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A myxoma is a benign intramuscular gelatinous tumor that is rarely known to arise from the scrotum. It can be confused both clinically and radiologically with other more common scrotal wall lesions such as a sebaceous cyst or an abscess. We report a case of a 54-year-old patient who presented with a scrotal wall swelling that was initially suspected to be an infected cyst or cold abscess on imaging. The final diagnosis of a myxoma was made after surgical excision and histopathological examination.
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Biliary Ascariasis occurs when Ascaris lumbricoides worms invade the biliary system. It may cause biliary obstruction, cholangitis, cholecystitis, or acute pancreatitis. We report a case of a 37-year-old female patient who presented with a history of upper abdominal pain, nausea, vomiting, and weight loss for two weeks. Ultrasound showed dilated common bile duct with linear tubular echogenic structure in the common bile duct and bowel loops. Endoscopic Retrograde Cholangio pancreatography (ERCP) revealed large adult worms confirming the diagnosis of Ascariasis.
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Renal lymphangiectasia is one of the rarest surgical complications in post-transplant kidney patients. A few patients may clinically complain of nonspecific symptoms, and the other few might be diagnosed incidentally. We report the case of a 32-year-old female patient with a known case of Joubert syndrome who presented with nonspecific clinical manifestations. The patient underwent ultrasound, magnetic resonance imaging (MRI), and nuclear medicine (NM) imaging to confirm the diagnosis, which showed radiologic features of renal lymphangiectasia. Conservative medical management was delivered to the patient.
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The agenesis of the left common carotid artery, with independent origins of the external and internal carotid arteries from the aortic arch, is a well-described but extremely rare congenital anomaly. We present a case of agenesis of the left common carotid artery with the independent origin of the left internal and left external arteries from the arch of the aorta in a patient with ankylosing spondylitis which was depicted by CT angiogram and magnetic resonance angiography. The diagnosis of this anatomical variant especially before interventional procedures is of great importance, as it could complicate the catheterization of these arteries.
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INTRODUCTION: In the emergency room, acute pain in the abdomen is one of the most common symptoms that patients present with, and it is a result of a myriad of causes, leading to an exhaustive differential diagnosis. A perforated peptic ulcer is a rare cause of acute right iliac fossa or lower quadrant abdominal pain. It causes leakage of gastrointestinal contents in the area, resulting in localized inflammation and pain that is clinically similar to acute appendicitis. This condition is known as Valentino's syndrome. AIM: This study aims to highlight clinical and radiological features for patients with Valentino's syndrome, improving diagnostic accuracy. METHODS: The authors conducted a retrospective analysis of all diagnosed cases of Valentino's syndrome from multiple facilities within the same organization for the research study. A total of 14 nonsequential cases were gathered. The term "Valentino's syndrome" was used to search in the PubMed and Google Scholar databases for the review of literature, and only 17 cases were found and reviewed. RESULTS: Of the 31 patients, 83.9% were male, with a mean age of 39 years. Of all patients who presented with abdominal pain, 25.8% had it in the lower right abdomen. Vomiting (38.7%), nausea (35.4%), fever (16.1%), and constipation were all associated symptoms (12.9%). All cases were clinically diagnosed as acute appendicitis. Many patients had elevated levels of white blood cells, neutrophils, and CRP. Computed tomography (CT) scan was used in 70.9% of the cases, followed by ultrasound (58%) and x-ray (45.1%), where pneumoperitoneum and duodenal perforations were common. Graham's patch was used in 48.3% of the cases, appendectomy was used in 16.1% of the cases, and conservative care was used in 19.3% of the cases. Most patients were given proton pump inhibitors and antibiotics for Helicobacter pylori. CONCLUSION: Timely diagnosis of Valentino's syndrome via CT imaging is critical because it leads to immediate perforation repair. Patients' mortality and morbidity may be reduced if they are aware of the condition and receive an accurate, rapid preoperative diagnosis.
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Hepatic endotheiloid hemangioendothelioma (EHE) commonly presents with multilobar involvement with locally aggressive behavior. In most cases, it presents with right upper quadrant abdominal pain, hepatomegaly, and weight loss with metastasis commonly to the lung. We present a 33-year-old woman with hepatic EHE with an initial presentation mimicking hepatic abscess and imaging findings misleading for metastatic liver lesions. It was confirmed on pathology with immunohistochemistry, but the patient could not survive due to her late presentation and the presence of metastatic lesions in the lung.
