Radiology Quiz Case 2
A 14-year-old girl presented to the emergency department with an 8-day history of worsening headache and right-sided nasal obstruction. She complained of pain and pressure localized primarily over the right periorbital and temporal region. She reported mild puffiness in the region and associated nausea but denied blurry or double vision, fevers, chills, or epistaxis. Her medical history was significant for type 1 diabetes mellitus, attention-deficit/hyperactivity disorder, and migraine headaches, which are characterized by nonfocal pain lasting no more than 2 days.
- [Show abstract] [Hide abstract] ABSTRACT: ObjectivesMagnetic resonance (MR) imaging may provide some information as to the extent and tissue characteristics of a cancerous mass, but the imaging features of lesions in the floor of the mouth have not been sufficiently clarified. MR imaging features of tumescent lesions in this region were characterized, and the differential diagnoses are discussed. MethodsMR images of 12 patients with tumescent lesions in the floor of the mouth (three patients with squamous cell carcinoma, two with adenoid cystic carcinoma, one with hemangioma, one with schwannoma, one with lipoma, and four with ranula) were reviewed. The literature on the imaging features of tumescent disease in the floor of the mouth was searched using the Medline database. ResultsSix types of tumescent lesions in the floor of the mouth are presented. The differential diagnosis through a review of the references is discussed. Malignant tumors were demonstrated as ill-defined masses. MR images were good at showing the internal structures, such as fluid, hemorrhage, fat, nerves, calculus (phlebolith), cholesterol, and keratin, as different signal intensities. Therefore, MR images gave clues for the differential diagnosis. ConclusionMR images presented the distinctive features or the extent of the lesions and were therefore considered useful for a more accurate diagnosis prior to treatment.0Comments 6Citations
- [Show abstract] [Hide abstract] ABSTRACT: Retropharyngeal masses are benign or malignant. Because of their location, even the most benign lesion may behave in such a manner as to endanger life by compressing and obstructing the air and/or food passages. The case of an elderly woman whose life was endangered because of excessive hypercarbia, severe dysphagia, weight loss, and excessive daytime sleepiness secondary to a rare retropharyngeal benign mass, a lipoma, is presented. The literature is reviewed, and all the available cases are tabulated.0Comments 1Citation
- [Show abstract] [Hide abstract] ABSTRACT: In a 3-year prospective study, all cases of disseminated Fusobacterium necrophorum infections found in Denmark from 1998 to 2001 were analysed, with the aim of describing the epidemiology and clinical features of the variants of Lemierre's syndrome and disseminated non-head-and-neck-associated F. necrophorum infections. Fifty-eight cases of Lemierre's syndrome were reported in previously healthy persons, with an incidence of 14.4 cases per million per year in youngsters aged 15-24 years old. There was no increase during the study period. Lemierre's syndrome originating from an oropharyngeal infection was seen in 37 youngsters. An otogenic variant of Lemierre's syndrome was seen in 5 children with dissemination to nearby regions, and other variants of Lemierre's syndrome, e.g. from the sinuses and teeth, were seen in 16 adults. Patients often had metastatic infections already on admission and needed prolonged hospitalisation. The overall mortality of Lemierre's syndrome was 9%. Forty-two elderly patients had disseminated F. necrophorum infections originating from foci in lower parts of the body. They frequently had predisposing diseases, e.g. abdominal or urogenital cancers, which contributed to the high mortality of 26%. This study shows that the incidence of Lemierre's syndrome is higher than that previously found and has a characteristic age distribution. Early suspicion of the diagnosis, several weeks of antibiotic therapy, often combined with surgical drainage, is mandatory to lower the mortality. In disseminated non-head-and-neck-associated F. necrophorum infections, underlying cancers must be considered.0Comments 72Citations