Journal of Clinical Case Reports

Background: Inflammatory pseudotumor (IPT) is a rare liver tumor, and is not easy to distinguish from liver cancer in imaging examinations. We retrospectively analyzed the clinical data of a case of IPT misdiagnosed as liver cancer.

Case Report: A 39-year-old man was hospitalized in February 2014 because of right upper quadrant pain for 7 months. Enhanced multi-detector computed tomography and Gd-EOB-DTPA-enhanced magnetic resonance imaging findings were consistent with malignant liver tumors. The patient had a history of chronic hepatitis B. Therefore, he was diagnosed with liver cancer. However, his physical condition was not suitable for surgery, and he had a history of 2 abdominal surgeries and tested negative for alpha-fetoprotein (AFP). Thus, we performed a liver biopsy and the histological diagnosis was IPT. The patient avoided interventional therapy, which is the preferred treatment for patients with inoperable primary liver cancer.

Conclusion: IPT should be considered in the differential diagnoses when a mass lesion in the liver is encountered, especially for those patients with a history of infection in the abdomen or abdominal surgery who are AFP-negative. Pathologic examination may be necessary.

Study Background: The term “Gossypiboma” is used to define a mass inside the body consisting of cotton matrix with surrounding foreign body reaction. Gossypibomas may be clinically silent or present in the postoperative period with a broad range of symptoms, mimicking a mass or abscess both clinically and radiologically. Although extremely rare, their precise incidence is unknown and probably underestimated.

Methods: Herein we describe the case of a 71-year-old man with a large pelvic Gossypiboma diagnosed at the time of radical prostatectomy (RP) 30 years after inguinal hernioplasty.

Results: Clinical stage of prostate cancer was cT2N1M0. Preoperative CT scan showed a 3.0 cm × 5.0 cm mass of unknown nature with inhomogeneous uptake of contrast medium close to the right iliac vessels suspected for lymph node metastasis. For this reason, an open approach was chosen for RP and extended lymph node dissection. A solid mass, firmly adherent to the surrounding tissues, was carefully dissected from the iliac vessels and removed en-block. The intraoperative examination revealed a left-behind surgical sponge. No surgical complications were recorded. At definitive histopathological analysis, a Gleason 4+4 pT3b N0 (n=28) prostatic acinar adenocarcinoma was found and a retained surgical sponge with a peripheral fibrous pseudocapsule, resulting from an inflammatory foreign-body reaction, were found. Surgical margins were negative for malignancy.

Conclusion: Although more infrequent with the advent of standardized surgical counting, gossypibomas can still occur in surgical practice, being either asymptomatic occasional findings or, if not promptly diagnosed, lifethreatening causes of acute abdomen. In our case, the radiological appearance of the pelvic gossypiboma simulated a malignant lymphadenopathy and changed our surgical strategy from the robotic to the open approach. Overall, our case highlights how prevention represents the key aspect to ensure the maximal safety of surgical patients.

Tubercular cerebral abscess (TBA) is an extremely rare entity. Although tuberculosis is a common infectious disease occurring worldwide, with meningitis and tuberculoma being the commonest CNS manifestations, TBA, has been infrequently described in the literature and its MRI features have also been rarely reported. Its clinical and radiological features may simulate other infectious and noninfectious neurological diseases and cystic tumors. Hence, it is essential for every radiologist to be familiar with the imaging presentations of various forms of CNS tuberculosis for timely diagnosis and treatment, thereby reducing the morbidity and mortality of this disease. Here, we report to you a case of tubercular cerebral abscess of a 60-year-old male who presented with headache and seizures for one month with no history of pulmonary tuberculosis and negative HIV serology. We further discuss about the MRI, DWI and MR spectroscopy findings of this disease and compare with other cases reported in the literature.

