Fluid-filled Mass Research Articles

Modified lateral orbitotomy for vision‐sparing excision of a zygomatic mucocele in a dog

A 1-year-old Shar Pei presented for recent-onset exophthalmos and right peri-ocular facial swelling. Physical examination revealed the facial mass was of soft-tissue consistency and nonpainful to the dog. Due to inability to retropulse the globe during ophthalmologic examination, it was suspected the mass had impinged into the orbit, resulting in rostral displacement of the globe. Anatomic location suggested the lesion was probably associated with the zygomatic salivary gland. Fine-needle aspiration and subsequent cytological evaluation of fluid extracted from the facial mass was consistent with a diagnosis of zygomatic mucocele. Computed tomography imaging confirmed a single fluid-filled mass was resulting in both the facial distention and the exophthalmos. A modified, lateral orbitotomy surgical approach was selected for excision of the lesion to provide ventral exposure to the orbit, while minimizing trauma to the globe and supporting structures. Histopathology of the excised lesion confirmed a diagnosis of zygomatic mucocele. This case demonstrates utilization of a modified lateral orbitotomy for effective surgical management of a zygomatic mucocele in a dog, with preservation of vision and absence of any significant postoperative complications.

CASE REPORTS: A Thigh Mass Resulting from Polyethylene Wear of a Revision Total Hip Arthroplasty

The case of a 60-year-old man who had an enlarging thigh mass seen during a routine 12-year examination of a cementless revision total hip arthroplasty is presented. Aspiration of the mass yielded more than 200 cc of thick yellow fluid. Cytopathologic examination disclosed material consistent with polyethylene wear debris. The porous titanium acetabular and femoral components were not loose. Reoperation was recommended despite minimal symptoms, because the fluid-filled mass recurred after aspiration. At the time of reoperation, the components appeared well fixed and a linerhead exchange was performed. One year after surgery, the mass had not recurred and the patient had minimal symptoms.

Gluteus Maximus Avulsion and Closed Degloving Lesion Associated with a Thoracolumbar Burst Fracture

G luteus maximus ruptures are rarely reported. A single case report from the Polish literature in 1974 was the only one found by us1. Closed degloving injuries are caused by shear forces, which separate the subcutaneous fat from the underlying fascia. Hematoma and necrotic fat collect in this space and are associated with a high rate of bacterial colonization2. Most reports of closed degloving injuries are associated with high-energy pelvic and acetabular trauma. These lesions were initially described by Morel-Lavallee in the mid-nineteenth century3. Letournel and Judet referred to closed degloving injuries as Morel-Lavalee lesions when they were located over the greater trochanter4. The patient was informed that data concerning the case would be submitted for publication. Fig. 1 Lateral radiograph of the spine made with the patient supine, showing the L1 burst fracture with associated kyphosis and canal compromise. A twenty-year-old active-duty male United States Marine sustained multiple injuries as a passenger in an armored vehicle rollover accident. He was initially resuscitated and stabilized in the theater of war and then was medically evacuated within forty-eight hours after the injury and evaluated at the United States National Naval Medical Center in Bethesda, Maryland. The initial examination at Bethesda showed pain at the thoracolumbar junction with a palpable step-off. A closed fluid-filled mass was palpable and tender in the lower back overlying the sacrum and extending to the lower lumbar area but was not contiguous with the area of thoracolumbar pain. The initial neurologic examination demonstrated symmetric bilateral dysesthesias in the saddle area, brisk bilateral knee and ankle reflexes, normal rectal tone, and an intact bulbocavernosus reflex. He arrived with a bladder catheter in place. Spine radiographs (Fig. 1) and computed tomographic scans (Fig. 2) were notable for an L1 burst fracture with retropulsed …

Taeniacoenurus in the orbit of a chinchilla

A 4-year old, male intact, captive-bred chinchilla (Chinchilla lanigera) was presented due to progressive exophthalmos of the right eye over a 5-month period. Ophthalmic examination revealed exophthalmos with dorsal displacement of the right globe. Retropulsion was decreased and a fluctuant, subcutaneous mass could be palpated posterior and dorsal to the central aspect of the zygomatic bone. Transdermal ultrasonography revealed a fluid-filled mass consistent with a cyst located within the ventral right orbit. Computed tomography demonstrated dorsal displacement of the globe, lateral displacement of the zygomatic arch, and numerous mineral-dense foci within the lumen of the cyst. The cyst was removed en bloc by ventral transpalpebral orbitotomy. Histopathology revealed a single capsulated cyst with multiple invaginated protoscolices, characterized by a prominent scolex with refractile hooklets, suckers, and abundant calcareous corpuscles consistent with a Taenia coenurus. Exophthalmos resolved with surgical therapy and there was no evidence of recurrence or postoperative complications over a period of 2 years. To the authors' knowledge, this is the first reported case of an orbital cyst of parasitic origin in a chinchilla.

