16 research outputs found
Identifying the non-recurrent laryngeal nerve: Preventing a major risk of morbidity during thyroidectomy
No full textNon-recurrent laryngeal nerve (NRLN) is a rare anomaly which is reported in 0.3%-0.8% of people on the right side and in 0.004% (extremely rare) on the left side. Damage to this nerve during the surgical procedure may lead to severe iatrogenic morbidity and should therefore be prevented from being damaged. The best way to avoid this damage to the nerve is to identify the nerve with a systematic diligent dissection based on usual anatomical landmarks and awareness about the possibility of their existence. Hereby, we are going to present a 26-year-old woman, a case of NRLN on the right side which was identified during thyroidectomy. The nervous anomaly was accompanied with vascular abnormality which was confirmed by computerized tomography (CT) angiography, post-operatively
Away from the milky way: An extremely rare case of pulmonary ectopic breast
No full textEctopic breast is defined as the presence of breast tissue outside the pectoral region. In this article, we are reporting an extremely rare case of pulmonary aberrant breast tissue. A 79-years-old Caucasian woman with the history of hypertension, diabetes mellitus and ischemic heart disease, presented to the emergency department for worsening dyspnea on exertion and pleuritic chest pain over the last few days. Both thoracic CT scan and the gross evaluation of tumor after its removal by thoracotomy were in favor of a soft tissue tumor such as pulmonary lipoma, whilst surprisingly the histological examinations revealed the mass to be ectopic breast tissue. Although it is extremely rare, this diagnosis should be considered in the evaluation of pulmonary masses
Pulmonary sequestration: A rare case in a patient with acute chest pain and palpitation mimicking the acute coronary syndrome
No full textPulmonary sequestration (PS), a non-functioning lung tissue, which lacks the normal communication with the tracheobronchial tree and receives the blood supply from the systemic circulation, is a rare congenital malformation that comprises 0.5-6% of all congenital pulmonary malformations. The presentation of PS with chest pain is very rare. In this article, we are aimed to report the case of a patient with chief complaints of retrosternal chest pain and palpitation, which was suspected to be of cardiac origin. Primary evaluations including exercise tolerance test, 48-hour holter monitoring, coronary angiography ruled out any cardiac problem. Further evaluations with Thoracic CT scan revealed a cystic mass in the retrocardiac region of the lung. Thoracotomy surgery was done and the patient was finally diagnosed to be extralobar pulmonary sequestration
Spontaneous Rupture and Hemorrhage of Adrenal Pseudocyst Presenting With Acute Abdomen and Shock
No full textAdrenal gland pseudocysts are not common conditions, and most of them are nonfunctional and asymptomatic. However, large pseudocysts may causes abdominal discomfort and have compressive effects on adjacent organs. They may rupture spontaneously or after trauma, and lead to retroperitoneal hemorrhage and surgical emergency. Herein, we report a case of 21-year-old female who presented with acute abdomen and hemorrhagic shock due to spontaneous rupture of adrenal pseudocyst. She was treated successfully by open surgery, removal of adrenal pseudocyst and unilateral adrenalectomy
The early fecopneumothorax due to simultaneous colonic perforation and herniation through diaphragmatic laceration: within 6 days
No full textParathyroid adenoma as a cause of hypercalcemia in a patient with breast cancer: a case report and review of the literature
No full textAbstract Background Patients with breast cancer can develop hypercalcemia as a metabolic complication of this disease. Bone metastasis is the most common reason responsible for this complication. Yet, hyperparathyroidism is a rare cause of hypercalcemia in these patients. We present a unique case of parathyroid adenoma-related hypercalcemia in a patient with breast cancer and its diagnostic challenges that can alter patient treatment and outcome. Case presentation A 50-year-old Azeris woman presented with lethargy and weakness. She had a history of recently diagnosed breast cancer and had a left mastectomy 2 months ago. She was under chemotherapy at the time the symptoms started. Laboratory tests showed elevated serum calcium levels. Although initially, bone metastasis was considered as a cause of hypercalcemia, later investigation showed no metastasis. Elevated PTH levels along with persistent hypercalcemia after medical treatments revealed