Case 1: A 40-years-old female presented with asymptomatic growth on lower back which had gradually increased to the present size over a period of 25 years. There were no systemic complaints. Family history of similar lesions was absent. Cutaneous examination revealed multiple soft, skin colored to hyperpigmented, non tender, smooth surfaced, coalescing papules and cerebriform plaques situated on the right lower back [Table/ Fig-1]. There was no ulceration, discharge, associated excessive hair growth, comedo like plugs or cafe-au-lait spots. Biopsy from the papule revealed islands of mature adipose tissue in the dermis [Table /Fig-2]. Based on the clinical and histopathological findings diagnosis of nevus lipomatosus cutaneous superficialis was confirmed. Patient was referred to plastic surgery department for further management.
A 64-year-old woman presented with episodes of left facial and body numbness, recurrent right amaurosis fugax, right arm fatigability, and claudication of the tongue and jaw for 6 months duration. Systolic pressure was 55 mm Hg lower in the right arm, there was mild left temporal tenderness, and erythrocyte sedimentation rate was 25 mm/hour. Clopidogrel (75 mg/day) and prednisone (60 mg/day) were initiated for possible giant cell arteritis. Bilateral temporal artery biopsies were negative and symptoms continued unabated. Contrast enhanced MRA revealed brachiocephalic trunk stenosis (figure, A). This was successfully treated with a balloon expandable stent (figure, B and C) following which her symptoms completely resolved. There have been few reports describing similar clinical presentations of carotid atherosclerosis.
Figure. Contrast enhanced MR angiogram reveals short segment severe (Ͼ75%) stenosis of the brachiocephalic trunk (arrow) with relatively normal distal circulation (A). A metallic stent was placed across the stenosis after balloon dilatation (B). A check angiogram done at the end of the procedure reveals successful treatment of the stenosis (C).
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