RESUMO
Pigmented villonodular synovitis (PVNS) is a rare synovial proliferative disease featuring hemosiderin deposits. Calcium pyrophosphate deposition (CPPD) is a crystal-induced inflammatory arthritis common in the elderly. We reported the case of a 78-year-old male who was under stroke rehabilitation when acute inflammatory and hemorrhagic knee arthritis of his paretic lower limb occurred. CPPD was proven by synovial analysis. Ultrasonography showed widespread synovial nodular lesions in the affected knee and helped guiding difficult arthrocentesis. These led to a rapid diagnosis of PVNS with magnetic resonance imaging. In elderly stroke patients, knee pain, being a common complaint, warrants a careful diagnosis including adequate imaging. This case demonstrates that ultrasonography is an accessible and useful diagnostic tool.
RESUMO
Desmoid tumor originating from the small intestine is extremely rare. We report a 50-year-old man who presented with the sudden onset of severe abdominal pain. Computerized tomography (CT) demonstrated a huge homogeneous tumor in the lower abdomen that appeared to be in continuity with the distal ileum. The mass adherent to the ileum was resected and proved to be a desmoid tumor. The patient has remained recurrence free on follow-up.
Assuntos
Fibromatose Abdominal/patologia , Neoplasias Intestinais/patologia , Intestino Delgado/patologia , Fibromatose Abdominal/cirurgia , Humanos , Neoplasias Intestinais/cirurgia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT: A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION: In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.
Assuntos
Doenças dos Anexos/complicações , Doenças dos Anexos/cirurgia , Endometriose/complicações , Endometriose/cirurgia , Laparoscopia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Doenças dos Anexos/diagnóstico , Adulto , Endometriose/diagnóstico , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Imageamento por Ressonância Magnética , Pelve , Procedimentos de Cirurgia Plástica , Recidiva , Reoperação , Falha de Tratamento , Ureter/cirurgia , Obstrução Ureteral/diagnóstico , Ureterostomia , UrografiaRESUMO
We report a case of non-typhi Salmonella adrenal abscess in a patient with human immunodeficiency virus (HIV) infection and thalassaemia minor. Non-typhi Salmonella bacteraemia is common in HIV-infected patients, but infection localized in the adrenal gland is rare. Focal salmonellosis is common in haemoglobinopathy but unusual in thalassaemia minor. This patient was diagnosed by computed tomography (CT) guided aspiration and successfully treated with ciprofloxacin.
Assuntos
Abscesso/microbiologia , Doenças das Glândulas Suprarrenais/microbiologia , Infecções por HIV/complicações , Infecções por Salmonella/microbiologia , Salmonella/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Doenças das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/microbiologia , Glândulas Suprarrenais/patologia , Adulto , Humanos , Masculino , Salmonella/classificação , Talassemia beta/complicaçõesRESUMO
Gout presenting as an osteolytic lesion is exceedingly rare in children with asymptomatic hyperuricemia. We report the clinical and radiological presentation of intraosseous gout in a 13-year-old boy.