RESUMEN
Persistent trigeminal artery disease is one of the most common types of persistent carotid-vertebrobasilar anastomoses. Usually, it is unilateral, and it can be discovered with a magnetic resonance angiography (MRA), computed tomography angiography (angioCT), or classic angiography exam. It can be associated with non-specific symptoms, such as headaches, or more specific ones, such as III or VI nerve palsy or trigeminal neuralgia, but most of the time it goes undetected, being an incidental finding and not causing any symptoms. On MRA and angioCT, it has the characteristic "tau" sign. We present the case of a young woman who, incidentally, discovered this malformation after undergoing an MRA. She had been experiencing a persistent headache without a known cause, which did not improve despite medication.
RESUMEN
Solitary fibrous tumors are very rare in the pleura, and they are generally found incidentally. Even though they can potentially become malignant and metastasize, they have minimal clinical symptoms and can still be benign. Due to the low incidence of these tumors, there is no standard of therapy beyond surgical resection. We present an asymptomatic case of a large, rapidly expanding solitary fibrous tumor of the pleura in an elderly female.
RESUMEN
Thoracic aortic dissection (TAD) is an uncommon but potentially fatal complication of coronary artery bypass graft (CABG). Most patients present to the emergency room with severe chest pain, shortness of breath, or after a syncopal episode. Asymptomatic patients pose a challenge to diagnosis. The authors present a case of an 82-year-old male, who was found to have an incidental finding of a 5-cm ascending aortic aneurysm with an intimal dissection flap four months after CABG. Extensive workup on possible risk factors such as underlying aortic diseases, genetic conditions, and hypertensive crisis proved noncontributory. Aggressive blood pressure control was achieved, and the patient was observed in the intensive care unit before discharge with follow-up. The purpose of this case report is to alert clinicians of TAD after CABG and highlight the importance of developing a protocol for follow-up and monitoring of patients who have undergone CABG, as complications can be asymptomatic. Early and accurate diagnosis of TAD as a complication of CABG is essential to improving survival rates.
RESUMEN
Incidentaloma, a term that embodies the detection of certain problems during the performance of unreasonable investigations, resonates in the medical field. Retroaortic coronary sign is a recently recognized echocardiographic feature of the anomalous coronary artery. It is typically associated with anomalies of the left coronary artery, especially the left circumflex artery. As far as has been monitored, few echocardiographic signs that correlate with this feature have been identified. This feature often remains underdiagnosed on transthoracic echocardiograms due to confusion with artifacts, calcifications, and other cardiac structures. A 45-year-old male patient underwent regular cardiac routine assessment. Retroaortic anomalous coronary (RAC) sign was incidentally detected by transthoracic thoracic echocardiogram; consequently, the retroaortic route of the coronary artery was suspected. Coronary computed tomography angiography was requested to confirm the seen echocardiographic signs. After a 3D reconstruction imaging, the left circumflex retroaortic course was identified with right coronary sinus origin. This case ensures the importance of transthoracic echocardiography as a noninvasive tool in diagnosing anomalous coronary arteries. These anomalies are usually diagnosed by coronary computed tomography angiography and coronary angiography, mainly in the presence of retroaortic coronary sign or "crossed aorta sign."
RESUMEN
We present a rare double aortic arch (DAA) diagnosis incidentally on CT in a 60-year-old male who presented with pneumonia. DAA is a vascular ring that typically manifests in infants or children due to compression of the esophagus or trachea, resulting in dysphagia or dyspnea. Diagnosis of DAA in adulthood is usually due to the delayed emergence of obstructive symptoms. We present a case of DAA in an adult patient without dysphagia or dyspnea. We discuss factors that can lead to the presentation of DAA in adults. These include an absence of associated congenital disabilities, insufficient tracheal or esophageal constriction in childhood and the onset of compressive symptoms later in life from decreased vascular compliance.
