Protracted hypocalcemia following post-thyroidectomy lumbar rhabdomyolysis secondary to evolving hypoparathyroidism

March 2, 2015     Usman Y. Cheema, MD; Carrie N. Vogler, PharmD, BCPS; Joshua Thompson, PharmD; Stacy L. Sattovia, MD, FACP; Srikanth Vallurupalli, MD
article

Abstract

Rhabdomyolysis is characterized by skeletal muscle breakdown. It is a potential cause of serious electrolyte and metabolic disturbances, acute kidney insufficiency, and death. Recently, rhabdomyolysis has been increasingly recognized following certain surgical procedures. We discuss the case of a morbidly obese 51-year-old woman who developed postoperative rhabdomyolysis of the lumbar muscles following a prolonged thyroidectomy for a large goiter. We discuss how her morbid obesity, the supine surgical position, the duration of surgery (including prolonged exposure to anesthetic agents), and postoperative immobility contributed to the development of rhabdomyolysis. Immediately after surgery, the patient developed hypocalcemia, which was likely due to rhabdomyolysis since her serum parathyroid hormone level was normal. Later, however, persistent hypocalcemia despite resolution of the rhabdomyolysis raised a suspicion of iatrogenic hypoparathyroidism, which was confirmed by a suppressed parathyroid hormone level several days after surgery. In post-thyroidectomy patients with risk factors for rhabdomyolysis, maintaining a high degree of clinical suspicion and measuring serum creatine kinase and parathyroid hormone levels can allow for an accurate interpretation of hypocalcemia.

Multifocal inverted papillomas in the head and neck

March 2, 2015     Jyoti Sharma, MD; David Goldenberg, MD; Henry Crist, MD; Johnathan McGinn, MD
article

Abstract

Inverted papilloma is a rare benign neoplasm that usually originates in the lateral nasal wall. It can be a locally aggressive lesion and invade nearby structures. While primarily a nasal neoplasm, cases of an inverted papilloma involving the temporal bone, pharynx, nasopharynx, and lacrimal sac have been reported. We describe the case of a 67-year-old man with a history of nasal inverted papilloma who presented with a recurrent nasal mass and a large mass on the left side of his upper neck. The patient's history included inverted papillomas in multiple locations: the temporal bone, the sinonasal tract, and the nasopharynx. The new neck mass raised a concern for malignant degeneration and metastasis, but pathology demonstrated that it was a benign inverted papilloma. No clear etiology for the new neck lesion was evident except for an origin in salivary gland tissue. However, there was no physical connection between the neck mass and the submandibular gland identifiable on pathologic evaluation. This case illustrates the need for an aggressive primary resection to minimize local recurrence, as well as adequate surveillance to address recurrences early. Given the potential for multicentricity, patients with a typical sinonasal inverted papilloma should undergo a complete head and neck examination as part of their follow-up.

Minimally invasive drainage of a posterior mediastinal abscess through the retropharyngeal space: A report of 2 cases

March 2, 2015     Dan Lu, MD; Yu Zhao, MD, PhD
article

Abstract

Foreign-body ingestion is a common cause of esophageal perforation, which can lead to a fatal posterior mediastinal abscess. Routine treatments include the drainage of pus through the esophageal perforation, thoracotomy, and videothoracoscopic drainage. We present 2 cases of posterior mediastinal abscess caused by esophageal perforation. Both patients-a 44-year-old woman and an 80-year-old man-were successfully treated with a novel, minimally invasive approach that involved draining pus through the retropharyngeal space; drainage was supplemented by the administration of broad-spectrum antibiotics and nasal feeding.

Introduction In day-to-day otolaryngology practice, esophageal foreign bodies are common in adults, children, and even infants.1 However, the complication of esophageal perforation is not common, and retroesophageal abscesses caused by foreign bodies are rarely seen.

Thyroid gland follicular carcinoma

March 2, 2015     Lester D.R. Thompson, MD
article

The recommended treatment is lobectomy or total thyroidectomy, with or without radioablation. The choice depends on the size and stage of the tumor, extent of lymphovascular invasion, and patient's age.

Thyroid gland follicular carcinoma is a malignant epithelial neoplasm of follicular cell differentiation that exhibits capsular and/or lymphovascular invasion while lacking the nuclear features of thyroid papillary carcinoma. While rarely inherited, follicular carcinoma will develop in about 20% of patients with Cowden syndrome, related...

