spine MRI due to persistent LBP. The protocol consisted of T1 WI, T2 WI, and T2 WI with FS, in the axial, sagittal, and coronal plane. Results. MRI revealed structural abnormalities (scoliosis and kyphosis) in 4/11 (36.36%); disc abnormalities and endplate changes were found on 11/11 (100%). Typical Scheuermann’s disease was found in 3/11 (27.27%). Endplate changes were severe in Scheuermann’s patients and mild to moderate in the remaining 8/11 (72.72%). Kyphosis was in all cases secondary to Scheuermann’s disease. Disk bulges and hernias were found in 8/11 (72.72%), all located in the lumbar spine. Conclusion. In adolescents with LBP, structural spinal disorders, degenerative changes, and Scheuermann’s disease are commonly found on MRI; however, degenerative changes prevail

Extent of silent cerebral infarcts in adult sickle-cell disease patients on magnetic resonance imaging: is there a correlation with the clinical severity of disease?

The aim of this paper is to correlate the extent of silent cerebral infarcts (SCIs) on magnetic resonance imaging (MRI) with the clinical severity of sickle cell disease (SCD) in adult patients. Twenty-four consecutive adult asymptomatic SCD patients (11 male and 13 female) with a mean age of 38.4 years (range 20-59) were submitted to brain MRI on a 1 Tesla Gyroscan Intera, Philips MR scanner with a dedicated head coil. The protocol consisted of TSE T2-weighted and FLAIR images on the axial and coronal planes. MRI readings were undertaken by two radiologists and consensus readings. Patients were compound heterozygotes (HbS/β-thal). The extent of SCIs was classified from 0-2 with 0 designating no lesions. Clinical severity was graded as 0-2 by the hematologist, according to the frequency and severity of vaso-occlusive crises. There was no statistically significant correlation between the severity of clinical disease and the extent of SCIs on MR imaging. The extent of SCI lesions did not differ statistically between younger and older patients. Patients receiving hydroxyurea had no statistically significant difference in the extent of SCI lesions. The extent of SCIs in heterozygous (HbS/β-thal) SCD patients is not age related and may be quite severe even in younger (&lt;38.4 years) patients. However the extent of SCIs is not correlated with the severity of clinical disease

Epstein-Barr infection causing toxic epidermal necrolysis, hemophagocytic lymphohistiocytosis and cerebritis in a pediatric patient

Toxic epidermal necrolysis -the most serious variant of Steven Johnson Syndrome -arises as the result of cell-mediated cytotoxic reaction against keratinocytes. Most common inciting factors include drugs, and infections. On the other hand, Hemophagocytic lymphohistiocytosis (HLH), is a syndrome characterized by enormous immune response in the absence of down-regulation of activated immune cells resulting in cytokine storm causing severe tissue damage. Up to date, several cases of concomitance of Toxic Epidermal Necrolysis (TEN) and Hemophagocytic Lympohystiocytosis (HLH) in pediatric patients have been reported. Both situations can be fatal and pediatricians should be aware that these two clinical entities are not mutually exclusive, to the contrary they may coexist. We herein describe a case of Toxic Epidermal Necrolysis, complicated with Hemophagocytic Lymphohistiocytosis with Central Nervous System involvement due to EBV infection

Giant ileocolic intussusception in an adult induced by a double ileal lipoma: a case report with pathologic correlation

AbstractIntussusception in adults is rare, accounting for less than 5% of all cases. Unlike the childhood variant, adult intussusception is often associated with a small bowel lesion acting as the “lead point.” We herein report an uncommon case of giant intussusception secondary to 2 separate lipomatous lesions located in the ileum, in an adult admitted to our hospital for acute severe abdominal pain

Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis

Appendiceal mucocele is a rare cause of acute abdomen. Mucinous appendiceal neoplasms represent 0.2-0.7% of all appendix specimens. The aim of this study is to report a case of a mucinous appendiceal neoplasm presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting. A 72-year-old female patient was admitted to the emergency department with a clinical examination indicative of acute abdomen. The patient underwent abdominal computed tomography scan which revealed a cystic lesion in the right iliac fossa measuring 8.3 × 5.2 × 4.1 cm, with calcified walls, and a mean density indicative of high protein content. The patient was taken to the operating room and a right hemicolectomy was performed. The postoperative course was unremarkable. The histopathological examination revealed a low-grade mucinous appendiceal neoplasm with negative regional lymph nodes. Ultrasound and CT are useful in diagnosing appendiceal mucocele and synchronous cancers in the emergency setting. The initial operation should include appendectomy and resection of the appendicular mesenteric fat along with any fluid collection for cytologic examination. During urgent appendectomy it is important to consider every mucocele as malignant in order to avoid iatrogenic perforation causing pseudomyxoma peritonei. Although laparotomy is recommended, the laparoscopic approach is not contraindicated

Sclerosing Mediastinitis Causing Unilateral Pulmonary Edema Due to Left Atrial and Pulmonary Venous Compression. A Case Report and Literature Review

Abstract Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis, is an inflammatory process that in its end-stage results to sclerosis around the mediastinal structures. SM is quite rare and has been correlated with inflammatory and autoimmune diseases, as well as malignancy. SM may either present in a mild form, with minor symptoms and a benign course or in a more aggressive form with severe pulmonary hypertension and subsequent higher morbidity and mortality. The diagnosis of SM may be difficult and quite challenging, as symptoms depend on the mediastinal structure that is mainly involved; quite often the superior vena cava. However, practically any mediastinal structure may be involved by the fibrotic process, such as the central airways, as well as the pulmonary arteries and veins, leading to obstruction or total occlusion. The latter may be impossible to undergo proper surgical excision of the lesion, and is considered to be a real challenge to the surgeon. We herein report a case of SM that presented with arterial and venous compression. The imaging appearance was that of unilateral pulmonary edema, associated with lung collapse. The case is supplemented by a non-systematic review of the relevant literature