RESUMEN
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) infection predominantly affects the respiratory system, it has also been found to be responsible for several gastrointestinal effects due to its capability to attack angiotensin-converting enzyme (ACE) type 2 cells in various parts of the body. Several cases of radiologically confirmed thyroiditis, axillary lymphangitis, and acute pancreatitis related to COVID-19 infection have been reported, which seem to arise from a direct cytotoxic effect of the virus itself. This case report presents an incidental 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) finding of mild pancreatic inflammation/pancreatitis in an otherwise asymptomatic patient undergoing routine imaging as part of the staging process following stem cell transplant, who had recently recovered from a severe form of COVID infection. This case highlights the fact that COVID can trigger insidious inflammatory processes in a variety of organs often remaining clinically undetectable until resultant end-organ damage causes incipient clinical symptoms.
RESUMEN
Intestinal nonrotation is a subtype of malrotation occurring when the midgut fails to rotate before returning to the peritoneal cavity between weeks 8-10 of development. Though sometimes presenting as volvulus during the neonatal period, a subset of patients remains asymptomatic and are identified incidentally as adults. When patients with intestinal nonrotation present with abdominal symptoms, there exists a diagnostic dilemma for the treating surgeon. We present the case of a patient who presented with acute abdominal pain and vomiting, with radiographic findings of intestinal nonrotation and no other acute pathology. Symptoms spontaneously resolved with conservative management for likely etiology of viral gastroenteritis. At the one-month follow-up, the patient had no residual or recurrent symptoms, with no further interventions planned.
RESUMEN
Pott's puffy tumor (PPT) is a localized forehead swelling with underlying subperiosteal abscess formation and osteomyelitis of the frontal bone. It is a rare complication of frontal sinusitis, and it is especially rare in adult females. A careful review of existing literature identified only 17 cases in adult females. Treatment requires antibiotic therapy and often surgical drainage/debridement. Here, we present a case of a 76-year-old female diagnosed with PPT. She was placed on amoxicillin-clavulanate 875 mg twice daily for six weeks. Her symptoms resolved with the antibiotic course, and she is scheduled for otolaryngology (ENT) follow-up, including dedicated sinus computed tomography (CT). While Pott's puffy tumor is a rare manifestation of chronic sinusitis, it is important to recognize and treat to avoid serious intracranial complications.
RESUMEN
A pericardial cyst is a rare and benign cause of a mediastinal mass. They are frequently asymptomatic and are usually incidental findings on imaging. Symptoms may include persistent cough, atypical chest pain, dysphagia, and dyspnea. Diagnosis is usually established with the aid of imaging, including a chest x-ray, a computed tomography (CT) scan, and magnetic resonance imaging (MRI). Therapeutic options include surgical resection or aspiration for large and/or symptomatic cysts, whereas conservative management with routine follow-up is advised for small or asymptomatic cysts. We herein describe the case of a 48-year-old lady, who presented with clinical features suggestive of acute cholecystitis, with an incidental finding of a pericardial cyst, measuring approximately 10.1 cm x 8.7 cm x 10.7 cm. The patient underwent video-assisted thoracoscopic surgery (VATS) for excision of the pericardial cyst. She had an uneventful recovery and was discharged on the second post-operative day. At six months, there was no evidence of disease recurrence.
RESUMEN
Branchial cleft cysts (BCCs) are congenital anomalies that can be found in children and young adults. The exact incidence of these anomalies is unknown as the diagnosis may be missed. Branchial cleft cysts can present in a variety of locations depending on the cleft they are derived from. Regardless of location, branchial cleft cysts are rather benign. However, a variety of complications can arise due to infection, and infections are often recurrent. Diagnosis may occur incidentally on imaging studies as such studies are often performed to rule out a variety of complications from infections alone. Treatment includes first treating any infection and any such complications that exist, followed by surgical excision. Surgical excision is performed to prevent the recurrence of infection. A case of a 14-year-old female with a painful swollen throat, trismus, and difficulty swallowing is reported.