The harm of ham hocks: Foreign body impaction in long-standing multiple sclerosis

March 2, 2015     Anish Patel, MD; Jacqueline Weinstein, MD; Mandy Weidenhaft, MD; Enrique Palacios, MD, FACR
article

The incidence of foreign body impaction in neurologic dysfunctional swallowing, such as in multiple sclerosis (MS), has been not widely reported.

Lipoid proteinosis of the larynx

March 2, 2015     Jagdeep Singh Virk, MA(Cantab), MRCS, DOHNS; Sonal Tripathi, BSc, MBChB; Ann Sandison, FRCPath; Guri Sandhu, MD, FRCS, FRCS(ORL-HNS)
article

here is no accepted gold standard of management, but surgery should be used judiciously in selected patients to improve voice function and maintain the airway. Long-term follow-up and repeat procedures are usually required for disease control, and genetic counseling may be needed.

Necrotizing tonsillitis caused by group C beta-hemolytic streptococci

March 2, 2015     Jassem M. Bastaki, DMD, MPH
article

Abstract

Tonsillitis and pharyngitis are among the most common infections in the head and neck. Viral tonsillitis is usually caused by enterovirus, influenza, parainfluenza, adenovirus, rhinovirus and Epstein-Barr virus (causing infectious mononucleosis). Acute bacterial tonsillitis is most commonly caused by group A beta-hemolytic streptococci. On the other hand, pseudomembranous and necrotizing tonsillitis are usually caused by fusiform bacilli and spirochetes. Here we report what is, to our knowledge, the first case of necrotizing tonsillitis caused by group C beta-hemolytic streptococci.

Septic arthritis: A unique complication of nasal septal abscess

March 2, 2015     Steven M. Olsen, MD; Cody A. Koch, MD, PhD; Dale C. Ekbom, MD
article

Abstract

Nasal septal abscesses (NSAs) occur between the muco-perichondrium and the nasal septum. They most often arise when an untreated septal hematoma becomes infected. The most commonly reported sequela is a loss of septal cartilage support, which can result in a nasal deformity. Other sequelae include potentially life-threatening conditions such as meningitis, cavernous sinus thrombosis, brain abscess, and subarachnoid empyema. We report the case of a 17-year-old boy who developed an NSA after he had been struck in the face with a basketball. He presented to his primary care physician 5 days after the injury and again the next day, but his condition was not correctly diagnosed. Finally, 7 days after his injury, he presented to an emergency department with more serious symptoms, and he was correctly diagnosed with NSA. He was admitted to the intensive care unit, and he remained hospitalized for 6 days. Among the abscess sequelae he experienced was septic arthritis, which has heretofore not been reported as a complication of NSA. He responded well to appropriate treatment, although he lost a considerable amount of septal cartilage. He was discharged home on intravenous antibiotic therapy, and his condition improved. Reconstruction of the nasal septum will likely need to be pursued in the future.

Introduction A hematoma in the nasal cavity is an excellent medium for bacterial growth. In such cases, the nasal cavity frequently becomes infected, causing nasal septal abscess (NSA). Abscess formation results in rapid cartilage destruction and can lead to many additional complications. Previous presentation: The information in this article has...

Plexiform schwannoma of the posterior pharyngeal wall in a patient with neurofibromatosis 2

March 2, 2015     Luca Raimondo, MD; Massimiliano Garzaro, MD; Jasenka Mazibrada, MD, PhD; Giancarlo Pecorari, MD; Carlo Giordano, MD
article

Abstract

We report a case of plexiform schwannoma of the posterior pharyngeal wall that occurred in a 37-year-old man who had been previously diagnosed with neurofibromatosis type 2 (NF2). Plexiform schwannoma has been rarely reported in association with NF2. Moreover, as far as we know, only 6 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, none of which was associated with NF2 and none of which was histopathologically differentiated in schwannoma or plexiform schwannoma. The patient was treated with laser excision of the tumor via a transoral route, and at 6 and 12 months of follow-up, he exhibited no signs of recurrence. To the best of our knowledge, our patient represents the first reported case of a posterior pharyngeal wall schwannoma that occurred in association with NF2 and the first case in which the schwannoma was removed via transoral laser excision. This case illustrates that plexiform schwannoma is a possible finding in NF2 and that transoral laser excision is a safe surgical procedure in such a case.

The paramedian forehead flap for nasal lining reconstruction

March 2, 2015     Joshua D. Rosenberg, MD; Nikita Gupta, MD
article

The importance of reconstructing nasal lining defects cannot be overstated, especially for composite defects also involving the framework and skin soft-tissue envelope.

Page
of 67Next