Spontaneous splenic rupture during infection of cytomegalovirus. A case report.

Splenic rupture is most commonly encountered after blunt abdominal trauma. Spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. We report the case of a 27-year-old female patient without pathological history. Admitted to the emergency department for the sudden onset of left hypochondrial pain associated with vomiting, rapidly progressing to hypovolemic shock. She had reported an influenza-like illness a week earlier for which her COVID-19 PCR was negative. Emergency abdominal ultrasound and CT-scan revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy with good clinical evolution. Despite the rarity of this condition, physicians should consider the diagnosis of spontaneous non traumatic splenic rupture when encountering healthy patients presenting with nonspecific left hypochondrial abdominal pain and hypovolemia. Mortality is essentially related to the delay in diagnosis and treatment and to the severity of the underlying pathology. Treatment often consists of splenectomy.

Splenic volvulus on ectopic spleen in adults: A case report.

Ectopic spleen is a rare clinical entity characterized by splenic hypermobility which may be congenital or acquired. The spleen may be migrated to different positions in the peritoneum. The main complication is pedicular torsion with splenic volvulus, presenting as an emergency abdominal surgery. We present and discuss a case of ectopic and twisted spleen resulting in complete splenic infarction, diagnosed by ultrasound, confirmed by CT scan and treated by splenectomy.

Incarcerated primary anterior liver hernia: A case report.

The anterior liver hernia is a very rare entity that mainly occurs within an incisional hernia. Primary anterior liver hernia, in the absence of a previous abdominal incision, is extremely rare. The diagnosis is suspected in patients with epigastric bulging. The confirmation requires imaging studies such as computed tomography scan (CT scan). We report the case of an incarcerated primary ventral liver hernia, in an 83-year-old man who presented with a sudden epigastric swelling. A contrast-enhanced CT scan confirmed the diagnosis of incarcerated epigastric hernia with liver and epiploic content. Risk factors were thought to be the increased intra-abdominal pressure related to benign prostate hyperplasia, as well as the old age of the patient. The surgical conservative management was successful.

Primary true enterolithiasis: A rare cause of acute small bowel obstruction.

Enterolithiasis is an uncommon medical condition. It's defined by the formation of gastrointestinal concretion in the setting of intestinal stasis. Enteroliths are typically incidentally discovered during imaging and are a rare cause of acute small bowel obstruction. We report the case of acute small bowel obstruction, secondary to primary true enterolithiasis, in a 73-year-old male, with unremarkable medical history. He presented with clinical features in keeping with acute small bowel obstruction, for 2 days. An abdominal contrast-enhanced CT scan suggested a small bowel obstruction caused by a 32mm diameter enterolith located in the terminal ileum. The surgical management was successful and consisted of the removal of the enterolith after enterotomy.

Utero-cutaneous fistula following cesarean section: A case report.

Utero-cutaneous fistula is a rare pathology. It mostly occurs consecutively to surgical intervention such as Cesarean section. Blood discharge from the cesarean scar during menstruation is a quasi-pathognomonic feature. Imaging modalities, particularly with the injection of contrast material through the cutaneous fistulous opening, confirm the diagnosis. The management is mainly surgical. We report the case of a utero-cutaneous fistula in a 27-year-old lady, with systemic lupus erythematosus. She presented seven months after her third cesarean section with pain and blood discharge from the cutaneous scar during menstruation for four months. A pelvic CT scan with the injection of the contrast material through the cutaneous fistulous opening confirmed the diagnosis of utero-cutaneous fistula. Surgical management was successful.

[Hydrocele of the canal of Nuck detected during infertility evaluation: an atypical case report]. / Une hydrocèle du canal de Nuck découverte au cours d´un bilan d´infertilité: à propos d'un cas atypique.

Hydrocele of the canal of Nuck is a rare woman condition often detected during childhood. We here report a rare case of hydrocele detected in adulthood during infertility evaluation. The patient presented with chronic non painful right inguinal swelling. Imaging test demonstrated typical image of hydrocele of the canal of Nuck. The ultrasound found cyst formation with few thin septa and MRI did not find any communication with the peritoneum. The same imaging tests were performed which showed non-partitioned bicornuate uterus that could fall under the framework of infertility evaluation. The main purpose of this study was to report the typical imaging features of hydrocele of the canal of Nuck, which is a little known diagnosis that should be integrated into differential diagnoses of inguinal swellings in women.

[Nutcracker syndrome: a rare cause of abdominal pain in adults that shouldn't be ignored: a case report]. / Syndrome de Casse-Noisette: cause rare de douleurs abdominales chez l'adulte, à ne pas méconnaître (à propos d'un cas).

