Right Side Of Neck Research Articles

MON-444 The Case of a Rare Anaplastic Thyroid Cancer Variant with Rhabdoid Features

Introduction: We present a very rare case of a variant of anaplastic carcinoma, a high-grade thyroid carcinoma with rhabdoid features. Less than 15 cases have been reported in English literature over the last 20 years. The prognosis of thyroid cancer with this variant phenotype is unfortunately very poor with a mean survival time of only 6 months after diagnosis. Treatment includes surgery, often a total thyroidectomy due to the rapid rate of growth of this tumor type. The benefits of chemotherapy and radiation are not yet apparent. Case presentation: A 49 year old female with history of breast cancer status-post recent chemoradiation therapy presented to the emergency department for a rapidly enlarging, right-sided neck mass. The mass had been present for approximately one month, but it was estimated to have grown from 3cm to 5cm within the two weeks prior. The patient was being followed by her ENT specialist and had a recent outpatient CT scan done. The results of the CT revealed a large thyroid tumor partially obstructing the esophagus and given the rapid progression of symptoms, she was instructed to go straight to the ED for emergent admission. Upon arrival, the patient reported not having consumed any solids or liquids for the past day due to concerns of aspiration and increasing neck pain. She had complaints of worsening dysphagia. Initial lab work revealed low thyroglobulin (1.4 ng/mL), elevated T4 (15.42 nmol/L) presumably due to Tamoxifen exposure, and elevated PTH (96.9 pg/mL), likely primary hyperparathyroidism. She was admitted and endocrine was consulted for further evaluation. The patient underwent a fine-needle aspiration biopsy showing high-grade anaplastic carcinoma with extensive necrosis and rhabdoid features. The tumor was eventually classified as stage 4B with gross extra thyroidal extension to the adventitial layers of the esophagus, thus it was determined to be unresectable. It was recommended at that time she have a percutaneous tracheostomy and feeding tube to protect her airway. However, the patient requested to be discharged so that she could obtain a second opinion regarding treatment options and prognosis. She subsequently underwent a total thyroidectomy at another hospital. Conclusion: It remains unclear whether this patient’s history of breast cancer treated with chemoradiation therapy played a role in the development of this rare thyroid carcinoma. Some cases of the rhabdoid phenotype are documented to have transformed from papillary thyroid carcinoma, for which radiation therapy is a well-known risk factor. Future studies should use molecular markers, such as BRAF V600E mutations common to papillary and anaplastic thyroid carcinomas, to help differentiate between types of thyroid cancers and avoid delayed treatment options for rapidly metastasizing thyroid tumors.

SUN-482 A Very Rare Case of Thyroid Cancer

Background: Cribriform-Morular variant of Papillary Thyroid Cancer (PTC-CMV) is an exceedingly rare subtype of thyroid cancer that predominantly affects younger females. As the name implies, it is a papillary thyroid carcinoma with predominantly cribriform and morular pattern of carcinoma cells on cytopathology. While completion thyroidectomy is usually recommended for larger and higher-risk Papillary Thyroid Cancer (PTC), surveillance may be acceptable with PTC-CMV, which tends to be a less aggressive malignancy. Clinical Case: A 46-year-old Guyanese woman presented with a three week history of an enlarging right-sided neck mass associated with a globus sensation while swallowing food. She denied any history of radiation exposure. Her exam findings were positive for a tender, right-sided neck mass. CT neck without contrast revealed a 4.1 x 4.0 x 5.9cm heterogeneous mass within the right thyroid lobe causing mild tracheal deviation to the left. Ultrasound of thyroid gland showed a solid heterogeneous hypoechoic 4.22 x 2.39 x 2.46cm right lobe nodule with no microcalcifications, border irregularity or taller-than-wider morphology. Fine Needle Aspiration of the nodule came back as Atypia of Undetermined Significance. The patient then underwent a core needle biopsy. The resultant pathology was negative for thyroid carcinoma or medullary thyroid carcinoma but was suggestive of a bronchial cleft cyst versus bronchogenic cyst with atypical glandular proliferation. She subsequently underwent a right hemithyroidectomy which revealed a final pathological diagnosis of a 3.5cm PTC-CMV. Such pathology warranted the patient to undergo a colonoscopy which was negative for Familial Adenomatous Polyposis (FAP). Given her negative GI workup and non-contributory family history for colonic polyposis or carcinoma the decision was made to continue surveillance rather than performing completion thyroidectomy as the disease was presumed to be sporadic. Discussion: PTC-CMV accounts for 0.2% of all PTC. It is associated with FAP in more than 50% of cases but can also occur sporadically. This subtype of PTC generally follows a less aggressive course. Review of current literature revealed several case series of CMV-PTC patients. In the largest one, 32 cases were observed over a 19 year period and only two out of twelve patients with FAP-associated PTC-CMV initially treated with hemithyroidectomy developed recurrence to the contralateral lobe. Interestingly, none of the remaining patients with the sporadic type developed recurrence suggesting that completion thyroidectomy may not be mandatory in this group. It is, therefore, critical to identify these patients and screen them with a colonoscopy to avoid the potentially unnecessary resection of the contralateral lobe and the consequent need for thyroid hormone replacement.

