Unilateral Enlargement Research Articles

Association between comorbid COPD or chronic bronchitis and the prognosis of patients with Dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) is characterized by unilateral or bilateral ventricular enlargement and reduced ventricular systolic function, with or without heart failure. In previous studies, we found that a history of chronic obstructive pulmonary disease (COPD) or chronic bronchitis is a high risk factor for DCM combined with pulmonary hypertension (PH). Therefore, we propose that the comorbidity of COPD or chronic bronchitis will increase the cardiogenic mortality of patients with DCM. Data were collected from patients with DCM who were admitted to The First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2008 to April 2020. The primary endpoint was cardiac death. Multivariable Cox regression analyses were employed to assess the associations between the comorbidities COPD or chronic bronchitis with the study endpoints. Different adjusting models were used to adjust for potential confounders. A total of 305 DCM patients were ultimately enrolled, among whom 46 patients had COPD or chronic bronchitis. The median follow-up was 50 months. The rate of cardiac death in the COPD or chronic bronchitis group was significantly greater than that in the non-COPD or nonchronic bronchitis group (p < 0.001). The associations between comorbid COPD or chronic bronchitis and cardiac death remained robust after eliminating the possible effects of confounders. After grouping by PH, the risk difference was mainly derived from the intermediate- or high-probability PH group. Comorbid COPD or chronic bronchitis increased the risk of cardiac death among DCM patients with an intermediate or high PH probability.

Testicular enlargement, abdominal pain and vomiting in 3‐month‐old, male, entire Airedale terrier

AbstractNon‐neoplastic scrotal testicular torsions in juvenile dogs have been rarely reported. This case report describes a scenario in which a patient presented with abdominal pain, vomiting and unilateral testicular enlargement. The primary veterinarian performed abdominal radiographs that were suspicious for a hernia. The patient was referred to a specialty hospital for further diagnostics and treatment. Upon referral, an abdominal ultrasound revealed a suspected non‐neoplastic scrotal testicular torsion. The patient underwent hemicastration to remove the affected testis and recovered uneventfully.

A Rare Presentation of Acute Suppurative Thyroiditis.

A previously healthy 17-year-old female patient initially presented with symptoms of anterior neck pain. After multiple emergency department visits, she was found to have unilateral enlargement of her thyroid gland. Laboratory studies were consistent with hyperthyroidism. Symptoms were initially attributed to subacute thyroiditis, and she was discharged with steroids and propranolol. She presented again 1 week later with complaints of nausea, vomiting, abdominal pain, and shortness of breath. She was readmitted and developed sepsis with multiorgan system infection and Lemierre syndrome. Further imaging revealed acute suppurative thyroiditis as the likely source. Direct laryngoscopy and bronchoscopy revealed ulceration of the anterior esophageal wall, a fistulous tract to the thyroid, and copious purulent drainage. Esophageal biopsies with immunostaining established a diagnosis of herpes simplex virus esophagitis as the likely cause of esophageal perforation, fistula development, and acute suppurative thyroiditis.

Nephrectomy in a rabbit with renal adenocarcinoma

The following case report describes the clinical approach concerning diagnostic procedures and treatment of a renal adenocarcinoma in a 2-year-old rabbit presented due to hyporexia and polydipsia. The clinical examination disclosed an abdominal mass. Further imaging revealed a unilateral enlargement of the left kidney presumed to be of neoplastic origin. After staging via blood testing, abdominal ultrasound and radiographic imaging of the thorax and abdomen revealed no signs of metastasis, nephrectomy was performed. Patho-histological examination confirmed the diagnosis of a renal adenocarcinoma. Despite its guarded prognosis the patient recovered completely and was free of metastases or other health limitations 12 months after the surgery.

A Unique Case of Unilateral Pseudogynecomastia.

Gynecomastia is a common condition characterized by the benign enlargement of male breast tissue, often resulting from hormonal imbalances. A rare variant, unilateral pseudogynecomastia, involves enlargement due to adipose tissue accumulation without glandular proliferation and can be associated with occupational factors. We report the case of a 45-year-old male mechanic presenting with unilateral enlargement of the left breast. The patient reported daily microtrauma on his left axilla and chest wall. The clinical evaluation and imaging revealed lipomatosis with pronounced fibrous tissue and no glandular tissue involvement. The hormonal assays were within the normal limits. The patient underwent surgical excision of excess adipose tissue using the Kornstein technique, preserving the nipple-areola complex. The histopathological examination confirmed the absence of malignancy. The postoperative recovery was uneventful, and the follow-up examination at 12 months demonstrated a symmetrical breast appearance with no recurrence. This case underscores the importance of differentiating pseudogynecomastia from true gynecomastia and recognizing potential occupational risks. Surgical management using techniques that preserve the nipple-areola complex can achieve excellent cosmetic outcomes.