Nowadays, the knowledge of vascular abnormalities is essential for all specialists in their clinical practice and may prevent serious complications through early interventions. Nutcraker syndrome is caused by left renal vein (LRV) compression, usually occurring in the fork formed by the abdominal aorta and the superior mesenteric artery (SMA) and leading to the narrowing of the aortomesenteric portion of the left renal vein and to the dilatation of its distal portion. Symptoms are dominated by lumbar, abdominal, pelvic pain and haematuria. Diagnosis is essentially based on modern imaging tests (computed tomography (CT) scan, Doppler-ultrasound, phlebography) and treatment is controversial. We here report the case of a 43-year-old woman, admitted with epigastric pain associated with pelvic heaviness following nutcraker syndrome requiring radiological screening on admission.

A Rare Case of Exocrine Pancreatic Insufficiency.

Lipomatous pseudohypertrophy (LPH) of the pancreas is an uncommon affection of exocrine pancreatic insufficiency. It is defined as substitution of the pancreatic exocrine gland by a large fat component. We report the case of a young patient with malabsorption syndrome (chronic diarrhoea and steatorrhoea), abnormal laboratory results and normal fibroscopy. Computed tomography revealed characteristic diffuse pancreatic abnormalities. LEARNING POINTS: Computed tomography is key for identifying lipomatous pseudohypertrophy.Malabsorption syndrome is usually associated with lipomatous pseudohypertrophy.A syndromic aetiology should be considered.

Recurrent costovertebral hydatidosis with epidural extension.

Osseous echinococcosis is a relatively rare entity and that of the rib is even rare. Few cases of costal echinococcosis have been reported in the literature so far. We report a case of a recurrent costovertebral hydatidosis with epidural extension in a 49-year-old man who presented with paraparesis and back pain. MRI of the dorsal spine was performed. The imaging features were suggestive of echinococcosis involving the rib and vertebrae with epidural extension. This diagnosis was confirmed histopathologically after surgical treatment. The evolution was marked by the reappearance of the same symptoms due to recurrence. The prognosis of costovertebral hydatidosis is gloomy despite radical surgical treatment due to the frequency of recurrences. This case highlights the role of MRI for the diagnosis and follow-up of patients after treatment.

Ansa pancreatica: a rare cause of acute recurrent episode in chronic pancreatitis.

Ansa pancreatica is a rare anatomic variation of pancreatic ducts. It is a predisposing factor of recurrent pancreatitis. In this case report, we describe a case of a 24-year-old male suffering from an ansa pancreatica with a non-patent major papilla, diagnosed on magnetic resonance cholangiopancreatography (MRCP).The ansa pancreatica was revealed by an episode of acute pancreatitis attacks in chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed important abrupt dilation in the main pancreatic duct with an ansa loop in the pancreatic duct in the head of the pancreas, and a sphincterotomy of the minor papilla was performed. The procedure was difficult and the placement of a long-term pancreatic stent during the ERCP was impossible, thus a surgical pancreatico-jejunostomy was proposed as a treatment of an ansa pancreatica with a non-patent major papilla.

Curvilinear pericallosal lipomas diagnosed incidentally during evaluation following trauma with corpus callosum abnormalities in two patients.

Pericallosal lipomas are the most habitual location for an intracranial lipoma. They are fat-containing lesions arising from the interhemispheric fissure intimately related to the corpus callosum, which is often abnormal. They originate from aberrant differentiation of the persistent primitive meninx. Most Pericallosal lipomas are asymptomatic and come into clinical attention during neuroradiological investigations for other conditions. MRI is the modality of choice to characterize not only the extent of the lipoma but also the frequently associated agenesis/dysgenesis of the corpus callosum. Pericallosal lipomas can be divided into two groups: The Tubulonodular type and The curvilinear type. Curvilinear lipomas are less common than Tubulonodular. We report the clinical and radiological findings of curvilinear Pericallosal lipoma in two patients with corpus callosum abnormalities revealed incidentally during evaluation following trauma.

Clinical and radiological resolution of vertebral sarcoidosis mimicking metastatic disease.

