Journal of Clinical Case Reports

A 70-year-old man with left side inguinal hernia and phimosis was admitted to emergency department due to acute hemorrhage from skin of scrotum. High risk of respiratory failure after hernia repair due to increase of abdominal volume decided of a non-surgical approach. The patient is now being prepared for elective surgery

This patient with carpal tunnel syndrome presented with a rare branch of the palmar cutaneous branch of the median nerve. The branch diverged from the radial side in the carpal tunnel and immediately penetrated the flexor retinaculum. Upon stimulation of the nerve, numbness radiated to the thenar area without muscle contraction.

Introduction: Artery of Percheron (AOP) is a rare anatomical variant in which a single perforating artery arising from P1 segment of the posterior cerebral artery supplies paramedian thalami and rostral midbrain. Occlusion of AOP produces bilateral thalamic ischaemia and may be a rare complication in relation to an extended endoscopic endonasal approach. We report the case of a patient who developed AOP damage during endoscopic endonasal surgery; to our knowledge, this complication has been previously reported only in one case, in relation to a second surgery. We also review the anatomical variants in thalamic vascularization and the factors that may be involved in this complication. Case report: A 52-year-old female underwent an extended endoscopic endonasal approach with intraoperative neurophysiological monitoring. In the postoperative period she presented with decreased level of consciousness and bilateral mydriasis. MRI showed rostral midbrain and paramedian thalami ischaemia congruent with AOP infarction. Conclusion: Artery of Percheron infarction may be associated with extended endoscopic endonasal surgery when treating lesions with retrosellar extension. Every effort should be made to preserve the small perforating arteries. Intraoperative neurophysiological monitoring of motor and sensory pathways may not detect damage to the artery of Percheron.

Introduction: Intestinal intussusception is a pathology in which an intestinal segment and its mesentery are telescoped in the lumen of an adjacent intestinal segment as a result of peristalsis, and in many cases cause intestinal obstruction. Its etiology can be benign, malignant or idiopathic, mostly given by different entities, including intestinal diverticula, adhesion bands, vascular malformations, neoplasms, among others. The vast majority occur in paediatric patients, however, up to 5% of these are documented in adult patients and their main etiology in this age group is neoplasms. We present a case of intestinal intussusception secondary to Burkitt’s lymphoma that received management at the San Ignacio University Hospital in Bogotá, Colombia. Case presentation: This case report describes the clinical presentation and diagnostic approach of a patient who presented to the Emergency Department (ED) with clinical symptoms suggestive of intestinal obstruction, in which imagological findings of intestinal intussusception are documented, and led to an exploratory laparotomy where the presence of a jejunal-jejunal intussusception conditioned by a neoplastic mass is confirmed. This mass was resected and sent for histopathological study, where the diagnosis of Burkitt lymphoma with intestinal involvement confirmed. Subsequently, the patient had a good clinical evolution and is discharged to continue his long-term follow-up by the oncology service. Conclusion: Intestinal obstruction in adults secondary to intussusception is rare and case reports in which the etiology is Burkitt Lymphoma are scarce. Likewise, due to the unspecific symptoms, the surgeon must have the clinical suspicion to be able to carry out a successful diagnostic approach. This case shows how the use of appropriate diagnostic images can guide diagnosis and direct the appropriate surgical management of this surgical emergency

Introduction: A non-infective inflammatory mitral valve mass has never been described outside the context of a concurrent rheumatological condition. Case presentation: Routine TTE review of an asymptomatic healthy 73-year-old male, seven years following the insertion of a Cosgrove annuloplasty ring revealed a large mass attached to the atrial surface of the mitral valve repair ring. Cardiac surgery was performed to excise the mitral annular mass, the Cosgrove ring removed, and the annulus debrided. Upon histological examination of the mass, it was revealed to comprise of a chronic inflammatory infiltrate with plasma cells and foreign body type giant cells adjacent to an organising fibrinous exudate. The mass was subjected to extensive infectious testing which was negative. Discussion: Non-infective mitral valve masses are well reported in literature. However, to our knowledge this is the first identification of an inflammatory mitral valve mass associated with a Cosgrove ring annuloplasty and warrants consideration in those with a suspected non-infectious mass following valvular surgery.

