Journal of Clinical Case Reports

Acute aortic syndrome is defined as an acute process in the aortic wall caused by disruption of the medial layer to a varying degree with the risk of aortic rupture and other complications. A penetrating aortic ulcer is included in the AAS and represents the 2-7% of the AAS. With progression, it leads to intramural haemorrhage, the formation of pseudoaneurysm with great risk of rupture. We present a case of a 65-year-old patient with an atypical presentation of penetrating aortic ulcer in the aortic arch associated with intramural hematoma, pseudoaneurysm and Ortner´s syndrome that required thoracic endovascular aortic repair that present complication of endoleak Type IA that was managed with the strategies “wait and see” and review the medical literature.

Breast angiosarcoma is a severe and rare complication in the breast-preserving management of breast cancer through surgery and radiotherapy. Due to the few studies, there is no clear consensus regarding the optimal oncological management of radiation-induced angiosarcoma. However, aggressive surgical removal remains the gold standard. A 53-year-old woman had a history of medullary triple negative, metachronous bilateral breast cancer. The left tumor was treated with conservative surgery in 2000, while the right tumor was treated with radical surgery in 2004, followed in both by anthracycline-based chemotherapy, radiotherapy and brachytherapy. 21 years later after the first surgery, a locally advanced tumor appeared in her left breast. Radiation-induced angiosarcoma was impossible to diagnose with a core needle biopsy, which revealed an undifferentiated tumor. The patient received neoadjuvant chemotherapy before undergoing left mastectomy surgery and the pathological analysis yielded a diagnosis of angiosarcoma. 2 years later, a nodule appeared over the right mastectomy scar. A wide excision removing the pectoral muscle was carried out, revealing a contralateral breast angiosarcoma. Given the recurrence, the patient received adjuvant chemotherapy, despite the lack of a prospective trial study to determine whether adjuvant chemotherapy for resectable angiosarcoma should be recommended. Secondary breast angiosarcoma is a very rare and late malignant tumor induced by radiation used for the treatment of early breast cancer. Surgery is the cornerstone of therapy, however, adjuvant chemotherapy may be considered due to the risk of recurrence and distant metastasis. Prospective trials are required for more precise therapeutic strategies for this iatrogenic malignancy.

Sialolithiasis, the formation of calculi within the salivary glands, predominantly affects the submandibular glands but can occasionally involve the parotid glands with significant clinical consequences. We present a case of a 64-year-old male with who developed severe left lower jaw pain and swelling due to a large sialolith in the parotid gland. The patient underwent a successful sialoendoscopy and surgical removal under general anesthesia, which involved meticulous dissection and excision of a dense, calcific mass along with affected gland tissue. Postoperative analysis confirmed the presence of a sialolith with extensive glandular calcification. This case underscores the challenges in managing large parotid sialoliths, emphasizing the importance of surgical approaches for optimal outcomes.

This case investigation focuses on the comprehensive management and monitoring of Type 2 Diabetes Mellitus (T2DM) in a 16-year-old patient. The adolescent presents with symptoms of increased thirst, frequent urination, fatigue and unintended weight loss. Diagnostic evaluations reveal elevated fasting plasma glucose levels and a high HbA1c, confirming the diagnosis of T2DM. The management plan incorporates lifestyle modifications, including dietary changes and increased physical activity, alongside pharmacotherapy with Metformin. Regular monitoring of blood glucose levels, HbA1c and associated metabolic parameters is emphasized to ensure effective disease management and prevent complications. This case highlights the unique challenges and considerations in managing T2DM in adolescents and underscores the importance of a multidisciplinary approach in achieving optimal outcomes.

Hepatic cirrhosis represents the advanced stage of liver disease characterized by significant fibrosis and impaired liver function. In cases of severe hepatic failure, the management and treatment strategies become increasingly complex due to the critical nature of liver dysfunction. This case study explores a comprehensive, inclusive approach to treating hepatic cirrhosis in a patient experiencing severe hepatic failure. It examines the integration of multidisciplinary care, including pharmacological interventions, lifestyle modifications and novel therapeutic strategies. The patient's management plan involved a combination of conventional treatments and innovative approaches tailored to their specific needs. Outcomes of this case demonstrate the potential benefits and challenges of a holistic treatment strategy in improving liver function and overall quality of life in severe hepatic failure.

