Anomalies of the inferior vena cava (IVC) are an uncommon finding in the general population. A wide range of IVC anomalies has been described in the literature, the majority of which lack clinical significance.Agenesis of the IVC (AIVC) is a rare anomaly of the IVC in the general population. This anomaly may involve either complete agenesis of the IVC or agenesis of a segment of the IVC. Agenesis of the suprarenal segment is the most commonly occurring variant, while agenesis of the infrarenal and hepatic segments is less common. Here we report a case of agenesis of the intrahepatic segment of the IVC.
Gastrointestinal (GI) sarcoidosis is a rare manifestation of this multi-systemic granulomatous disorder. Esophageal involvement is extremely rare and there have been few case reports about this. Our article reports a case of esophageal sarcoidosis in which dysphagia was the main presenting symptom. The main initial treatment of symptomatic sarcoidosis in general and pulmonary sarcoidosis in specific usually involves corticosteroids, however, there are no specific guidelines for the management of GI sarcoidosis. Surprisingly, or maybe not, in our case, the dysphagia did not improve with steroid therapy which prompted further investigations as well as endoscopic intervention.
neurological deficits were noted. Liver enzymes were AST 9 U/L, ALT 3 U/L, total bilirubin 0.4 mg/ dL (direct 0.1), INR 1.2. Serum AFP one month prior to presentation was 24.5 ng/mL. CBC showed WBC of 3.7 K/UL, hemoglobin 8.2 g/dL and PLT 186 K/UL. Computed tomography showed a large expansile infiltration centered at the right ethmoid and upper nasal cavity extending to the superior medial aspect of the orbit, with associated mass effect upon the frontal lobes. Nasopharyngeal biopsies revealed poorly differentiated adenocarcinoma with immunostaining positive for heppar-1 compatible with metastatic HCC. The patient underwent bifrontal craniotomy for resection of the anterior skull base lesion, with a hospital course complicated by encephalopathy and sepsis necessitating ICU. The patient was discharged on comfort measures and hospice (Figure 1). Discussion: HCC metastasizing to the nasopharynx is exceedingly rare. The first case report documenting an isolated nasopharyngeal metastasis from a liver primary was described by Kattepur et al in 2014. In our case, the patient reported swelling behind the right eye as the initial presentation of a metastatic HCC after liver transplant. In patients with history of HCC, clinicians should maintain a broad differential with clinical suspicion for uncommon presentations of extra hepatic metastases, even after liver transplant.[3088] Figure 1. T1 weighted MRI orbit without contrast showing space occupying lesion extending through the right ethmoid sinuses with intracranial extension.
Boerhaave’s syndrome is a rare yet serious condition associated with high mortality and morbidity. Diagnosis of this syndrome is usually done with the aid of imaging and prompt management should be initiated to improve the outcomes. Treatment for this syndrome has been mainly surgical since its discovery by Herman Boerhaave; however, multiple endoscopic approaches have been successfully used recently with the advancement of this field. Here, we describe two cases of Boerhaave’s syndrome that were endoscopically managed along with a brief literature review of the different endoscopic methods used to manage this syndrome.
Metformin is considered an initial oral pharmacotherapy of choice for treating hyperglycemia in type 2 diabetes mellitus (T2DM). Although safe in the vast majority of the population, rare side effects will come to light as the prevalence of T2DM continues to rise. We present a rare case of metformin-induced hepatotoxicity and possibly the first reported case of dose-dependent metformin-induced hepatotoxicity. This case report aims to make clinicians aware of this infrequent yet significant adverse reaction that can arise with metformin therapy.
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