Mycotic Aortic Aneurysm, a very sudden development for a preexisting Aortic Aneurysm: Case report.

INTRODUCTION: An Infectious Aortic Aneurysm (IAA), also known as a Mycotic Aortic Aneurysm (MAA), is a rare lesion of the aorta resulting from an infection of its wall. PRESENTATION: A male patient in his 70s presented to our emergency department with fever, intense abdominal pain, and a pulsatile mass in the middle of the abdomen. A Computed Tomography (CT) angiography scan was done two weeks earlier and it showed a 6.6 cm subrenal aortic aneurysm. A new CT angiography scan revealed a 3.4 cm growth (10*10*9.3) with periaortic fluids. The diagnosis of MAA was considered, and emergency surgery was performed. DISCUSSION: MAA is a rare disease characterized by a high risk of rupture and a high mortality rate, up to 43 %, despite the advances in treatment techniques. Adjacent infection is a rare cause for MAA especially on a preexisting aneurysm. The two main surgical approaches are Open Surgical Repair (OSR) and Endo-Vascular Repair (EVR). We opted for OSR with careful debridement because EVR was not available at our center and the huge size of the aneurysm posed high rupture risk. CONCLUSION: This case demonstrates the importance of close monitoring and early intervention for aneurysms, particularly in cases with adjacent infection. Moreover, the rapid growth rate and rupture risk demands more urgent intervention if the MAA is suspected.

Secondary neoplasm to non-hodgkin lymphoma treatment manifesting as a cancer of unknown primary: the first case in literature.

Introduction: Cancer of unknown primary (CUP) is a tumour metastasis with no detectable primary origin. A secondary neoplasm (SN) is defined as a tumour secondary to a prior tumour treatment and has no histological relation to that primary tumour. Case presentation: The authors report a case of a 72-year-old female patient who presented with back pain and had a history of non-Hodgkin lymphoma (NHL) treated with RCHOP 12 years ago. MRI showed a compression fracture in T5 and T7 vertebrae, while the PET/computed tomography (CT) only showed hypermetabolic lytic bone lesions in these vertebrae. Pathological examination of a biopsy of these lesions suggested metastatic breast cancer, but the mammography was normal. The above clinical description indicates that our case is a SN to RCHOP treatment manifested as a cancer of unknown origin. Discussion: CUP is diagnosed when all screening procedures fail to find the original tumour. On the other hand, the literature showed that RCHOP treatment of non-Hodgkin lymphoma has a 0.68% chance of causing a SN. After an extensive literature search, we found that our case, which has the combination of both CUP and SN, is the first documented case. Conclusion: This case suggests that cancer patients who received chemical or radiological treatment should be screened more carefully on the long term as it is possible to developed secondary neoplasms without a primary tumour in areas difficult to diagnose with traditional screening tools.

Primary spinal oligodendroglioma with intracranial extension: a case report.

Introduction: Primary spinal cord oligodendrogliomas (PSO) are sporadic tumors that arise from oligodendrocytes in the central nervous system (CNS). They can affect adults and children and make up about 2% of all intramedullary (IM) spinal tumors. Here, the authors present the second case in the literature of a primary spinal oligodendroglioma with intracranial extension. Presentation: A 28-year-old right-handed female presented to our emergency room severely malaised with left-sided hemiparesis, numbness, tingling, and urinary retention with positive Babinski and negative Hoffmann. MRI showed a widespread heterogeneous mass extending from the medulla to C7 with syringomyelia inferior to the mass. The mass was removed surgically, and her neurological condition improved rapidly. The gross, pathological exams, and immunohistochemistry confirmed the diagnosis of oligodendroglioma. Discussion: Up until 2017, there have been 60 documented cases of PSO in the literature and we have found two more cases in our search between 2017 and 2023. Also, there has been only one case recorded with an intracranial extension, making our case the 63rd PSO case and the second one with cranial extension. Conclusion: The golden standard for imaging is MRI. Surgical excision is the main treatment in the literature. Single-stage laminectomy showed promising results and surgical resection was the critical intervention to which the patient responded. This matches what was stated in the literature that surgery is the primary mode of treatment in PSO patients.

Primary left intrathoracic extrapulmonary trans-diaphragmatic hydatid cyst causing eventration: first case in literature.

Hydatidosis is a zoonotic parasitic disease caused by the cystic stage of Echinococcus species. Intrathoracic extrapulmonary hydatid cysts causing eventration are very rare. Here, we report a case of a 62-year-old female who presented with chest pain, intermittent coughing, general weakness, and fever. On auscultation, there were diminished respiratory sounds at the base of the left lung. A computed tomography scan showed a cystic formation with an ambiguous location involving the left lower thorax and the left hypochondrium. Complete surgical resection is the standard treatment for intrathoracic extrapulmonary hydatid cysts. Due to the direct bordering of the cyst with the pericardium in the left cadiophrenic angle, a cystotomy and evacuation of the cystic cavity were performed, followed by washing it with povidone and hyperosmolar saline. The location of the hydatid cyst has an important role in determining the surgical approach, as the unusual location could affect the possibility of radically removing the cyst.