Torsion of epididymal cyst (EC) is an exceedingly rare cause of acute scrotum in both children and adults. We add our case as the ninth case to literature which was an 8-year-old child presented with features of acute scrotum with history of EC on conservative management. Doppler sonography showed perfused normal bilateral testes and a
4.1
×
1.7
cm
septate cystic lesion of right epididymis. On scrotal exploration, we found a haemorrhagic cystic lesion attached to the upper pole of right testis and twisted for 540 degrees with normal testis and appendage. Cyst was excised, and histopathology revealed a haemorrhagic EC. Our case was peculiar due to, presenting as acute scrotum in a child of 1-10 years age group who was conservatively managed for right-sided EC and presence of 540 degrees torsion.
Primary adrenal pleomorphic spindle cell sarcoma (PSCS) is an exceedingly rare mesenchymal tumour that was previously known as malignant fibrous histiocytoma. It commonly occurs in extremities, retroperitoneum, peritoneal cavity and rarely in visceral organs. We report the first case of PSCS in the left adrenal gland in a 65-year-old female who presented with a large abdominal mass with vague symptoms. The wide range of differential diagnoses posed a challenge in establishing the diagnosis. However, this was overcome by appropriate radiological, intra-operative, histological and most importantly, comprehensive immunohistochemical findings. The patient underwent complete surgical resection of the tumour and had an unremarkable recovery. She remains without metastasis or recurrences to date through her 18 months of post-operative follow-up despite the poor prognosis of this tumour.
Leg and foot swelling is inherently found in 70% of patients with critical limb-threatening ischaemia due to ischaemia, which does not necessitate any specific intervention. Unilateral leg swelling is a vital sign for the clinical suspicion and diagnosis of deep vein thrombosis and phlegmasia. There is a significant surgical dilemma to delay the diagnosis of deep vein thrombosis or phlegmasia in patients with critical limb-threatening ischaemia when a methodical approach is not followed. We report a case of proximal deep vein thrombosis in an elderly patient with ipsilateral critical limb-threatening ischaemia and discuss the role of diagnostic tools. The role of antiplatelets along with vitamin K antagonists, duration of anticoagulation, iliocaval venous obstruction, compression therapy and inferior vena cava filter is discussed.
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