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age and is characterized by irregular menstrual cycles, hyperandrogenism and polycystic ovaries. This case investigation details the long-term treatment strategies employed for a 32-year-old woman diagnosed with PCOS. The patient presented with persistent symptoms including menstrual irregularities, hirsutism and weight gain despite initial management efforts. A comprehensive, individualized treatment plan was developed incorporating lifestyle modifications, pharmacotherapy and hormonal treatments. Key interventions included a tailored diet and exercise program, metformin for insulin resistance and combination oral contraceptives for menstrual regulation and symptom control. Over a 24-month period, significant improvements were observed in menstrual regularity, reduction in hirsutism and overall quality of life. This case underscores the importance of a multifaceted approach in the long-term management of PCOS and highlights the positive outcomes achievable through personalized treatment strategies.

The global pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not yet over. The widespread infection from the COVID-19 virus resulted in unusual hyperinflammatory response in certain individuals leading to the cytokine storm and mortality. Efficacy and safety of the current therapeutic strategies in treating these patients still needs to be further probed. Although scientists across the globe are busy delineating the cause of unusual immune response in some of the COVID-19 patients, the underlying aetiological complexities associated with the cytokine storm still needs to be unearthed. To this goal, a very high level of pro-inflammatory markers followed by a sustained unexpected and prolonged antibody response in a well-documented case of surviving severe COVID-19 infection with simultaneous cytokine storm during the COVID-19 pandemic before vaccines against COVID were widely available, is the focus of this scientific report. On one hand significant number of deaths following severe COVID infection can be attributed to cytokine storm, it may also have been a reason why antibody levels from severe COVID infection may provide longer term protection in survivors.

Here we report a 95-years-old woman presenting with a chronic history of frequent cough, dysphagia for solids and later difficulty in swallowing fluids along with decreased appetite and weight loss from 6 months ago who diagnosed with large Zenker diverticula. According to the patient’s age and general condition, the surgeon consultation considered her as inoperable so an endoscopic diverticulectomy performed as a therapeutic option by using flexible endoscope under deep sedation and the patient discharged from hospital 5 days after procedure.

Background: Visual hallucinations are disturbances of perception present in various pathologies. Peduncular hallucinosis is complex visual hallucinations involving animals or often terrifying people that occur after pontine injuries. In this case report we present the clinical history of a middle-age man who reported peduncular hallucinosis due to mild but numerous ischemic lesions in the pontine region. This is a peculiar condition as the literature reports PH for much more severe injuries. Case presentation: A 55-year-old Caucasian man with hypertension, dyslipidemia, carotid atheromatosis and a previous diagnosis of bipolar disorder was admitted to the psychiatry ward of the Sant'Andrea Hospital due to the appearance of a mixed mood state with psychomotor agitation, ideic acceleration, anguish, auditory hallucinations, severe anxiety, panic attacks, total insomnia, disturbances in concentration and suicidal ideation. During hospitalization, he had complex visual hallucinations. On MRI of the brain, there were numerous ischemic areas in the pontine paramedian ventral region. On audiometric examination, there was bilateral sensorineural hearing loss. The patient was discharged with Valproic Acid 1000 mg/day, Quetiapine 200 mg/day. After discharge he underwent a neuropsychological evaluation that showed a cognitive decline. Conclusion: There are various cases in the literature of pontine ischemias that have given simple and complex, terrifying and beautiful visual hallucinations. Patients generally had a normal state of consciousness, no delusions, and had sleep disturbances. Lesions of the pons involving the dorsal raphe nucleus result in the loss of ascending serotonin inhibition to the dorsal lateral geniculate nucleus. Consequently, an over-excited geniculate can generate visual hallucinations at the cortical level. These ischemias in the paramedian ventral pontine region may have damaged the nucleus of the acoustic nerve causing a bilateral sensorineural hearing loss and the nuclei of the lenticular formation which, through the serotinenrgic and dopaminergic dysregulation, gave rise to visual hallucinations. These visual hallucinations can be considered PH. Considering the cognitive impairment, assessed through neuropsychological assessment, and the cardiometabolic risk factors, we can also affirm that the previous psychiatric diagnosis of bipolar disorder could have delayed the neurological diagnostic investigations.