Mucoceles are benign mucus-containing cysts formed due to the obliteration of sinus ostium. They are most commonly found in the frontal sinus. Mucoceles can spread both intraorbitally and intracranially causing complications such as meningitis, brain abscess, and loss of vision. Radiological investigations are required for diagnosis, with both computed tomography (CT) and magnetic resonance imaging (MRI) being useful. Surgical approaches for management have changed from external to endonasal these days. We report a case where a 54-year-old patient presented to us with a 14 days' history of loss of vision and complete closure of eyes over 2 days. Contrast-enhanced CT scan and MRI confirmed the diagnosis of frontoethmoidal mucocele breaching the left frontal sinus floor. Endoscopic orbital decompression with functional endoscopic sinus surgery was done. Eye movements and ptosis recovered completely after the surgery, but the vision did not. Although the etiology of mucocele is multifactorial, obstruction of sinus ostium is the most plausible cause. Increasing pressure on adjacent structures by the expanding mucocele can cause intraorbital and intracranial complications. MRI is superior to CT in differentiating mucocele from soft-tissue neoplasms, although CT gives a more detailed information on bone structure. Endoscopic approaches have become the most preferred way to access frontoethmoidal mucoceles, with external approaches being reserved for mucoceles in certain inaccessible locations. Timely intervention is imperative to prevent undesirable complications.
Megaloblastic anaemia is one of the important causes of pancytopenia in children and nutritional deficiencies of vitamin B12 and folate are the most common causes comprising 95% of these cases. Defects in absorption, transport and metabolism of vitamin B12 are well described, however, are very rare. We report a rare case of Imersland Grasbeck syndrome, in an infant who presented with pancytopenia, with defective absorption of B12-intrinsic factor complex at the ileum and defective tubular reabsorption of proteins in renal tubule due to same protein defect caused by mutations in two genes – CUBN (cubilin) and AMN (amnionless).
Pleomorphic adenoma (PA) is the most common benign tumor of major salivary glands, and it rarely arises in minor salivary glands. PA has been reported at various sites where minor salivary glands are found and include nasal cavity, nasopharynx, pharynx, larynx, hypopharynx, and even lacrimal glands. We report one such a case in the nasal cavity in a middle-aged woman. The patient presented with nasal mass and symptoms of obstruction and epistaxis. After clinical and radiological evaluation, the mass was excised endoscopically, and histopathological examination revealed a biphasic benign cellular tumor with scant hyalinized stroma. On immunohistochemistry, the tumor was diffusely positive for CK7 and focally positive for P40 and smooth muscle actin (SMA). Proliferation index was 2%–3%. Finally, the diagnosis of PA was rendered. PA is generally restricted to the cavity due to paucity of space and presents early in the course. Surgical excision with wide margins is the treatment of choice. There are chances of recurrences and malignant transformation of the tumor. To conclude, although rare, one should consider a possibility of PA in the differentials of nasal masses, and accurate diagnosis of this entity is essential to ensure follow-up as recurrence and malignant transformation are reported in PA.
BACKGROUND: Mitraclip procedure is an effective and minimally invasive approach for mitral regurgitation in
patients of advanced age and high risk to surgical intervention. Even though it is approved by USFDA for the treatment of
high-risk patients with primary mitral regurgitation (MR), complications like atrial fibrillation have been observed. The
primary objective of this case report is to bring to notice the incidence of atrial fibrillation after mitraclip implantation.
CASE REPORT: A 78-year-old patient with multiple co-morbidities like systemic hypertension, peripheral neuropathy,
etc. presented with severe chest pain and found to have severe MR, severe pulmonary arterial hypertension, normal left
ventricular function, an ejection fraction of 68% and was planned for mitraclip implantation procedure. A week after the
mitraclip procedure, the patient was presented with atrial fibrillation.
DISCUSSION: Thus there is a possibility of side effects such as atrial arrhythmias, and this can also alter the mortality rates.
The occurrence of atrial fibrillation should be kept in mind and necessary precautions should be taken to prevent it.
Introduction
Ectopic thyroid is a rare congenital condition. Dual ectopic thyroid is rarer still with only 30 cases reported in literature. The most common location is the lingual or sublingual region followed by the hyoid region. Instances of dual ectopic thyroid with one in lingual region and the other in mediastinum are very few.
Case Report
A case of dual ectopic thyroid is presented with absent normal thyroid in a girl of 14 years who presented with difficulty in swallowing and lump sensation in throat. Ultrasound, MRI scan and Technetium 99m pertechnetate thyroid scan were done. She showed lingual thyroid and thyroid tissue in upper mediastinum and no thyroid tissue in the normal anatomical location.
Discussion
The discovery of mediastinal ectopic thyroid was incidental. She had subclinical hypothyroidism and was treated with thyroxine replacement therapy.
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