Hematogenous infantile infection presenting as osteomyelitis and septic arthritis: a case report

The case of a 6-month old male infant presenting at the emergency department with fever and swelling at the left knee joint is discussed. Laboratory tests showed an inflammatory condition. Left knee plain radiograph demonstrated local soft tissue oedema. Percutaneous needle aspiration of articular fluid showed a positive culture for Staphylococcus aureus. The diagnosis of septic arthritis was confirmed. Because of inadequate response to treatment an MRI study was followed to evaluate possible abscesses. The presence of an abscess in the suprapatellar bursa was confirmed and an additional inflammatory process of the bone marrow was revealed, consistent with osteomyelitis. The pathophysiology, the imaging findings, the patient’s management and a review of septic arthritis and osteomyelitis coexistence are presented in this paper

Intrahepatična cistična bolest s kongenitalnom fibrozom (Carolijev kompleks) - prikaz slučaja i pregled literature

A female patient affected by Caroli\u27s disease with congenital fibrosis (Caroli\u27s complex), aged 27 years, is described. Caroli\u27s disease had been asymptomatic to the present. It was recognized as an intraoperative finding during the left hepatectomy procedure after an acute abdominal crisis episode. The main reason for this surgery was the incidence of malignant transformation to cholangiocarcinoma of the cells of the cystic walls. The complex Caroli\u27s disease is more common than other forms. The case report is supplemented with literature review and discussion on the etiopathogenetic mechanisms hypothesized.Opisan je slučaj 27-godišnje bolesnice s Carolijevom bolešću i kongenitalnom fibrozom (Carolijev kompleks). Carolijeva bolest dotad je bila asimptomatska. Prepoznata je kao intraoperacijski nalaz tijekom postupka lijevostrane hepatektomije nakon akutne epizode abdominalne krize. Glavni razlog za operacijski zahvat bila je maligna pretvorba u kolangiokarcinom stanica cističnih stjenka. Carolijev kompleks češći je od drugih oblika bolesti. Prikaz slučaja je dopunjen pregledom literature i raspravom o pretpostavljenim etiopatogenetskim mehanizmima

Intrahepatična cistična bolest s kongenitalnom fibrozom (Carolijev kompleks) - prikaz slučaja i pregled literature

A female patient affected by Caroli\u27s disease with congenital fibrosis (Caroli\u27s complex), aged 27 years, is described. Caroli\u27s disease had been asymptomatic to the present. It was recognized as an intraoperative finding during the left hepatectomy procedure after an acute abdominal crisis episode. The main reason for this surgery was the incidence of malignant transformation to cholangiocarcinoma of the cells of the cystic walls. The complex Caroli\u27s disease is more common than other forms. The case report is supplemented with literature review and discussion on the etiopathogenetic mechanisms hypothesized.Opisan je slučaj 27-godišnje bolesnice s Carolijevom bolešću i kongenitalnom fibrozom (Carolijev kompleks). Carolijeva bolest dotad je bila asimptomatska. Prepoznata je kao intraoperacijski nalaz tijekom postupka lijevostrane hepatektomije nakon akutne epizode abdominalne krize. Glavni razlog za operacijski zahvat bila je maligna pretvorba u kolangiokarcinom stanica cističnih stjenka. Carolijev kompleks češći je od drugih oblika bolesti. Prikaz slučaja je dopunjen pregledom literature i raspravom o pretpostavljenim etiopatogenetskim mehanizmima

Primary psoas abscess extending to thigh adductors: case report

<p>Abstract</p> <p>Background</p> <p>Psoas abscess is a rare condition consisting of pyomyositis of the psoas. The worldwide incidence was 12 cases per 100,000 per year in 1992, but the current incidence is unknown. Psoas abscess can descend along the psoas sheath and reach the inner upper third of the thigh, but only infrequently does it penetrate the sheath and involve the thigh adductors. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge. Delayed diagnosis can result in poor prognosis.</p> <p>Case presentation</p> <p>A 45-year-old male with no significant past medical history presented with pain in the left thigh, and limitation of movement at the left hip and knee joint for one month. Ultrasound, CT, and MRI revealed a liquid mass in the left psoas. Percutaneous drainage of this mass yielded 300 ml pus from the psoas. After surgery, the patient reported relief of pain; however, ten days after removal of the drainage tube, the patient complained of persistent pain in his left thigh. CT revealed that the psoas abscess had extended inferiorly, and involved the entire set of adductors of the left thigh. Open surgical drainage was performed at the flank and at the thigh, yielding 350 ml of pus from the thigh. After open drainage and adequate antibiotic therapy, the patient made a good recovery. Follow-up CT confirmed complete resolution of the abscess.</p> <p>Conclusions</p> <p>Large psoas abscess can penetrate the psoas sheath, and descend to thigh adductors even after percutaneous drainage. Appropriate treatment includes open surgical drainage along with antibiotic therapy.</p

Symptomatic Abdominal Simple Cysts: Is Percutaneous Sclerotherapy with Hypertonic Saline and Bleomycin a Treatment Option?

Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n=14, kidney n=3, and adrenal n=2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst’s volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst’s volume reduction was documented over time (P<0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts

Cystadenocarcinoma of the appendix: an incidental imaging finding in a patient with adenocarcinomas of the ascending and the sigmoid colon

BACKGROUND: Primary adenocarcinomas of the appendix are uncommon. Mucoceles that result from mucinous adenocarcinomas of the appendix may be incidentally detected on imaging. CASE PRESENTATION: A case of a mucocele of the appendix, due to cystadenocarcinoma, is presented as an incidental imaging finding in a female, 86-year-old patient. The patient was admitted due to rectal hemorrhage and underwent colonoscopy, x-ray, US and CT. Adenocarcinoma of the ascending colon, adenomatous polyp of the sigmoid colon and a cystic lesion in the right iliac fossa were diagnosed. The cystic lesion was characterized as mucocele. The patient underwent right hemicolectomy, excision of the mucocele and sigmoidectomy. She recovered well and in two-year follow-up is free from cancer. CONCLUSIONS: Preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management, but it is difficult on imaging studies. Small lymph nodes or soft tissue stranding in the surrounding fat on computed tomography examination may suggest the possibility of malignancy

Optic nerve sheath meningioma: a case report

A case of a 75-year old male with right-sided exopthalmos is presented. Outside proptosis of the right eye was initially observed 6 years ago. Opthalmological and endocrinological clinical examination as well as laboratory tests revealed no pathology from optic nerve disc, optic bulb and thyroid related hormones. MRI study demonstrated an optic nerve meningioma. The key imaging findings and the differential diagnosis were discussed in this present paper

The course of traumatic pancreatitis in a patient with pancreas divisum: a case report

BACKGROUND: The peculiar anatomy of pancreatic ducts in pancreas divisum (PD) may interfere with the development of acute chronic pancreatitis. In the presented case, PD influenced the evolution of lesions after pancreatic trauma. CASE PRESENTATION: A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years. The first episode occurred four months after blunt abdominal trauma. Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Imaging of upper abdomen and Magnetic Resonance Cholangiopancreatography disclosed pancreas divisum, changes consistent with chronic pancreatitis in the dorsal pancreatic duct, atrophy in the body and tail of the pancreas and a pseudocyst in the pancreatic head, that was drained endoscopically. CONCLUSION: Pancreas Divisum may interfere with the evolution of posttraumatic changes in the pancreas after blunt abdominal trauma