Nonpuerperal uterine inversion caused by an adenosarcoma: A case report.

INTRODUCTION: Eighty-five per cent of uterine inversions are puerperal. Non-puerperal uterine inversion is usually caused by tumours that exert a traction force on the fundus of the uterus. This causes the uterus to be partially or completely inverted. It is commonly related to benign tumours like submucosal leiomyomas. Nevertheless, malignancies are an infrequent association. CASE PRESENTATION: We report a case of a 35-year-old female patient, medically and surgically free, gravida0 para0, complaining of menometrorrhagia associated with pelvic pain for 2 years. A suprapubic ultrasound scan showed an enlarged, globular uterus with a heterogeneous, undefined mass of 49 mm in size. MRI scan showed the appearance of a U-shaped uterine cavity and a thickened inverted uterine fundus with an endometrial infiltrating mass of 25 mm. Intraoperative exploration showed uterine inversion involving the ovaries; the fallopian tubes and the round ligaments and a necrotic intracavitary mass. The malignancy of the tumor was confirmed through anatomopathological examination as Adenosarcoma. CONCLUSIONS: Uterine inversion is rare outside the puerperal period, and malignant etiology must not be overlooked. Therefore, comprehensive care with meticulous etiological investigation is crucial.

Hydatid cyst in the parotid gland, a rare localization of the disease: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid cysts are often found in the liver or lungs. As for the parotid localization, it remains exceptional even in endemic areas and presents as a tumor of the parotid thus representing a challenge to the practitioner. CASE PRESENTATION: A 54-year-old male farmer presented with a swelling in the left parotid gland region evolving over the past 2 years. Physical examination revealed a non-tender and mobile swelling in the left parotid region, the overlying skin was normal. Magnetic resonance imaging showed a cystic lesion of the left parotid gland. Fine-needle aspiration cytology (FNAC) yielded a clear fluid with a few benign epithelial cell. A superficial parotidectomy was performed. Histopathological examination confirmed the presence of a hydatid cyst in the parotid gland. CLINICAL DISCUSSION: Parotid hydatid cyst is exceptional. However, it can be suspected in the context of an isolated parotid cystic mass in an endemic area, even in the absence of any other associated location. CONCLUSION: Hydatid cysts of the parotid gland have a polymorphic and a specific symptomatology and require surgical removal.

A superior ophthalmic vein thrombosis following an acute pansinusitis: A case report.

INTRODUCTION AND IMPORTANCE: Superior ophthalmic vein thrombosis (SOVT) is a very rare condition that can occur following either septic or aspetic causes. Early recognition and management is important in order to avoid vision-threatening and fatal complications. CASE PRESENTATION: A 28-year-old man presented with orbital cellulitis complicating acute pansinusitis. CT scan revealed ipsilateral SOVT. The patient received intravenous antibiotics and anticoagulation with strict ophthalmic monitoring. No orbital complications were recorded during the course of treatment. CLINICAL DISCUSSION: SOVT is caused either by septic or aseptic causes. Treatment depends on the etiology. Corticosteroids and anticoagulants are controversial. CONCLUSION: Early diagnosis is key to successful management of SOVT.

Tuberculous tenosynovitis of the hand: A challenging diagnosis.

Tuberculous tenosynovitis of the hand is a very rare condition. Herein, we report the case of tuberculous tenosynovitis of the hand in a 32-year-old woman. We highlight the success of anti tuberculosis drugs alone without resort to surgical treatment.

Prevalence and prognosis of Computed-Tomography defined sarcopenia in Tunisian cirrhotic patients.

INTRODUCTION: Sarcopenia is an underdiagnosed and understudied complication of cirrhosis, especially in patients not undergoing liver transplantation. AIM: To evaluate the prevalence and prognostic impact of radiological sarcopenia in non-transplanted cirrhotic patients. METHODS: Longitudinal retrospective study including cirrhotic patients explored by an abdominal CT scan, over a period of 6 years, in a single gastroenterology department in Tunisia. Sarcopenia was defined according to transversal psoas muscle thickness normalized to height (TPMT/h) in the sagittal CT slice. Two groups were defined: Group 1 with sarcopenia (TPMT/h <16.8mm/m); and Group 2 without sarcopenia (TPMT/h ≥16.8mm/m). RESULTS: Seventy patients were included (mean age=62 years). The mean MELD score was 12.81 and the mean TPMT/h of 13.56 mm/m. Forty-four patients were sarcopenic (63%). When included, the 2 groups' baseline characteristics were comparable except for women predominance and refractory ascites in group 1. After an average of 21-month follow-up, sarcopenia was associated with a higher number of complications per patient (p=0.013) and a longer average hospital stay duration per patient (p=0.001). Overall survival was significantly decreased in sarcopenic patients (p=0.035). Survival rates at 6 months, 1 year, and 2 years were respectively 42%, 30%, and 24% in Group 1 versus 67%, 40%, and 27% in Group 2. Sarcopenia was an independent factor of mortality in multivariate analysis (OR=2.5; 95% IC [1.02-6.16]; p=0.045). CONCLUSION: Sarcopenia is frequent and an independent poor prognostic factor in cirrhosis. TPMT/h is an easy and often available method for sarcopenia diagnosis.

