-
Clinical Medicine Insights. Ear, Nose... 2019Deep neck spaces are regions of loose connective tissue filling areas between the 3 layers of deep cervical fascia, namely, superficial, middle, and deep layers. The...
Deep neck spaces are regions of loose connective tissue filling areas between the 3 layers of deep cervical fascia, namely, superficial, middle, and deep layers. The superficial layer is the investing layer, The pretracheal layer is the intermediate layer and the prevertebral layer is the deepest layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Once the natural resistance of fascial planes is overcome, spread of infection occurs along communicating fascial boundaries. More recent trends include the increasing prevalence of resistant bacterial strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are purely aerobic and 25% with isolated anaerobes. The epidemiology of DNIs needs to be monitored for changing trends and the impact of underlying host immunity and developing microbial multidrug resistance is established. Surveillance at laboratory level should include mandatory susceptibility testing of all empiric antibiotics against microbes commonly identified in adult DNI microscopy, culture, and sensitivity (MC&S) specimens. The role of susceptibility testing of microbes not commonly identified in adult DNI MC&S specimens needs further review, on a clinical case-by-case basis.
PubMed: 31496858
DOI: 10.1177/1179550619871274 -
Respirology Case Reports Mar 2023Pneumomediastinum and subcutaneous emphysema are conditions that carry significant morbidity. They are uncommonly seen as complications of lung abscess formation and...
Pneumomediastinum and subcutaneous emphysema are conditions that carry significant morbidity. They are uncommonly seen as complications of lung abscess formation and prompt recognition and treatment is necessary. We present a 59-year-old male patient who complained of shortness of breath and chest pain for 2 weeks. Computed tomography (CT) of the thorax showed a left lower lobe lung abscess. This was associated with leucocytosis and raised C-reactive protein. Ultrasound-guided drainage revealed viscous pus requiring manual aspiration for adequate drainage. The patient later developed extensive pneumomediastinum and subcutaneous emphysema involving the pretracheal space, without evidence of pneumothorax. Left lower lobectomy was performed to control sepsis. The patient achieved a complete recovery following his surgery and antibiotic treatment, with interval resolution of pneumomediastinum and subcutaneous emphysema. We present the radiological and clinical features leading to the diagnosis of pneumomediastinum and subcutaneous emphysema.
PubMed: 36751398
DOI: 10.1002/rcr2.1090 -
Journal of Medical Case Reports Feb 2020Papillary breast lesions may be benign, atypical, and malignant lesions. Pathological and clinical differentiation of breast papillomas can be a challenge. Unlike...
BACKGROUND
Papillary breast lesions may be benign, atypical, and malignant lesions. Pathological and clinical differentiation of breast papillomas can be a challenge. Unlike malignant lesions, benign breast papillomas are not classically associated with lymph node and distant metastasis. We report a unique case of a recurrent, benign breast papilloma presenting as an aggressive malignant tumor.
CASE PRESENTATION
Our patient was a 56-year-old postmenopausal African American woman who was followed in the breast clinic with a long history of multiple breast papillomas. She underwent multiple resections over the course of 7-9 years. After being lost to follow-up for 2 years, she once again presented with a slowly enlarging left breast mass. Subsequent imaging revealed a predominantly cystic mass in the left breast, as well as a suspicious hypermetabolic internal mammary node and a hypermetabolic nodule in the pretracheal space. Biopsy of the internal mammary node demonstrated papillary neoplasm with benign morphology and immunostains positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2/Neu. Due to the clinical picture concerning for malignancy, the patient was then started on endocrine therapy with palbociclib and letrozole before surgery. She then underwent simple mastectomy and sentinel lymph node dissection with negative nodes and pathology once again revealing benign papillary neoplasm. She underwent adjuvant chest wall radiation for 6 weeks and received letrozole following completion of her radiation therapy. She was without evidence of disease 30 months after surgery.