Osler-Rendu-Weber or HHT (Hereditary Hemorrhagic Telangiectasia) is a genetic disease that causes patients to bleed, especially from the nose (epistaxis). The management of epistaxis in HHT is often very complex and frustrating. Epistaxis affects patient’s quality of life but can also be life threatening highlighting the importance of finding a permanent solution for this problem. Multiple management strategies have been proposed: packing, chemical and electrical cauterization, septodermoplasty, embolization, SPA ligation, antifibrinolytic agents. In the present study, we discuss the case of three patients with HHT and recalcitrant epistaxis who failed most of these strategies. The placement of nasal silicone septal button was shown to incidentally decrease significantly the incidence of bleeding in one patient by isolating the septal mucosa. The same procedure was then offered to the two other patients with similar success in decreasing bleeding and transfusion rate over 4 years of follow up.

Background: Edward syndrome is commonly known as the trisomy 18 syndrome. It is a common chromosomal disorder due to the presence of an extra chromosome of 18. The feature of Edward syndrome involved in craniofacial, skeletal, cardiovascular, central nervous system and genitourinary malformations. Developmental delay is common in every child. Physiotherapy is recommended by several author to reduce the further progression of symptoms. Case study: The case study was used to report this case and describe the physiotherapy management for child with Edward syndrome. Discussion: A 6-year-old girl was diagnosed as Edward syndrome. The child is receiving physiotherapy treatment from June 2018. The treatment focused on improving active movement, posture, sitting balance, standing ability, respiratory status and others.Conclusion: Edward syndrome is a rare autosomal chromosomal disorder. This case improved in developmenta milestone. Edward syndrome can be identified by second trimester ultrasonography up to 97% cases in second and third trimester. Early provision of physiotherapy is very important to prevent further progression of symptoms and can helpful to reach developmental milestone as early as possible. This case adds our knowledge of physiotherapy management that had not been previously described.

Background: Osteo-Lymphoma is a bone tumor that could be found in children. The world health organization (WHO) has defined Osteo-Lymphoma as lymphoma that affect only bones without the involvement of soft tissue organs. Osteo-Lymphoma is very rarely found lymphoma in pediatric patients and accounts for about 3% to 7% of bone malignancies and 4% to 5% of extranodal lymphomas. The aim of this study was to review bone lymphoma of pediatric patient, and to report Osteo-Lymphoma case diagnosed in imaging department of our hospital including Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT). Case presentation: A 6-year-10-month old Chinese male (weight: 25 Kg, height: 120 cm) was admitted to our hospital for 2 months’ bilateral lower extremities pain. He had more aggravated pain in both elbows lately associated with 15 days’ headache. This patient underwent for different investigations including imaging. The imaging investigations have found multiple Osteo-Lymphoma and soft tissue tumors on forehead and right parietal
bone. In addition, differential diagnosis cases from our data base were also presented and compared. The patient underwent surgery for the removal of forehead and right parietal tumors. The samples of the resected tumors were sent for immunohistochemistry analysis that confirmed the diagnosis as B cells lymphoma. Therefore, the patient was treated on the hospital standard chemotherapy regimen that is usually used in lymphoma. Conclusion: The patient follow-up whole body SPECT/CT and other clinical tests have revealed treatment good
outcomes.

Antiemetic medications are commonly prescribed, especially in the Oncologic population. Every group of antiemetics have their specific mechanism of action and side effect profile. There is little evidence that NK-1 agonists can produce an anaphylactic shock. We report a case of a 57-year-old female diagnosed with advanced stage lung adenocarcinoma who received aprepitant as a premedication for chemotherapy that caused anaphylactic shock and cardiac arrest. The literature we found on anaphylaxis due to aprepitant, were mainly case reports and case series.We encourage more research on this topic to come to the best treatment approach for these patients for a better outcome.

There are multiple etiologies that are responsible for an intracardiac mass, either benign or malignant, among
them intracardiac abscess or a primary tumors. There is little evidence of diagnostic and treatment approaches
for intracardiac masses. We report a case of a 60-year-old male diagnosed with a left tight leiomyosarcoma that
developed two left cardiac metastases. The current literature of cardiac metastases are mainly case reports and
case series, there is an unmet need of more research on this area to come to the best diagnostic and treatment
approach for this kind of patients for a better overall outcome.