A Case of an Atypical Presentation of Spontaneous Esophageal Rupture.

Spontaneous esophageal rupture is an uncommon medical phenomenon that involves a sudden increase in intraesophageal pressure with negative intrathoracic pressure. Here, a 21-year-old female with no history of medical illness was admitted to our accident and emergency department with a one-day history of sudden retrosternal chest pain with other symptoms. There was no foreign body ingestion, vomiting, fever, cough, trauma, or recent procedures. Physical examination revealed a soft abdomen with epigastric tenderness and normal respiratory and cardiovascular examinations. The patient underwent a chest X-ray and a computed tomography scan of the neck and chest, which revealed retropharyngeal air extending to the mediastinum with anterior chest surgical emphysema. Oesophago-gastro-duodenoscopy revealed mild gastritis with no evidence of foreign body or esophagus injury. The patient was prescribed paracetamol, pantoprazole, and clindamycin. On follow-up, the patient was doing well with no active complaints. Conservative management of spontaneous esophageal rupture can result in good clinical outcomes with no requirement for additional interventions.

Nasopharyngeal Chordoma: A Case Report.

Chordoma is a rare malignant neoplasm arising from remnants of primitive notochord. The most common location for chordoma is in the sacrum. This case presents a 10-year-old medically free male who came to the ENT clinic with the impression of adenoid hypertrophy. After further investigations, including imaging and biopsy, it was found to be a nasopharyngeal chordoma. Our aim, in this case, is to increase the suspension of differential diagnosis of nasopharyngeal masses other than adenoid hypertrophy. In addition, it highlights the importance of imaging in the evaluation of nasopharyngeal masses.

Challenges in Diagnosis and Management of Infantile Deep Neck Abscess: A Case Report and Literature Review.

A deep neck abscess is a relatively rare bacterial infection in infants that can rapidly progress to life-threatening complications. Mostly, the patients present with fever and neck pain. Some may present with dysphonia, sore throat, torticollis, trismus, or neck swelling. Early diagnosis and management can prevent life-threatening complications, such as airway obstruction, mediastinitis, and tracheitis. In this report, we present a case of a six-month-old infant presenting with retropharyngeal and parapharyngeal abscesses with prompt diagnosis leading to complete recovery of the patient.

Clinical Outcomes of Early vs. Late Tracheostomy in Ventilated COVID-19 Patients.

Background The coronavirus disease 2019 (COVID-19) global pandemic prompted a significant use of intensive care resources for managing hypoxic respiratory failure. A substantial portion of these patients required mechanical ventilation. While intubation is common, its impact on mortality improvement has been questionable. Tracheostomies have become crucial for patients needing prolonged ventilation. However, tracheostomies also risk infections, ranging from early-stage mild cellulitis to later-stage nosocomial pneumonia. Our study evaluates the incidence of bacterial infections in COVID-19 patients who underwent tracheostomy early (within 14 days) versus late (more than 14 days after initiation of mechanical ventilation) during their stay in the intensive care unit (ICU). Methods We conducted a retrospective single-center study at Royal Medical Services Military Hospital. The study included COVID-19 patients who underwent tracheostomy and were admitted to the ICU from March 2020 to March 2022. We analyzed the incidence of ventilator-associated pneumonia, the timing of weaning from mechanical ventilation, and outcomes between early and late tracheostomized patients. Analyzed variables included demographics, comorbidities, use of steroids, tocilizumab, inflammation parameters, tracheostomy timing, incidence of bacterial infections, complications, and outcomes. Results The study comprised 36 patients. We found no statistically significant difference in the incidence of bacterial infections between the early and late tracheostomy groups (P>0.05). Complications and overall outcomes did not show significant statistical associations. Inotropes use was more frequent in the late tracheostomy group (P=0.122). In contrast, continuous renal replacement therapy was higher in the early tracheostomy group, showing no significant association (P>0.05). Mortality was higher in the early tracheostomy group, with nine deaths compared to seven in the late tracheostomy group. Interestingly, infection with Acinetobacter baumannii was associated with a statistically significant lower mortality rate, with 75% survival following tracheostomy. Conclusions Findings suggest that tracheostomy timing does not significantly impact the incidence of bacterial pneumonia or other complications, such as the use of inotropes, continuous renal replacement therapy, or mortality rates. These results support the use of personalized decision-making while conducting tracheostomies. Further research is necessary to determine the impacts of tracheostomy timing on patient outcomes more definitively.

