Introduction: Acute hematogenous osteomyelitis (AHO) usually occurs in the first two decades of life. Evidence shows that 50% of patients with AHO are younger than five years. This infection typically affects the metaphyseal region of long tubular bones, whereas the fibula is rarely involved. Staphylococcus aureus is the causative agent of AHO in the majority of cases, while Escherichia coli is isolated rather uncommonly beyond the neonatal period. Case Presentation: Herein, we describe the case of an adolescent girl who was treated medically and surgically for AHO with an unusual location in the proximal fibula, caused by E. coli. The source of the causative agent remained unknown after the patient had been evaluated for possible urinary tract infection and underlying immune system defect. Conclusions: The fibula is a rare anatomic location for AHO, and such cases may pose a diagnostic challenge. Lack of response to empiric antibiotic treatment in patients with AHO may indicate the involvement of an uncommon pathogen, which is not susceptible to standard empiric antimicrobials aimed to target S. aureus as the most likely pathogen. In such instances, prompt surgical intervention can help determine the causative pathogen and optimize antimicrobial treatment.
Background and Objectives: Idiopathic anterior knee pain is a common condition in adolescents and is mostly of unknown cause. The aim of this study was to examine the influence of the Q-angle and muscle strength on idiopathic anterior knee pain. Materials and Methods: Seventy-one adolescents (41 females and 30 males) diagnosed with anterior knee pain were included in this prospective study. The extensor strength in the knee joint and the Q-angle were monitored. The healthy extremity was used as a control. The Student’s paired sample t-test was applied for testing the difference. Statistical significance was set at 0.05. Results: There was no statistically significant difference in the Q-angle value between the idiopathic AKP and the healthy extremity (p > 0.05) within the entire sample. A statistically significant higher Q-angle of the idiopathic AKP knee (p < 0.05) was obtained in the female subgroup. No statistically significant difference (p > 0.05) was found in the male subgroup. Within the male subgroup, the strength of the extensors within the knee joint of the healthy extremity had statistically significant higher values than the strength of these muscles in the affected extremity (p < 0.05). Conclusion: A greater Q-angle is a risk factor linked to anterior knee pain within the female population. Decreased muscle strength of knee joint extensors is a risk factor linked to anterior knee pain in both sex subgroups.
Introduction. Ectopic cervical thymus tissue results from incomplete migration of the thymic primordia during embryogenesis. It is asymptomatic in most of the cases, however, in 10% of patients there are different kind of symptoms. Case report. A 4-month-old boy was referred to our clinic, for the evaluation of a growing large neck mass on the right side that has been present since birth. Physical examination revealed a painless, soft, moderately mobile, and irregular round solid neck mass localized on the right side, in front of the sternocleidomastoid muscle, below the parotid gland, and above the carotid lodge. The mass was 40 x 32 x15 mm in diameter. Following the clinical, ultrasonographic and magnetic resonance imaging findings, we suspected that it was an ectopic cervical thymus. Surgical excision was done. The pathology report confirmed the presence of the ectopic cervical thymic tissue with Hassall?s corpuscles. The postoperative course was unremarkable and the wound healed well. Furthermore, clinical, immunological, and echography 6-month follow-up was unremarkable. Conclusion. The congenital cervical ectopic thymus is a rare congenital anomaly, however it should be considered in the differential diagnosis of neck masses.
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