Soft Tissue Swelling Research Articles

Uncommon case report of maxillary sporadic odontogenic keratocyst

The odontogenic keratocyst (OKCs) is a rare disease manifested in the maxillofacial region, mainly affecting the mandiblerather than maxilla and is associated with the presence of a retained tooth. Most cases are asymptomatic, affecting males than women in their second decade of life and patients may present pain or soft tissue swelling in infected OKCs. Bony expansion and paresthesia of the lips are reported in fewer cases. The most common region in the maxillae is the third molar and cuspid region. The objective of this report is to present an uncommon clinical case of a 72 years old male with asymptomatic OKCs in the left maxilla region, presenting with bone lysis in the vestibular and palatine region with nostril alloy without compromising the teethes. Patient was treated with enucleation and peripheral osteotomy using a rotary instrument, today day without recurrence. A simple review of cases with maxillary keratocyst was made too.

Unusual presentation of a common tumor

Hepatocellular carcinoma(HCC) is the most common primary malignant tumour of liver. It is 5th most common malignancy in males and 8th most common tumour in females. The patients of HCC may remain clinically asymptomatic or may present with abdominal pain, weight loss, malaise, fever, jaundice or ascitis. HCC is a highly malignant tumor with frequent extrahepatic metastasis. The most frequent site of metastasis is lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). We present a case of 67 year old male, who presented with progressively increasing swelling in the left occipital region for 2 months. MRI brain showed large lobulated moderately enhancing T2 isointense to hyperintense and T1 hypointense mass lesion in occipital region, causing destruction of occipital bone with large intracranial extradural soft tissue component. Possibilities suggested were Meningioma or metastatic lesion. The scalp mass was excised. The histopathological examination of the excised tissue followed by elaborate immunohistochemistry suggested metastatic hepatocellular carcinoma, which was later confirmed by S.AFP and multiphase CT thorax, abdomen, pelvis which showed multiple liver lesions. Initial presentation of HCC as a subcutaneous lesion is very rare and only very few cases of HCC presenting with primary soft tissue swelling have been reported.

The effect of local intraoperative corticosteroid application on postoperative dysphagia following anterior cervical spine surgery.

Dysphagia is a common complication following anterior cervical spine surgery (ACSS). Although several literatures have reported the potential benefit of local corticosteroid application on dysphagia, its safety and efficacy are still unclear. A systematic review was performed aiming to evaluate the evidence of local corticosteroid application in prevention or treatment of postoperative dysphagia following ACSS. A systematic search was performed in September 2018 in PubMed and Embase database. The following information was extracted: study investigator, year of publication, number of patients, study design, inclusion/exclusion criteria, administration protocol of steroid, type of surgical procedure, number of levels performed, assessment methodology of dysphagia, radiologic assessment of prevertebral soft tissue swelling (PSTS), follow-up time points, outcome of dysphagia, and corticosteroid-related complications. Qualitative synthesis was performed. Finally, 5 studies met the inclusion/exclusion criteria. Four studies found that local corticosteroid application could decrease the incidence and magnitude of postoperative dysphagia while 1 study showed no effect on dysphagia significantly at 6 weeks and 3 months follow-up time. A total of 2325 patients received local corticosteroid intraoperatively; no early corticosteroid-related complication was reported. Totally, 4 adverse events occurred in long-term follow-up time, including 2 bone nonunion at 1.5 and 2.5 years postoperatively, 2 esophageal perforation at 2 months and 11 months of follow-up, respectively. Local corticosteroid application can reduce the incidence and severity of dysphagia following ACSS without increasing early corticosteroid-related complications. But further high-quality study is necessary to analyze potential delayed complications.

