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Congenital Anomalous Azygos Vein Drainage Causing Pulmonary Embolus in a 91-Year-Old Patient
Get PDFBackground: Retroaortic course and azygos continuation of aberrant left brachiocephalic vein is a rare venous anomaly, which is usually associated with congenital heart disease and pulmonary artery anomalies. Venous stasis is a cause of pulmonary arterial thromboembolism, which can result from venous anomalies.Case presentation: We describe the case of a 91-year-old female admitted to our hospital with shortness of breath diagnosed with pulmonary embolism and infarctions by a CT pulmonary angiogram. CT also showed aberrant left brachiocephalic vein with vascular webs at its retroaortic course and azygos continuation, suggesting chronic venous thrombosis, which was considered to be the suspected source of emboli. Conclusion: To our knowledge, this is the first report presenting this vascular anomaly manifesting with chronic venous thrombosis and pulmonary embolism. Although rare, awareness and identification of this entity is important, especially in the absence of obvious embolic sources or in patients with recurrent embolus/consolidation
New data about the Cathedral of Catania by geophysical investigations
Get PDFThe town of Catania, located in the southern part of the Sicily region, Italy, holds the remains of an ancient settlement in the city centre. One of the most important buildings is the Cathedral and the buried Achillean Baths. The Cathedral was repeatedly destroyed and rebuilt after the earthquakes and volcanic eruptions that occurred over time. The first building dates back to the period 1078-1093 and was built on the ruins of the Roman Achillean Baths, on the initiative of Count Roger, acquiring all the characteristics of an equipped (i.e. fortified) ecclesia. Already in 1169, a catastrophic earthquake demolished it almost completely, leaving intact only the apse. In 1194 a fire created considerable damage and finally in 1693 the earthquake that hit the Val di Noto destroyed it almost completely. The area around the Cathedral is today highly urbanized, but it was the locus of social and political life over the centuries for people of different cultures who have inhabited the area since the 8th century BC. Therefore, this area contains stratigraphically complex layers of buildings and other remains, which can help understand the use of this area of the town over many centuries. A ground-penetrating radar and electrical resistivity tomography surveys were performed inside and outside the Cathedral of Catania. Data were visualized in three-dimensions using a standard amplitude slice technique as well as the construction of isosurface images of amplitudes. These images reveal the position of architectural features whose shape, size and burial depth suggest they are Roman and earlier in age. The features mapped overlap the development of the Achillean Baths and the presence of some tombs and unknown rooms
Abdominal Splenosis Mimicking a Colon Tumour
Get PDFSplenosis is a benign condition which results from the self-implantation of splenic tissue on intra or extraperitoneal surfaces, after splenic trauma or splenectomy. Patients are usually asymptomatic but may present with varied symptoms related to the implantation site. The diagnosis is a challenge because abdominal splenosis can mimic several diseases, including neoplasm. The gold standard examination for its diagnosis is scintigraphy with 99mTc-labelled heat-denatured erythrocyte. When splenosis is found in an asymptomatic patient, surgical removal is not indicated. A 57-year-old male patient presented with sporadic epigastric pain and a suspected mass in the recto-sigmoid transition. Abdominal ultrasound, CT and MRI identified this mass, its characteristics and location, but failed to distinguish its nature. However, given the patient’s past history of splenectomy and because the mass showed a similar sign to that of the splenic parenchyma, a hypothesis of abdominal splenosis was raised, which was confirmed by scintigraphy with 99mTc-labelled heat-denatured erythrocyte.In this case, the diagnosis was obtained before the patient was subjected to more invasive procedures, which are associated with high morbidity, and, as in most cases, no targeted intervention was necessary
Unusual Location of a Giant Cell Tumour
Get PDFGiant cell tumours (GCT) are rare aggressive non-cancerous tumours which usually affect the long bones. We describe a case of GCT of the first rib in a young woman without a relevant history. The patient presented a left cervico-thoracic mass which was biopsied in our department (CT-guided biopsy). She was referred to the thoracic surgery department after histological result
Delayed-onset Necrotizing Myositis following COVID-19 Infection
Get PDFAs the numbers of cases of COVID-19 continue to rise, the heterogeneity of its clinical manifestation continues to increase. Here, we describe a case of delayed-onset, biopsy-proven necrotizing myositis following infection with SARS-CoV-2
Strategy for Removing an Impacted Enterolith usingDouble-Balloon Enteroscopy in Crohn’s Disease
Get PDFAn enterolith in Crohn’s disease is an uncommon but serious condition because it can cause intestinal obstruction. Endoscopic treatment to remove the enterolith is attempted first, but is sometimes difficult owing to poor accessibility of the endoscope. In such cases, surgical treatment is inevitable. We successfully overcame poor accessibility and removed an enterolith using double-balloon enteroscopy. We describe our method below and suggest several helpful techniques
Giant Cell Arteritis among Fevers of Unknown Origin (FUO): An Atypical Presentation
Get PDFGiant cell arteritis (GCA), or Horton’s arteritis, presenting solely as fever is very rare. Usually, it manifests with typical features such as visual problems, headache and jaw claudication, or it can be associated with polymyalgia rheumatica. We describe the case of a patient with GCA who presented only with prolonged fever, the cause of which was not determined by diagnostic tests
Neurofibromatosis Type 1 with Highly Active Relapsing-Remitting Multiple Sclerosis (RRMS)
Get PDFNeurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disease which confers an increased risk of malignant tumour development. Relapsing remitting multiple sclerosis (RRMS) is an inflammatory demyelinating disease of the central nervous system. The coexistence of multiple sclerosis and NF1 is rare but has been reported. Here, we describe the case of a 31-year-old man with NF1 and subacute walking problems with proximal pain in the lower limbs who was successfully treated with natalizumab
Delayed Recognition of Levetiracetam-induced Pancytopenia
Get PDFBlood dyscrasias associated with levetiracetam use can be difficult to identify, especially when other potential differential diagnoses are concurrently present. Here we present a 57-year-old man with metastatic adenocarcinoma of unknown primary origin on levetiracetam who initially presented with an in-stent thrombosis of the right external iliac vein and then developed worsening thrombocytopenia followed by pancytopenia. Levetiracetam was not identified as the culprit until other causes like platelet consumption, heparin-induced thrombocytopenia, idiopathic immune thrombocytopenic purpura, and bone marrow involvement by metastatic disease were ruled out
COVID-19-Induced Hyperleucocytosis in Chronic Lymphocytic Leukaemia
Get PDFSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the current global pandemic, coronavirus disease 2019 (COVID-19). COVID-19 usually presents with respiratory symptoms but can affect multiple organ systems. A
wide spectrum of complications can occur depending upon the comorbidities of patients. There is limited literature available regarding the presentation and outcome of COVID-19 in chronic lymphocytic leukaemia (CLL) patients. We report 2 cases of COVID-19-induced
hyperleucocytosis (WBC count >100,000/μl) in CLL patients