Clinical Cases

  • Giant cell tumor of the larynx

    Summary:  A 39-year-old male presented with an enlarging right neck mass he has had for the last 6 months. He reported odynophagia, voice hoarseness, and cough, but denies ear pain, hearing loss, dysphagia, or airway obstruction. Physical exam revealed a large palpable mass of the right neck. Endoscopic examination showed a bulging, nonulcerated mass in the right glottic area extending to the epiglottis. The right vocal cord was obliterated by the mass. The left vocal cord was normal in appearance and motility. The patient had no history of smoking, heavy alcohol use, or radiation exposure.

  • Ruptured giant mucocele of the appendix with pseudomyxoma peritonei

    Summary:  A 46-year-old man presented to the emergency department with complaints of acute right lower abdominal pain and a mild fever for 6months. An intraperitoneal, tender, ballotable, soft lump with smooth margins was palpable in the right iliac fossa. High white blood cell counts of 13,000 cells/µl with neutrophil count of 82% were noted.

  • Arterial injury to an anomalous anterior tibial artery during total knee arthroplasty

    Summary:  Although arterial complications during or after total knee arthroplasty (TKA) are rare; however, their sequelae can be disastrous. This case report describes the injury to an anomalous anterior tibial artery during total knee arthroplasty (TKA) and its successful surgical management. The operation was quite uneventful, but on release of the tourniquet at the end of the procedure, excessive bleeding was encountered. Further exploration to locate the source of the bleeding revealed injury to the anterior tibial artery, which was taking off quite higher off from the popliteal artery (Figure 1). The vessel was however successfully repaired with prolene sutures with no postoperative vascular complications and an uneventful recovery.

  • Angiotropic large cell lymphoma of the superior vena cava

    Summary:  The patient was a 44-year-old woman who was transferred to our institution with a presumed diagnosis of superior vena cava syndrome (SVCS) secondary to thrombus formation. The patient experienced syncope, along with headache, bilateral facial, neck, and upper-extremity swelling, as well as shortness of breath that was progressive over several months. The review of systems was negative for fever, night sweats, chills, myalgias, weight loss or other constitutional symptoms. The patient appeared cyanotic and had edema of the face and upper extremities with engorgement of the superficial neck and chest veins. There was no palpable lymphadenopathy or organomegaly.

  • Epiploic appendagitis

    Summary:  A 62-year-old man presented with acute onset of right lower-quadrant pain that was made somewhat worse by motion. The patient was afebrile and had a normal white blood cell count.

  • Anaplastic spinal cord ependymoma

    Summary:  A 29-year-old pregnant woman presented to her primary care physician with mild right leg weakness and numbness 6 weeks before delivery. The symptoms were attributed to her pregnancy and improved somewhat after delivery, although she continued to have minor symptoms. Approximately 6 months later, her symptoms worsened abruptly. She presented to a neurologist with bilateral lower extremity numbness and impaired vibratory sensation and proprioception. A magnetic resonance imaging (MRI) examination of the lumbar spine was performed (Figure 1), which prompted further MRI of the entire neural axis (Figure 2).

  • Gamekeeper’s thumb (Skier’s thumb)

    Summary:  A 36-year-old man presented with a painful, swollen right thumb following a fall. Examination revealed extreme tenderness over the base of the right thumb. The patient also experienced pain on valgus stress applied to the metacarpophalangeal joint of the right thumb.Anteroposterior (AP) and lateral radiographs revealed a Gamekeeper’s fracture. The patient was treated by immobilization of the thumb in a spica cast for 4 weeks.

  • HIV-related benign lymphoepithelial lesions

    Summary:  An 18-year-old woman presented to the emergency department with dry mouth and difficulty swallowing. She described a longstanding history of bilateral facial swelling. She denied symptoms of fever, pain, and dry eyes. She had a known history of human immunodeficiency virus (HIV) and had been noncompliant with her medication. Her CD4 count and HIV viral load were unknown.

  • Hunter syndrome

    Summary:  A 10-year-old boy with a known history of Hunter syndrome and a history of spastic quadriplegia presented with worsening paresthesias and dysesthesias in both hands. Magnetic resonance imaging (MRI) of the cervical spine was performed without contrast.

  • Gouty arthritis

    Summary:  A 40-year-old man presented to the clinic with complaints of left knee pain. His medical history included an 18-year history of gouty arthritis and on and off treatment for the same. He used to take nonsteroidal anti-inflammatory drugs for occasional pain in both feet. He also took allupurinol along with nonsteroidal inflammatory drugs during acute attacks of joint pain and prophylaxis up to the age of 35 years.

    Summary:  On examination of the left knee, there was no effusion. Knee movements were clinically normal. Multiple small nodules were seen on the dorsum of the left hand with a 2-x-3 cm large nodule over the base of the third metacarpal. They were not warm, not tender, and cystic to firm in consistency and the underlying extensors tendons were free. The skin over the nodules was normal and pinchable. There was no discharging sinus or ulcer noted.

    Summary:  Multiple tophaceous deposits, grayish discoloration, and hallux valgus deformity were noted on the great toe on both sides. A large localized swelling was seen in the retrocalcaneal region of this patient that was cystic in nature, not warm and tender and free from the tendo calcaneus.

    Summary:  Erythrocyte sedimentation rate was 25 mm in the first hour (normal <14). The patient’s blood parameters revealed hemoglobin 11.2 gms, TLC 7,500/cu mm. Complete blood counts, C-reactive protein, liver function tests, creatinine, electrolytes, and thyroid function test and protein electrophoresis were normal. Tests for antinuclear body, rheumatoid factor, and HLA-B27 were negative. Serum uric acid was 4.1 mgs (normal 3-7 mgs). Ultrasound KUB was normal. Urine examinations were normal.

    Summary:  Radiograph of the wrist (Figure 1) showed a circular punched-out lytic lesion involving scaphoid, capitate, and trapezoid bones. Metacarpals and phalanges were normal. A radiograph of the feet revealed a classic ‘punched-out’ lytic lesion, marginal erosions, and an associated overhanging edge at the distal metatarsals.

    Summary:  Straw colored fluid was aspirated from both the retrocalcaneal region and left wrist dorsal swelling. Microscopic examination and culture for aerobic, anaerobic, acid fast, and fungal organisms were negative. Needle-shaped urate crystals were seen with few RBC’s in between (Figure 2). Pus cells were not seen.

    Summary:  He was treated with nonsteroidal anti-inflammatory drugs, protected weight bearing, and physiotherapy. Four weeks after the visit, he had improved, with decreased pain and increased movement. 

Copyright © Anderson Publishing 2014