Diagnosing ovarian torsion with computed tomography. A case report

BACKGROUND: The diagnosis of adnexal torsion is difficult to make on the basis of symptoms, physical findings or radiologic techniques. Unfortunately, delayed intervention can lead to irreversible damage and loss of the adnexa. This report describes a finding seen on computed tomography (CT) that may increase suspicion of the diagnosis of ovarian torsion. CASE: A 21-year-old woman was admitted with constant abdominal pain and a tender retrouterine mass. Ultrasound failed to provide a definitive diagnosis. CT showed a central, hypodense area consistent with fat and surrounded by a shell of intermediate density. At laparotomy the patient was found to have a necrotic left adnexa due to torsion. Bisection of the adnexal mass confirmed a dermoid cyst with overlying edematous ovarian cortex. CONCLUSION: The observation of a round, hypodense central lesion (dermoid cyst) surrounded by thickened, edematous ovarian cortex on CT is a finding that may aid in the diagnosis of adnexal torsion. The finding is a thickened shell of ovarian cortex surrounding a central mass that has caused the torsion; in this case it was a dermoid cyst.     

Isolated torsion of the fallopian tube. A case report

BACKGROUND: While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone remains a rare occurrence. Diagnosis and surgical intervention are often delayed. CASE: A 38-year-old woman presented with acute lower right abdominal pain initially managed as renal colic. She returned to the emergency department three days later. After surgical consultation, a computed tomography scan and ultrasound showed a cystic pelvic mass with normal ovarian flow studies. Ultimately, the gynecology team performed laparoscopy with the suspicion of intermittent adnexal torsion. A 6 x 8-cm, twisted, dusky purple right fallopian tube was noted. A laparoscopic salpingectomy was performed. CONCLUSION: In the differential diagnosis of acute lower abdominal pain, isolated torsion of the fallopian tube should be considered. A timely diagnosis and surgical intervention may allow preservation of the tube. Even when irreversible damage has occurred, laparoscopic management is recommended.     

Bilateral synchronous testicular torsion: a case report

A man presented to the emergency room with testicular pain and swelling. Bilateral synchronous testicular torsion was diagnosed and treated. Physical and radiographic findings are discussed as well as differential diagnosis. Avoiding the confusion between torsion and epididymitis with the help of the nuclear scan is stressed.     

Gallbladder diverticulum: a case report and review of the literature

BACKGROUND: The clinical significance of the 14 and 6 positive spikes (PS) electroencephalographic (EEG) phenomenon is not well established. This study was performed to provide further data regarding the clinical correlates of the PS, particularly attention-deficit/hyperactivity and somatic symptoms. METHODS: Diagnostic information gathered through structured interviews was compared among four groups of psychiatric inpatients aged 4-17 years who underwent an EEG examination over a 2-year period. Groups consisted of patients with: 1) 14 and 6 PS (n = 25); 2) epileptic discharges (n = 29); 3) slow-wave abnormalities (n = 23); and 4) a normal EEG group age and sex matched to the 14 and 6 PS group (n = 25). RESULTS: Attention-deficit hyperactivity disorder (ADHD) symptoms were significantly more frequent in the PS group (chi 2 = 2.96, p < .05) compared to the other three groups combined. Although somatic symptoms were not increased in the 14 and 6 PS group, anxiety symptoms tended to occur more in this group (chi 2 = 3.50, p < .06). CONCLUSIONS: The PS profile appears associated with ADHD symptoms. Possible treatment implications of this finding (e.g., use of anticonvulsants in ADHD patients with PS) need to be explored.     

Thymic carcinoid. A case report

A case of thymic carcinoid appearing in a 56-year-old man is presented. No endocrine disturbances were apparent. Mediastinal lymph node metastases were found at operation. The tumour was positive with Grimelius argyrophil silver stain. Ultrastructurally neurosecretory granules were seen.     

