RESUMO
We present the case of a 56-year-old man who presented to our accident and emergency department 15 years after a work-based injury to his left thumb.In January 2017, the patient was woken up acutely with excruciating pain in his left thumb with no preceding trauma. On clinical examination, only a subungual haematoma was noted. Radiographs of the effected thumb demonstrated a round, lytic lesion with an accompanying hairline fracture on the distal phalanx of the left thumb. The radiologist suggested a differential diagnosis of enchondroma should be considered.The patient was referred for a routine plastic surgery outpatient appointment. Curettage sampling of the lesion was performed and a cement filler was used to prevent further pathological fractures.The biopsy report stated that the sample contained normal bone tissue with no evidence of enchondroma or other malignancy and the patient was discharged without any further complications.
Assuntos
Neoplasias Ósseas , Condroma , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Cimentos Ósseos/uso terapêutico , Diagnóstico Diferencial , Fraturas Espontâneas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , PolegarAssuntos
Mordeduras e Picadas/virologia , Ectima Contagioso/diagnóstico , Traumatismos dos Dedos/virologia , Vírus do Orf/isolamento & purificação , Carneiro Doméstico , Adulto , Animais , Mordeduras e Picadas/complicações , Ectima Contagioso/transmissão , Ectima Contagioso/virologia , Feminino , Traumatismos dos Dedos/complicações , Higiene das Mãos , Humanos , CicatrizaçãoRESUMO
Necrotising fasciitis (NF) is a rapidly progressive soft tissue infection involving necrosis of subcutaneous tissues. Early surgical intervention reduces mortality, but initial clinical findings are often non-specific and can delay the diagnosis. An 80-year-old patient, presented to our emergency department with pain in her left hip and mild bruising following a fall. An x-ray, requested to investigate a possible hip fracture, in fact demonstrated air in the subcutaneous tissues. She rapidly deteriorated and soon developed blood-filled blisters, crepitus and fixed staining of the skin. She underwent urgent debridement of involved tissues in theatre confirming the diagnosis of NF. The presence of subcutaneous emphysema on plain radiograph as in this case, is extremely specific to the diagnosis of NF. Although other imaging modalities can aid diagnosis these remain as an adjunct rather than a definitive diagnostic tool and should not delay surgical intervention based on clinical findings.
Assuntos
Acidentes por Quedas , Artralgia/etiologia , Fasciite Necrosante , Quadril , Infecções dos Tecidos Moles/complicações , Infecções Estreptocócicas/complicações , Enfisema Subcutâneo/diagnóstico por imagem , Idoso de 80 Anos ou mais , Artralgia/diagnóstico por imagem , Artralgia/microbiologia , Vesícula , Desbridamento , Fasciite Necrosante/complicações , Fasciite Necrosante/diagnóstico por imagem , Feminino , Quadril/diagnóstico por imagem , Quadril/patologia , Humanos , Radiografia , Pele/patologia , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagemAssuntos
Cicatriz Hipertrófica/cirurgia , Traumatismos do Pé/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Retalhos Cirúrgicos/efeitos adversos , Acidentes de Trânsito , Cicatriz Hipertrófica/etiologia , Seguimentos , Traumatismos do Pé/diagnóstico , Humanos , Escala de Gravidade do Ferimento , Masculino , Músculo Esquelético/transplante , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica/métodos , Reoperação/métodos , Transplante de Pele , Telas Cirúrgicas , Técnicas de Sutura , Resultado do TratamentoRESUMO
This article describes a variant of palmaris longus muscle resulting in median nerve compression in the mid forearm. Although the palmaris longus has several well-documented anomalies, these seldom lead to nerve compression. The dual tendon, central muscle belly variant observed in this case is the first of its kind to be reported causing compressive neuropathy at this level. This is of both anatomical and clinical interest as it reminds surgeons of the anatomical variations of this unique muscle and presents a new mechanism of nerve compression in the forearm.