Evaluation of the Management of Asymptomatic Unilateral Tonsillar Enlargement-Can We Avoid Diagnostic Surgery?

Unilateral tonsillar enlargement (UTE) generally prompts suspicion of malignancy and tonsillectomy is often performed for histological diagnosis. This may be unnecessary in asymptomatic patients. We performed a retrospective study of all patients who had asymptomatic UTE and underwent tonsillectomy over a 5-year period. We found no malignancies in our cohort of 78 patients. 22 out of 74 (29.7%) patients had a difference of 50% or more in the size of their tonsils. Around 1 in 4 patients had an inaccurate clinical diagnosis of UTE compared to the final size of their tonsil specimens. In a comprehensive literature review, only 2 out of 1152 patients (0.17%) were found to have lymphoma with UTE as the only presenting symptom and no other suspicious features. There can be huge variability between the size of normal tonsils. UTE alone without any other concerning features should prompt clinicians to consider other management options such as a period of observation rather than diagnostic tonsillectomy.

Management of Children with Megafoot Secondary to Proteus Syndrome: A Report of Three Cases with Long-Term Follow-Up.

Proteus syndrome is a rare disorder characterized by overgrowth of limbs and organs and neurocutaneous findings. We examined three Proteus syndrome cases with unilateral foot enlargement, megafoot. The patients had ambulatory and cosmetic difficulties. Debulking surgery was performed. After the surgeries, patient mobility and functional scores were analyzed and found to be improved; only one patient had recurrence after 5 years. In the literature, there is no consensus about the treatment and the timing of treatment of Proteus syndrome. The literature suggests that early surgery for megafoot leads to better functional results. Debulking surgery and amputation are the two options mentioned. In the present cases, soft-tissue debulking was performed. In patients with megafoot caused by Proteus syndrome, the functional results were better for those with early debulking surgery compared with those who did not undergo surgery. Patients were able to fit into shoes and walk without difficulty.

316 Clinical Significance and Diagnostic Approach for Paediatric Unilateral Tonsillar Enlargement: Insights from a Retrospective Analysis

316 Clinical Significance and Diagnostic Approach for Paediatric Unilateral Tonsillar Enlargement: Insights from a Retrospective Analysis

Follow-up outcome analysis of 324 cases of early-onset and late-onset mild fetal ventriculomegaly: a retrospective cohort study

BackgroundMild fetal ventriculomegaly (VM) is a nonspecific finding common to several pathologies with varying prognosis and is, therefore, a challenge in fetal consultation. We aimed to perform a constant, detailed analysis of prenatal findings and postnatal outcomes in fetuses with early-onset and late-onset mild ventriculomegaly, and provide a new evidence basis and new perspective for prenatal counseling.MethodsThis is a retrospective cohort study of women with a diagnosis of mild fetal VM between January 2018 and October 2020. The population was divided into two groups according to the gestational ages (GAs) at initial diagnosis: the early-onset group (diagnosed at/before 24+6 weeks) and the late-onset group (diagnosed after 24+6 weeks). Clinical data and pregnancy outcomes were obtained from hospital records. The children’s neurodevelopment status was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3) and telephone interviews.ResultsOur study cohort comprised 324 fetuses, out of which 94 (29%) were classified as early-onset group and 230 (71%) late-onset group. Early-onset group was more likely to have concurrent additional abnormalities, whereas in the late-onset group, isolated enlargement was more common (P = 0.01). Unilateral enlargement was more common in the late-onset group (P = 0.05), and symmetrical enlargement in the early-onset group (P < 0.01). In addition, early-onset mild VM cases were more likely to have intrauterine progression (P = 0.03), and many had a higher proportion of complex multisystem abnormalities. Compared with the late-onset group, the early-onset group was more often associated with congenital brain structure malformations. Approximately 11% of fetuses with mild VM had postnatal neurodevelopmental delay/disorders, and the risk was higher in the early-onset group (19.4% vs. 7.4%). Regression analysis showed that the GA at first diagnosis, non-isolated, and intrauterine progression significantly correlated with neurodevelopmental abnormalities.ConclusionsEarly-onset and late-onset mild VM had significantly different ultrasound features and outcomes. Early-onset mild VM may have more complex potential abnormalities and are more likely to predict poor prognosis than the late-onset.

