Occult traumatic impaled foreign body, a challenging diagnosis of severe chronic lower extremity radicular pain.

The investigation of embedded soft tissue foreign bodies relies heavily on radiological imaging. The prompt identification of these objects is critical as retained foreign bodies may lead to serious infection or chronic debilitating pain depending on anatomical location. In this report, we present a case of a radiographically occult traumatically implanted foreign body in a 15-year-old female after a high-speed motor vehicle accident. Initial computed tomography (CT) scan was unremarkable and exploration under anesthesia demonstrated no other significant findings, yet the patient continued to suffer severe refractory radicular pain with marked limitation of daily function. It was not until 12 weeks after the accident that a magnetic resonance image (MRI) of the pelvis revealed a deep sinus tract with central low magnetic resonance (MR) signal, raising suspicion for a retained foreign body. A 10-centimeter plastic foreign body extending from the patient's coccyx to the sciatic foramen was identified and surgically removed resulting in immediate symptom relief. This case illustrates that the detection of a retained foreign body is not always straightforward and multiple imaging modalities may be necessary for accurate diagnosis. We also discuss the most appropriate diagnostic imaging algorithm when a foreign body of the musculoskeletal system is suspected.

Mediastinal ganglioneuroma with osseous invasion simulating malignant transformation of osteochondroma on CT imaging.

Ganglioneuromas (GN) are rare, mature tumors that arise in the posterior mediastinum or retroperitoneum from neural crest cells and present as slow growing masses in the pediatric population. While they are often found incidentally in unrelated diagnostic workup, they can become symptomatic due to their size and location. They typically demonstrate the nonspecific appearance of a solid mass without invasive or destructive features across different modalities. Such features are normally indicative of more aggressive neoplasms from similar cellular ancestry or an entirely different lineage. Here we present a case of mediastinal GN that on imaging was initially suggestive of an osteochondroma with malignant degeneration based on the presence of an exostosis associated with a large solid mass. Final pathology, however, revealed GN with involvement of the adjacent bone. While the final diagnosis was benign, it is important to recognize this pattern of exostosis with solid mass, especially since the overall survival rate of sarcomata is much worse than that of a classic GN.

Adverse events following immunization in patients with primary immunodeficiencies.

BACKGROUND: Adverse events following immunization (AEFI) requires special consideration in patients with primary immunodeficiency diseases (PID) because they may represent a "red flag" for the initial diagnosis and may cause disease complications. Therefore, the definition of appropriate vaccination schemes is a major issue in PID. The aim of this study is to describe the AEFI in a cohort of PID patients. METHODS: Medical records from 379 PID patients were included. AEFI severity was classified according to the WHO 1999 guidelines. Causality was assessed using the Clinical Immunization Safety Assessment (CISA) 2009 criteria. RESULTS: Evidence of AEFI was found in 26 medical records and represented a total of 29 reactions. Most of the AEFI were observed in patients with idiopathic hypogammaglobulinemia (IHG), chronic granulomatous disease (CGD) and severe combined immunodeficiency (SCID), representing 10, 4 and 4 cases, respectively. A total of 21 reactions were associated with replicative vaccines, 7 of which were serious cases related to Bacille Calmette-Guérin (BCG). BCG was also the vaccine more often associated with definitive AEFI in PID. In addition to BCG-related complications, seizures were the most serious AEFI among PID patients. CONCLUSIONS: Our study included a large cohort of PID patients and confirmed an increased risk of serious AEFI in these populations. The design and implementation of neonatal screening strategies for the early detection of congenital lymphopenias and other PID are urgently needed to avoid serious complications of the BCG vaccine usually applied immediately after birth. Our findings also support the use of the acellular pertussis vaccine to minimize the appearance of seizures in PID patients vaccinated with diphtheria, pertussis and tetanus (DPT).