Assessment of preferable site for temperature measurement using non contact infra-red temperature among pediatric patients.

Accurate temperature measurement with little or no discomfort that is safe, without risk of hospital-acquired infections or perforations, is the preferred choice of medical professionals in pediatric settings. The objective was to discover the preferable site for body temperature measurement using non-contact infra-red thermometer (NCIT) among pediatric patients. NCIT measurement at mid forehead (F), right temporal region (T), right side of neck- over-carotid artery area (N), jugular notch (J), sternum (S), umbilical region and sublingual region (U) were compared with digital axillary temperature (DAT) in a single attempt in 500 patients, aged between 2 to 5 years with fever. Data was analyzed using Pearson's correlation, paired T-test and Bland-Altman plot to assess the correlation and agreement between the DAT and NCIT sites. The mean temperature of NCIT-T (38.42 ± 0.64 °C) was more agreeable with DAT (38.42 ± 0.63 °C) compared to other body sites. The minimum mean bias of -0.00480 °C was noted for NCIT-F with 95% CI of -0.164-0.15; however, NCIT-F revealed many outliers as compared to NCIT-J. A strong positive correlation existed between DAT and NCIT sites (r value: 0.99-0.98). However, significant difference was found between DAT and NCIT-N, NCIT-F and NCIT-U (p value < 0.0001). NCIT-J is the most preferable choice for measuring body temperature and can be interchanged with DAT. It will help to deliver fast results with enhanced patient comfort due to its non-invasive nature.

Parapharyngeal schwannomma: a case report

&lt;p class="abstract"&gt;Schwannomas are uncommon neurogenic tumors that are typically benign, slow growing, and asymptomatic. Upto 45% of schwannomas arise from the head and neck region, the sites of origin are: face, scalp, intracranial cavity, orbit, nasal and oral cavities, parapharyngeal space, middle ear, mastoid, larynx, and medial and lateral regions of the neck. The age distribution is 30 to 70 years and male:female 3:1. Symptoms and signs are neck swelling (54%), pain (11%), cranial nerve palsy (10%), oropharyngeal swelling (8%), dysphagia (6%) and trismus, otalgia (11%). This case is being presented because it is the rare case of neck swelling. A young male patient aged 22 yrs, presented with complains of swelling in right side of neck since 6 months. Patient also complains of difficulty in swallowing, difficulty in breathing and change in voice since 4 months. On examination of neck, a diffuse swelling noted at right level III neck, extending from the superior border of thyroid cartilage up to the level of hyoid bone. Horizontally the swelling was extending from mid thyroid cartilage till the anterior border of sternocleidomastoid muscle. On examination of swelling, a pink smooth globular mass seen pushing the right aryepiglottic fold anteriorly obscuring the laryngeal inlet. No pooling of saliva. elective tracheostomy was done, through lateral cervical approach, mass was excised in toto and extubated after 7 days.&lt;/p&gt;

Implicit motor imagery performance is impaired in people with chronic, but not acute, neck pain.