Sarcoidosis is a disease that exhibits extreme heterogeneous clinical manifestations. Bone involvement in sarcoidosis is rare (1%-13%), and involvement of the vertebrae is even rarer. Usually, it is a diagnosis of exclusion with nonspecific characteristics in imaging. A 35-year-old male, who has no significant medical history£. He came to clinical examination for lower back and associated bilateral lower extremity pain. Magnetic resonance imaging (MRI) was performed to exclude disc-related pathology. It demonstrates left paramedian lumbar disc herniation at L4-L5 level. Multiple small enhancing lesions throughout the lumbar vertebrae were discovered as an incidental finding. An 18F-labeled fluorodeoxyglucose was performed to evaluate for metastatic disease that shows hypermetabolic apical right nodule of the lung parenchyma with multiple mediastinal and right iliac external adenopathy. Increased uptake throughout the lumbar vertebral lesions was also seen. A CT-guided biopsy of the right apical lung nodule and one of the vertebral lesions (L3) revealed noncaseating granulomas consistent with sarcoidosis. We introduce steroid treatment with favorable evolution of vertebral lesions. Vertebral sarcoidosis cannot be certainly differentiated from metastatic disease based on imaging only. Accurate diagnosis is only attainable by histopathological verification of the lesions.

Emphysematous Pancreatitis: A Rare Complication of Acute Necrotizing Pancreatitis.

Emphysematous pancreatitis is a rare and fatal complication of acute necrotizing pancreatitis. We report a radioclinical observation of a 61-year-old female patient who consulted for epigastric pain radiating to the back, associated with vomiting and elevated lipasaemia more than 3 times the normal value. The abdominal computerized tomography (CT) scan carried out on the fourth day of hospitalization, based on worsening of the clinical condition, showed pancreatic necrosis associated with the presence of air bubbles. Percutaneous puncture of a peripancreatic collection was positive for Escherichia coli. A diagnosis of emphysematous pancreatitis was established. The clinical and biological evolution of our patient was favourable with antibiotic treatment. LEARNING POINTS: Emphysematous pancreatitis is a rare and fatal complication of acute necrotizing pancreatitis.Abdominal CT allows for suspicion of this pathology based on the intra- and/or peripancreatic presence of air.The diagnosis is confirmed by the isolation of the bacterial agent in peripancreatic needle aspiration fluid.

[Intramedullary lipoma: about a case]. / Lipome intramédullaire: à propos d'une observation.

Intramedullary lipomas are rare benign lesions accounting for approximately 1% of bone marrow cancers. We report a new case of histologically confirmed non-dysraphic intramedullary lipoma. The study involved a 46-year old female patient who had undergone surgical biopsy for medullary lipoma 6 months before and who did not have radiological reports prior to this surgery. She suffered from rachialgias, sensory disorders, difficulties to walk and recently aggravated muscular weakness. Medullary MRI objectified well-defined mass presenting hypersignal on T1 and on T2 measuring 8cm x 2.5cm in the conus terminalis. Magnetic resonance imaging is the gold standard for the exploration of intramedullary lipomas. It allows early diagnosis as well as surgical management before the onset of irreversible neurological complications.

Poorly differentiated thyroid carcinoma: a retrospective clinicopathological study.

Poorly differentiated thyroid carcinoma (PDTC) is an independent thyroid cancer histotype. In spite of its scarcity, it represents the main cause of death from non-anaplastic follicular cell-derived thyroid cancer. However, given the newness of this entity, few data are available on its clinical behaviour and no explicit consensus sets its treatment. To report the experience of a tertiary medical centre in morocco with PDTC over a period of 7 years. Retrospective study selecting all patients treated for thyroid carcinoma in Nuclear Medicine Department of a tertiary medical centre in Casablanca over seven years period. Patient's files were reviewed for background data, clinico-pathological characteristics, treatment and outcome. Seven patients were included in the study. Patient's average age was 60 years old (30-81) including six women and one man. All patients underwent a total thyroidectomy completed by cervical lymph node dissection in 57% of cases. Mean primary tumour size was 4cm (1-9cm). Patients were classified pT3 in 70% of cases, pT1 and pT2 in 15% each. Vascular invasion was found in 85% of cases. Pathological subtypes found were "insular carcinoma" in 85% of cases. Radioiodine therapy (RIT) was indicated in all cases. Follow-up period ranged between 10 months and 6 years. It showed a complete remission in 57% of cases, persistent disease in 28% of cases and a progressive disease in 15% of cases with a local recurrence. To date, the survival rate is 85%. PDTC is an aggressive thyroid cancer histotype. Treatment remains surgical followed by RIT if the tumour is radioavid. Multimodality therapy is indicated depending on the case and close monitoring is always indicated given the high risk of relapse.

Spontaneous bilateral perirenal hematomas in two patients with eclampsia.

The purpose of this report is to provide two illustrative cases of spontaneous and bilateral perirenal hematomas that occurred during a pregnancy complicated by eclampsia. The sonographic and computed tomographic findings included bilateral perirenal hematoma with no evidence of an underlying malignancy. Since renal hematomas that occur in association with preeclampsia and eclampsia syndrome are extremely rare, but potentially life-threatening complications, prompt laboratory and radiologic evaluations are essential and can reduce the associated morbidity and mortality.