Left-sided Swelling Research Articles

Treatment-Resistant Bacterial Lymphadenitis in an Otherwise Healthy Girl.

1. Oze Henig, MD*,† 2. Soma Jyonouchi, MD‡,§ 3. Torsten Joerger, MD¶ 4. Katie Kennedy, MD‡ 1. *Division of General Pediatrics 2. ‡Division of Allergy and Immunology, and 3. ¶Department of Infectious Disease, Children’s Hospital of Philadelphia, Philadelphia, PA 4. †Children’s Hospital of Philadelphia Inpatient Pediatrics at Virtua, Voorhees, NJ 5. §Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA A previously healthy 5-year-old girl presents to the pediatric emergency department of a community hospital with 3 days of fever and neck swelling. She reports pain when moving the neck upward and to the right, but there is no neck stiffness. On physical examination she has a temperature of 102.2°F (39°C) but is well appearing. She has a 2-cm, left-sided, mobile, tender mass along the anterior cervical chain and shotty lymphadenopathy of the right anterior cervical chain. She is diagnosed as having lymphadenitis and is discharged with a prescription for clindamycin. Despite consistently taking the antibiotic, she returns 3 days later with persistent fever and worsening swelling. On physical examination her left-sided swelling has increased to 3 cm, but she continues to have normal range of motion of her neck. A complete blood cell count reveals a white blood cell count of 11,000/µL (11×109/L); hemoglobin concentration, 9.0 g/dL (90 g/L); and platelet count, 424×103/µL (424×109/L). The differential cell count includes 63% neutrophils, 24% lymphocytes, 12% monocytes, and 1% eosinophils. Ultrasonography is performed and demonstrates 2 lymph nodes in the left cervical chain that seem reactive in nature and with no abscess formation. The patient is admitted on intravenous (IV) ampicillin-sulbactam for presumed outpatient treatment failure of acute lymphadenitis. However, her symptoms persist, and further testing is needed to reveal the etiology of her infection. While receiving IV ampicillin-sulbactam, the patient continued to have persistent fever. Serologic tests for Epstein-Barr virus, cytomegalovirus, and Bartonella henselae as well as a tuberculin skin test and rapid human immunodeficiency virus testing were negative. A chest radiograph showed no abnormality. After 10 days of fever with stable physical examination findings, otolaryngology performed an excisional biopsy, with resultant …

Synovial sarcoma of the neck

Synovial sarcomas are rare malignant neoplasms commonly arising from articular tendons and joint capsules. Despite being termed synovial sarcomas due to their histologic similarity to the synovium, they rarely involve a synovial structure. Although they mostly occur in lower extremities, rare cases originating from the thorax, abdomen, head, and neck have also been reported. A 60-year-old male patient was admitted to the hospital with a complaint of swelling in left side of the neck. CT revealed a mass of approximately 6.5x5 cm, occupying the left parapharyngeal space and left submandibular fossa and protruding into the pharynx lumen. The lesion was non-infiltrative, well circumscribed, and uniformly ovoid. The patient underwent surgery, and subsequent pathological examination confirmed the diagnosis of synovial sarcoma. Despite their rarity, synovial sarcomas should be considered, along with Ewing’s sarcoma, rhabdomyosarcoma, and other sarcomas, in the differential diagnosis of a large juxtaarticular mass containing calcifications.

Bezold’s abscess: a rare complication of chronic suppurative otitis media in a 13 year old female child

<p class="abstract">Suppurative otitis media is one of the most common ear diseases in developing countries. The advent of antibiotics has decreased the otogenic complications of this disease. Benzold’s abscess is one such rare complication of chronic suppurative otitis media. The study was done with the objective to report a case of a patient presenting with Bezold’s abscess as a complication of chronic suppurative otitis media. The case report included a 13 year old female presented with a complaint of foul smelling and scanty discharge in left ear for the past 2 years. She developed fever & a painful swelling in left side of neck extending from the tip of mastoid to the angle of mandible which was of 1 week duration. Clinical examinations and investigations revealed as left sided chronic suppurative otitis media (active squamosal type) with severe conductive hearing loss with a rare extracranial complication of Bezold’s abscess. Chronic suppurative otitis media can lead to a rare complication of Bezold’s abscess<span lang="EN-IN">.</span></p>

