Spontaneous bilateral dural arteriovenous fistulas with pulsatile tinnitus

January 19, 2015     Tzu-Chieh Lin, MD; Hsiung-Kwang Chung, MD; Jeng-Nan Hsu, MD
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Abstract

Pulsatile tinnitus with normal otoscopic findings often presents a diagnostic challenge to otolaryngologists and can be attributed to serious vascular malformations such as dural arteriovenous fistulas (DAVFs). Spontaneous DAVFs are relatively rare. A 65-year-old woman presented with sudden-onset subjective/objective pulsatile tinnitus on the right side that had persisted for 2 months. Angiography and magnetic resonance angiography revealed DAVF formation. Stereotactic radiosurgery was performed, and total remission of the DAVFs was achieved.

An uncommon cause of allergic fungal sinusitis: Rhizopus oryzae

January 19, 2015     Marie Devars du Mayne, MD; Maxime Gratacap, MD; David Malinvaud, MD, PhD; Frederic Grenouillet, PhD; Pierre Bonfils, MD, PhD
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Abstract

We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis and bone erosion. T2-weighted magnetic resonance imaging demonstrated a signal void that suggested the presence of a fungal infection. The patient underwent unilateral ethmoidectomy. Histologic examination of the diseased tissue identified allergic mucin with 70% eosinophils and no fungal hyphae. Mycologic culture detected R oryzae. After a short period of improvement, the patient experienced a recurrence, which was confirmed by radiology. A second surgery was performed, and the same fungal hyphae were found in the mucus and on culture, which led us to suspect AFRS. Since no IgE test for R oryzae was available, we developed a specific immunologic assay that confirmed the presence of specific IgG, which identified a high degree of immunologic reaction against our homemade R oryzae antigens. With a long course of systemic antifungal treatment, the patient's symptoms resolved and no recurrence was noted at 5 years of follow-up.

Bronchoscopic extraction of a chicken bone 5 years after aspiration

January 19, 2015     Parth Shah, MD; Angela Han, BA; Rishin Patel, MD; Paul Howlett, MD; Scott Akers, MD; Mitchell Margolis, MD; Sunil Singhal, MD
article

Abstract

A 58-year-old man with a remote history of choking on a chicken bone 5 years earlier presented with chronic cough but had no remarkable clinical examination findings. He was being followed for recurrent pneumonias complicated by a resistant empyema, for which he had undergone thoracotomy and decortication. Imaging studies initially missed a foreign body (the chicken bone), which was found on follow-up studies and was removed with a flexible bronchoscope despite the fact that 5 years had passed since the aspiration.

Introduction A review of the literature shows that occult foreign body aspiration poses difficulties in diagnosis and that a history of aspiration is often lacking. However, the recurrent nature and persistent localization of pneumonia to one area of the lung, as well as findings during bronchoscopy, should alert the physician to the possibility...

IgG4-related disease of the thyroid: A consideration in the differential diagnosis of an expanding thyroid mass

January 19, 2015     Irina Chaikhoutdinov, MD; Eelam Adil, MD, MBA; Michael D.F. Goldenberg, BA, MA; Henry Crist, MD
article

Riedel thyroiditis is a rare inflammatory process associated with IgG4; it involves the thyroid and surrounding cervical tissue, and it is associated with various forms of systemic fibrosis.

A 70-year-old woman was transferred to our institution with progressive shortness of breath secondary to a compressive thyroid mass. Over the previous 2 months, she had noticed an enlargement of her thyroid mass and the onset of compressive symptoms, including difficulty breathing when lying supine or with neck flexion. On physical examination,...

A case of myoepithelioma mimicking a parotid cyst

January 19, 2015     Haldun Onuralp Kamburoglu, MD, FEBOPRAS; Aycan U. Kayikcioglu, MD; Cigdem Himmetoglu, MD
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Abstract

Myoepithelioma is an uncommon tumor of the myoepithelial cells that is considered to represent a distinct category of tumor by the World Health Organization. It accounts for less than 1% of all tumors that develop in the salivary glands. We describe the case of a 35-year-old woman who presented to us with a painless swelling on the right side of her face. She was diagnosed with a parotid gland cyst by ultrasonography and computed tomography. Following excision of the mass, however, the pathology report identified the tumor as a solid myoepithelioma. To the best of our knowledge, this is the first reported case of a myoepithelioma that exhibited cystic features on radiologic examination even though it had a solid architecture. We also discuss the preoperative diagnostic aspects of the myoepitheliomas.

Introduction Myoepithelial cells are specialized basal epithelial cells that are found in the secretory endpieces and intercalated ducts of the normal exocrine glands, such as the salivary glands, respiratory tract glands, lacrimal glands, mammary glands, prostate glands, and sweat glands. Histologically, they are situated between basement...