BackgroundPeople with chronic neck pain have impaired proprioception (i.e., sense of neck position). It is unclear whether this impairment involves disruptions to the proprioceptive representation in the brain, peripheral factors, or both. Implicit motor imagery tasks, namely left/right judgements of body parts, assess the integrity of the proprioceptive represention. Previous studies evaluating left/right neck judgements in people with neck pain are conflicting. We conducted a large online study to comprehensively address whether people with neck pain have altered implicit motor imagery performance.MethodsPeople with and without neck pain completed online left/right neck judgement tasks followed by a left/right hand judgement task (control). Participants judged whether the person in the image had their head rotated to their left or right side (neck task) or whether the image was of a left hand or a right hand (hand task). Participants were grouped on neck pain status (no pain; <3 months—acute; ≥3 months—chronic) and pain location (none, left-sided, right-sided, bilateral). Outcomes included accuracy (primary) and response time (RT; secondary). Our hypotheses—that (i) chronic neck pain is associated with disrupted performance for neck images and (ii) the disruption is dependent on the side of usual pain, were tested with separate ANOVAs.ResultsA total of 1,404 participants were recruited: 105 reported acute neck pain and 161 reported chronic neck pain. When grouped on neck pain status, people with chronic neck pain were less accurate than people without neck pain (p = 0.001) for left/right neck judgements, but those with acute neck pain did not differ from those without neck pain (p = 0.14) or with chronic neck pain (p = 0.28). Accuracy of left/right hand judgements did not differ between groups (p = 0.58). RTs did not differ between groups for any comparison. When grouped on neck pain location, people were faster and more accurate at identifying right-turning neck images than left-turning neck images, regardless of history or location of pain (p < 0.001 for both); people with no pain were more accurate and faster than people with bilateral neck pain (p = 0.001, p = 0.015) and were faster than those with left-sided neck pain (p = 0.021); people with right-sided neck pain were more accurate than people with bilateral neck pain (p = 0.018). Lastly, there was a significant interaction between neck image and side of neck pain: people with right-sided neck pain were more accurate at identifying right-sided neck turning images than people with left-sided neck pain (p = 0.008), but no different for left-sided neck turning images (p = 0.62).ConclusionsThere is evidence of impaired implicit motor imagery performance in people with chronic neck pain, which may suggest disruptions to proprioceptive representation of the neck. These disruptions seem specific to the neck (performance on hand images intact) but non-specific to the exact location of neck pain.

Giant parathyroid adenoma: a case report and review of the literature

BackgroundGiant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East.Case presentationA 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised.ConclusionsGiant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence.

Demographics, Histopathologic, and Anatomical Variations of Cutaneous Malignant Melanoma: an Iranian Study

The aim of this study was to evaluate the histopathologic and anatomical characteristics of cutaneous malignant melanoma (CMM) according to demographic variables in an Iranian population. This retrospective study was conducted at a tertiary care university-affiliated cancer institute in Tehran, Iran. Medical records of all the patients diagnosed with CMM were reviewed between 2012 and 2018. The histopathologic and anatomical data were analyzed based on demographic characteristics of the patients. A total of 370 patients with CMM (58.4% female) were included in this study. The lower extremity (32%) and head and neck (29%) were the most common sites for initial occurrence of CMM. There was no statistically significant difference between male and female for anatomical location of CMM (p = 0.11). In men, 80% of the lesions were located on the right side of the body while in women, only 54% of the lesions were located on the right side (p = 0.03). Furthermore, CMM of the lower extremity occurred more commonly in the right side in men than it did in women (p = 0.04). However, women were more likely to have a right-sided head and neck lesion (p = 0.02). Among Iranian patients with CMM, lower extremity is, in general, the most common site of involvement in both genders. In men, the lesion is more commonly found on the right lower extremity while in women CMM presents more commonly on the right side of the head and neck.

Three cases of branchial fistula in one family: a rare presentation

&lt;p&gt;Branchial cleft anomalies comprise approximately 30% of congenital neck mass and present as cyst, sinus or fistula. They occur due to disturbance in the maturation of the branchial apparatus during fetal development. They are congenital lesions usually present in childhood, but they are usually diagnosed in later childhood or early adulthood because of enlargement or infection. Branchial cleft fistulae are usually diagnosed earlier than cysts. Correct diagnosis leads to proper management. Complete surgical excision is the treatment of choice. Second branchial cleft and pouch anomalies are commonest amongst all branchial cleft lesions, but complete second branchial cleft anomalies with external and internal opening is rare. Branchial anomalies with family history are also very rare. Here we present a case report of complete branchial fistula with family history which was managed by complete excision of fistula through transcervical and transoral approaches. 3 members of one family in 2 generations presented with branchial apparatus anomalies (father and his two children, elder son and younger daughter). All of them were having branchial fistula on right side of neck since birth.&lt;/p&gt;

Salvage of exhausted neck access using a novel inside‐out device in dialysis‐dependent patients

Chronic central venous occlusion represents a challenge for upper body central dialysis access for both surgical and endovascular interventions. The Surfacer (Surfacer Inside-Out Access Catheter System) is a novel technique that offers a device-based solution over various physician-modified techniques in salvaging exhausted right-sided neck veins for catheter placement. We report a retrospective series of four cases in which this system is used to gain upper body venous access from a single center in Singapore. This report seeks to integrate the understanding of the technical aspects of a new inside-out device and its utility in recanalization of occluded right-sided neck veins as it relates to Asian patients.