Prevalence and Risk Factors Associated with Rib Lesions in Dairy Cows.

Unilateral or bilateral hard bony enlargement is sometimes palpated over dairy cows' ribs. Although usually not painful, these injuries may have welfare and economic implications and can be used as indicators of poor husbandry conditions. The objective of this study was to determine the prevalence of rib lesions in dairy cows kept in intensive systems and to identify the risk factors either associated with the housing or with the animal's clinical history. We examined the ribs of all 1319 lactating cows from 22 Portuguese dairy farms. In each farm, housing and animal potential risk factors were recorded. Additionally, clinical examination, including lameness scoring, was performed on all cows showing rib lesions. The global rib lesions' prevalence per farm was 2.3%, ranging from 0% (n = 12 farms) to 6.1% (n = 1 farm). Lesions were found in cows with an average of 3.7 lactations. The main farm risk factors were narrow stalls; insufficient feeding places; insufficient cubicles; and the presence of an exposed curb at the back end of the stalls. Rib lesions were associated with a history of lameness but not with lame cows at the moment of examination or a history of being a downer cow. In conclusion, rib lesions' prevalence can be high in some farms, being significantly associated with cubicle design and lameness. By being associated with chronic lameness and inadequate housing, rib lesions should be included in dairy cows' welfare assessment protocols.

Unilateral right mammary gland enlargement in a multiparous, pregnant 14-year-old American Quarter Horse mare.

Unilateral right mammary gland enlargement in a multiparous, pregnant 14-year-old American Quarter Horse mare.

Unilateral Tonsillar Enlargement as Initial Presentation of Bilateral Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

Unilateral tonsillar enlargement is a common indication for tonsillectomy, but there are varying rates of malignancy among tonsils removed for asymmetry and a lack of clear guidelines for management within the literature. Lymphoma of the palatine tonsils is among the concerns leading to tonsillectomy, but chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the tonsil is rare. We report a case of primary CLL/SLL of the palatine tonsil in a 51-year-old gentleman who presented with tonsillar asymmetry and obstructive sleep apnea (OSA) but lacked signs and symptoms suspicious for malignancy, including lymphadenopathy and "B-symptoms." To our knowledge, only 7 cases of CLL/SLL of the palatine tonsil have been reported in the English literature, with the tonsil being the primary site of involvement in only 4 of those cases. Our unique case highlights the importance of thorough physical exam, family history, and tissue biopsy in patients presenting to the otolaryngologist with OSA and asymmetric tonsils.

САРКОИДОЗ ВНУТРИГРУДНЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ. КЛИНИЧЕСКОЙ СЛУЧАЙ ИЗ ПРАКТИКИ ТЕРАПЕВТА

Sarcoidosis is a multisystem inflammatory disease of unknown etiology. Thoracic radiography is used to detect pathological changes in the lungs or intrathoracic lymph nodes. The classic image finding of pulmonary sarcoidosis is bilateral, symmetrical hilar and mediastinal lymph nodes enlargement. Lymph nodes are spherical or ovoid shape and homogeneous structure, with smooth clear contours, and without perifocal infiltration and sclerosis. Atypical manifestations of intrathoracic lymphadenopathy in sarcoidosis can be detected rarely. The presented clinical case indicates the importance of high-resolution computed tomography in patients with intrathoracic lymphadenopathy syndrome. It has to be noted that the detection of unilateral or asymmetric enlargement of hilar lymph nodes, the enlargement of mediastinal and pericardial groups of lymph nodes does not exclude sarcoidosis as a possible cause of pathology and requires morphological confirmation of the diagnosis. The case is discussed from the standpoint of personalized medicine and clinical recommendations.

Iatrogenic Cerebrospinal Fluid Breast Augmentation: Rare Complication of Ventriculoperitoneal Shunts and Management Strategies