CONCLUSIONS
We present an unusual case of multiple recurrent peripheral papillomas with entirely benign histologic features exhibiting malignant behavior over a protracted period of many years, with an invasion of pectoralis musculature and possibly internal mammary and mediastinal nodes. Her treatment course included multiple surgeries (ultimately mastectomy), radiation therapy, and endocrine therapy.
Topics: Antineoplastic Agents; Breast Neoplasms; Female; Humans; Letrozole; Lymph Node Excision; Magnetic Resonance Imaging; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Papilloma, Intraductal; Radiotherapy; Tomography, X-Ray Computed
PubMed: 32070435
DOI: 10.1186/s13256-020-2354-7 -
Cureus May 2022Lymphoblastic lymphoma (LBL) is a rare subtype of non-Hodgkin lymphoma (NHL) and the majority (85-90%) of the cases are comprised of precursor T-lymphoblastic lymphoma...
Lymphoblastic lymphoma (LBL) is a rare subtype of non-Hodgkin lymphoma (NHL) and the majority (85-90%) of the cases are comprised of precursor T-lymphoblastic lymphoma (T-LBL). We report a case of a 17-year-old male who presented with a productive cough for one month along with complaints of difficulty in breathing (unrelated to exertion) for four days and chest pain (left-sided, non-radiating) for two days. On clinical examination, lymphadenopathy was observed; mid jugular cervical lymph nodes were palpable on the left side, which were non-tender, matted, and approximately 1 x 1 cm in diameter. CT pulmonary angiogram showed a diffuse isodense mass in the mediastinum involving perivascular, pretracheal, paratracheal, and subcranial spaces. CT findings suggested multiple lymph nodal masses, possibly lymphoma. On histopathology, it was initially reported as NHL and, on immunohistochemistry, it was confirmed as T-LBL. A thorough clinical examination of the patient along with appropriate investigations is required to reach a precise diagnosis and achieve favorable outcomes. This case is unique as the patient presented with a cough and was reported to have NHL on histopathology.
PubMed: 35712338
DOI: 10.7759/cureus.25011 -
Cureus Sep 2022Ectopic thyroid is a rare clinical presentation to encounter in day-to-day clinical practice. It occurs due to developmental defects in the early stages of the thyroid...
Ectopic thyroid is a rare clinical presentation to encounter in day-to-day clinical practice. It occurs due to developmental defects in the early stages of the thyroid gland embryogenesis during its descent from the floor of the primitive foregut to its final pre-tracheal position. It is usually present along the extent of the thyroglossal duct as well as in distant locations such as sub-diaphragmatic or mediastinal spaces. The diverse clinical presentation of this rare entity often causes a diagnostic dilemma. A thyroid scintigraphy scan is pivotal in the diagnosis of ectopy, but ultrasonography is done more frequently. Surgical management is preferred for symptomatic cases, followed by radioactive iodine ablation and levothyroxine supportive therapy for refractory cases. We present a case of a 62-year-old female patient who presented with pain and swelling of the right submandibular region. On ultrasonography, a 5*4 cm firm mobile swelling of the right submandibular region was found, suggestive of right submandibular sialadenitis. Fine needle aspiration cytology (FNAC) was subsequently done, and it showed features of basaloid neoplasm like pleomorphic adenoma, and as the thyroid tissue was in an ectopic location, it must have been misdiagnosed. The patient was then taken up for right submandibular sialoadenectomy, and the histopathological examination of the operative specimen showed nodular colloidal goiter and mild chronic sialadenitis. Ectopic thyroid can present at various anatomical locations and thereby has varied clinical presentations which makes it a diagnostic dilemma for clinicians. The usual radiological investigations done include USG and CT scan, whereas thyroid scintigraphy is more precise in reaching the diagnosis of ectopic thyroid. The confirmatory diagnostic method is the histopathological examination of the excised specimen. Most cases of ectopic thyroid are asymptomatic and require regular follow-up. Symptomatic cases are managed by surgical excision followed by periodic monitoring and adequate thyroxine replacement.
PubMed: 36204041
DOI: 10.7759/cureus.28717