Sonographic Evaluation of a Perpetual Penetrating Retained Wood Splinter, Ulnar Artery Occlusion, and Soft Tissue Swelling in the Left Arm

Penetrating foreign bodies are frequently encountered, most commonly wood, glass, or metal slivers. Retained foreign bodies are often overlooked on initial examination and only 15% of wooden foreign bodies are detected by radiographic visualization such as radiography (X-ray), computerized tomography (CT), and magnetic resonance imaging (MRI). Soft tissue infection is the most common complication of a penetrating foreign body. This case report describes a 63-year-old man who was caught under a falling tree limb. His left forearm was speared by a large branch causing an open wound. Ten years later, the patient presented to the emergency department with pain, edema, and erythema. A left arm venous duplex was performed using dynamic B-mode imaging with pulsed Doppler to evaluate the venous system for thrombosis and a palpable mass. Sonography revealed a “perpetual” retained linear foreign body encased in a fluid collection and a distal ulnar artery occlusion with reconstitution of flow at the level of the wrist. Surgical correlation confirmed the presence, size, and location of the foreign body and associated fluid and debris. The foreign body, a wood splinter, was surgically removed without complications.

P046 Pointing the finger: an unusual presentation of dactylitis

Abstract Background/Aims Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results Blood tests showed elevated c-reactive protein 55 (normal <4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure N. Cernovschi - Feasey: None. J. Wajed: None.

Improving the Diagnosis of Fibrodysplasia Ossificans Progressiva

Fibrodysplasia ossificans progressiva (FOP) is a distinctive but often-overlooked disorder, owing to its extreme rarity and insidious presentation. However, the signs of classic FOP are evident at birth, and the disease clinically manifests typically within the first decade of life. The characteristic and invariably early sign of FOP is congenital malformation of the great toes (Figure 1). 1 Pignolo R.J. Wang H. Kaplan F.S. Fibrodysplasia ossificans progressiva (FOP): a segmental progeroid syndrome. Front Endocrinol (Lausanne). 2020; 10: 908 Crossref PubMed Scopus (12) Google Scholar , 2 Pignolo R.J. Shore E.M. Kaplan F.S. Fibrodysplasia ossificans progressiva: clinical and genetic aspects. Orphanet J Rare Dis. 2011; 6: 80 Crossref PubMed Scopus (159) Google Scholar , 3 National Organization for Rare Disorders [homepage on the Internet]. 2020https://rarediseases.org/rare-diseases/fibrodysplasia-ossificans-progressiva/ Google Scholar In 50% of cases, the thumbs are similarly affected. Other findings at birth may include a broad femoral neck and bony malformation of the cervical spine. 4 Meyers C. Lisiecki J. Miller S. Levin A. Fayad L. Ding C. et al. Heterotopic ossification: a comprehensive review. JBMR Plus. 2019; 3: e10172 Crossref PubMed Scopus (95) Google Scholar , 5 The International Clinical Council on FOP (ICC) and Consultants [homepage on the Internet]. 2019https://d3n8a8pro7vhmx.cloudfront.net/ifopa/pages/212/attachments/original/1559059247/FOP_TREATMENT_GUIDELINES_June_2019.pdf Google Scholar , 6 International Fibrodysplasia Ossificans Progressiva Association (IFOPA) [homepage on the Internet]. 2020www.ifopa.org/what_is_fop Google Scholar Heterotopic ossification, the abnormal growth of bone in extraskeletal tissues, typically is not present at birth, although areas of soft-tissue swelling may be evident in neonates. Infants and children with FOP may present to pediatric orthopedic surgeons with progressive “bunions” or malformed great toes. However, it is rare that the disease is recognized at this stage. In most cases, unfortunately, the diagnosis of FOP is not made until affected persons have consulted several physicians and the associated deformity and disability are undeniable. 7 Kapan F. Xu M. Glaser D.L. Collins F. Connor M. Kitterman J. et al. Early diagnosis of fibrodysplasia ossificans progressiva. Pediatrics. 2008; 121: e1295-e1300 Crossref PubMed Scopus (113) Google Scholar It is estimated that 3500-4000 people worldwide have FOP, although the disorder has been diagnosed in only about 900 people. 3 National Organization for Rare Disorders [homepage on the Internet]. 2020https://rarediseases.org/rare-diseases/fibrodysplasia-ossificans-progressiva/ Google Scholar Although there are currently no approved treatments for FOP, early recognition and diagnosis is important to prevent unnecessary trauma, such as intramuscular vaccination or surgery, that may induce disease flares.

