Association of hemorrhagic shock and pulmonary embolism following the administration of dienogest in a patient diagnosed with adenomyosis.

Adenomyosis is a chronic disease associated with abnormal uterine bleeding and debilitating pain with severely reduced quality of life in many affected women. Primary strategies for its management encompass surgical interventions, hormonal therapy, or a synergistic blend of these therapeutic modalities. Dienogest (DNG), a new progestin, is primarily utilized to treat adenomyosis due to its exceptional selectivity for the progesterone receptor. In this uncommon case report, we introduce a 42-year-old woman who experienced hemorrhagic shock as a result of uterine bleeding and pulmonary embolism that occurred while a patient was undergoing dienogest therapy for uterine adenomyosis. This situation necessitated blood transfusion and introduction of drugs then an emergency hysterectomy was scheduled followed by the initiation of anticoagulation. We hypothesize that the emergence of pulmonary embolism was intimately tied to adenomyosis, and the occurrence of hemorrhagic shock was likely due to the intake of dienogest.

Miliary brain tuberculomas and tuberculous meningitis presenting with stroke.

Even though it is an uncommon presentation of tuberculosis, tuberculous meningitis is one of the most deadly manifestations. We report a case of a 6-year-old female who presented to the emergency room for left hemiparesis. Cerebral CT and MRI showed a right ischemic stroke with severe leptomeningitis in the medial cranial fossa. Numerous miliary tuberculomas were demonstrated, as well as a moderate hydrocephalus. Lumbar puncture revealed meningitis, and the mycobacterium tuberculosis polymerase chain reaction from CSF was positive. Pulmonary micronodules on chest CT were suggestive of tuberculosis. The clinical and radiological features, as well as the management approaches of this unusual disease complex, are addressed.

Is vestibular schwannoma really a benign tumor? Case report and review.

Introduction: Vestibular schwannoma (VS) is a benign tumor that develops from Schwann cells of the eighth cranial pair, mainly in the cerebellopontine angle. Case Presentation: We report the case of a 30-year-old female patient who developed left otalgia associated with neglected tinnitus, the evolution of which was marked by the development of a static cerebellar syndrome and a behavioral disorder, whose brain MRI revealed a locally advanced process in the cerebellopontine angle at the expense of the vestibulocochlear nerve, in favor of a VS, complicated by involvement of the tonsils, which unfortunately led to the patient's death. Discussion: VS, formerly known as acoustic neuroma, is an extra-axial intracranial tumor that accounts for over 80% of pontocerebellar angle tumors, and is secondary in the majority of cases to inactivation of the neurofibromatosis type 2 (NF2) tumor suppressor gene, either by mutation of the NF2 gene or loss of chromosome 22q. In the majority of cases, it is unilateral and solitary, but in almost 8% of cases, it is associated with NF2. Cerebral MRI is the examination of choice for the detection, characterization, and diagnosis of VS without the need for biopsy, mainly with T1-weighted sequences before and after gadolinium injection. Treatment is based essentially on surgery or radiosurgery, depending on the size, impact, and expertise of the treatment team. Conclusion: VS remains an important intracranial tumor entity, which can be life-threatening in cases of advanced local invasion.

A cerebral lymphoma mimicking a meningioma: case report.

Introduction: Cerebral lymphoma is a rare and aggressive brain tumor. It accounts for 1% of all non-Hodgkin's lymphomas (NHL) and 2% of all brain tumors. Untreated brain lymphoma has a very poor prognosis, with an overall life expectancy of around 1.5 months. Case presentation: The authors report the case of a 35-year-old patient, with no previous pathological history, who presented for 3 weeks with deafness and recently aggravated otalgia. In MRI, brain imaging revealed a formation initially suggestive of an aggressive meningioma, and the histological study of the operative specimen was in favor of a diffuse large-cell non-germ-center B NHL. Clinical discussion: Primary central nervous system lymphoma is an extra-nodal NHL localized to the brain, meninges, spinal cord, and eyes. In 90% of cases, these are diffuse large B-cell lymphomas, the other types being poorly characterized low-grade lymphomas, T-cell lymphomas, and Burkitt's lymphomas. MRI with gadolinium contrast is the gold standard for diagnosis which enhancement is homogeneous and well-limited, frequently associated with perilesional vascular edema. In T2-weighted sequences, there is a weak signal with restricted diffusion on diffusion-weighted imaging. The management of brain lymphoma is currently based on chemotherapy with high-dose methotrexate combined with the other agents, mainly rituximab. Conclusion: Cerebral lymphoma remains a non-negligible entity of central nervous system tumors, which can be confused with several other tumors, mainly glial and meningioma.

Diagnostic criteria for myocarditis on cardiac magnetic resonance imaging: an educational review.

Acute myocarditis represents one of the most mysterious acute cardiovascular diseases due to the great diversity of its clinical presentation, ranging from simple symptoms such as flu-like syndrome to lethal conditions such as cardiogenic shock or sudden cardiac death. The diagnosis will be suspicious in the presence of chest pain in a subject with risk factors, and guided mainly by the ECG, biological markers, trans-thoracic echocardiography, and the cardiac MRI. In this sense, and returning to the pathophysiological bases of this condition, the positive diagnosis will rely mainly on the detection of tissue abnormalities secondary to the myocardial inflammatory storm. Cardiac MRI represents a diagnostic pillar, given the information it can provide, both in analyzing the morphology, and the myocardial function but also tissue abnormalities that represent the main element of the diagnostic criteria of Lake Louisse.

Association between Cowden syndrome and Lhermitte-Duclos disease: A case report of an uncommon Genetic Hamartomatous Disorder.