Metastatic papillary thyroid cancer presenting with a recurrent necrotic cystic cervical lymph node

SummaryWe report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst. A 55-year-old woman presented with a 3-month history of a right-sided upper neck mass following an upper respiratory tract infection. Past medical history includes a right-sided nephrectomy secondary to a benign renal tumor and hypertension. She was evaluated by Otolaryngology, and fine-needle aspiration was performed. The mass recurred 2 months following aspiration. Ultrasound of the neck showed a 2.2 × 1.4 × 1.9 cm right cervical lymph node with a small fatty hilum but a thickened cortex. Neck computed tomography (CT) scan showed a well-defined 2.3 cm mass in the right upper neck corresponding to a necrotic cervical lymph node at level IIA. It also revealed a 7 mm calcified left thyroid nodule. Cytology revealed a moderate collection of murky fluid with mildly atypical cells presumed to be reactive given the clinical history of infection. The cyst had re-grown 2 months following aspiration. Excisional biopsy was performed and revealed metastatic classic papillary thyroid carcinoma (PTC). Subsequently, a total thyroidectomy and right neck dissection was performed. Pathology confirmed metastatic unifocal classic PTC of the right thyroid lobe and two lymph node metastases out of a total of 17 resected lymph nodes. The patient underwent radioactive iodine ablation. Subsequent I-131 radioiodine whole-body scan showed no evidence of metastases. In conclusion, metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.Learning points:Metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.A dedicated thyroid ultrasound is the preferred modality for identifying thyroid lesion over computed tomography.There is a risk of non-diagnostic cytology following FNA for cystic neck lesions, largely predicted by the cyst content of the nodule.

A Real Pain in the Neck: A Football Player with Atypical Post-Traumatic Neck Pain

HISTORY: 18 yo M football player presented to college training room clinic with painful right-sided neck swelling after blunt neck trauma from another player’s shoulder pad 2 weeks prior. He had presented to ER 2 days after the incident with acute neck pain and limited ROM, headaches, and difficulty concentrating. CT head & cervical spine were unremarkable. Diagnosed with concussion and SCM strain. He started concussion and muscle strain rehab. Concussion symptoms improved over the next two weeks, but his cervical pain and ROM didn’t, and his neck became more swollen. He denied recent illness, cough, rash, fever, chills, dyspnea, dysphagia. POCUS was performed before referal to ER. PHYSICAL EXAMINATION: VS: Normal; Gen: No acute distress HEENT: tender 5 x 3 cm subcutaneous mass on the antero-lateral neck, no bruits appreciable; MSK (Neck): tenderness to palpation along the entire right SCM, no spinous process tenderness, decreased lateral flexion and rotation towards the contralateral side; Card: Regular rate and rhythm, no murmurs; Resp: Clear bilaterally DIFFERENTIAL DIAGNOSIS: Occult cervical spine fracture, Intramuscular infection, Ruptured sternocleidomastoid, Internal jugular thrombosis, Arterial pseudoaneurysm TEST AND RESULTS: POCUS: diffuse heterogenous regions throughout the SCM musculature, increased vascularity; ED Labs: WBC: 15.40; ED CT Neck with Contrast: diffuse inflammation of the right SCM muscle with multiple intramuscular abscesses collections in the deep aspect, largest measuring 2.1 x 2.4 x 6.0 cm with associated narrowing of the right internal jugular vein. FINAL/WORKING DIAGNOSIS: Traumatic SCM myositis with intra-muscular abscesses TREATMENT AND OUTCOMES: Hospitalized and started on IV Unasyn and Decadron. Ultrasound guided needle aspiration collected 2 cc purulent fluid that grew 2+ strep pyogenes. Symptoms didn’t improve, so sent to OR for I&D where purulent fluid was drained from cavities superficial to and within the SCM. Neck swelling, pain, and range of motion improved. Repeat neck CT confirmed resolution of infection. Discharged on oral Augmentin. Over several weeks rehabbed to full strength and range of motion in the neck. Given the duration of time away from sport, patient decided to red-shirt the rest of his football season.

