RESUMO
The focal calcification or ossification of the ligamentum flavum is a rare cause of thoracic myelopathy and most often occurs among individuals of Japanese descent. It is rare in other ethnic groups and in individuals below the age of 50. It is most often described at the lower thoracic level, being uncommon in the lumbar region and rare in the cervical region. Here, we present the case of a 44-year-old White female patient who sought medical attention with an eight-month history of paraesthesia of the lower limbs and progressive difficulty in walking. The clinical profile, together with computed tomography and nuclear magnetic resonance imaging of the spine, led to a diagnosis of compressive thoracic myelopathy due to ossification of the ligamentum flavum in the thoracic and lumbar spine. The patient underwent laminectomy and dissection of some of the affected ligamentum flavum, without any intraoperative complications. After three months of clinical follow-up, the patient had progressed favorably, having no sensory complaints and again becoming ambulatory.
RESUMO
Omental infarction is a rare cause of acute abdominal pain, and the cause of omental infarction itself remains unknown. The diagnosis of omental infarction is occasionally made intra-operatively, because it is poorly known and presents no specific clinical features. Therefore omental infarction should always be considered in the differential diagnosis of abdominal inflammatory processes, mainly those affecting the right lower quadrant. The increasing use of computed tomography in cases of acute abdomen has facilitated the diagnosis of omental infarction in the pre-operative period. Here, we present the case of a 36-year-old, overweight female patient with clinical symptoms of acute abdomen. Computed tomography of the abdomen revealed indications of omental infarction. The patient was treated conservatively with analgesics and a nonsteroidal anti-inflammatory. The clinical evolution was favorable.
RESUMO
Since when the first transesophageal echocardiography (TEE) was undertaken in 1975, technological advances have made this diagnostic modality more reliable. TEE indications became widespread in cardiac and non-cardiac surgeries, intensive care units, and ambulatory clinics. The procedure is generally considered a safe diagnostic tool, but occasionally complications do occur. The insertion and manipulation of the ultrasound probe can cause oropharyngeal, esophageal, or gastric trauma. Although rare, these complications may present a mortality rate of up to 56% depending on the treatment approach and the elapsed time to the diagnosis. The authors report a case of a 65-year-old woman submitted to attempt a TEE in order to better study or diagnose an inter-atrial communication. After 3 days of the procedure, the patient was admitted to the hospital with edema, hyperemia of the anterior face of the neck, accompanied by systemic symptoms. The imaging diagnostic work-up evidenced signs of esophageal rupture and upper mediastinal involvement, the former confirmed by upper gastrointestinal endoscopy. The patient was treated with antibiotics and cervical and mediastinal drainage, with a favorable outcome.
RESUMO
Sclerosing encapsulating peritonitis (SEP), also called encapsulating peritonitis, is a rare and benign cause of intestinal obstruction of unknown etiology. Its onset may be acute or subacute although there are some reports with a two-month history. More commonly, this entity is secondary to chronic peritoneal dialysis, ventriculoperitoneal and peritoneovenous shunting, the use of ß-blockers and systemic lupus erythematous. Recurrent episodes of bacterial peritonitis, intestinal tuberculosis, sarcoidosis, familial Mediterranean fever, gastrointestinal cancer, liver transplantation, intra-abdominal fibrogenic foreign bodies, and luteinized ovarian thecomas are also related to SEP. The idiopathic presentation is more rare. Abdominal pain, nausea, vomiting, weight loss, malnutrition, and clinically palpable mass characterize the clinical features. Diagnosis is frequently made with gross findings during surgery, imaging workup and histopathology. The authors report the case of a 36-year-old male patient with a 10-day history of abdominal pain that was operated on because of intestinal obstruction. Diagnosis was made preoperatively and confirmed by the intraoperative findings and histopathology.