The dysplastic gangliocytoma of the cerebellum, also known as Lhermitte-Duclos disease, is an uncommon hamartomatous lesion in the posterior fossa with some distinctive neuroradiological characteristics. It can happen in combination with Cowden syndrome or sporadically. Cowden disease, or multiple hamartoma-neoplasia syndrome, is a rare autosomal dominant condition which is characterized by mucocutaneous lesions and systemic malignancies. We present a case of Lhermitte-Duclos disease and Cowden disease occurring in adult patients. The clinical and radiological features as well as the management approaches of this unusual disease complex are addressed.

Spontaneous gastric perforation in a newborn: About a case.

Spontaneous neonatal gastric perforation is rare. We report a case of a newborn from a pregnancy and birth with no complications, who presented on day 5 of life with sudden severe abdominal distension, and subsequently bilious vomiting. The radiography of the abdomen without preparation showed a massive pneumoperitoneum. The CT scan showed a pneumoperitoneum more accentuated at the supra-mesocolic level with a defect in the anterior wall of the stomach. The laparotomy found a perforation in the anterior gastric wall, which was sutured in one plane. The postoperative course was simple. The evolution of spontaneous gastric perforations in newborns is usually favorable. The key to avoiding complications is obviously to make a good diagnosis and perform the correct surgical treatment as soon as possible.

Acute pancreatitis revealing an isolated hydatid pancreatic cyst simulating a pseudocyst: A case report.

Hydatid disease is a worldwide public health problem, especially in endemic countries, caused by the larval stage of Echinococcus granulosis. The pancreatic location of this disease is exceptional, representing only 1% of all possible locations, making this a widely misdiagnosed entity. We report a case of a 42-year-old man with a history of alcoholism and recurring abdominal pain, who presented to the emergency department with acute pancreatitis revealing a hydatid pancreatic cyst mimicking as a pseudocyst of the pancreas. The diagnosis was established using computed tomography and magnetic resonance imaging.

Magnetic resonance imaging of non-pueperal total uterine inversion due to a leiomyoma.

We report a case of a 43-year-old woman admitted to the emergency's department for an externalized mass through the vulva. The exploration by magnetic resonance imaging shows complete uterine inversion caused by a giant leiomyoma. Non-puerperal uterine inversion is a rare condition that is usually difficult to diagnose clinically. The role of imaging, specifically magnetic resonance imaging, is essential for the diagnosis, to establish the classification and to adapt the management.

Primary synovial osteochondromatosis of the ankle: A case report and review of the literature.

Primary synovial osteochondromatosis of the ankle is a rare and benign disease of the young adult. It is characterized by the formation of multiple nodules of hyaline cartilage under the synovium. It is usually asymptomatic but can sometimes be revealed by pain or joint mobility disorders. X-rays and CT scans can easily diagnose calcified osteochondromas, but ultrasound and MRI can provide a quicker diagnosis by visualizing non-calcified foreign bodies. Surgery under arthroscopy remains the best therapeutic choice, however, this pathology still causes recurrence in less than 1/3 of cases.

Complete common mesentery revealed by acute perforated appendicitis: case report and review of the literature.

Intestinal malrotation in children is a rare aberration, due to a halt in the rotation and attachment of the primitive gut, it can be asymptomatic if the rotation terminates at 90 degrees, which manifests itself in unusual forms of appendicitis as in our observation, or dangerous in cases of inadequate common mesentery and worsened by small intestine volvulus. This 12-year-old boy experienced abdominal discomfort in the hypogastrium and left iliac fossa 4 days before admission. The pain had been developing in a feverish setting, and the clinical examination had revealed abdominal sensitivity. A biological inflammatory syndrome was detected throughout the biological workup, the CT scan allowed the diagnosis of acute appendicitis on a complete common mesentery, and the patient underwent a laparotomy appendectomy. Even though children frequently experience acute appendicitis in its conventional form, it is nevertheless highly challenging to identify in its atypical forms when intestinal malrotation is involved. An abdominopelvic CT scan is used to make the diagnosis, and appendectomy, preferably with laparoscopy, is the recommended course of action.

Extraskeletal Ewing sarcoma: A case report.

Extraskeletal Ewing sarcoma is a rare tumor mainly affecting young people, of poor prognosis with very high mortality rates especially in metastatic forms. It can affect different locations, without specific clinical signs, which delays the diagnosis. Imaging plays an important role for diagnosis, staging, preoperative assessment and surveillance. The diagnosis should be set early to a better management. We report a case of a 30-year-old man with a large extraskeletal Ewing sarcoma of the left thigh. The patient was initially treated with chemotherapy. Unfortunately, the tumor has increased in size making surgery impossible. The patient ultimately died of pulmonary metastases.

Low-grade fibromyxoid sarcoma arising in the mediastinum: Case report and review of the literature.

Low-grade fibromyxoid sarcoma (LGFMS) is a rare tumor characterized by bland histological features and aggressive clinical course, it is a distinctive variant of fibrosarcoma with high metastasizing potential and sometimes a long interval between tumor presentation and metastasis, the most common anatomic locations of occurrence are the lower extremities, thorax, inguinal area, and upper limbs, Here, we present the case of a 29-year-old patient with a deceptively benign-appearing mass arising in the mediastinum that had been discovered on computed tomography, a biopsy under cervicotomy was performed and histopathological examination revealed low-grade fibromyxoid sarcoma. In conclusion, LGFMS can arise in the mediastinum, and physicians should consider this entity as a differential diagnosis in the presence of such mass.