A case of transient cortical blindness associated with hypercapnia as a result of extremely enlarged adenoid tissue

January 19, 2015     Baris Malbora, MD; Nihan Malbora, MD; Zekai Avci, MD; Asburce Olgac, MD; Alper Nabi Erkan, MD
article

Abstract

Adenotonsillar hypertrophy is common among children, but it can lead to serious complications if left untreated. Among the well-known complications are obstructive sleep apnea syndrome, growth failure, cor pulmonale, and hypertension. One complication of adenotonsillar hypertrophy that has not been previously reported in the English-language literature is transient cortical blindness. We describe such a case, which occurred in a 6-year-old boy who presented with a sudden loss of vision and subsequent unconsciousness. He had experienced hypercapnia and was resuscitated via endotracheal tube ventilation. Laboratory and radiologic assessments found no pathology except for extremely enlarged adenoid tissue. Once the patient was stabilized, an urgent adenotonsillectomy was performed. The patient recovered well, and his vision and respiratory symptoms resolved. Severe hypertrophy of the adenoid tissue can cause hypercapnia and acidosis secondary to upper airway obstruction. The possibility of adenoid hypertrophy and hypercapnia should be kept in mind in cases of transient cortical blindness. Aggressive treatment, including early intubation and adenoidectomy, may lead to a rapid resolution of symptoms.

Metastatic squamous cell carcinoma of the tonsil presenting as otorrhea: A case report

January 19, 2015     Eelam Adil, MD; Dhave Setabutr, MD; Soha N. Ghossaini, MD; David Goldenberg, MD, FACS
article

Abstract

We describe the case of a 52-year-old man with a history of squamous cell carcinoma (SCC) of the tonsil who presented with right subacute otalgia and otorrhea. Dedicated computed tomography of the temporal bones showed opacification within the mastoid process with destruction of bony mastoid septations consistent with coalescent mastoiditis. Preoperative imaging showed no destruction or expansion of the bony eustachian tube that would indicate that a direct spread had occurred. An urgent cortical mastoidectomy was performed. Intraoperatively, a friable white mass surrounded with purulence and granulation tissue was biopsied and returned as SCC. The discrete metastasis was removed without complication. Postoperatively, the patient was prescribed palliative chemotherapy. This case shows that a metastatic SCC can be masked by an overlying mastoiditis, and thus it should be considered in the differential diagnosis of a patient with a history of oropharyngeal cancer.

Introduction The incidence of oropharyngeal squamous cell carcinoma (SCC) in the United States is 11.18 per 100,000 population; the tonsil is the most common subsite within this region.1 Distant metastases are usually found in the lung or liver.2 We describe an unusual case of tonsillar cancer metastatic to the temporal bone.

Impact factor: What is it and is it still relevant?

January 19, 2015     David Goldenberg, MD, FACS; Neerav Goyal, MD, MPH
article
There are many reasons to publish, publish in, and read medical journals. Some are intended to promulgate state-of-the-art research, others focus on practical clinical writings, and most present a combination of both. It is important for authors to choose journals that will not only reach the desired audience, but also have sufficient prestige to...

Reconstructive and rehabilitation challenges following a cranio-orbital gunshot wound

January 19, 2015     Sachin S. Pawar, MD; John S. Rhee, MD, MPH; Timothy S. Wells, MD
article

Abstract

We present a case of a 26-year-old man who sustained a close-range gunshot wound to the head. His injuries included significant left orbital injury resulting in a ruptured, blind eye and severely comminuted fractures of the left orbital roof, superior and inferior orbital rims, and orbital floor. Associated injuries included left frontal lobe injury, anterior and posterior table fractures of the left frontal sinus, and a comminuted left zygomaticomaxillary complex fracture. We employed an interdisciplinary surgical approach with collaboration among the Otolaryngology, Neurosurgery, and Oculoplastic Surgery services performed in two stages. Management of such extensive craniofacial injuries can be challenging and requires a coordinated, interdisciplinary approach.

Group A beta streptococcal infections in children after oral or dental trauma: A case series of 5 patients

January 19, 2015     Brittany E. Goldberg, MD; Cecile G. Sulman, MD; Michael J. Chusid, MD
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Abstract

Group A streptococcus (GAS) produces a variety of disease processes in children. Severe invasive diseases such as necrotizing fasciitis can result. Traumatic dental injuries are common in the pediatric population, although the role of dental injuries in invasive GAS disease is not well characterized. In this article, we describe our retrospective series of 5 cases of GAS infection following oral or dental trauma in children.

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