ABSTRACT
Technetium-99m sestamibi single-photon emission computed tomography/computed tomography (99mTc-sestamibi SPECT/CT) is a mainstay of the pre-operative localization of parathyroid lesions. We report here the case of a 30 year-old woman with a fortuitously discovered 2 cm cervical mass for which a parathyroid origin was originally suspected due to its retro-thyroidal localization and a personal history of nephrolithiasis. Normal serum calcium and parathyroid hormone (PTH) levels excluded primary hyperparathyroidism, raising suspicion of a non-functional parathyroid adenoma, and SPECT/CT imaging showed that the mass was 99mTc-sestamibi-avid. Fine-needle aspiration (FNA) was performed; cytology was non-diagnostic but the needle washout was negative for thyroglobulin, calcitonin and PTH, arguing against a thyroidal or parathyroidal origin of the mass. Core needle biopsy revealed a schwannoma, ostensibly originating from the recurrent laryngeal nerve; upon surgical resection, it was finally found to arise from the esophageal submucosa. This case illustrates the fact that endocrinologists, radiologists, nuclear medicine, head and neck, and other specialists investigating patients with cervical masses should be aware that schwannomas need to be considered in the differential diagnosis of focal 99mTc-sestamibi uptake in the neck region.
Subject(s)
Adenoma , Neurilemmoma , Parathyroid Neoplasms , Technetium Tc 99m Sestamibi , Humans , Female , Parathyroid Neoplasms/diagnostic imaging , Parathyroid Neoplasms/pathology , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/diagnosis , Adult , Neurilemmoma/diagnostic imaging , Neurilemmoma/pathology , Neurilemmoma/diagnosis , Diagnosis, Differential , Adenoma/diagnostic imaging , Adenoma/diagnosis , Adenoma/pathology , Adenoma/metabolism , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Single Photon Emission Computed Tomography Computed Tomography , RadiopharmaceuticalsABSTRACT
OBJECTIVES: To review treatment and outcomes in patients with congenital cricoid cartilage malformation. METHODS: Retrospective analysis of patients with diagnosis of congenital cricoid malformation (CCM) treated in a single tertiary pediatric referral center between 1985 and 2022. Patients were grouped according to the morphology of the cricoid cartilage that was diagnosed during endoscopy. We reviewed the treatment strategy(s), decannulation rate, complications, and functional outcomes. RESULTS: Twenty-nine patients were grouped into four morphological subtypes of cricoid cartilage: 10 patients had a hypoplastic cricoid, eight had an elliptic shape, five had severe anterior thickening, and six an accentuated V-shape posterior cricoid plate. Twenty-four patients underwent surgery, and five were closely followed up without surgical treatment. Eight patients had a tracheostomy prior to surgery, and the majority had a hypoplastic cricoid. Most patients (20 out of 24) required additional procedures postoperatively to achieve an age-appropriate airway. Thirteen patients needed endoscopic dilatation(s) and granulation tissue removal; four needed more aggressive treatment, and three patients required revision open surgery. Decannulation was achieved after a median of 4.5 months in all previously tracheostomized patients. Endoscopy at the last follow-up showed an age-appropriate airway in 27 patients; 20 patients had normal oral feeding, and 11 patients had a normal voice. CONCLUSION: Endoscopy is important to diagnose CCM and most of the time patients would need only watchful waiting. In this report, surgery was required for patients who continued to remain symptomatic and had a compromised airway. The type of surgery depends on the type of cricoid malformation and the grade of stenosis. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:3185-3191, 2023.
Subject(s)
Airway Obstruction , Laryngostenosis , Child , Humans , Airway Obstruction/etiology , Airway Obstruction/surgery , Cricoid Cartilage/surgery , Laryngostenosis/etiology , Laryngostenosis/surgery , Laryngostenosis/diagnosis , Retrospective Studies , Treatment OutcomeABSTRACT
Acute tonsillitis is a common disease. The tonsillar infection can be uni- or bilateral with a high rate of spontaneous recovery. In some cases, a peritonsillar cellulitis or abscess can occur, characterized by an inflammatory reaction of the peritonsillar space. The red flags consist of a gradually worsening odynodysphagia, an ipsilateral swelling of the soft palate, a trismus (infrequent in children) and in some cases a change of voice (« hot potato voice ¼). A needle puncture of the swollen soft palate is then required. If pus is found, a surgical drainage by either hot tonsillectomy or incision under local anesthesia with an appropriate antibiotic therapy must be carried out.
L'amygdalite aiguë représente un motif de consultation fréquent. Elle est caractérisée par une infection amygdalienne uni ou bilatérale de résolution spontanée dans la majorité des cas. Dans certaines situations, celle-ci se complique d'un phlegmon ou d'un abcès périamygdalien caractérisés par respectivement une réaction inflammatoire ou du pus dans l'espace périamygdalien. Les signes d'alerte sont une odynodysphagie sévère latéralisée, une tuméfaction ipsilatérale du voile du palais, un trismus (rare chez l'enfant) et une modification de la voix. L'examen complémentaire comprend une ponction de la tuméfaction du voile à la recherche de pus. En cas d'abcès avéré, un drainage chirurgical en urgence par amygdalectomie à chaud ou incision sous anesthésie locale est préconisé en plus d'une antibiothérapie adéquate.
Subject(s)
Peritonsillar Abscess , Child , Humans , Peritonsillar Abscess/diagnosis , Peritonsillar Abscess/therapyABSTRACT
This article proposes, through a literature review, an updated summary of the initial evaluation, treatment and follow-up of sudden sensorineural hearing loss (SSNHL) based on current guidelines. SSNHL occurs within 72h with at least 30dBHL loss over 3 consecutive frequencies. Diagnosis is medical in the emergency setting, the etiological workup aims at treating known causes, while different pathophysiological hypotheses exist for idiopathic SSNHL. Controversy exists regarding optimal management due to frequent spontaneous recovery. However, corticotherapy remains widely accepted. Prognosis depends on initial severity, age, associated vertigo and shape of the audiometric curve. Hearing rehabilitation in proposed for significant residual hearing loss.
Cet article propose, par une revue de la littérature, une synthèse actualisée de l'évaluation initiale du traitement et du suivi des surdités brusques (SB). La SB est une surdité de perception survenant en moins de 72 heures, et d'au moins 30 dBHL sur 3 fréquences consécutives. De diagnostic clinique, le bilan étiologique vise à dépister les étiologies connues comme un traumatisme acoustique, un accident vasculaire ou un neurinome de l'acoustique. Plusieurs hypothèses physiopathologiques existent pour les SB idiopathiques: virale, vasculaire, pressionnelle et autoimmune. Le traitement est controversé vu la récupération spontanée fréquente, néanmoins la corticothérapie reste largement acceptée. Le pronostic dépend de la sévérité de la perte auditive, l'âge, les vertiges et la forme de la courbe audiométrique. En cas de séquelles auditives, différentes options de réhabilitation auditive sont disponibles.