Stomach diverticulum. A case report

The author reports a case of gastric symptomatic diverticulum, not connected to other gastric-biliary-duodenal pathology. The author points out the rarity of diverticulum of the alimentary canal, and points out the symptomatic picture that, in association with a radiologically ascertained diverticulum staunching, represent indications for surgery.     

Morgagni-Larrey hernia. A case report

The authors report a case of Morgagni-Larrey hernia. It is anuncommon diaphragmatic hernia, often asymtomatic and occasionally found. The authors point out the disease's clinical, diagnostic and therapeutic aspects. The hernia's repair can be done both abdominal and thoracic via. The operation is always advisable as well as in asymptomatic pazients.     

Castleman's disease. A case report

Angiofollicular lymph node hyperplasia or Castleman's Disease (CD) is a rare lymphoproliferative disorder that manifests itself as a local or generalized tumor-like condition affecting both lymph nodes and non-nodal tissues, usually in the chest and abdomen. Hyaline vascular and plasma cell types have been identified histologically. A new clinical form of CD with multisystemic involvement has been defined as multicentric Castleman's disease. It is very rare in childhood. In this paper we present an eight-year-old boy with multicentric Castleman's disease.     

Fatal exorcism. A case report

A five-year-old girl was killed by her mother when she tried to pull the devil out of the girl's mouth by means of her hands. In that way the enlarged tonsils were pushed back and caused together with the woman's fingers a temporary closure of the hypopharynx and at least the suffocation of the child. About two years ago the woman began to show paranoic ideas exacerbating up to the fatal event.     

Neonatal listeriosis. A case report

The author describes a case of early neonatal listeriosis following by a positive outcome. The severity of this infection is underlined as well as the need to examine carefully the role of listeria monocytogenes as a cause of similar influenza-type syndromes in pregnant women.     

Shprintzen-Goldberg syndrome. A case report

Major hemorrhage after pulmonary resection is infrequent. It is usually due to an unsecured vessel, and immediate reoperation to control hemorrhage is indicated. Diffuse bleeding from raw chest wall surfaces can complicate pleurectomy. Control of bleeding from this cause is difficult, and standard techniques may fail. Thoracic packing is occasionally needed. The authors describe a technique for thoracic packing. This technique permits removal of thoracic packing at the bedside, and simplifies subsequent management of an empyema, should one develop.     

Reno-colo-cutaneous fistula. A case report

Reno-colo-cutaneous fistula due to genito-urinary tuberculosis is extremely rare. We describe one such case which was successfully managed by single stage surgery (nephroureterectomy, fistulectomy and primary repair of colon) and anti-tubercular treatment.     

Orbital cellulitis. A case report

This study describes the case of a 6 years old child, male, with orbital cellulitis and underlines the importance of an early diagnosis and therapy to avoid severe complications often present in this disease. Swelling and redness of the eyelid, pain and ophthalmoplegia are the first sign of an orbital cellulitis and they require rapid diagnostic procedure such as ultrasound and TC scan of the orbital region to evaluate the integrity of the profound orbital tissues. The child was admitted at the Department of Pediatrics, University "La Sapienza" of Rome and underwent an ultrasound, TC scan and serum exams which demonstrated the elevation of the sedimentation rate, reactive C protein and WBC plus the interesting of the profound orbital tissues. The child was treated with antibiotic and antiinflammatory therapy showing a complete recovery within 7 days. An ultrasound performed 7 days later demonstrated a complete resolution of the inflammatory process. In summary, this study would like to stress the necessity of an early diagnosis and an appropriate therapy in order to avoid the severe complications often present in children with orbital cellulitis.     

Cervical pregnancy. A case report

Cervical pregnancy is one of the most dangerous forms of ectopic pregnancy. This condition is frequently unsuspected before evaluation of the uterus and it is characterized by massive bleeding during that procedure. We report a case of cervical ectopic pregnancy diagnosed by ultrasound at 11 weeks' gestation and managed by emergency hysterectomy for severe hemorrhage occurring immediately after removal of the placenta.