the need to do an ultrasonography of the thyroid and parathyroid glands, which showed a mass in the right parathyroid gland. After a surgical consultation, the patient underwent neck exploration. The only enlarged parathyroid gland was in the right lower, and it was removed successfully. Calcium levels decreased significantly after surgery, and the patient’s symptoms improved. She was discharged 2 days after surgery and showed no recurrence during follow-ups. The pathology result was compatible with parathyroid adenoma. Conclusion This case, along with similar ones reported before, shows the challenges of diagnosing the cause of hypercalcemia in patients with breast cancer. Although hyperparathyroidism is rarely encountered, it can be managed and treated with better outcomes than bone metastasis. It highlights the need for more detailed diagnostic protocols to ensure better management
Aggressive Surgical Treatment in Late-Diagnosed Esophageal Perforation: A Report of 11 Cases
No full textIntroduction. Esophageal perforation is a relatively uncommon and lethal disease usually resulting from endoscopic procedures. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40% to 60%, but this rate decreases is 10%–25% if treatment is carried out within 24 hours of perforation. Case Presentation. To analyze the characteristics, etiology, site of perforation, presentation, time interval till diagnosis, treatment and outcome of patients with esophageal perforation. Over a five-year period, from October 2004 through March 2009, 11 patients with esophageal perforation were referred to the division of thoracic surgery of a tertiary referral hospital. In eight patients, perforations were thoracic with delayed diagnosis for at least 48 hours. Two patients had cervical esophageal perforation, and one patient had early-diagnosed Boerhaave's syndrome. Eight patients are alive after followup for a period ranging from eight months to five years. In the remaining three patients, cancer was the underlying disease and the reason of death.
Conclusion. No patient with esophageal perforation should be deprived from surgical repair due to delayed diagnosis. All, except preterminal patients, should undergo exploration after resuscitation, and appropriate treatment should be carried out depending on the findings during operation. Aggressive treatment is necessary in the case of established mediastinitis.</jats:p
Aberrant Right Subclavian Artery: A Life‑threatening Anomaly that should be considered during Esophagectomy
No full textLusoria artery or aberrant right subclavian artery (ARSA) is a rare anatomical variation of the origin of the right subclavian artery. Essentially, right subclavian artery originates from the brachiocephalic artery, but in 0.4-1.8 % of the general population it may arise directly from the aortic arch distal to the left subclavia
Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment
No full textBackground: Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory disease of the breast. Due
to its uncommon etiology, diagnosis and treatment is still unknown. Selection of a standard method for
diagnosing idiopathic granulomatous mastitis is sophisticated. In view of non-definitive clinical and imaging
finding, histopathology is the cornerstone of definitive diagnosis.
Objective: To determine and help solve the dilemma of treatment and diagnosis of idiopathic granulomatous
mastitis.
Methods: This historical cohort study was conducted on 48 patients who referred to the general surgery clinic of
Imam Khomeini Hospital of Urmia, were diagnosed with IGM and were histopathologically selected by census
using the registry system, in Urmia city, Iran, during 2010-2015 so that medical reports, ultrasonography (US)
and mammography (MMG) findings, follow-up information and recurrence rate were obtained from records. The
data were analyzed using SPSS software version 18 and descriptive statistics were used.
Results: According to records, 68.75% of patients (n=33) had palpable mass, 45.83% of patients (n=22) had
breast pain and swelling, erythema and 20.83% of patients (n=10) had purulent drainage. Of the 48 patients 12
(25%) had mammography, which revealed the following findings: mass with irregular border in 6 patients, skin
thickness in 2 cases (4.16%), and parenchymal asymmetry in 4 cases (8.33%). Minimum follow-up was 24 (range
24–56) months.
Conclusions: According to our findings, histopathology of the disease is fundamental for correct diagnosis.
Steroid therapy as a therapeutic method such as prednisolone was an effective and applicable choice in the
treatment of idiopathic granulomatous mastitis by decreasing in inflammation
