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Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laryngotracheitis (croup) is a rare manifestation of COVID-19 in adults. Presentation of case: A 52-year-old female presented to the emergency department (ED) with shortness of breath and inspiratory stridor. Clinical findings and investigations: Physical examination of the head and neck revealed a congested posterior pharyngeal wall. Laryngeal endoscopy with a 70-degree rigid endoscope demonstrated an edematous, bilaterally moving vocal cords. Chest radiographs showed tapering of the upper trachea (the "steeple" sign), which is observed in parainfluenza-associated croup infections. Interventions and outcome: The patient was admitted to the intensive care unit (ICU) for close observation for possible airway compromise and the need for intubation. Upon which, she tested positive for COVID-19 by polymerase chain reaction testing of nasopharyngeal samples. A regimen of ceftriaxone, nebulized racemic epinephrine, and dexamethasone was initiated. Conclusion: During the current COVID-19 pandemic, early diagnostic testing for SARS-Cov-2 are strongly recommended even when symptoms are not typical of COVID-19.
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INTRODUCTION: Thyroid goiter is a benign chronic enlargement of the thyroid gland, which presents as a painless anterior neck mass with occasional extension to the mediastinum. Retropharyngeal goiter is a rare presentation and hardly reported in the literature. PRESENTATION OF CASE: A 70-year-old male presented with a multinodular goiter with a large retropharyngeal component. CLINICAL FINDINGS AND INVESTIGATIONS: Physical examination of the head and neck revealed a massive anterior neck mass. Laryngeal endoscopy with a 70-degree rigid endoscope demonstrated a large retropharyngeal mass completely obstructing the view of the larynx. Computed tomography (CT) scan revealed a large multinodular goiter with suprahyoid and retrosternal extension, resulting in displacement of the trachea. INTERVENTIONS AND OUTCOME: The mass was excised completely under general anesthesia and intubation was done under fiberoptic bronchoscopy guidance. The mass was sent for histological analysis, which confirmed the diagnosis of Hashimoto thyroiditis. CONCLUSION: Eventually, upon follow-up at three months post excision, no evidence of recurrence was detected.
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INTRODUCTION AND IMPORTANCE: Schwannomas are relatively uncommon, benign, slow-growing neoplasms, which are derived from schwann cells that can arise from any cranial, peripheral, or autonomic nerves. The involvement of the palate is a rare presentation and hardly reported in the literature. CASE PRESENTATION: Here, we report the case of a 39-year-old woman with a history of a foreign body sensation in the throat and difficult swallowing. CLINICAL FINDINGS AND INVESTIGATIONS: Oral examination showed a smooth, non-tender, right-sided, soft palate mass. Computed tomography (CT) scan revealed a well-defined, non-enhancing, homogenous pedunculated soft tissue mass arising from the posterior edge of the right side of the soft palate. INTERVENTIONS AND OUTCOME: The mass was excised completely under local anesthesia in the clinical setting using a CO2 surgical laser. The mass was sent for histologic analysis, which confirmed the diagnosis of a benign schwannoma. CONCLUSION: Eventually, upon follow-up at six months post excision, no evidence of recurrence was detected.
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OBJECTIVES: To evaluate the incidence and risk factors of Venous thromboembolism (VTE) among total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients following surgery. Methods: We conducted a retrospective review of electronic medical records of consecutive patients between January 2010 and January 2015 who underwent TKA or THA at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Results: The incidence of symptomatic VTE was 1.9% (17 events, 95% CI: 1.1-2.8) in 756 patients who underwent 889 surgeries. All VTE cases developed before hospital discharge. Twelve (1.4%) patients developed pulmonary embolism, and 5 (0.6%) patients developed deep vein thrombosis. The majority of patients (n=557, 62.7%) underwent surgery for single TKA, and 138 (15.5%) patients underwent bilateral arthroplasty. Based on univariate risk analysis, bilateral arthroplasty was the only potential predictor for VTE after surgery. Conclusion: The rate of symptomatic VTE in a Saudi population following arthroplasty is low and comparable to the international data. However, efforts and more trials are needed to further improve in-hospital thromboprophylaxis measures.