A case of venous aneurysm

A 70-year-old woman was referred to our hospital with a complaint of a soft mass at the right elbow. Venography demonstrated that the mass was connected with vein. This mass was surgically removed and histologically a marked reduction of both elastic fibers and the adventitia were observed in the aneurysmal wall. Venous aneurysm (VA) is different form varicose veins by many features. It was considered that congenital fragility of the venous walls was associated with the onset of VA. We classified VA into type-I VA (cystic ectasia) and type II (fusiform ectasia).     

Popliteal venous aneurysm: report of two cases and review of the world literature

Two new cases of popliteal venous aneurysm are reported and added to the 22 other cases of popliteal venous aneurysm available for review. Both patients were first seen with acute pulmonary embolism and were treated with thrombolytic therapy followed by anticoagulation. Each had recurrent venous thromboembolism before discovery of the popliteal venous aneurysm. One popliteal venous aneurysm was diagnosed with phlebography and the second with venous duplex imaging, confirmed with phlebography. Both were surgically corrected with tangential aneurysmectomy and lateral venorrhaphy. Twenty-four cases of popliteal venous aneurysm are now available for review. Seventy-one percent (17 of 24) presented with pulmonary embolism, 88% (21 of 24) were saccular, and 96% (23 of 24) were located in the proximal popliteal vein. All but two were diagnosed by ascending phlebography. Three patients received no treatment: in two of these the outcome was not documented and the third had occasional pain. Two patients received anticoagulation without subsequent operative repair and both died of recurrent pulmonary emboli. Operative correction resulted in a 75% patency rate with 21% complications, most of which were related to postoperative anticoagulation. No patient who was operated on had subsequent pulmonary embolism, and there were no operative deaths. We suggest that all patients who have pulmonary embolism have lower-extremity venous duplex imaging. All popliteal venous aneurysms should be surgically repaired, inasmuch as nonoperative therapy results in recurrent thromboembolism and an unacceptably high mortality rate. Tangential aneurysmectomy with lateral venorrhaphy is the recommended procedure.     

Tracheobronchopathia osteochondroplastica . Apropos a case

We present one case of osteochondroplastic tracheobronchopathy in a patient with right laterocervical tumoration as a manifestation of a normofunctional nodular goiter detected in a thyroid morphofunctional study, and tracheal stenosis secondary both to the goiter and the tracheobronchial process. The coincidence of these two processes, probably fortuitous, has never been described before.     

Multiple pilomatricoma. Apropos of a case

Pilomatricoma is a benign, solitary tumor. The histopathologic findings of viable basaloid cells in the periphery, shadow cells in the central part and foci of calcification are characteristic of pilomatricoma. The microscopic aspect of multiple pilomatricomas was not different from solitary pilomatricomas. Though, some consider them as a pathognomonic sign of myotonic dystrophy. Complete surgical excision is the best management.     

Pseudocystic ureteritis. Apropos of a case

The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.     

Odontoid bone. Apropos of a case

Reporting a clinical observation, the authors emphasize upon the extreme scarceness of this variety of so called "congenital" pseudarthrosis of the odontoid process. The congenital origin, due to a lack of fusion, or the acquired one by avascular necrosis following a trauma is explained. The diagnosis may be clinical, consisting either on a vertebral syndrome occurring in childhood, or on a neurological syndrome in the adult age. It is mainly radiological : A scanner investigation is presented here. Owing to the potential neurological severity of the disease, the posterior fusion has to be recommanded.     

Secreting retroperitoneal paraganglioma. Apropos of a case

A case of secreting, asymptomatic retroperitoneal paraganglioma is presented. Paragangliomas are rare neuroendocrine tumors and the malignant behaviour, higher than pheochromocytomas, is based on metastases or local recurrence. The treatment is complete surgical excision. Radiotherapy and chemotherapy may be used for palliation of symptoms.     

Post-traumatic liponecrosis. Apropos of a clinical case

Localized post-trauma liponecrosis, also called lipoatrophy, is a benign disease with no functional consequences but does cause important aesthetic problems. Diagnosis is often missed. Necrosis of the adipocytes occurs after direct trauma and absorption of the haematoma. It is important to search for favouring factors and order the necessary examinations. The therapeutic strategy is presented.     

Lipogranuloma of the orbit. Apropos of a case

We present a case of orbital lipogranuloma with a supero-nasal retrobulbar localisation associated with axial proptosis and major choroidal thickening. No clinical sign of inflammation, neither orbital nor in the posterior segment, was revealed. The systemic work-up as well as paraclinical data were within normal limits. The diagnosis was made after histopathologic examination of the biopsy taken via superior orbit. Outcome was favorable following long-term systemic corticotherapy. Orbital lipogranuloma is a rare particular form of orbital pseudotumour of unknown etiology. It is characterized, histologically, by orbital fat necrosis. Pathogenesis remains controversial. The differential diagnosis includes iatrogenic lipogranulomas secondary to sinus surgery (paraffinoma), orbital granulomas in sarcoidosis and Wegener's disease and orbital lymphomas. The prognosis is usually good following treatment with steroids.     

Respiratory manifestations of carbamazepine. Apropos of a case

A 14-year-old girl developed skin rash, fever and dyspnea. The chest roentgenogram showed diffuse reticulonodular infiltration. Pulmonary function tests revealed mild restrictive defect and blood oxygen pressure at 71 mm Hg. BAL showed increased cell counts with lymphocytosis at 15% and neutrophilia at 3%. Outcome was good after carbamazepine withdrawal and without corticosteroid therapy. Relapse was observed after patient-induced rechallenge.     

Post-partum malignant amebic colitis. Apropos of a case

A 26-year old female developed acute fulminant amoebic colitis during the post-partum period, successfully managed by subtotal colonic resection without anastomosis. Fulminant transmural amoebic colitis is a rare life-threatening complication of invasive bowel amebiasis. Pregnancy, delivery, diabetes mellitus and immunodeficiency are the main risk factors. At pathologic examination, bowel wall necrosis can be seen with amoebae present in the lumen of capillary vessels. The diagnosis of amoebic colonic perforation is difficult, especially in a non-endemic area. Conservative surgical management is required in non-perforated forms. If perforated, the bowel must be resected, limited to macroscopic lesions.     

Retinopathy caused by interferon. Apropos of a case

Toxic retinopathy due to alpha interferon in a 20-year-old female is reported. This was an unusual case due to its severity in a non diabetic patient. Recovery of visual acuity was incomplete though angiographic tests normalized. Retinal toxicity in nondiabetic patients is usually reversible, suggesting careful surveillance of high risk patients with retinal microangiopathy given interferon therapy.     

Coxiella burnetti infectious endocarditis. Apropos of a case

Chronic forms of Q fever (endocarditis) are rare, but are responsible for severe and desperately recurrent infections, resulting in multiple valve replacements with a reserved prognosis. The authors report the case of a 35-year-old patient with a known history of rheumatic fever, who developed blood culture negative infectious endocarditis on a mitral bioprosthesis. The diagnosis of Q fever was based on serological arguments. Despite long-term antibiotic therapy, serology remained strongly positive and was associated with repeated mitral valve disinsertion. The patient died immediately after the fourth operation in a context of haemodynamic failure. This clinical case emphasizes the importance of performing Q fever serology in any case of culture negative endocarditis and the therapeutic difficulties encountered in chronic recurrent endocarditis.