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Key Clinical Message: Consideration of spontaneous urinary bladder rupture in the differential diagnosis of acute abdominal pain for alcohol-abusing patients is crucial for ensuring timely surgical intervention and preventing life-threatening complications due to its high associated morbidity and mortality. Abstract: Spontaneous rupture of the urinary bladder (SRUB) is a rare but critical urological emergency, typically associated with malignancy, neurogenic dysfunction, or previous radiation therapy. Here, we present a unique case of SRUB in a 65-year-old chronic alcoholic male who presented with acute lower abdominal pain following heavy alcohol consumption. Initial evaluations revealed leukocytosis, elevated serum creatinine levels, and ultrasound findings suggestive of bladder rupture. Computed tomography confirmed the diagnosis, indicating an intraperitoneal rupture with associated hematoma. Immediate surgical repair was performed, leading to a successful outcome. This case underscores the importance of considering SRUB in patients with acute abdominal pain, especially in the context of alcohol intoxication, and highlights the diagnostic and therapeutic challenges associated with this condition. Early recognition and intervention are crucial to prevent life-threatening complications associated with urinary bladder rupture.
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Key Clinical Message: Tarlov cysts are uncommon causes of sacral radiculopathy, with particular predilection to second and third sacral roots, requiring timely diagnosis with lumbosacral MRI, and surgical management if symptomatic. Abstract: Tarlov cysts or Type II meningeal cysts, are CSF-filled sacs located in the extradural space of the sacral spinal canal, commonly originating at the dorsal root ganglion. While they were first documented by Tarlov in 1938, their etiology remains uncertain, with theories suggesting trauma-induced bleeding or congenital abnormalities. These cysts, estimated to affect between 1% and 9% of the adult population, typically manifest as incidental findings but may lead to symptoms such as radiculopathies, sacral pain, and weakness in related sacral muscles. We present a case of a 63-year-old female presenting with recurrent left buttock pain and radiating leg discomfort. Physical examination revealed tenderness in the left buttock region, positive straight leg raise test, and minimal sensory deficits in the S1-S2 dermatomes. A provisional diagnosis of radiculopathy was made, prompting further evaluation with MRI, revealing a Tarlov cyst and absence of lumbar spinal canal stenosis or neural foraminal compromise. The patient declined intervention and was managed conservatively. This case highlights the diagnostic challenges and therapeutic considerations in managing symptomatic Tarlov cysts, emphasizing the importance of tailored treatment strategies.
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Ectopic teeth, growing in abnormal locations like the maxillary sinus, are rare occurrences, with uncertain causes including trauma, infection, and developmental abnormalities. They often appear in the second or third decade of life, sometimes without symptoms. They are often missed as symptoms can mimic chronic sinusitis but may include sinonasal issues like obstruction and facial pain. Complications ranging from recurrence to potential blindness or carcinoma have been reported. Diagnosis involves radiographic imaging, with CT scans providing precise localization. Following accurate diagnosis, treatment typically involves surgical removal, with endoscopic procedures gaining popularity due to reduced risks. Follow-up for asymptomatic cases can be conducted through periodic radiographs. We report a case of maxillary ectopic tooth as an incidental finding in an asymptomatic patient presenting to the emergency department with head trauma.