Thyroid cancer risk assessment indicators: A correlation between preoperative and postoperative criteria.

BACKGROUND AND OBJECTIVES: To differentiate preoperatively between benign nodule and thyroid cancer (TC) is highly important. Therefore, we investigated the risk assessment indicators that correlate preoperative clinical, radiological, and pathological features with post-operative TC characteristics. METHODS: An observational retrospective study was performed in Bahrain Defense Force (BDF) hospital for all patients suspected of having thyroid cancer from January 2016 to October 2020. All the medical records, including clinical, laboratory, radiological, and pathological assessments of these patients, were retrieved and analyzed for association using binary and multivariate logistic regression analysis to estimate significance, odds ratio (OR), and 95% confidence interval. RESULTS: A total of 87 patients were included in the study with a mean age of 40 ± 12.5 years old. The histopathology revealed that 27 patients had TC with a mean age of 38.1±10.8 years (p>0.05 vs. benign conditions). Furthermore, the TC frequencies within gender were 29.9% and 36.4% for females and males, respectively. Besides, most patients (85.2%) had papillary TC cancer, whereas 7.4% had follicular cancer, and 3.7% had either medullary TC or minimally invasive follicular TC. The correlation results between demographic, clinical characteristic evaluations, laboratory findings of the study patients, and TC as reported by the histopathology were all not significant except for ultrasound features including solitary nodule (p<0.05), lymph node involvement, and consistency (p<0.01). The sensitivity and specificity values of FNAC for detection of TC were 77.8% and 86.3%, respectively. Multivariate analysis revealed that only solid consistency of the tumor (OR = 9.88) and lymph node involvement (OR = 14.78) were correlated with TC detection. On the other hand, gender, symptoms of hypothyroidism, hyperthyroidism, or compression, family history of TC, abnormal thyroid function tests, neck swelling, and ultrasounds imaging with regards to vascularization and microcalcification were not correlated with the detection of TC. CONCLUSION: Preoperative nodule and FNAC assessments need further research and development to approach higher sensitivity in detecting TC.

Common Findings in Blunt Thyroid Fracture.

Although blunt neck trauma is known to be rare, occurring in approximately 5% of all neck traumas, undiagnosed cases may have a devastating outcome. Physicians need to fully understand the mechanism of the injury and the external laryngeal trauma signs. A physician's precise diagnosis and proper management are necessary to avoid long-term complications or death. Although blunt laryngeal injuries are uncommon, prompt recognition of the subtle signs is crucial to avoid the catastrophic complications associated with such injuries. This case report aims to demonstrate the symptoms and signs of laryngeal injury in a young healthy male following a road traffic accident.

From Neck Swelling to Abrupt Compromised Airway: A Case of a Hemorrhagic Ruptured Thyroid Cyst.

Here, we present a rare case of spontaneous hemorrhagic rupture of a benign thyroid cyst in an adult Indian female who had no history of thyroid gland disease, trauma or coagulopathies. The patient presented to the Emergency Department with a suddenly progressive left-sided neck swelling of short duration. A 36-year-old otherwise healthy female presented to our Emergency Department with a progressive swelling on the left side of her neck that had started 2 days before her visit. Initially, the clinical neck examination revealed a well-defined soft cystic lesion confined to the left side of the neck anteriorly, measuring around 4 cm × 4 cm, tender to touch and moving with deglutition. Preliminary flexible scope examination of her larynx was normal. Within a few hours of having undergone ultrasonography examination, the neck swelling became diffused with increased tenderness. However, the patient remained clinically stable with no signs of airway compromise. A repeat of the fiber optic flexible scope examination showed submucosal hematoma in the left aryepiglottic area that mildly pushed the patient's laryngeal inlet to the contralateral side. Shortly after, the patient's condition worsened with the progression of swelling leading to compression of the airway. This promoted the decision to intubate the patient, who was subsequently, managed conservatively with close monitoring in the intensive care unit. Postintubation ultrasonography and computer tomography scans showed diffused inflammatory changes on the left side of the neck in the superficial and deep planes, mainly confined to the infrathyroid. Spontaneous sudden hemorrhagic rupture of a thyroid gland cyst is a rare condition but should be considered in a massive abrupt neck swelling that could potentially be life threatening.