An internal carotid artery pseudoaneurysm with neck hematoma: A rare cause of a life-threatening neck mass mimicking an abscess.

A neck mass has a broad and complex differential diagnosis, generally divided into neoplastic, congenital and inflammatory categories. An internal carotid artery hemorrhage with pseudoaneurysm formation is a very rare entity that may resemble other common conditions in the differential diagnosis. Large, expanding or symptomatic pseudoaneurysm is critical to efficiently diagnose and manage, due to risk of life-threatening hemorrhage. We present a case of an adult male patient with clinical and laboratory signs of severe neck cellulitis and a large gradually increasing neck mass, primarily suggestive of an abscess. Neck CT and MRI imaging revealed the presence of a disruption of the internal carotid artery resulting in a large hematoma and formation of pseudoaneurysm. A multidisciplinary team of interventional radiologists and ENT surgeons successfully treated the patient by endovascular placement of stents and subsequent surgical drainage. Awareness of such a rare, life-threatening condition and efficient multidisciplinary teamwork are essential for patient management.

Pathological characteristics and clinical perspectives of papillary thyroid cancer: study of 714 patients.

Papillary thyroid cancer belongs to most commonly diagnosed well-differentiated malignant tumor of the thyroid gland, with only minority of cases being more aggressive, recurring locoregionally and developing distant metastatic foci. The aim of this study was to determine the clinical relationship between parameters of age, gender, size of primary tumor, intraglandular dissemination and regional metastatic spread and evaluate the importance of each parameter; analyze other major aggressive factors (tumor border, thyroid capsule invasion, perivascular, perilymphatic spread) on prevalence and extent of intraglandular dissemination and relation to metastatic spread in neck. This study is a retrospective analysis of clinical and pathological data from 714 patients with papillary thyroid cancer, presented and operated at the Department of ENT/Head and Neck surgery, Sisters of Charity University Hospital, Zagreb, in the period from 1980 to 2008. All patients were operated upon with total thyroidectomy and some type of neck lymphonode dissection (paratracheal or lateral). In results, we found 46.9% tumors were aggressive; 34.7% tumors were multicentric, with foci in the contralateral lobe nearly twice as often as in the ipsilateral lobe; 27.8% were regionally metastatic, with equal distribution between paratracheal and lateral regions. In conclusion, we revealed contralateral lobe multicentricity and male gender as independent risk factors for regional metastatic dissemination. Nodular goiter has been identified as a protective parameter.

Hidradenoma of the external auditory canal: clinical presentation and surgical treatment.

The aim of this article is to present clinical features, diagnostic procedures and surgical treatment of a rare ear tumor. We report a case of 78 year old female with hidradenoma of the external auditory canal. Patient had a sensation of pain and fullness with permanent ottorhea from the right ear for one year Temporal bone computed tomography showed a tumor of the external ear, 6 centimeters in diameter, without bone, temporomandibular joint or intracranial invasion; the tumor was limited medially by the tympanic membrane. Biopsy was performed and pathohistology finding was: hydradenoma nodulare atypicum. Surgical intervention and wide tumor removal in general endotracheal anesthesia was performed. One year after the surgery there was no sign of tumor recurrence. Hidradenoma is rare ear tumor arising from the epithelial cells of sweat glands of the external auditory canal. Radiological evaluation and pathohistology confirmation of hidradenoma is necessary and wide excision of the tumor is the treatment of choice.

[Clinical and pathophysiological patterns of otitis externa and overview of problematic cases]. / Klinicki i patofizioloski obrasci upale vanjskog zvukovoda s osvrtom na problematicne slucajeve.

Otitis externa can sometimes present itself as a difficult clinical problem, in cases such as unsuccessful outcome of usual therapy, prolonged duration of symptoms or frequent recurrencies with local or systemic complications. In these cases more attention should be focused on possible errors made in establishing the right diagnosis, incorrect sequence of applying therapeutical measures, or presence of unrecognized problems, including individual patient factors, characteristics of the pathogen, or other. In this article we present a case report of a 84-year-old patient with complicated otitis externa, together with a short review of physiology, patophysiology, diagnostic and therapeutical measures in external otitis, and suggest a possible clinical approach in the management of problematic cases.

Bacterial colonization and granulocyte activation in chronic maxillary sinusitis in asthmatics and non-asthmatics.

The impact of bacterial colonization on the severity and pattern of chronic inflammation in rhinosinusitis is not clear. In this study, it was hypothesized that bacterial colonization of the sinus mucosa would have a greater impact on inflammatory response modulation in asthmatic patients than in non-asthmatic patients with chronic rhinosinusitis. In order to test this hypothesis, granulocyte activation was measured and related to bacteria identified in the sinus lavage. Lavages from the maxillary sinuses of 21 asthmatic and 19 non-asthmatic patients with chronic rhinosinusitis (CRS) were microbiologically examined for aerobic and anaerobic growth. Eosinophil cationic protein (ECP), an eosinophil activation marker, and myeloperoxidase (MPO), a neutrophil activation marker, were measured in the sinus lavages. Bacteria were recovered in 20/32 samples from the asthmatics and in 21/33 samples from the non-asthmatics. Gram-positive aerobes and anaerobes were slightly more common than Gram-negative bacteria. A different bacterial profile was found when comparing Gram-negatives between the groups. Concentrations of MPO were significantly higher in samples with bacterial recovery from asthmatic patients, compared to sterile samples of both groups. Concentrations of ECP in the samples from asthmatic patients were significantly higher than in the controls, with no significant difference related to bacterial colonization. Bacterial colonization in chronically inflamed sinuses may have an impact on neutrophil granulocyte activation in patients with bronchial asthma, which was not confirmed for patients with CRS without asthma.