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Ear, Nose, & Throat Journal Jun 2017Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal...
Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.
Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Mediastinitis; Microbial Sensitivity Tests; Middle Aged; Neck; Neck Dissection; Soft Tissue Infections; Streptococcal Infections; Streptococcus milleri Group; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28636733
DOI: 10.1177/014556131709600622 -
Multimedia Manual of Cardiothoracic... Jan 2018Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the...
Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the pleural cavity to confirm or rule out tumor dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and improve the staging for lung and pleural cancers. VAMLA consists of complete removal of the mediastinal fat and lymph nodes of the subcarinal space, the right paratracheal and pretracheal areas, and the left paratracheal space. Once this mediastinal tissue is removed, the right mediastinal pleura can be identified and incised. A 30o thoracoscope is then inserted through the video-mediastinoscope into the pleural cavity to obtain samples of pleural fluid and biopsies of the parietal pleura and lung nodules, if present. In the case of left-sided thoracoscopy the access route to the left pleural cavity is anterior to the aortic arch, as for extended cervical mediastinoscopy. The combination of VAMLA and thoracoscopy is useful for exploring the mediastinum and the pleural space from a single incision and in the same surgical setting as the transcervical approach.
Topics: Biopsy; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Mediastinoscopy; Mediastinum; Neoplasm Staging; Pleural Cavity; Pleural Neoplasms; Thoracic Surgery, Video-Assisted; Thoracoscopy; Video-Assisted Surgery
PubMed: 29384599
DOI: 10.1510/mmcts.2018.004 -
Mediastinum (Hong Kong, China) 2019Surgical techniques remain the gold standard to diagnose and staging lung and pleural tumours. Non-invasive techniques have become more accurate but actually they are...
Surgical techniques remain the gold standard to diagnose and staging lung and pleural tumours. Non-invasive techniques have become more accurate but actually they are not enough to plan and evaluating prognosis of lung and pleural tumours. In some cases, we need to explore the pleural cavity and the mediastinal lymph node status to confirm or rule out tumour dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and to improve the staging for lung and pleural cancers. VAMLA allows to perform a complete lymphadenectomy of the subcarinal space, the right and pretracheal areas. We consider sampling more safety on the left side to avoid left recurrent nerve injuries. Once this mediastinal tissue is removed, the right mediastinal pleura can be identified and incised. Once mediastinal pleura is opened, a 5 mm 30º thoracoscope is inserted through the video- mediastinoscope into the pleural cavity. It allows to obtain samples of parietal or visceral pleural, pleural fluid or lung nodules if present. In case of left-sided thoracoscopy the access to the left pleural cavity is anterior to the aortic arch as for extended cervical mediastinoscopy. The combination of VAMLA and thoracoscopy is useful to explore the mediastinum and the pleural space from a single incision and in the same surgical setting through the transcervical approach.
PubMed: 35118249
DOI: 10.21037/med.2019.05.02 -
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 -
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 -
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 -
Journal of Visualized Experiments : JoVE Dec 2014Thymectomy in neonatal rodents is an established and reliable procedure for immunological studies. However, in adult rats, complications of hemorrhage and pneumothorax...
Thymectomy in neonatal rodents is an established and reliable procedure for immunological studies. However, in adult rats, complications of hemorrhage and pneumothorax from pleural disruption can result in a significant mortality rate. This protocol is a simple method of rat thymectomy that utilizes a mini-sternotomy and endotracheal intubation. Intubation is accomplished with a non-invasive and easily reproducible method and allows for positive pressure ventilation to prevent pneumothorax and a controlled airway that allows sufficient time for careful thymus dissection to minimize pleural disruption. A 1.5 cm sternal incision decreases contact with mediastinal vessels and pleura, while still providing full visualization of the thymus. Following exposure of the mediastinum, the thymus is removed by blunt dissection under magnification. The pleural space is then sealed by suture closure of the pre-tracheal muscles followed by the application of surgical glue. The thorax is then closed by suture closure of the sternum, followed by suture closure of the skin. All thymectomies were complete as evidenced by immunohistochemical (IHC) staining of mediastinal tissue, and absence of naïve T-cells by flow cytometry, and the procedure had a 96% survival rate. This method is suitable when complete thymectomy with minimal complications is desired for further immunological studies in athymic adult rats.
Topics: Animals; Intubation, Intratracheal; Rats; Thymectomy
PubMed: 25590868
DOI: 10.3791/52152