IP107. Endovascular Repair of Spontaneous Common Carotid Pseudoaneurysm With Covered Stent: A Case Report

Covered stents are primarily used for treatment of arterial aneurysms, pseudoaneurysms and traumatic arterial injuries especially in high-risk patients. However, their use in carotid pseudoaneurysms remains uncommon and is limited to case reports and small case series. We report a successful case of endovascular treatment of a spontaneous right common carotid artery pseudoaneurysm with a covered stent. Our patient is 45-year-old woman with no comorbidities, who presented with complaints of pulsatile swelling of right side of neck, insidious in onset and gradually progressing in size over last 2 months. History of right upper limb acute limb ischemia category III of the right upper limb for which she underwent right above-elbow amputation 25 days earlier in another hospital. No history of trauma or signs of cranial nerve palsy were present. Computed tomography angiogram revealed a 7 × 7-cm contained hematoma with 2 × 2-cm pseudoaneurysm of the common carotid artery with a 7-mm neck, arising 11 mm from the common carotid artery origin (Fig 1). The patient was not willing to undergo open surgical repair, so she underwent right common carotid and distal innominate covered stenting with FLUENCY 9 × 60-mm via right femoral approach (Fig 2). In this particular case distal innominate is covered so as to achieve a 2-cm sealing zone and because she had already underwent right above-elbow amputation with a healed stump, there is no threat of acute ischemia after covering the subclavian ostia. The operative and perioperative periods were uneventful. Thrill and bruit disappeared in the immediate postoperative period. Postoperative duplex examination showed no endoleak with good flow across stent graft. This study highlights that carotid pseudoaneurysm can be managed safely and effectively with covered stent graft.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Position of Knot and Relation With Working Hand in Hanging Cases- A Medico Legal Study

Background: Hanging is the most common form of violent asphyxial death in our country. Typical and atypical variety of hanging depends on position of knot at the victim body.&#x0D; Objective: The objective of this study was to find out the position of knot of ligature material and relation of knot with the working hands in hanging cases along with socio demographical status of the study subjects.&#x0D; Materials and Methods: This retrospective study was conducted among 574 Autopsy cases of hanging victims at the Dhaka Medical College Morgue during the period January 2013 to December 2015.&#x0D; Results: Out of 574 cases, 159 (27.71%) were male and 415 (72.29 %) female. Among them 304(52.96%) were married and 270(47.04%) were unmarried. Most of the victims 269(46.86%) were from the age group 21- 30 years. Considering the knot, most were situated at right side of neck 281 (48.95%), followed by left side 235 (40.94%), at the nape of neck 50(8.71%) and in front of neck below chin 8(1.39%). Most of the study subjects were right handed. Dopatta (orna) was the commonest 237(41.28%) ligature material. 556 (96.86%) cases had some form of ligature mark in neck. Most of the victims 401(69.86%) hanged themselves at night. 545 body (94.95%) were recovered from inside the living rooms. 472 (82.23%) victims had complete suspension and 102 (17.77%) were cases of partial hanging.&#x0D; Conclusion: To reduce the number of suicidal hanging cases a well designed and comprehensive programme is needed, which will identify the causative factors and prevent of suicidal behaviors of affected persons.&#x0D; KYAMC Journal Vol. 10, No.-1, April 2019, Page 17-20

Hear Hooves, Think Zebras: A Case Report & Systematic Literature Review of Isolated Neck Node Metastases from Prostate Cancer