Intussusception in Childhood Acute T Cell Lymphoblastic Leukemia: An Unusual Complication - Report of 2 Cases.

Clinically significant gastrointestinal complications in children with acute lymphoblastic leukemia (ALL) have been reported. However, intussusception is a very rare complication. In one study of 286 children with ALL gastrointestinal complications occurred in 5.6% of patients with intussusception seen in only 0.3% of patients. We describe two cases of intussusception during chemotherapy for T-cell leukemia. Patient #1 was an 8 year old girl on chemotherapy for T-cell ALL. Around week 9 following POG 9404 protocol of consolidation chemotherapy, patient presented with severe abdominal pain and vomiting, and had marked, diffuse tenderness of the abdomen with guarding and hypo-active bowel sounds. Abdominal radiograph showed thickening of the descending colon; abdominal sonogram was normal; abdominal computed tomography (CT) scan however, revealed a soft tissue and fluid-filled mass extending from the cecum to the descending colon. These findings were consistent with a large bowel intussusception, which was successfully reduced with a barium enema. Patient #2 was a 15 year old male receiving chemotherapy for T-cell ALL following POG 9404 protocol. At week 14 of consolidation chemotherapy, patient presented with a 2 day history of nausea and colicky peri-umbilical and right lower quadrant abdominal pain. An abdominal CT scan revealed an ileocolic intussusception without bowel obstruction and mild wall thickening of the cecum. Barium enema resulted in successful reduction of the intussusception. Interestingly, both our patients were treated with high dose methotrexate 5gm/m2 during this time period and both experienced delayed excretion of methotrexate. To our knowledge, there is no known reported association between high dose methotrexate and intussusception. We speculate that the two could be related. The increased use of high dose methotrexate therapy in T-cell ALL may result in a higher incidence of intussusception in this population. Although, intussusception in ALL is a very rare complication, awareness of this entity and early recognition with radiological intervention may prevent unnecessary surgery and the associated morbidity and mortality in these patients.

Progressive Enlargement of Cavity Within Melanoma Masquerading as Iris Cyst

To describe progressive enlargement of intralesional cavities within a mass that masqueraded clinically as an iris pigment epithelial cyst for 2 years but later proved to be a melanoma. An 81-year-old woman developed asymptomatic focal elevation of the iris, and ultrasound biomicroscopy showed a fluid-filled mass that was interpreted as an iris pigment epithelial cyst. Over a 2-year period of observation, the cavity enlarged from 0.7 to 10 mm, and the solid component enlarged from approximately 6 to 16 mm basal dimension. On referral, visual acuity was 20/400 in the right eye and 20/25 in the left eye. The affected right eye displayed a pigmented mushroom-shaped ciliary body mass with anterior chamber invasion, distorting the pupil and occupying 40% of the anterior chamber. Ultrasound biomicroscopy and B-scan ultrasonography revealed many cavities within the 14-mm-thick mass, suggestive of ciliary body melanoma. After enucleation, histopathology disclosed multiple cavities, some with granular eosinophilic material, within a mushroom-shaped mixed-cell melanoma. Cavitation can occur in ciliary body melanoma and can lead to misinterpretation as a cyst. Cavitary melanoma should be considered in the differential diagnosis of cystic lesions of the anterior segment.

The popliteal cyst

A popliteal cyst, originally called Baker's cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?

Management of Intraabdominal Hypertension by Percutaneous Catheter Drainage

The authors report a case of an 18-year-old man with T-cell acute lymphocytic leukemia who developed hemorrhagic pancreatitis after chemotherapy. He subsequently developed abdominal compartment syndrome (ACS). Computed tomography showed a large fluid-filled mass in the area of the pancreas. As a result of the instability of his condition, surgical decompression, the standard therapy for ACS, was believed to carry significant morbidity and potential mortality. The patient underwent ultrasound-guided drainage of the peripancreatic fluid, which decreased his abdominal pressures and improved his clinical status. Without this procedure, the patient may not have tolerated subsequent surgery.

Torsion of an epididymal cyst

Torsion of an epididymal cyst is a very rare condition. We present a case of torsion of an epididymal cyst in a 13-year-old boy. The patient presented with acute scrotal pain. Scrotal ultrasonography showed a 38 x 35 x 30 mm fluid-filled mass within the caput of the left epididymis. Histologically, the cells of the epididymal duct were necrotic. To our knowledge, this is the second case report in the literature.