Successful treatment of idiopathic knuckle pads with a combination of high-dose salicylic acid and urea topical keratolytics: A case report.

Knuckle pads are benign subcutaneous and usually hyperkeratotic fibromas for which no specific treatments exist. Unspecific treatments are, most of the time, ineffective and a wait-and-see policy is often recommended to patients. However, especially in adolescents, knuckle pads are often poorly tolerated for cosmetic reasons, potentially causing embarrassment and social anxiety. Here we present the case of a young adult successfully treated with a combination of high-dose salicylic acid and urea topical keratolytics. In addition, we provide ideal diagnostic images obtained via high-resolution ultrasonography and histological features that can be used by medical practitioners to better distinguish knuckle pads from other proximal interphalangeal/ metacarpophalangeal joint diseases as also from other diseases inducing swelling of periarticular soft tissues.

The reliability and distribution of foot osteoarthritis assessed by ultrasound and clinical examination in a hand osteoarthritis cohort

Purpose: Foot osteoarthritis (OA) is a disabling and painful disease with similar prevalence to knee OA. To date, foot OA has been largely ignored in the OA research society. There are guidelines regarding the diagnosis of hand and knee OA, but no such recommendations are available for foot OA. Clinical markers of foot posture, range of motion, inspection and palpation have shown limited ability to discriminate persons with and without radiographic OA in the midfoot. Ultrasound may be a useful tool for the assessment of OA features in the foot. Recently, the OMERACT Ultrasound Task Force proposed definitions of inflammatory and structural lesions in the foot, but more research is needed before ultrasound can be recommended for the assessment of structural features in the foot. No studies have explored the frequency of joint involvement using ultrasound in comparison to clinical examination. Hence, the aims of the current study were to compare reliability and distribution of ultrasound-detected and clinical features of foot OA. Methods: The Nor-Hand study is an observational cohort where 300 patients with hand OA (89% women, median (IQR) 61 (57-66) years old) were recruited. The current analyses include cross-sectional data from the baseline examination. A trained medical student (CMF) performed the ultrasound examination of the feet using a General Electric (GE) Logic E9 ultrasound machine with a 6-15Mz probe. The bilateral tibiotalar, talonavicular, 1st and 2nd to 3rd naviculocuneiform, 1st to 4th tarsometatarsal (TMT), 1st metatarsalphalangeal (MTP), 1st interphalangeal (IP), lateral subtalar, medial subtalar and the calcaneocuboid joints were scored for the presence of grey-scale synovitis, power Doppler signals and osteophytes on 0-3 semi-quantitative scales (0=no, 1=mild, 2=moderate, and 3=severe pathology). Ten patients were also examined by a rheumatologist with extensive ultrasound experience (HBH) to evaluate the inter-observer reliability. An experienced rheumatologist (BSC) examined the bilateral tibiotalar, talonavicular, 1st and 2nd naviculocuneiform, 1st to 4th TMT, 1st MTP and subtalar joints for the absence/presence of soft tissue swelling and bony enlargement. A rheumatology fellow performed the joint evaluation if BSC was not available. Ten patients were examined by both the experienced rheumatologist and the rheumatology fellow to evaluate inter-observer reliability. We calculated the inter-observer reliability for ultrasound and clinical examination in all foot joints using prevalence and bias adjusted kappa (PABAK) values due to low frequency of OA in many foot joints. We then compared the pattern of OA features in individual foot joints in the left and right foot by ultrasound and the frequency of sonographic joint involvement in comparison to clinical examination using Chi square tests. Results: Good to excellent inter-observer reliability by PABAK was observed for all ultrasound features (grey-scale synovitis: 0.78; osteophytes: 0.82; power-Doppler activity: 0.98). Similar good inter-observer reliability was found for clinical assessment of the foot with PABAK values ranging from moderate to excellent (bony enlargement: 0.90, soft tissue swelling: 0.99). By ultrasound, OA was most prevalent in the MTP1, IP1, talonavicular and subtalar joints (Table 1). Overall, osteophytes and synovitis were numerically more prevalent in the right foot compared to the left foot (Table 1). Clinical bony enlargement was most common in MTP1 and TMT1-2. Clinical soft tissue swelling was uncommon in all joints with the highest prevalence in the MTP1 joints. Ultrasound-detected osteophytes and grey scale synovitis were more common than clinically observed bony enlargement and soft tissue swelling in most foot/ankle joints (Table 2). In the MTP1 joints, clinical examination detected more frequent bony enlargement, whereas ultrasound was more sensitive in the detection of synovitis (both grey-scale synovitis and power Doppler activity) in comparison with soft tissue swelling by clinical examination. Conclusions: We found good inter-reader reliability for ultrasonographic and clinical examination of OA features in patients with foot OA. Ultrasonographic features of OA were more prevalent in the right than left foot, and most frequent in the MTP1, IP1 and talonavicular joints. In most individual foot joints, ultrasound detected more osteophytes than clinical examination found bony enlargements. The high prevalence of synovitis in the MTP1 joint may reflect normal increased effusion in this joint.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vascular impulse technology versus elevation for the reduction of swelling of lower extremity joint fractures: results of a prospective randomized controlled study.

Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40). Patients were randomized to the two study groups in a 1:1 ratio. The effectiveness of VIT (intervention) compared with elevation (control) was analyzed separately for the whole study population and for the three subgroups. The primary endpoint was the time from admission until operability (in days). The mean length of time until operability was 8.2 days (SD 3.0) in the intervention group and 10.2 days (SD 3.7) in the control group across all three fractures groups combined (p = 0.004). An analysis of the subgroups revealed that a significant reduction in the time to operability was achieved in two of the three: with 8.6 days (SD 2.2) versus 10.6 days (SD 3.6) in ankle fractures (p = 0.043), 9.8 days (SD 4.1) versus 12.5 days (SD 5.1) in pilon fractures (p = 0.205), and 7.0 days (SD 2.6) versus 8.4 days (SD 1.5) in calcaneal fractures (p = 0.043). A lower length of stay (p = 0.007), a reduction in pain (ppreop = 0.05; pdischarge < 0.001) and need for narcotics (ppreop = 0.064; ppostop = 0.072), an increased reduction in swelling (p < 0.001), and a lower revision rate (p = 0.044) could also be seen, and a trend towards fewer complications (p = 0.216) became apparent. Compared with elevation, VIT results in a significant reduction in the time to achieve operability in complex joint fractures of the lower limb. Cite this article: Bone Joint J2021;103-B(4):746-754.

Synovial fluid mitochondrial DNA as a biomarker after naturally occurring intra-articular fracture

Synovial fluid mitochondrial DNA as a biomarker after naturally occurring intra-articular fracture

Rheumatoid Hand and Other Hand-deforming Rheumatic Conditions.

The hand and wrist are commonly involved in rheumatic conditions, particularly rheumatoid arthritis and other systemic connective tissue diseases. With spondyloarthritis, hand and wrist involvement frequently occurs in psoriatic arthritis but generally does not occur in the remaining subtypes. The hand and wrist may also be affected in various metabolic and endocrine diseases, but these lie beyond the scope of this review.Radiographs may demonstrate the presence of joint space narrowing, bone loss, cysts and erosions, malalignments, and osteolysis. They may also show regions of soft tissue swelling or thinning, and detect calcifications. Ultrasonography and magnetic resonance imaging (MRI) enable evaluation of the soft tissues, particularly the synovium, tenosynovium, and tendons. Furthermore, erosions are better demonstrated than on radiographs. MRI allows evaluation of periarticular bone marrow edema.This article discusses typical imaging features of the hand and wrist in rheumatologic conditions including the advantages and limitations of the various methods.

