Search

Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma by gas-forming organisms, with a risk of the gas extending into peri-nephric or para-renal spaces and in advanced cases, the involvement may be extensive and bilateral. It is a common complication in patients with long-term diabetes, primarily caused by Gram-negative organisms or, in some cases, anaerobes. The diagnosis of emphysematous pyelonephritis is made by clinical features and confirmed by computed tomography. Treatment is decided based on the computed tomography classification, with minimally invasive conservative techniques and antibiotic treatment before considering nephrectomy. We present a case of a 30-year-old women with an emphysematous pyelonephritis associated with pneumoperitonuem., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Actinomycosis is a suppurative granulomatous infection caused by the Gram-positive bacillus Actinomyces israelii. It rarely affects the pelvis, but its incidence appears to be increasing, possibly due to the frequent use of intrauterine devices (IUDs). We report the case of a patient with an IUD in place for over 10 years who presented with pelvic pain, general health deterioration, and imaging findings suggesting a neoplastic origin., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It constitutes a public health problem, especially in developing countries. Pelvic localization is rare with tubal involvement being the most frequent. It presents clinically, radiologically, and biologically as an ovarian tumor. We report the case of a patient who presented to the emergency department with pelvic pain, an abdominal-pelvic mass, and a general state of deterioration. The patient had a high CA125 level, and imaging initially suggested a neoplastic origin. She underwent laparoscopy with histopathological examination, confirming the diagnosis of tuberculosis, showing giant cell granulomas with caseous necrosis. A favorable outcome was observed on all fronts after antitubercular treatment., (© 2024 Published by Elsevier Inc. on behalf of University of Washington.)

Persistent fetal vasculature, previously called persistent hyperplastic primary vitreous, is a rare congenital condition where a component of fetal vessels within the eye fails to regress, leading to visual acuity decrease or loss. We present a case of a 13-year-old male patient, with a history of second-degree consanguinity, psychomotor development retardation, intellectual deficit from birth, in addition to a progressive bilateral visual acuity decrease. He recently presented a leukocoria in the right eye. Ultrasound and MRI were performed showing a linear structure traversing the vitreous antero-posteriorly, in addition to a retinal detachment and lens luxation, suggestive of posterior persistent fetal vasculature. We draw attention to the late age at diagnosis due to the insidious evolution in our case, and we highlight the importance of ultrasound and MRI in establishing the diagnosis and identifying associated brain malformations., (© 2024 Published by Elsevier Inc. on behalf of University of Washington.)

A subcutaneous mass in the anterior region of the thorax, (presternal region). Subcutaneous metastases in ovarian cancer are rare, occurring in 0.9% to 5.8% of cases. They are usually a late manifestation that arises several years after the initial diagnosis and often serve as a poor prognostic indicator. Their presence suggests a reported median survival ranging from 3 to 18 months. subcutaneous metastases can be categorized into umbilical metastases, commonly referred to as Sister Joseph's nodules (SJN) the most prevalent type, and non-SJN cutaneous metastases. We present the unusual case of a 57-year-old woman who underwent surgical intervention and received adjuvant chemotherapy for serous ovarian adenocarcinoma. She presented for consultation 5 years later with a painful presternal mass, and the histopathological examination of the mass revealed a metastasis of the primary ovarian tumor., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The Buschke-Lowenstein Tumor is a giant condyloma acuminatum caused by human papillomavirus, most commonly types 6 or 11. It is a rare condition with an estimated frequency of 0.1% in the general population. Transmission primarily occurs through sexual contact. It particularly affects men, predominantly appearing on the penis, characterized by its deep-seated growth, potential for degeneration, and tendency to recur after treatment. Surgery is the preferred treatment. We present the case of a50-year-old patient with a history of recurrent urethritis and multiple sexual partners. The patient sought medical attention for a swelling on the penis that had been progressively developing over the past 10 years. An MRI was performed for a locoregional study, revealing a perineal and penile mass with polylobed contours resembling a cauliflower, along with a sizable perineal mass Histological examination of a biopsy sample from the penis confirmed the diagnosis. Unfortunately, due to the tumor's characteristics and the patient's condition, surgery was contraindicated., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024. Published by Oxford University Press.)

A pheochromocytoma is a tumor that typically originates within the chromaffin cells of the adrenal glands, resulting in excessive production of catecholamines. Cystic forms are exceptional and pose a diagnostic challenge, especially those that are non-secreting. The most prevalent symptom associated with this condition is arterial hypertension, which can be either persistent or, more commonly, intermittent. The Ménard triad, comprising headaches, excessive sweating, and palpitations, may accompany episodes of hypertension. The presence of elevated levels of methoxylated derivatives serves to confirm the diagnosis of an adrenal pheochromocytoma. We report the case of a woman who presented with arterial hypertension associated with the Ménard triad, along with elevated methoxylated derivative levels. Imaging modalities revealed a predominantly cystic left retroperitoneal mass. The diagnosis of a cystic pheochromocytoma was established and confirmed through histological examination of the surgical specimen after adrenalectomy., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024. Published by Oxford University Press.)