BackgroundVentriculoperitoneal shunt is one of the most common neurosurgical procedures in the treatment of hydrocephalus. There are reports of migration of the distal catheter to the breast pocket where cerebrospinal fluid then collects and can develop into a pseudocyst. There exist case reports in the literature of patients with prior breast augmentation who present with distal catheter migration from the peritoneal space into the breast tissue. We present a case series of three patients with pre-existing breast augmentation who returned with unilateral breast enlargement after ventriculoperitoneal shunt. In all three patients, the distal catheter migrated out of the peritoneal space and was found to be coiled around the breast prosthesis. Additionally, we offer recommendations for managing these complications and a review of the literature. MethodsWe performed a systematic review without meta-analysis of studies involving management of shunt migration in the setting of pre-existing breast implants. We present a case series of three patients who we treated with breast cerebrospinal pseudocyst after migration of the distal catheter into the breast tissue. ResultsA total of 17 studies, dating from 2002 to 2022, met our inclusion and exclusion criteria and were selected for full review. Catheter migration occurred between two weeks and 9 months of initial shunt placement. All patients presented with unilateral breast enlargement and CSF pseudocyst formation. All patients underwent revision shunt surgery. Surgical treatment strategies utilized included re-implantation of the distal catheter into the pleural space or ipsilateral or contralateral peritoneal space or complete removal of the entire shunt system. ConclusionsBreast-related VPS complications is a rare entity that is increasingly seen as more patients receive breast augmentation. Breast related shunt complications most commonly present with CSF pseudocyst formation in the breast. It is important for neurosurgeons to be aware of an underlying breast implant prior to placing a VPS. For patients who have migration of the distal catheter into the breast, a protocol for managing these situations should be followed to ensure no shunt infection and avoidance of future catheter migration complications with subsequent shunt revisions.

SAT476 A Case of Thyroid Hemiagenesis

Abstract Disclosure: P. Kachhadia: None. S. Khan: None. S. Aldasouqi: None. A. Abu Limon: None. Introduction: Thyroid hemiagenesis is congenitally rare, in which one side of the thyroid does not develop. Hemiagenesis is more common with an absent left thyroid lobe, at a 4:1 ratio. Though prevalence is sited at 0.05%, actual incidence of hemiagenesis amongst the population is unknown as most patients are euthyroid and asymptomatic. We present a case of a patient who was referred to our clinic for unilateral thyroid enlargement on physical exam. Thyroid Ultrasound (US) was done which showed an absent left thyroid lobe along with enlarged right thyroid lobe and hypervascularity. There was also an incidental thyroid nodule noted on US. Case Presentation: Patient is a 38 year old female who presented to the clinic 4 years prior for enlarged thyroid nodule noted on ultrasound. With symptoms of dysphagia and a visibly enlarged gland, an US with labs was prompted by her primary physician. US showed absent left thyroid lobe and right lobe enlargement with hypervascularity and incidental subcentimeter nodule. Clinically and biochemically, the patient was euthyroid. Singular right lobe was verified on clinic real time ultrasound and on NM uptake scan. The 24 hour uptake was at 30.5%, with the upper limit of normal being 30%. With increased uptake and hypervascularity, thyroid stimulating immunoglobulin and thyrotropin receptor antibodies were checked and were not detected. It was thought that the right thyroid gland enlargement and hypervascularity were compensatory due to the left hemiagenesis. The thyroid nodule was monitored, and within 3 years of original imaging, it enlarged to 0.98 x 0.59 x 0.39 cm, with TI-RADS 5 assessment per ACR criteria. Patient chose to undergo thyroid biopsy which showed Bethesda III, Follicular Lesion of Undetermined Significance (FLUS). Microscopy showed follicular cells arranged in microfollicles and crowded groups with round, enlarged, irregular nuclei and overlapping nucleoli. Intranuclear chromatin clearing and intranuclear grooves are present. Background is hemorrhagic with minimal colloid. Molecular Thyroseq testing was at 5-10% chance of malignancy or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Genetic markers were only positive for copy number alterations. Discussion: Thyroid Hemiagenesis, though rare, has been associated with other thyroid pathologies such as hypothyroidism, hyperthyroidism and thyroid malignancies. Genetic studies have not found a common background within cases reported. As these patients are more likely to incur additional thyroid pathologies, questions still remain as to the clinical management and outcome of such patients. Due to concerning cytological features for PTC, the patient was offered right thyroidectomy and will be looking to make a decision in the near future. Presentation Date: Saturday, June 17, 2023

Complete recovery after glucocorticoid replacement therapy in a case of primary adrenal insufficiency caused by adrenal tuberculosis infection.