Intracochlear Hemorrhage: A Rare Cause of Sudden Sensorineural Hearing Loss.

Inner ear hemorrhage is an extremely rare cause of sudden sensorineural hearing loss with few cases reported in the literature. We report the case of a 30-year-old male who presented with a sudden left ear hearing loss, with no tinnitus nor vertigo. The audiogram revealed a profound left sensorineural hearing loss. An MRI of the brain and internal auditory canal was performed 3 weeks after and revealed an increased signal intensity on T1-weighted (T1W) and T2 fluid-attenuated inversion recovery (FLAIR) images in the left cochlea. No other abnormalities were found, in particular no enhancement after intravenous administration of gadolinium. The CISS 3D sequence showed a signal of discreetly lower intensity in the left cochlea compared to the right one. The diagnosis of intracochlear hemorrhage was made. No improvement of the hearing loss has been noted after medical treatment and hyperbaric oxygen therapy.

Pheochromocytoma presenting as fulminant myocarditis mimicking COVID-19 pneumonia.

Adrenergic cardiomyopathy is uncommon but can be fulminant and life-threatening. Nowadays, the need to exclude the possibility of COVID-19 pneumonia in patients with acute dyspnea in a previously healthy adult may cause a delay in the diagnosis.

Primary hepatic large B-cell lymphoma following direct-acting antiviral treatment for hepatitis C.

Hepatitis C virus (HCV) infection is a major public health concern worldwide, raising important medical and economic issues. HCV-related end-stage liver disease is one of the most common indications for hepatic transplantation. Chronic hepatitis C is also assimilated to a systemic disease because of multiple extrahepatic manifestations, including lymphoproliferative disorders. The revolution of HCV treatment with the advent of direct-acting antivirals has significantly improved the management with high antiviral efficacy and good safety profile compared with old regimens, thus allowing good outcomes on hepatic and extrahepatic symptoms. However, with the widespread use of these new agents, controversial concerns about unexpected increasing cases of hepatocellular carcinoma were reported. We now report the case of a patient presenting with HCV-related cirrhosis, treated with direct-antiviral therapy and diagnosed with primary hepatic lymphoma shortly after the end of the treatment.

Spontaneous rupture of large bilateral renal angiomyolipomas in a patient with tuberous sclerosis complex: A case report and literature review.

Enormous bilateral renal angiomyolipoma (AML) are extremely rare, their spontaneous bleeding also called Wunderlich's syndrom (WS) is also an unusual situation. It is considered as a life threatening condition requiring fast and effective care. We present a case of hypovolemic shock due to spontaneous rupture of bilateral giant angiomyolipomas in a 35-year-old female patient with tuberous sclerosis complex (TSC). The hemodynamic instability of the patient leads to an immediate surgery and unilateral nephrectomy was done for the biggest angiomyolipomas. The review of the literature revealed only few cases of spontaneous rupture of renal angiomyolipomas of comparable size.

The Role of Computed Tomography Coronary Angiography in Kawasaki Disease: Comparison with Transthoracic Echocardiography in a 25-Case Retrospective Study.

Although transthoracic echocardiography (TTE) is the first-line examination for the study of coronary lesions in Kawasaki disease, CT coronary angiography (CTCA) is increasingly used and showed good results. Our aim is to evaluate the contribution of CTCA in the detection of coronary lesions and to compare its results with those of TTE. Retrospective study that included 25 patients with Kawasaki disease enrolled in La Rabta University Hospital. The study was conducted over a 4-year period from January 2012 to May 2015. A TTE and a CTCA have been performed for all patients during KD first 3 months of evolution to investigate the coronary artery lesions. There were 23 lesions described on CTCA and not diagnosed with TTE: there were 16 aneurysms, 6 ectasia and 1 case of stenosis. The lesions concerned: LCX in eight cases, RCA in eight cases, LMCA in three cases, and LAD and PDA in two cases each. Differences of description between TTE and CTCA were identified in 14 cases. These discrepancies concerned the type of lesion in seven cases (50%), the size of the aneurysm in five cases (35%) and the shape of the aneurysm in two cases. The CTCA showed its superiority in detecting coronary lesions in our series especially fusiform ones and those interesting distal and posterior network. However, because of its radiating character and its availability, TTE should remain the fist-line examination.

Traumatic cervical spine injuries in a patient with pycnodysostosis.

Pycnodysostosis is a rare hereditary disease, characterized by systemic bone sclerosis. Susceptibility to long bone fractures is characteristic, whereas vertebral fractures are extremely rare. We report a case of a 21-year-old man with a past history of pycnodysostosis and spontaneous leg fractures who was admitted in hospital for a neck pain after a banal fall. Radiological examination revealed C1-C2-C3 posterior arch fractures with a C3-C4 left articular fracture dislocation. A surgical stabilization was decided but refused by the patient. To the best of our knowledge, this is the first publication that reports pycnodysostosis with cervical spine traumatic staged injuries.