Transdiaphragmatic Intercostal Hernia-An Unusual Hepatic Injury After a Car Accident: A Case Report and Review of the Literature.

Transdiaphragmatic intercostal hernia, in which the abdominal contents of the hernia protrude through the diaphragm and the thoracic wall defect. is a very rare type of hernia with only a few cases having been reported in the literature. That type of hernia is usually manifested in male patients after trauma, penetrating or blunt. It is frequently presented with a palpable thoracic mass and pain. The indicated treatment is surgery. We present the case of a 60-year-old female admitted to the hospital after a car accident and suffered multiple rib fractures (6th, 7th, 8th right ribs / 7th, 8th, 9th left ribs), as well as flail thorax, hemothorax bilaterally, left subcutaneous emphysema and swelling of soft tissues of the right lateral thoracoabdominal wall. CT scan revealed herniation of hepatic parenchyma and intestinal loops into the thorax. The patient was treated surgically, and his postoperative course was uneventful. We also review the relevant literature concerning this transdiaphragmatic, intercostal hernia and identify 42 cases. Transdiaphragmatic intercostal hernia is a rare condition, usually manifested in male patients after trauma, penetrating or blunt. It is frequently presented with a palpable thoracic mass and pain. The indicated treatment is surgery.

Open reduction and internal fixation of posterior malleolus fractures

Stabilization of the syndesmotic complex by open reduction and internal fixation (ORIF) of the posterior malleolus, restoration of the tibial articular surface, stability of the ankle, posterior tibiofibular ligament and the incisura tibiae, reduction of the fibula into the incisura tibiae by ligamentotaxis. Unstable ankle fractures (OTA/AO type 44-B3, C1.3, C2.3, C3.3) with involvement of the posterior malleolus (typeII-IV according to Bartoníček and Rammelt). Critical general condition, circulatory disorders, severe soft tissue swelling (if necessary, first external fixator), percutaneous treatment the better alternative. Positioning in unstable lateral position, dorsolateral approach dorsally of the peroneal tendons, incision of the superficial and deep fascia, retraction of the flexor hallucis longus tendon medially, visualization of the posterior malleolus, reduction and fixation. To treat the lateral malleolus fracture, preparation of afull-thickness flap above the peroneal tendons on the fibula, treatment according to AO principles. For the treatment of the medial malleolus positioning in supine position without changing the sterile covers, medial approach for the medial malleolus, wound closure. Sixweeks partial weight bearing (20 kg), early functional exercise, exercise of the flexor hallucis longus muscle; transition to full weight bearing after clinical and radiological follow-up after 6weeks RESULTS: Few clinical results on open ORIF of the posterior malleolus have been published. However, most studies found that ORIF resulted in better reconstruction of the distal articular surface and the tibial incisura, better reduction of the fibula into the tibial incisura, stabilization of the distal tibiofibular joint and better clinical results, regardless of fragment size, when compared to closed reduction or untreated fragments.

Clinical presentations of Kingella kingae musculoskeletal infections in South Australian children.