Symptoms of primary adrenal insufficiency (PAI) are commonly nonspecific, causing the disease to be misdiagnosed or often delayed, and patients may present to the hospital with a life-threatening crisis. Previous case reports have documented that patients in this condition often require lifelong glucocorticoid replacement therapy. This study aimed to present a noteworthy outcome of PAI caused by adrenal tuberculosis infection, demonstrating complete recovery after six months of glucocorticoid replacement therapy. A 38-year-old Indonesian man presented to the endocrinology clinic in a tertiary hospital with a chief complaint of epigastric pain. The patient experienced nausea, vomiting, loss of consciousness, weight loss, excessive sweat, decreased appetite, weakness, and dizziness in the past 2 weeks. Laboratory examinations revealed hyponatremia, elevated adrenocorticotropic hormone, and suppressed morning plasma cortisol level. A non-contrast-enhanced abdominal MRI showed unilateral right-side adrenal enlargement and calcification. The patient's Mantoux test was positive. Corticosteroids and anti-tuberculosis therapy were administered. After 6 months, hydrocortisone was discontinued due to the patient's good clinical condition and normal morning plasma cortisol levels. After a 1-year follow-up, the patient remained asymptomatic with normal cortisol levels. We hypothesized several reasons for this unique outcome: (i) the patient was relatively young compared to previous cases, suggesting an adequate immune system may play a role; (ii) despite a 1-month delay in diagnosis and treatment, the absence of skin hyperpigmentation suggested an acute presentation, potentially contributing to the favorable outcome; and (iii) the absence of comorbidities potentially positively impacted the patient's outcome. Symptoms of adrenal insufficiency are often nonspecific and may only become apparent once significant damage has occurred to the adrenal gland. Clinical adjustments and a comprehensive understanding of epidemiological knowledge are necessary for diagnosing patients with endocrine diseases in limited-resource settings. Complete recovery in primary adrenal insufficiency caused by tuberculosis infection might be due to younger age, acute presentation, and absence of comorbidities.

Vitamin D and smell impairment, routine histology for unilateral tonsillar enlargement, and a machine learning model for predicting the three-year survival status of patients with hypopharyngeal squamous cell carcinoma.

Vitamin D and smell impairment, routine histology for unilateral tonsillar enlargement, and a machine learning model for predicting the three-year survival status of patients with hypopharyngeal squamous cell carcinoma.

A case report of unique unilateral idiopathic gingival enlargement

Gingival enlargement is usually characterized as an increase in the size of the gingiva. Idiopathic gingival enlargement is a rare condition and the etiology usually will be undetermined. The enlargement may be generalized enlargement or it may be confined to either of the jaws. The gingival enlargement is usually treated according to the type of enlargement encountered. In this article, we discussed a rare case report of a 15-year-old young adult with unilateral idiopathic gingival enlargement with unknown etiology and the management of the enlargement with internal bevel gingivectomy. There was no recurrence observed at 2 and 6 months maintenance visits and the healing was better with no discomfort for the patient. Key Words: Gingival enlargement, internal bevel gingivectomy, idiopathic gingival enlargement, hereditary gingival hyperplasia.

Histopathological features of asymmetric lacrimal gland enlargement in patients with thyroid eye disease

PurposeLacrimal gland enlargement can be a feature of thyroid eye disease (TED). Unilateral or asymmetric lacrimal gland enlargement is poorly described and may impede diagnosis. We present the histological and clinical findings of four patients with asymmetric lacrimal gland enlargement.MethodsA retrospective case note review was performed for patients over two tertiary orbital clinics (Royal Adelaide Hospital, South Australia and the Sussex Eye Hospital, Brighton, United Kingdom) presenting with an asymmetrical lacrimal gland enlargement with a background of TED that underwent biopsy to exclude alternate diagnoses. Baseline data was collected for each patient and histopathological images and reports were reviewed.ResultsAll four patients were hyperthyroid at time of lacrimal gland biopsy. Biopsy demonstrated nonspecific, lymphoid aggregates, typically of B cell type, with no diagnostic findings to support lymphocyte clonality or IgG4-related disease. One biopsy specimen demonstrated evidence of some fibrosis.ConclusionAsymmetrical lacrimal gland enlargement can occur as part of the TED spectrum but may require biopsy to exclude alternate pathology. Histology demonstrates a non-specific lymphocytic infiltrate.

Case Report: A Parotid Abscess With Otorrhea, Drainage via the Fissure of Santorini.

We report a case of a healthy 62-year-old male with no identifiable risk factors who presented with a 2-week history of progressive unilateral parotid gland enlargement and tenderness followed by subsequent otorrhea. A computed tomography scan and ultrasound confirmed a markedly enlarged posterior aspect of the parotid gland with the evidence of necrosis. The culture of aspirated fluid grew Staphylococcus aureus. Purulent fluid was then noted draining from the external auditory canal, via the fissure of Santorini. The patient was treated with antibiotics, pain management, and daily parotid massage with complete resolution of the parotitis. Acute bacterial parotitis with subsequent drainage and otorrhea through the fissures of Santorini is rare, with only a few reported cases in the literature.