Laparoscopic Approach to an Uncommon Adnexal Neoplasm Associated with Infertility: Serous Cystadenofibroma of the Fallopian Tube

A rare case of serous cystadenofibroma of the fallopian tube was discovered during evaluation for in vitro fertilization-embryo transfer. Bilateral tubal occlusion was noted on hysterosalpingogram, and a right adnexal cyst, initially thought to be of ovarian origin, was identified by office transvaginal sonography. Laparoscopy revealed a 5.5-cm, fluid-filled mass involving the distal aspect of the right fallopian tube. Both ovaries and uterine exterior appeared grossly normal. The cyst was decompressed and removed intact without incident through a 5-mm laparoscopic cannula. The mass showed histologic features consistent with benign serous cystadenofibroma. The patient had an uncomplicated postoperative convalescence and continued to do well 3 months after surgery.

Calf Mass in an 11-Year-Old Girl

Calf Mass in an 11-Year-Old Girl

CT Diagnosis of Afferent Loop Syndrome

OBJECTIVE: To report the computed tomography (CT) features of afferent loop syndrome which is often clinically unsuspected. MATERIALS AND METHODS: The CT studies of five patients with afferent loop syndrome were reviewed. These patients had undergone gastroenterostomy and other surgical procedures, for malignant neoplasms in four and for peptic ulcer in one. Patients presented between 4 months and 15 years (average 5.5 years) after surgery. Symptoms were acute in all patients, the most common symptom being abdominal pain. In addition three of the patients had chronic symptoms including recurrent episodes of abdominal pain, recurrent ascending cholangitis, jaundice and bilious vomiting. RESULTS: The obstructed afferent loop appeared on CT as a fluid-filled tubular mass with an average diameter of 5.3cm. Valvulae conniventes were identified in all, and small intraluminal air bubbles in four. The dilated afferent loop was opacified with oral contrast material in only one patient. The loop was located in the subhepatic area in three patients and crossed the midline between the aorta and the superior mesenteric vessels in the other two. Additional findings included biliary dilatation in all five patients and signs of pancreatitis in one. Treatment was surgical in four patients (delayed for four months in one) and conservative in one. CONCLUSION: A fluid-filled tubular structure containing small air bubbles in the right upper quadrant or crossing the midline on CT in symptomatic patients after gastroenterostomy is characteristic of a dilated, possibly obstructed, afferent loop. The diagnosis is often not suspected clinically since patients may present many years after the initial surgery. Recognition of the characteristic CT findings will avoid both inappropriate procedures such as aspiration or drainage of an obstructed afferent loop and delay in treatment. Gayer, G. etal. (2002). Clinical Radiology57, 835–839.

CT Diagnosis of Afferent Loop Syndrome

OBJECTIVE: To report the computed tomography (CT) features of afferent loop syndrome which is often clinically unsuspected. MATERIALS AND METHODS: The CT studies of five patients with afferent loop syndrome were reviewed. These patients had undergone gastroenterostomy and other surgical procedures, for malignant neoplasms in four and for peptic ulcer in one. Patients presented between 4 months and 15 years (average 5.5 years) after surgery. Symptoms were acute in all patients, the most common symptom being abdominal pain. In addition three of the patients had chronic symptoms including recurrent episodes of abdominal pain, recurrent ascending cholangitis, jaundice and bilious vomiting. RESULTS: The obstructed afferent loop appeared on CT as a fluid-filled tubular mass with an average diameter of 5.3cm. Valvulae conniventes were identified in all, and small intraluminal air bubbles in four. The dilated afferent loop was opacified with oral contrast material in only one patient. The loop was located in the subhepatic area in three patients and crossed the midline between the aorta and the superior mesenteric vessels in the other two. Additional findings included biliary dilatation in all five patients and signs of pancreatitis in one. Treatment was surgical in four patients (delayed for four months in one) and conservative in one. CONCLUSION: A fluid-filled tubular structure containing small air bubbles in the right upper quadrant or crossing the midline on CT in symptomatic patients after gastroenterostomy is characteristic of a dilated, possibly obstructed, afferent loop. The diagnosis is often not suspected clinically since patients may present many years after the initial surgery. Recognition of the characteristic CT findings will avoid both inappropriate procedures such as aspiration or drainage of an obstructed afferent loop and delay in treatment. Gayer, G. etal. (2002). Clinical Radiology57, 835–839.

Large, Vascular Cecal Mass

A 74-year-old woman had a recent weight loss and history of breast and cutaneous malignancy. Medical evaluation included colonoscopy, which showed a 4 x 3 cm, vascular-appearing mass in the cecum. It was blue-tinged, soft, and easily deformed by pressure. Endoscopic ultrasonography characterized the lesion as a fluid-filled submucosal mass. Because of the suspicion of neoplasm, the patient had exploratory laparotomy and right hemicolectomy. Histopathologic examination revealed a lymphangioma. We review the literature regarding diagnosis and management of colonic lymphangiomas and describe a distinctive case.