Primary laryngo-tracheobronchial amyloidosis is a rare pulmonary disease for which there is currently no established treatment. Herein, we report a case involving a 51-year-old woman who was admitted to hospital primarily due to intermittent hoarseness. Botryoidal masses were visible at the entrance of the throat. On chest computed tomography, eccentric soft tissue density shadows were apparent in the tracheal bifurcation of the proximal segment of the trachea, and the lumen was narrowed. Electronic bronchoscopy revealed extensive new biological invasive growth from the nasopharynx to the glottis. The glottis and larynx were irregularly shaped with clear characteristics and congestion. New biological growth was also observed in the right upper lobe, right middle bronchus, and right lower lobe mucosa. The patient was ultimately diagnosed with primary laryngo-tracheobronchial amyloidosis via pathological analysis. Although amyloidosis is a benign lesion, to date, there are no curative treatments. The present article briefly highlights the pertinent literature, and discusses the clinical manifestations and progress of treatment in primary laryngo-tracheobronchial amyloidosis.

Introduction: Bilharzia is a major parasitic endemic, perpetuated by the habits of life of the tropical populations. He is responsible for digestive or urinary manifestations; Neurological complications are rare. Case presentations: We relate two cases of patients admitted in Fann teaching hospital during year 2016. They were 2 men respectively 25 years and 32 years old living in endemic bilharzia area and with a notion of repetitives bathings and haematuria in one case. They presented a subacute myeloradiculitis and a terminal cone syndrom. The findings revealed blood hypereosinophilia, positive bilharzian serology in blood and CSF and the presence of bilharzi’s eggs in urine. The medullar MRI was normal in the first case and was like a pseudo tumor located from T11 to L1. Both patients benefited a treatment with a single-dose (40 mg/kg) of praziquantel, 6 weeks of corticosteroid therapy and intensive kinesiotherapy. The evolution was very favorable. Discussion and Conclusion: Neurobilharzia was rare but grave because of the functional sequelae. The epidemiological context can be a major contribution to the diagnostic orientation because very earlier hypereosinophilia are just found in half of cases. Treatment, associate praziquantel and corticosteroid, avoids the occurrence of important sequelae or even a total cure.

Amiodarone Induced Pulmonary Toxicity (AIPT) is a rare but one of the most serious adverse event that can be potentially life threatening. The incidence of AIPT is 2% to 10% and mortality rate ranges from 10% to 50% in patients who develop Acute Respiratory Distress Syndrome (ARDS). Age, preexisting lung disease, cumulative dose, thoracic surgery and pulmonary angiography are the risk factors associated with AIPT. Although there is no pathognomonic clinical, laboratory, radiographic or histological findings the diagnosis depends on clinical suspicion and exclusion of other possibilities of pulmonary disease. We present a case of 77-year-old man who presented with symptoms of pneumonia and diagnosed as AIPT by the elimination method for specific and non-specific pulmonary infection. Despite discontinuation of amiodarone and systemic therapy with corticosteroids the patient continued worsen. Pre-existing lung disease, the rapid onset of the clinical picture and the extent of lung injury on CT were the poor prognostic factors for our patient.

Endovascular aneurysm repair with visceral artery incorporation using fenestrated devices has gained widespread acceptance as a feasible alternative to the traditional open repair for the management of juxta-renal abdominal aortic aneurysms. However, complications with this endovascular technique continue to emerge. We present a patient who developed de novo inflammatory aortic aneurysm 3 years following endovascular repair of a juxta-renal AAA using a fenestrated stent graft.

The situs inversus is a rare anatomical condition which is characterized by the transposition of organs towards the opposite side. The left position of the gall-bladder makes the diagnosis of acute cholecystitis difficult because of an unusual symptomatology. It is also associated with a difficulty of laparoscopic dissection of the stone-block triangle especially for the right-handed surgeons. We report the cases of 2 patients whose different explorations confirmed the diagnosis of acute cholecystitis and total situs inversus and benefited from a laparoscopic cholecystectomy. Laparoscopic cholecystectomy, in these two cases, is an original intervention because of the mirrored vision of the intraperitoneal organs and can even be difficult leading to iatrogenic complications. However, the laparoscopic approach remains the gold standard even in the presence of this mirrored anatomy.