Bilateral Primary Adrenal B-Cell Lymphoma Diagnosed by Workup for Primary Adrenal Deficiency.

Primary adrenal lymphoma (PAL) often occurs bilaterally and is a rare malignancy of old age. Workup for primary adrenal insufficiency often unmasks this underlying grave pathology. In this article, we present a case of a 73-yearold patient who presented with features of primary adrenal insufficiency and renal colic. Diagnostic abdominal imaging revealed bilateral suprarenal masses as the cause of adrenal gland destruction and the patient's symptoms. FDG PET-CT scan and histopathology confirmed the diagnosis of mature bilateral B-cell primary adrenal lymphomas. Though the patient showed an excellent initial response to the first four chemotherapy cycles, a relapse resulted in metastatic disease. This article highlights the PAL's disease course, imaging features, and management dilemma due to Chemotherapy's side effects and a higher recurrence rate. Keywords: Primary adrenal lymphoma, Primary adrenal insufficiency, R-CHOP, Role of imaging.

Intratendinous Ganglionic Cyst of Semimembranosus: A Rare Cause of Thigh Swelling.

Ganglionic cysts are common swellings of the hands. Various mechanisms are thought to generate these lesions, such as cystic mucoid degeneration and inflammation. Typically, ganglionic cysts are asymptomatic but can cause pain. They usually originate from soft tissues like ligaments, joint capsules, and sheaths of tendons. We present the case of a 37-year-old man with mid-thigh swelling with intermittent mild pain. However, no systemic symptoms like fever or weight loss were present. Workup unmasked the presence of a rare intratendinous ganglionic cyst. Ultrasonography (USG) and magnetic resonance imaging (MRI) can confirm the presence of ganglionic cysts and estimate their sizes and relationships with the surrounding structures. Treatment options range from observation and conservative management to interventions like aspiration and surgical excision.

Coexistence of diabetic ketoacidosis and thyrotoxicosis: a jeopardy of two endocrine emergencies.

Simultaneous occurrences of diabetic ketoacidosis (DKA) and thyroid storm have long been known, but only a few cases have been reported to date. Both these endocrine emergencies demand timely diagnosis and management to prevent adverse outcomes. Due to the similarities in their clinical presentation, DKA can mask the diagnosis of thyroid storm and vice versa. This case report describes a patient with Graves' disease who presented to the emergency department with nausea, vomiting and abdominal pain. He was found to have severe DKA without an explicit history of diabetes mellitus. Further evaluation revealed that the patient also had a concomitant thyroid storm that was the likely cause of his DKA. Early recognition and appropriate management of both conditions resulted in a favourable outcome. This paper emphasises that a simultaneous thyroid storm diagnosis should be considered in patients with DKA, especially those with a known history of thyroid disorders.

Zinner Syndrome Unmasked by Workup for Renal Colic and Uncontrolled Hypertension.

Zinner syndrome is a rare hereditary disorder of the mesonephric duct. The triad of the absence of one kidney, ipsilateral cystic dilatation of the seminal vesicle, and ejaculatory duct obstruction makes the diagnosis. Mostly, it is asymptomatic. However, genitourinary manifestations and workup for the incidental absence of one kidney often uncover the disease. Ultrasound and CT scan can identify the absence of a kidney and seminal vesicle cyst, while MRI is the gold standard for diagnostic elaboration of the pelvic anatomy. In this article, we have presented a 51-year-old male patient who presented with renal colic and hypertension. Radiological investigations for the renal colic uncovered the diagnosis of Zinner syndrome incidentally. This case highlights the incidental nature, variability in the clinical presentation, and the diagnostic challenges of this rare disorder. It also emphasizes on the radiologist for a careful evaluation of the pelvic images in patients with unilateral absence of a kidney.

Bilateral Epiploic Appendagitis: A Rather Benign but Diagnostically Challenging Cause of Acute Abdominal Pain.

Epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. It is a benign and self-limited condition but mimics other underlying causes of acute abdominal pain like acute diverticulitis, acute appendicitis, acute cholecystitis, etc. Inaccurate diagnosis can lead to iatrogenic adverse outcomes. To the best of our knowledge, the present report represents the first case of bilateral EA involving both cecum and descending colon. The patient presented with symptoms of bilateral iliac fossa pain. Conservative management and close outpatient follow up resulted in a successful clinical outcome with no recurrence of symptoms. This article illustrates that clinicians and radiologists should include this etiology among differential diagnoses of patients presenting with acute abdominal pain, as it might prevent unnecessary hospitalizations, antibiotic therapy, and unwarranted surgical interventions.

Heterotopic Pregnancy - A Diagnostic Challenge. Six Case Reports and Literature Review.

Heterotopic pregnancy is defined as the simultaneous presence of intrauterine and ectopic pregnancies. It is a rare condition, but due to the increasing use of artificial reproductive techniques, the incidence of heterotopic pregnancy is increasing. Most of the patients with heterotopic pregnancy have a previous history of infertility or tubal diseases. In this case series, we are presenting six cases of heterotopic pregnancy. Three of them had a history of assisted reproductive technique: one patient had in vitro fertilization with three embryos transferred, and two patients received follicular stimulating hormone therapy. In one of the cases, heterotopic pregnancy was missed on an initial transabdominal scan, and in the following weeks, it was diagnosed on transvaginal ultrasound. Five patients underwent laparoscopic salpingectomy, and one patient had laparotomy and then a salpingectomy was done. Follow-up ultrasound scans for intrauterine pregnancy (IUP) showed abortion of the IUP, except in one patient who delivered a healthy full-term baby via spontaneous vaginal delivery. Therefore, there is a need to develop diagnostic criteria to rule out heterotopic pregnancy if the patient underwent any type of assisted reproductive techniques. We are emphasizing the need for more careful scanning of the adnexa via transvaginal ultrasound, especially in high-risk patients, even if the intrauterine gestation is confirmed.