Torsion of an indirect hernia sac: An unusual cause of acute scrotal swelling in children

An indirect inguinal hernia is a common cause of inguinoscrotal swelling in young boys. We describe 3 cases of an extremely unusual entity that has a similar clinical presentation to more commonly diagnosed intrascrotal processes. Two patients presented with acute hemiscrotal enlargement and pain, and a third patient presented with scrotal enlargement only. All patients underwent a scrotal ultrasound evaluation and subsequent inguinoscrotal exploration. All patients had a multiseptated peritesticular fluid-filled mass on ultrasound evaluation. Subsequent inguinoscrotal exploration revealed a torsion of the indirect hernia sac in each case. A high ligation and excision of the sac was curative. Torsion of a hernia sac is an extremely rare entity, and current sonographic imaging fails to clearly diagnose this unusual phenomenon. Because pediatric urologists are commonly called to evaluate a child with an acutely swollen scrotum, awareness of this diagnosis is important.

Uterine problems discovered after presumed hysterectomy: The Manchester operation revisited

The Manchester operation consists of amputation of the cervix, leading some patients to believe that they have undergone a hysterectomy. A 69-year-old woman with vaginal discharge proved to have a well-differentiated adenocarcinoma in the retained uterine corpus. Another 69-year-old woman with a central fluid-filled pelvic mass proved to have a retained blood-filled corpus with an early-stage fallopian tube cancer. The third patient was a 90-year-old woman with symptoms of constipation and urinary frequency, who was found to have a large fluid-filled central mass. At surgery, the retained corpus was distended and filled with mucoid material. Patients who have undergone a Manchester operation may develop disease in the retained uterine corpus, which should be considered in the differential diagnosis of a pelvic mass.

Ultrasonographic diagnosis of uterine rent at 33 weeks' gestation with history of curettage

A 30-year-old pregnant woman with a history of an uncomplicated curettage for incomplete abortion was seen at 33 weeks' gestation with decreased fetal movement and intermittent abdominal pain for 1 week. Ultrasonographic evaluation demonstrated a singleton vertex pregnancy, oligohydramnios, and a fundal uterine rent continuous with a large, fluid-filled cystic mass. Laparotomy revealed a right comual uterine rent with hourglass amniotic sac and fluid. A healthy infant was delivered by cesarean section.

Uterine hematoma in a mare

Summary An 8-year-old grey Arabian mare was presented for reproductive evaluation with a history of failing to become pregnant during two previous breeding seasons. An enlargement was identified on the right uterine horn on rectal examination which was confirmed as a fluid-filled nonechogenic mass on ultrasonography. Subsequent examination procedures and laparotomy revealed an old hematoma in the wall of the uterine horn.

Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia

As more infants with congenital diaphragmatic hernia (CDH) survive by means of extracorporeal membrane oxygenation (ECMO), new clinical observations are being made. We report anatomic and functional abnormalities of the esophagus in these infants. Twenty-two of 30 infants with CDH survived. Three of 7 non-ECMO-treated infants and 14 of 17 ECMO-treated infants had an air- or fluid-filled mediastinal mass that was confirmed by an upper gastrointestinal series as ectatic esophagus. Contrast studies demonstrated severe gastroesophageal reflux. Intra-esophageal pH monitoring confirmed significant reflux (Euler scores greater than 50) in 69% of tested patients. Prolonged acid clearance in most patients implied abnormal peristalsis. Hydramnios was correlated to the observed esophageal abnormalities, being present in 13 of 16 infants with an available amniotic history. All patients had symptomatic gastroesophageal reflux managed without antireflux surgery and were discharged 36 +/- 2 days after initiation of feeding. Follow-up (range: 7 to 56 months; mean: 32 months) showed that weight gain in affected children was slower than in those not affected. All but one are asymptomatic. Repeat upper gastrointestinal series shows persistent ectasia but less gastro-esophageal reflux. Gastroesophageal reflux/ectasia is a new observation with CDH. The associated hydramnios may result from proximal foregut obstruction by kinking the gastroesophageal junction with CDH. The radiographic appearance can be quite unusual. Clinical manifestations of gastro-esophageal reflux are manageable without surgery but may account for the observed compromised growth.

Esophageal dilatation and reflux in neonates supported by ECMO after diaphragmatic hernia repair.

Extracorporeal membrane oxygenation (ECMO) for survivors of surgical repair of congenital diaphragmatic hernia was used in 14 neonates. All showed marked esophageal dilatation on postoperative chest radiographs; the dilated esophagus simulated an air- or fluid-filled mass. All patients were later shown to have marked gastroesophageal reflux as well. The finding suggests a problem in swallowing exists before birth, which may explain the recent correlation between diaphragmatic hernia and hydramnios. The observation of a mediastinal mass in neonates with congenital diaphragmatic hernia may represent esophageal ectasia and may be related to significant gastroesophageal reflux.