This study aimed to alert clinicians to the spectrum of presentations of Kingella kingae musculoskeletal infections. Between August 2010 and March 2018, 55 children presented with positive K. kingae polymerase chain reaction on joint fluid, bone or deep soft tissue collections involving the limbs and subsequently underwent retrospective medical record, radiological and laboratory review. Demographics and clinical information are presented. Median age at presentation was 15.9months (range 4.3months-10.7 years) and 64% were male. Septic arthritis was the most common diagnosis (95%), median duration of symptoms was 4 days, 65% had a preceding infection (e.g. upper respiratory or gastrointestinal) and 22% re-presented to emergency departments after prior discharge. The lower limb was involved in 84%, with the knee being most affected (55%). If the lower limb was involved, 82% of previously weight-bearing children had a limp or were unable to weight bear. On presentation, median temperature was 36.7°C and inflammatory markers were mildly elevated. No blood cultures grew K. kingae. Five synovial fluid cultures were positive for K. kingae. Plain radiography showed effusion, soft tissue swelling or a lesion in 53% of patients. All 41 ultrasounds showed effusion, soft tissue swelling or synovial thickening. One patient with delayed diagnosis later presented with avascular necrosis of the femoral head. Kingella kingae is difficult to diagnose due to non-specific symptoms, absence of fevers and often unremarkable blood tests. Despite generally having good long-term outcomes, our case of avascular necrosis suggests accurate diagnosis and treatment are important.

A Clinical Review of Slipping Rib Syndrome.

Slipping rib syndrome is pain created at the lower, anterior border of the rib cage when performing upper-extremity activities, coughing, laughing, or leaning over. Defects in the costal cartilage of ribs 8 to 10 result in increased movement of the ribs, impinging soft tissue and intercostal nerves. Advancements have been made in the diagnosis of slipping rib syndrome by dynamic ultrasound. Ultrasound can identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling. Although the mainstays of treatment continue to be reassurance, nonsteroidal anti-inflammatory drugs, physical therapy, intercostal nerve injections, osteopathic manipulative treatment, surgery for refractory pain, and botulinum toxin injections have been attempted, and there may be a role for prolotherapy in treatment. Surgical techniques are being examined secondary to recurrence of pain following resection. The hooking maneuver and surgery remain important for identification and treatment, respectively.

Abstract P581: Neonatal Stroke is Not Associated With Birth Trauma

Acute neonatal stroke causes cerebral palsy, lifelong morbidity and mortality. Neonatal arterial ischemic stroke (NAIS) and hemorrhagic stroke (NHS) are most common. Pathophysiology is poorly understood and causation is often attributed to observed obstetrical factors such as instrumentation (forceps or vacuum) or operative delivery despite no empiric evidence supporting an association. We explored the relationship between birth trauma and neonatal stroke via population-based, prospectively collected registries in Southern Alberta, Canada. Consecutive cases of NAIS (n=59), NHS (n=20), and neonatal hypoxic-ischemic encephalopathy HIE with MRI-confirmed injury (HIE+, n=78)) were compared to neonates without injury (HIE-n=77). Cranial soft tissue swelling was objectively quantified as a trauma score from T1-weighted images using a semi-automatic segmentation method performed by two blinded investigators. Maternal, obstetrical, perinatal, and outcome variables were obtained from medical records. Multinomial regression modeling evaluated the relationship between diagnosis and birth trauma as measured by total soft tissue swelling score and diagnosis (HIE- as controls). Across the 234 infants studied, mean age at MRI (4.1+/-1.3 days) and sex (54% male) were comparable. Measurable scalp trauma was present in 93(40%), the proportion of which did not differ across groups. On univariate analysis, mean trauma scores did not differ between groups, were not associated with NHS or HIE+, and were lower for the NAIS group compared to HIE- (controls). Multinomial modeling revealed no relationship between scalp trauma and outcome. We conclude that the leading forms of acquired neonatal brain injury are not associated with objectively measured birth trauma. The term “birth trauma” should be removed from the perinatal stroke vernacular to help counsel traumatized parents and advance studies of genuine pathophysiology.

Sudden neck swelling with rash as late manifestation of COVID-19: a case report

BackgroundAlthough there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature.Case presentationWe report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient’s husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab.ConclusionSudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.