Importance of Preserving Parathyroids in Surgery for Hemiagenesis of Thyroid: Analysis with Review of Literature

ABSTRACT Background/objectives As congenital anomalies of the thyroid are rare and the pathology associated with it warranting total thyroidectomies is still rare, so the inadvertent parathyroidectomies are rarely reported. Unilateral or bilateral hypoplasia or agenesis of one or both thyroid lobes, with or without isthmic agenesis, is a rare developmental anomaly. Meticulous subcapsular dissection with preserving the vascular twigs to the parathyroid is very important in avoiding complications. Materials and methods We report two cases of thyroid hemiagenesis in our medical college institution over a period of 10 years. Both were females in the 6th decade with swelling in the neck. One had a right-sided swelling and the second had a left-sided swelling, both measuring about 5 ⨯ 5 cm. Conclusion So the total thyroidectomy surgery in hemiagenesis cases poses a risk to the parathyroids as the altered anatomy. So the time-tested technique of subcapsular dissection and meticulous preservation of the multiple vasculature of the parathyroids in the fascial compartment provides better results with least morbidity. How to cite this article Naik SM, Halkud R, Chavan P, Appaji M, Sathya P, Bhat SR, Deekshith RM. Importance of Preserving Parathyroids in Surgery for Hemiagenesis of Thyroid: Analysis with Review of Literature. Int J Head Neck Surg 2015;6(4):146-148.

Anterior Neck Lipoma with Anterior Mediastinal Extention – A Rare Case Report

Lipomas are the most common benign mesenchymal tumour. Thirteen percent of lipomas are seen in head and neck region. Anterior neck lipoma is a rare one. Anterior neck lipoma with mediastinal extension is extremely rare. We are presenting a case of 52 years old male reported to Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim with complains of swelling in left side of neck for last 18 months along with occasional history of dyspnoea. Physical examination, ultrasound, computed tomography and fine needle aspiration cytology are in favor of lipoma. Due to its location up to the anterior mediastinum, the surgery could not be done in this hospital and patient was referred to higher center having cardiothoracic surgical back up.

Synovial chondromatosis originally arising in the lower compartment of temporomandibular joint: A case report and literature review

Introduction More than 200 cases of synovial chondromatosis (SC) in the TMJ were reported. Most of SC described exclusively involved the upper compartment of the joint. SC originally arising in the lower compartment is rarely found. Material and methods This article presents a 50-year-old man with a slow growing, pain, preauricular swelling in left side and the limitation of mouth-opening. Panoramic radiograph, CT scans and MR images were taken. An arthroscopic examination and a surgical intervention were performed. Results Panoramic radiograph and CT scans didn’t reveal the calcifying lesions in left TMJ region. Sagittal MR images and the arthroscopic examination demonstrated distinct nodules within an extremely expanded lower joint compartment and a normal position of the articular disc. All loose bodies and grossly abnormal synovium were removed. The diagnosis of SC was confirmed by histologic examination. Conclusion MRI and arthroscopy may be helpful diagnostically. Removal of all involved synovium, and loose cartilaginous bodies may be required for adequate treatment.

A rare case of primary mediastinal non-seminomatous germ cell carcinoma in a 18 year old boy

A 18 year old Hindu boy presented with left sided chest pain, shortness of breath, high fever and swelling of left side of chest and left arm. He was anaemic with fea­tures of Superior Venacaval (SVC) Obstruction. CT Scan of Thorax revealed huge heterogeneous anterior mediastinal mass. He had very high level of serum alpha fetoprotein. CT guided Fine Needle Aspiration Cytology (FNAC) gives the diagno­sis of Yolk sac tumour . As USG of abdomen and testes were normal, it is a case of primary mediastinal Yolk sac ( Endodermal sinus ) tumour. Although nonseminomatous germ cell tumour is 30-40% more common in Klinefelter's syndrome [1] , Karyotyping of this patient was normal.