RESUMEN
Lipoma is a common benign soft tissue lesion that can virtually develop anywhere in the body. However, the retropharyngeal space is an extremely rare location for lipoma. We report the case of a 48-year-old man who presented with progressive dysphagia of 3 months duration. It was associated with a weight loss of 6 kg. There was no history of cough, regurgitation, or heartburn. He was a heavy smoker, but he denied consuming alcohol. On examination, the patient was noted to have a hoarse voice. Examination of the oral cavity revealed a bulge in the posterior pharyngeal wall with intact and smooth overlying mucosa. Examination of the neurological system revealed normal findings. The patient was referred to undergo a computed tomography of the neck, which demonstrated a well-defined homogeneous lesion with fat density in the retropharyngeal space. Subsequently, magnetic resonance imaging revealed a well-encapsulated midline retropharyngeal mass, measuring 4.6 x 10.2 x 13.8 cm, filling the retropharyngeal space and extending from the C2 vertebra superiorly to the inferior border of C7 inferiorly. The mass has a high signal intensity on T1- and T2-weighted images with complete suppression of the signal on the fat-saturated sequences, likely representing a retropharyngeal lipoma. The patient underwent surgical resection of the tumor by the lateral cervical approach. Histopathological examination showed lobules of mature adipose tissue, representing a lipoma. Retropharyngeal space is a very rare location of lipoma. The case highlights the importance of considering retropharyngeal lesions when encountering a patient with progressive dysphagia.
RESUMEN
Cerebrovascular complications, including strokes, are relatively frequent during pregnancy. Artery of Percheron is an anatomic variant that supplies the paramedian thalamus. Occlusion of this artery results in bilateral thalamic infarction, which manifests clinically with altered mental status. We present the case of a 33-year-old pregnant woman who presented with drowsiness and headache. The patient was at 12 weeks of gestation. She had normal vital signs, including blood pressure, and no focal neurological deficits were noted on physical examination. Magnetic resonance imaging of the brain was performed. The scan demonstrated abnormal high signal intensity in both thalami on T2-weighted images and corresponding restricted diffusion and low apparent diffusion coefficient. Such findings were consistent with the artery of Percheron infarct. The patient received antiplatelet therapy and exhibited gradual improvement. On discharge, the patient had a near-complete resolution of symptoms. Artery of Percheron infarct is a rare type of stroke. Clinicians should be able to recognize its clinical and imaging features.
RESUMEN
Introduction Thyroid nodules are very common. However, the majority of thyroid nodules are benign. Ultrasound is the first-line imaging investigation of choice for thyroid nodules. Certain sonographic features are associated with an increased risk of malignancy. Recent studies suggested that the location of the nodule may be associated with the malignancy risk. Hence, this study aims to investigate this association. Methods After obtaining approval from the ethics committee, we conducted a retrospective study that involved all patients who attended our hospital, and who underwent fine-needle aspiration cytology for the evaluation of suspicious thyroid nodules (TR3-5). Electronic medical records were used to obtain data about the ultrasound and cytology reports. A multivariable binary logistic regression analysis model was conducted to identify the independent factors significantly associated with malignant thyroid nodules. Results The study included 366 patients who underwent fine-needle aspiration cytology for suspicious nodules on thyroid ultrasound. In total, 52 (14.2%) nodules were found to be malignant on cytology. By far, the most common thyroid malignancy was papillary carcinoma. The multivariable analysis model revealed that women were 24% less likely to have malignant thyroid nodules compared with men. After adjusting for the age, gender, and Thyroid Imaging Reporting and Data System (TI-RADS) group, the nodules located within the isthmus were four times more likely to be malignant compared to those located in the right or left lobes. Conclusions The study demonstrates that the isthmus location of thyroid nodules is associated with a higher risk of malignancy. Physicians should have a lower threshold to biopsy such nodules. Further studies are needed to confirm this interesting finding.