Orbital Pseudotumor: Diagnosis and Management in A Secondary Hospital

Objective: To increase the awareness in diagnosing orbital pseudotumor and its management, especially in a peripheral secondary hospital with limited facilities.Case presentation: A 47 years old woman came with left eye (LE) protrusion, blurred vision, retrobulbar pain, and severe headache at regular intervals. This condition begun 8 months ago, and was diagnosed with orbital cellulitis, however the symptoms persisted until now. Physical examination of the LE showed a decreased in visual acuity, protrusion, chemosis and conjunctiva injection, increased in IOP, limited ocular motility, ipsilateral afferent pupillary defect and optic disc oedema. Plain and contrast CT-Scan showed a hypertrophy of ocular muscles with soft tissue swelling. Patient then diagnosed with idiopathic orbital inflammation and immediately prescribed with high dose steroid for 5 days with observation with glucose level observation for toxicity. Afterwards, she was given an oral corticosteroid and was tapered off for the next few weeks. At two months follow up, there were improvement in protrusion, motility and visual acuity. Conclusion: A complete history taking, physical examination and appropriate additional examination are needed. In hospital or clinical setting with limited facilities, a thorough and comprehensive examination are needed in order to establish the diagnosis and management of orbital pseudotumor.

Stress fracture of the palmar, distal cortex of the third metacarpal bone: A diagnostic challenge with a good prognosis.

Transverse stress fracture of the palmar cortex of the distal aspect of the third metacarpal bone (TSF PCD McIII) is poorly documented. To describe the typical signalment of this injury, the common clinical and radiological signs and prognosis. A retrospective hospital-based case series with follow-up of racing records. All cases of TSF PCD McIII diagnosed among racehorses in training at the Hong Kong Jockey Club between 2011 and 2019 were identified. Clinical records were reviewed and documented signs were recorded for each case. Findings from a predefined list of radiological features were listed. Descriptive statistics were used to describe the age and training profile of horses, the clinical and radiological findings and time to return to ridden exercise. Twenty-three cases (n=23) were identified. The majority (57%) had recently started or returned to training from a break and 35% (n=8) of cases had not yet undertaken timed gallops at the time of injury. Most cases (20/23; 87%) were lame; in nine (39%), lameness was severe. Localised swelling of superficial soft tissues was reported in 15/23 (65%) cases. Pain on palpation of the distal McIII was present in 15/23 (65%) cases and in response to fetlock flexion in 12/23 (52%). Diffuse, localised increase in radiopacity, disruption to the outline of the bone periosteal surface and outward displacement of the button of the splint bone were common radiological features in early cases (70%, 67% and 67% of all cases). Sixty-one per cent of cases (14/23) were initially misdiagnosed. Most horses (n=18/23) resumed training and racing after a median of 83 and 246days. Clinical notes were not consistent between cases. Radiographs were taken at different times. Horses commencing training are at risk of TSF PCD McIII, which presents with confusing clinical signs and subtle radiological findings. The long-term outlook is favourable.

Giant Anterior Neck Lipoma in an Elderly: A Rare Differential Diagnosis

Lipoma is a benign mesenchymal tumour of adipose tissue and relatively rare occurrence in head and neck area. Mostly lipoma have a diameter of 2 cm and rarely grow beyond 10 cm. However, it may occasionally enlarge rapidly and become huge to become a giant lipoma which measures at least more than 10 cm in one dimension or weighing at least 1000g. The presentation of the anterior neck swelling is mostly related to the thyroid gland. However, it also can be the other soft tissue swellings, such as lipoma, which is the commonest mesenchymal tumours in adults. The lipomas however, are commonly involving the head and posterior neck region, which estimate about 15-20% of the cases and mostly small. We present the case of a 80-yearold man with huge anterior neck swelling for thirty years. The complete excision was performed with a good post-operative healing and cosmesis.&#x0D; Bangladesh Journal of Medical Science Vol.20(2) 2021 p.449-452