Most cancers that metastasize to the cervical lymph nodes are from the upper aerodigestive tract. We use a case report and systematic literature review to highlight a very rare example of atypical metastatic spread to the cervical lymph nodes from advanced prostate cancer without involvement of other lymph node groups. All possible clinical, imaging and pathological documents were collected from the patient’s chart. Those documents were subjected to an independent review and data abstraction. A literature search was performed using relevant key words and MESH headings. Additional papers were found using the ‘cited by’ and ‘related articles’ functions of the search engines, and the references section of relevant papers. In July 2012, a 56 year old man presented with PSA 8ng/ml, cT2a, Gleason 8 prostate adenocarcinoma. Metastatic workup was negative and he had a radical prostatectomy. He had extensive positive surgical margins, pT3b N0, Gleason 9, with post-operative PSA of 0.77 and underwent salvage radiotherapy to the prostate bed with 2 years of adjuvant androgen deprivation therapy (ADT). In July 2015, he developed widespread bony metastases and received 6 cycles of chemotherapy with ADT. He subsequently developed castrate-resistant disease. In December 2017, the patient reported a painful lump in his left neck. PSA was 0.22 ng/ml. Ultrasound-guided aspiration confirmed metastasis from prostate cancer. CT revealed a level 3 neck node, 3cm in diameter. Whole body imaging indicated no other lymph node or visceral metastases. The patient then received 3 of 5 cycles in a phase 1 trial of an oncolytic virus plus monoclonal antibodies, but was removed from the study when his neck node disease progressed. Imaging showed necrotic nodes at left neck levels 2, 3, 5A. There was an infiltrative soft tissue mass surrounding the left C1 transverse process and encasing the left vertebral artery just below the skull base. There was no right-sided neck involvement. In July 2018, IMRT was used to deliver 51Gy in 20 fractions to a geometrically complex CTV in the left neck. To date, the neck nodes have reduced, but have not resolved completely. He still has no other lymph node or visceral metastases, and continues on ADT with a latest PSA of 1. An exhaustive review of the literature resulted in the identification of 13 case reports of cervical lymph node metastases from advanced prostate cancer, spanning 17 years. Misdiagnosis and delays to appropriate treatment were common due to the rarity of the phenomenon. 11 of 13 document nodes only in the left neck, and 5 of 13 report no lymphadenopathy except in the neck. All but one case were successfully palliated using ADT + chemotherapy. The remaining case saw disease progression on ADT, and received 70Gy chemo-rads to the left neck. This case report and literature review indicate that, although exceedingly rare, it is possible for advanced prostate cancer to metastasize to the left cervical lymph nodes without involvement of other lymph node groups. Improper assumptions about the site of primary disease, leading to inappropriate treatment choices, has been reported in the literature. ADT, chemotherapy and state-of-the-art radiotherapy can all be considered for palliation, on a case-by-case basis.

Unicentric Castleman disease in the paediatric neck: an unusual case of a rare diagnosis

We present a rare case of unicentric Castleman disease (CD) in the paediatric neck. A 12-year-old Caucasian girl was referred to us due to a slowly enlarging, painless right-sided neck mass. Our thorough investigative approach identified unicentric CD, with previously undocumented CD-like features occurring simultaneously in a separate lesion from the lymph node group involved in unicentric CD. Recognition of CD in the paediatric patient is essential, despite the condition’s rarity, to ensure adequate diagnostic work-up and management. We discuss features of unicentric CD, current concepts surrounding histology of the two separate variants of unicentric and multicentric CD, and the implications for management.

Abstract TP475: A Case of Suspected Vertebral Giant Cell Arteritis Causing Cervico-medullary Ischemia

Objective: To present a rare case of cervico-medullary ischemia suspected to be from giant cell arteritis (GCA). Background: In patients with GCA, vertebral artery involvement occurs in 3-4% of ischemic events and manifests by disturbances, cranial nerve palsies, cerebellar signs, weakness and altered consciousness (1,2). Design: Case Report. Results: A 79-year-old man presented with 2-week history of vertigo right-sided weakness, right-sided neck pain and occipital headaches with magnetic resonance imaging (MRI) brain and cervical spine without contrast showing right distal medulla and cervico-medullary junction infarct and magnetic resonance angiogram (MRA) neck showing bilaterally diminutive/atherosclerotic vertebral arteries with absence of flow in right vertebral C2 segment. Relevant tests showed an elevated white cell count of 14 K/mm 3 , C-reactive protein (CRP) of 171 mg/L, erythrocyte sedimentation rate (ESR) of 67 mm/hour, antinuclear antibodies (ANA) of 1: 1280 and unrevealing Reichlin profile, temporal artery ultrasound, carotid duplex, PET/CT and cerebrospinal fluid infectious workup. After initiation of Prednisolone 60 mg PO daily, patient reported improvement in pain and levels of inflammatory markers decreased. As patient was on Clopidogrel, temporal artery biopsy (TAB) was delayed and performed 14 days after initiation of steroids and showed no signs of inflammation. Patient is being planned for gradual steroid taper and monitoring of response. Conclusion: Vertebral GCA is a high fatality condition. A combination of persistently elevated inflammatory markers, unusual stroke location, bilateral vertebral artery disease with multiple areas of stenosis, improvement in weakness and pain after initiation of steroids were all highly suggestive of GCA vasculitic process. High index of suspicion is crucial as specific and curative treatment exists. In select cases where TAB is delayed, treatment should not be withheld.

