Accessory bile duct: a rare but important anatomical variant

An 84-year-old man presented with pancreatic adenocarcinoma. Following neoadjuvant chemoradiation, the patient underwent a pancreaticoduodenectomy, complicated by early bile leak. Re-exploration and intraoperative cholangiogram identified an accessory common bile duct draining segment 5 of the right hepatic lobe, which was then ligated. The patient underwent a complicated postoperative course eventually developing sepsis secondary to biliary stasis. He elected for comfort measures and passed away secondary to complications of sepsis.

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Identification of left ventricular chamber-like aneurysm related to cardiac sarcoidosis

Description

A 58-year-old woman was referred to us with an abnormal ECG, showing complete right bundle branch block and left anterior fascicular block. An echocardiogram showed left ventricular (LV) septal thinning and hinted at the presence of an LV aneurysm. An enhanced CT indeed revealed an LV aneurysm-like structure. After appropriate testing to exclude coronary artery disease, this LV anomaly led us to suspect the possibility of cardiac sarcoidosis (CS). Cine cardiac magnetic resonance (CMR) imaging showed an apparent chamber-like aneurysm, and late gadolinium enhancement (LGE) CMR showed transmural positive enhancement in the mid-portion of the LV at the region of the aneurysm (figure 1A,B). As our institution lacked an FDG-PET scanner, gallium scintigraphy was instead performed, which showed uptake in the heart and bilateral hilar lymph nodes (figure 2A,B); hilar lymphadenopathy was undetected on enhanced CT, and its presence strongly indicated sarcoidosis. We finally made...

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Concurrent metastases of papillary thyroid carcinoma to the scalp and Meckels cave

We present the case of a 65-year-old man with severe headaches and unilateral facial weakness, seen in consultation by the dermatology service to rule out primary cutaneous melanoma after brain imaging identified an enlarging mass within the right trigeminal (Meckel's) cave. Examination revealed only a pair of erythematous papules on the scalp, for which biopsy demonstrated metastatic papillary thyroid carcinoma. Further evaluation and subsequent thyroidectomy confirmed the origin of widespread internal disease, followed by definitive excision of scalp lesions and multimodal management of systemic involvement. Whereas presentation of metastasis to the skin is highly variable, a low threshold for biopsy may allow for histological identification of internal disease not otherwise considered in the clinical differential.

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Varicella zoster lumbosacral plexopathy: a rare cause of lower limb weakness

This is a rare case of Varicella zoster virus (VZV) lumbosacral plexopathy in an 84-year-old women presenting with lower limb weakness and rash. Contrast-enhanced MRI showed enhancement of the left L3–L5 descending nerves and left lumbosacral plexus consistent with inflammatory/infectious aetiology. Cerebrospinal fluid PCR confirmed VZV DNA and cerebrospinal fluid serological testing was positive for VZV immunoglobulin (Ig)M and IgG antibodies. The patient was treated with intravenous acyclovir but this was complicated by the development of acute renal failure attributed to acyclovir-induced nephropathy, requiring dose adjustment. After a prolonged course of oral acyclovir and inpatient rehabilitation, the patient made a partial neurological and functional recovery.

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Bone inside eye: choroidal osteoma presenting as exudative retinal detachment: a challenge to diagnosis

Description 

A 38-year-old woman presented to outpatient department with the chief complaints of gradual onset of painless diminution of vision in the right eye since last 1 month. At presentation, the visual acuity in OD was perception of light and 20/20 in OS. Slit-lamp examination of anterior segment was found to be within normal limits in both eyes. On fundus evaluation of right eye, exudative retinal detachment1 with shifting fluid along with oedematous disc with blurry margin and juxtapapillary subretinal yellowish brown mass were noticed (figure 1A). Fundus in the left eye was within normal limits (figure 1B). With the above clinical examination, a provisional diagnosis of right-eye choroidal osteoma with exudative retinal detachment was made and confirmed on sonography, with an elevated highly reflected choroidal mass persisting at lower scanning sensitivity and acoustic shadow along with retinal detachment (figure 2A). CT scan depicted evidence of...

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Tracheal agenesis in a new born: lessons learnt

Tracheal agenesis is a rare but fatal congenital tracheal malformation. Lack of prenatal symptom and a typical clinical presentation lead to failure to arrive at a correct diagnosis and confusion during resuscitation. We report a case of a newborn male child with type 2 tracheal agenesis. Despite a typical presentation, diagnosis was delayed after unsuccessful intubation, examination under anaesthesia and emergency tracheostomy. The embryology, diagnostic criteria and potential treatment options are discussed. This case report is valuable in increasing awareness of this rare condition and will help us in being better prepared in managing these children. Future studies should aim to find the optimal replacement for the tracheal.

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Isolated thyroid metastasis from benign phyllodes tumour

We present a rare and interesting case of a 35-year-old woman who initially underwent an uneventful wide excision for a 13 cm left benign phyllodes tumour. She then noted a slowly growing left thyroid nodule 8 months postsurgery which on thyroidectomy 4 years later was shown to be a 6.9cm isolated thyroid metastasis from the phyllodes tumour. As this may be the first reported such case in the literature, implications on histological classification, predictive factors for disease progression, mechanisms of metastasis, and evaluation, management and surveillance of benign phyllodes tumours and thyroid nodule/s with a history of phyllodes tumour can thus be significantly impacted.

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