The brown tumor is a non-neoplastic lesion resulting from an abnormality in bone metabolism in the context of primary, secondary, or tertiary hyperparathyroidism. They can affect any bone structure and be single or multiple. They are usually located on the long bones, pelvis, ribs, and collarbones. Facial localization is rare and is found in only 4.5% of brown tumors dominated by mandibular involvement. The treatment of a brown tumor depends on several elements: etiology, location, and symptomatology. It can regress or disappear after the treatment of hyperparathyroidism, thus avoiding surgical removal. Otherwise, excision of this mass is performed. We illustrate through this case a brown mandibular tumor revealing secondary hyperparathyroidism in a patient with a history of end-stage chronic renal failure on hemodialysis and associated neurofibromatosis type 1., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Rhinoscleroma is a rare benign granulomatous disease in children, the pathogen of which is Klebsiella rhinoscleromatis. Rhinoscleroma almost always affects the respiratory tract, the nasal cavities are the most common site, but can also be found over the entire extent of the respiratory tree, clinically the patient often presents with nasal obstruction with other non-specific signs, Histology is the basis of the diagnosis of rhinoscleroma. Early and appropriate medical treatment improves the prognosis and prevents progression to disabling sequelae. We present the case of a 9-year-old child who presented to the pediatric emergency department with a 2-month history of nasal obstruction unresponsive to medical treatment (Oxymetazoline). This was accompanied by mild nasal swelling and intermittent episodes of epistaxis. A CT scan of the paranasal sinuses was performed, ruling out a malignant tumor in the nasal cavity due to the absence of bone lysis. A nasal cavity biopsy with histopathological examination was conducted, confirming the diagnosis of rhinoscleroma. This was supported by the presence of an infiltrate rich in histiocytes and plasma cells, along with the identification of Russell bodies during PAS (Periodic Acid Schiff) staining. The patient underwent a medical treatment regimen involving a sulfamide-based antibiotic therapy (trimethoprim/sulfamethoxazole) for 8 weeks, along with a short-term corticosteroid therapy at a dose of 1 mg/kg/24 hours. At the first follow-up after 1 month, there was a noticeable reduction in nasal swelling and an improvement in nasal obstruction. A second follow-up 3 months later showed favorable results, with complete disappearance of both the swelling and nasal obstruction. Considering the possibility of recurrence, an annual follow-up was decided upon., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Acute disseminated encephalomyelitis (ADEM) is an acute and rapidly progressive auto-immune demyelinating disorder in the central nervous system. It is a rare disease but is more frequently observed in the pediatric population. We report a case of a monophasic postvaccination ADEM, which presented with paraparesis associated with fever. It showed a favorable evolution under corticosteroids, without recurrence after 3 years of follow-up. The diagnosis was established due to the postvaccination context and the MRI abnormalities characteristics. This case prompted a general discussion about the etiologies of myelin insults in children, especially demyelinating disorders, by shedding the light on their MRI features., (© 2023 Published by Elsevier Inc. on behalf of University of Washington.)

Meningocele is a rare congenital malformation of the central nervous system resulting from a herniation of the meninges containing cerebrospinal fluid through a bony defect in the skull. It is part of neural tube closure anomalies. The overall incidence of meningocele is 0.8 to 3 per 10 000 live births; it varies based on geographical location and race, with a predominance of occipital localization. Among diagnostic methods, computed tomography (CT) and magnetic resonance imaging (MRI) remain crucial examinations. Prenatal diagnosis of this malformation primarily relies on ultrasound and screening through maternal serum alpha-fetoprotein (AFP) levels. They typically manifest very early at birth with a highly suggestive radioclinical presentation. Surgical treatment usually allows for a definitive cure. Superinfection and rupture of the meningocele are exceptional, resulting from delayed diagnosis and management. In several developed countries, prevention through genetic counseling and the intake of folic acid during the periconceptional period, along with accurate prenatal diagnosis and the legalization of therapeutic abortion, has led to a decrease in the prevalence of meningoceles. In less developed countries, where there is a delay in diagnosis in exceptional cases, superinfection and rupture may occur. We present the case of an 8-month-old infant with a complicated occipital meningocele with superinfection and rupture., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Mesenchymal hamartoma (MH) is a benign liver tumor accounting for 3% to 8% of all liver tumors in children, commonly manifesting before 3 years of life. Distinguishing MH from hepatoblastoma and other liver tumors relies on imaging and alpha-fetoprotein (which is usually within normal range in MH), before histologic examination. We report a case of a hepatic MH associated with elevated alpha-fetoprotein, leading to a misdiagnosis of hepatoblastoma and the administration of chemotherapy. We draw the attention to the diagnostic difficulty and pitfalls related to alpha-fetoprotein elevation in the setting of a liver tumor, and we highlight the importance of imaging and histology in establishing the diagnosis., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)