The Lymph Node Content of Supraclavicular Lymph Node Flap: A Histological Study on Fresh Human Specimens.

Introduction: Vascularized lymph node transfer (VLNT) has become the established treatment for secondary lymphedema. The proposed mechanisms of VLNT include lymphangiogenesis and absorptive action of transplanted lymphatic tissue. Therefore, in theory, the lymph node content of lymph node flap is crucial to clinical response. The supraclavicular lymph node flap (SCLNF) has been described as one of the flap options for VLNT. However, its lymph node content has not been fully studied. The aim of this study is to find out the lymph node content of SCLNF with histological examination. Methods: Patients who required radical neck dissection or modified radical neck dissection due to cervical lymph node metastasis from head and neck cancer were included in this study. The SCLNF harvesting was performed as the first part of neck dissection. After flap harvesting, neck dissection was continued. The fresh SCLNF specimens were then sent for histological study. Results: Twelve SCLNFs were studied. The mean age of patients was 67.5 (range, 54-84) years. There were 10 males and 2 females. Seven flaps were harvested from the left side of neck, while five flaps were harvested from the right side of neck. The mean width, height, and thickness of SCLNF were 5.9 ± 0.6, 4.0 ± 0.5, and 1.8 ± 0.2 cm, respectively. The mean number of lymph nodes per flap was 8 ± 4.7 (range, 3-15). Conclusion: The lymph node content of SCLNF was confirmed. Its lymph node content is comparable to other lymph node flaps used in VLNT.

Effort Thrombosis Provoked by Saxophone Performance.

Internal jugular venous thrombosis (IJVT) is an uncommon condition rarely diagnosed in the outpatient setting. IJVT carries significant morbidity and mortality and must be considered in the differential diagnosis for new-onset neck pain and swelling, especially in the emergency setting. Paget-Schroetter syndrome (PSS), or primary thrombosis secondary to effort, is an uncommon, likely under-recognized etiology of thrombosis. We report a case of PSS extending from the right subclavian vein into the right internal jugular vein, suspected based upon patient history and physical examination and confirmed by point-of-care ultrasound (POCUS). We then review the presentation, causes, and diagnostic standards for PSS. We present a case of a 79-year-old man who presented to the Emergency Department with acute right-sided neck pain 1day after playing the saxophone for 4h the prior evening. POCUS confirmed Paget-Schroetter syndrome, or primary effort thrombosis of the internal jugular vein. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is the first documented case of PSS resulting from venous stasis with prolonged Valsalva maneuver and vascular trauma with activity of playing the saxophone. The significance of this case is the unusual etiology of a rare presentation and the ability to diagnose this condition quickly and accurately with POCUS.

A rare case of primary hydatid cyst of neck

&lt;p class="abstract"&gt;Primary hydatid cyst swelling of neck is an uncommon occurrence even in regions where hydatidosis is common. We report a case of a 13 year old male patient who presented with a swelling in right side of neck since 4 years, which turned out to be a hydatid cyst. FNAC is a useful pre-operative investigation for diagnosis of hydatid cyst. Complete surgical excision followed by medical treatment (benzimidazole derivatives) is considered to be the treatment of choice. Hydatid cyst should always be considered in the differential diagnosis of neck swellings.&lt;/p&gt;

Ruptured Mycotic Aneurysm of the Common Carotid Artery: A Case Report

Mycotic aneurysms of the common carotid artery (CCA) are very rare and warrant surgical treatment to prevent rupture and death. A 89-year-old man who complained of a sore throat and swelling of the right side of neck. He had no history of trauma or neck infection. Physical examination revealed hard and pulsatile mass. Computed tomography showed initially pseudoaneurysm rupture on the right CCA with surrounding inflammation. The emergency operation revealed mycotic aneurysm rupture with CCA necrosis and was successfully done by wide debridement and carotid artery resection with interposition bypass. The resected tissue and blood culture grew growth of Staphylococcus aureus group. We report a rare case of mycotic aneurysm of right CCA that treated by bypass interposition.