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Focal depressed fracture of the proximal tibial metaphysis without any articular involvement is a rare condition. We present a case of a 46-year-old man with a lacerated wound over the right proximal tibia after a history of slip and fall. The imaging involved to diagnose the condition included an X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) to exclude a pathological fracture and to better delineate the relationship between the fractured bone and the surrounding structures. Conservative management was indicated and implemented with a positive outcome.
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Beta-thalassemia represents a range of hemoglobinopathies that are a consequence of an impairment in the synthesis of beta-globin chains. They result in different degrees of hemolysis and ineffective erythropoiesis, depending on the underlying mutations. They can lead to severe complications mainly resulting from anemia. However, there is no bleeding tendency in this disorder, and it is uncommon to see hematoma formation in affected patients. To our knowledge, subperiosteal hematomas have been rarely described in the context of beta-thalassemia. Herein, we report a unique case of a 19-year-old boy who was diagnosed with transfusion-dependent beta-thalassemia and secondary hemochromatosis and developed atraumatic subperiosteal hematomas along the humerus.
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Meckel's diverticulum (MD) is the most frequent congenital abnormality of the digestive tract. Although it is silent, it can rarely come up as a complicated case including but not limited to obstruction, inflammation, and neoplasm. Perforation as a consequence of MD is extremely infrequent and mostly related to foreign objects. We report a case of a 24-year-old man who presented to the emergency department with signs and symptoms suggestive of acute appendicitis. Computed tomography (CT) of the abdomen demonstrated foreign body perforation from a protrusion outside the small bowel. The patient underwent laparoscopy and a fish bone perforating MD was found which was removed.
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Primary anterior abdominal wall (AAW) abscess is a rare condition that can present clinically as an abdominal disorder and baffle even the most experienced clinicians. We discuss ultrasound, CT, and MRI features of a rare case of primary anterior abdominal wall abscess that was confirmed by histopathological findings.
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The practice of manually siphoning diesel from fuel tanks is widespread among car mechanics in Asian countries. To date, there are just a few reports in the literature about hydrocarbon pneumonitis caused by diesel fuel aspiration. An early diagnosis based on clinical suspicion, imaging results, and histopathology can help prevent permanent damage to the lungs.
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Parotid gland trauma is a rare condition due to the anatomical location of the parotid gland. Imaging of the parotid gland trauma is restricted to ultrasound (US), sialogram, and computed tomography scans in the published literature. We present a case of penetrating parotid gland injury caused by a fishhook. The foreign object was removed under local anesthesia and the patient was managed conservatively with antibiotics and tetanus toxoid vaccine. A swelling appeared in the left parotid region after two weeks that was diagnosed using US and magnetic resonance imaging as granulation tissue formation in the injured parotid gland.
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Extensive surgical emphysema can lead to a life-threatening condition causing hemodynamic instability and significant physician challenges in its management. Here we describe an uncommon case of extensive subcutaneous emphysema caused by stabbing neck, which led to complications such as pneumothorax, pneumopericardium, pneumomediastinum as well as pneumoperitoneum. The role of radiological imaging is crucial in managing this relatively uncommon presentation. This article highlights clinical presentation, radiological findings, and various management options.
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Cases of acute scrotum presenting to the emergency department are usually due to testicular torsion, complicated hernia, or epididymo-orchitis. Thrombosis of the spermatic vein is an uncommon entity and most of the cases reported to date are of unilateral involvement. Here, we present an extremely rare case of spontaneous bilateral spermatic vein thrombosis, which was diagnosed by a Doppler ultrasound of the testes. This article highlights its clinical presentation, radiological imaging, etiology, and management.
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Atraumatic splenic rupture is a rare and life-threatening condition, if not diagnosed. We present two cases with a history of travel to endemic areas, who came to the emergency department with abdominal pain and were diagnosed to have spontaneous splenic rupture as a complication of severe malaria. Both patients were treated surgically by splenectomy. A high level of clinical suspicion is critical in every malaria patient presenting with abdominal pain, even if it is mild. Clinical imaging modalities like ultrasonography and computed tomography (CT) are crucial diagnostic tools in managing such patients.