Invasive maxillary sinus aspergillosis: a case report successfully treated with voriconazole and surgical debridement

Introduction: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. Case Report: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voricona - zole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. Conclusions: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achie - ve a successful treatment

Cavernous hemangioma of the parotid gland in adults

Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, never - theless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults

Linfoma angiocéntrico centrofacial

El linfoma angiocéntrico centrofacial es una neoplasia linfoide rara, con un diagnóstico a menudo difícil, debido al cuadro clínico inespecífico y a que muchas veces son necesarias varias biopsias para llegar a un diagnóstico correcto. Se trata de un linfoma no Hodgkin(LNH) agresivo, de localización preferente en el tracto respiratorio superior (sobre todo en cavidad nasal), y con un pronóstico ominoso, ya que la supervivencia media es de 12-18 meses aproximadamente(1). Predomina en orientales y sudamericanos, entre los 50-60 años de edad, y con ligera preferencia por el sexo masculino (2:1). Se presenta el caso de una paciente ecuatoriana que acude a nuestro servicio con edema hemifacial, rinorrea achocolatada y obstrucción respiratoria nasal de 1 mes de evolución, sin respuesta al tratamiento antibiótico y antiinflamatorio, que tras realizar varias pruebas diagnósticas se evidenció histológicamente la presencia de un linfoma T extranodal de tipo nasal (también llamado linfoma de células T angiocéntrico).The centrofacial angiocentric lymphoma is a rare lymphoid neoplasm, with an often-difficult diagnosis due to the non-specific clinical picture. On many occasions it is necessary to perform various biopsies to reach the correct diagnosis. This lymphoma is an aggressive Non-Hodgkin's (NHL) type, which is normally found in the upper respiratory tract (predominantly in the nasal cavity), and has an ominous prognosis, as the average survival rate is between 12 and 18 months (1). It is predominantly found in subjects of oriental and South American extraction, who are between the ages of 50 and 60 years and with a slight tendency towards males (2:1). This is the case study of a female Ecuadorian patient who was referred to our department with a hemifacial edema, chocolate- like rhinorrhea and nasal respiratory obstruction, which had been treated with antibiotics and anti-inflammatories for a month without success. After performing a number of diagnostic tests, it was found histologically that the patient had an extranodal T-cell lymphoma of the nasal type (also known as T-cell angiocentric lymphoma)

Frontal sinus mucocele with intracranial and intraorbital extension

ABSTRACT Introduction: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. Case report: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possible clinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. Conclusion: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications

Frontal sinus mucocele with intracranial and intraorbital extension

ABSTRACT Introduction: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. Case report: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possible clinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. Conclusion: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications

Percutaneous tracheostomy in COVID patients. Experience in our hospital center after one year of pandemic and review of the literature

The pandemic caused by SARS-COV-2 has caused an increase in the need of tracheostomies in patients affected with respiratory distress syndrome. In this article we report our experience during a year of pandemic, we develop our surgical technique to perform percutaneous tracheostomy with the patient in apnea and we compare our results with those of other centers through a bibliographic review. A one-year retrospective clinical study was carried out on tracheotomies performed on patients admitted to the intensive care unit with severe SARS-CoV-2, with difficulty for ventilation or weaning. The technique performed was percutaneous, with fibroscopic control through the endotracheal tube, keeping the patient under apnea during the opening of the airway, reducing by this method the risk of exposure to the virus. From 35 percutaneous tracheotomies performed, 31% of the patients died from respiratory complications due to SARS-COV-2, but none due to the surgical procedure. The most frequent complication (8.5% of patients) was bleeding around the tracheostoma, resolved with local measures. No healthcare provider involved in the performance of the technique had symptoms or was diagnosed with COVID-19. Our technique of performing percutaneous tracheostomy maintaining apnea during the procedure, under fibroscopic control, has proven to be safe for all those involved in the procedure, and for the patient

Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis

Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis