Iatrogenic systemic air embolism during Endoscopic RetrogradeCholangiopancreatography (ERCP) is a rare but potentially fatal complication. We present the case of a patient that showed a persistent comatose state after ERCP.Radiological imaging was consistent with venous cerebral air embolism followed by venous congestion with fatal brain swelling. Only 5 cases of fatal intracranial air embolism during ERCP have been reported in the literature before. Awareness of this potentially fatal complication and knowledge of adequate therapeutic measures is necessary to improve the outcome in those patients.Keywords: ERCP, air embolism, cerebral, systemic, fatal, radiological imaging Introduction:
We describe three cases of parotid gland lipoma, a relatively rare, asymptomatic, slow growing, freely movable, soft tissue mass. Preoperative clinical diagnosis is generally difficult but MRI using fat saturation techniques provides accurate diagnostic information regarding this benign parotid gland tumor, enabling better treatment planning.
SUMMARY -We describe the case of a 39-year-old man in whom diagnostic work-up for combined right-sided hearing loss revealed a lipoma of the internal auditory canal (IAC).
Case ReportA 39-year-old man with a six-year history of bilateral conductive hearing loss and highpitched tinnitus of unknown aetiology was referred to our department of otorhinolaryngology by his primary care physician because of acute worsening of right-sided hearing loss. He denied any otorrhoea, ear pain or vertigo. Weber test was lateralized to the left, whereas Rinne test was negative on the right side and positive on the left side. Otoscopy was normal bilaterally. Threshold pure tone audiometry (PTA) revealed conductive hearing loss on the left at 40-50 dB and combined multi-frequency hearing loss on the right side at 85 dB. A oneweek treatment with dexamethasone did not change symptoms or PTA findings.On subsequent 3 Tesla MRI, a well-defined lesion with a maximum diameter of 7 mm was found in the internal auditory canal (ICA) on the right side. The lesion was hyperintense on T1-and T2-weighted sequences, did not enhance with administration of a gadoliniumbased contrast agent, and showed a marked signal drop on an additional fat-saturated T1-weighted sequence (Figure 1). A complementary CT scan was performed, where the lesion showed fat density (-68 Hounsfield units), no calcifications and no bone erosion (Figure 2). Based on the imaging findings, the diagnosis of a lipoma of the IAC was established. The lipoma was the most likely explanation for the sensorineural component of the patient's hearing loss and tinnitus, but the conductive hearing loss remained unexplained. A follow-up examination was planned three to five years after diagnosis.
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