Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of "neck pseudoaneurysm, neck infection, parapharyngeal abscess" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10 case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.
Aged, 80 and over ; Humans ; Male ; Abscess/diagnosis* ; Aneurysm, False/diagnosis* ; Carotid Artery, Common/surgery* ; Carotid Artery, Internal/surgery* ; Neck ; Parapharyngeal Space

Diagnostic Errors ; Humans ; Lymphoma, Large B-Cell, Diffuse/diagnosis* ; Peritonsillar Abscess/diagnosis*

Abscess/diagnosis* ; Cardiac Tamponade/etiology* ; Humans ; Klebsiella Infections/diagnosis* ; Klebsiella pneumoniae ; Mediastinal Diseases/diagnostic imaging*

Brucella ; Brucellosis/diagnosis* ; Cervical Vertebrae/diagnostic imaging* ; Epidural Abscess ; Humans ; Magnetic Resonance Imaging ; Quadriplegia ; Spondylitis/diagnostic imaging*

Abscess/diagnosis* ; Diagnostic Errors ; Humans ; Mycoses ; Penicillium ; Talaromyces

diagnosis according to the Paris classification by comparison with patients from the European multicenter 5-years recruitment of children with newly developed IBD (EUROKIDS registry).METHODS: Korean children and adolescents who had been newly diagnosed with CD at the age of < 18 years during 2013–2016 were included in this multicenter retrospective study. Disease phenotype at diagnosis was classified according to the Paris classification, and compared with the published data from the EUROKIDS study.RESULTS: A total of 255 patients were included. The median diagnosis age was 14.7 years (range, 0.8–17.9 years). No significant difference was observed in male-to-female ratio with EUROKIDS (1.9:1 vs. 1.45:1, p=0.062). The proportion of children aged < 10 years was significantly lower in Koreans (7.1% vs. 19.6%, p < 0.001). Colonic disease was less prominent (10.0% vs. 27.3%, p < 0.001), while upper GI involvement was more prominent in Korean children (59.3% vs. 46.2%, p < 0.001). The proportion with perianal fistulizing disease at diagnosis was significantly higher in Korean patients (44.8% vs. 8.2%, p < 0.001). A separate analysis of Korean patients revealed that perianal fistulizing disease at diagnosis was positively associated with male sex and body mass index z-score (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.20–3.76, p=0.010; and OR=1.29, 95% CI=1.05–1.58, p=0.015, respectively).CONCLUSION: Approximately half of pediatric CD patients in Korea present with perianal fistulas and/or abscesses at diagnosis, which is a distinct feature of CD in Korean children and adolescents compared to their European counterparts. An underlying genetic difference between ethnicities may play a role in this expression of different phenotypes in pediatric CD.]]>
Abscess ; Adolescent ; Body Mass Index ; Child ; Classification ; Colonic Diseases ; Crohn Disease ; Diagnosis ; Europe ; Fistula ; Humans ; Inflammatory Bowel Diseases ; Korea ; Male ; Pediatrics ; Phenotype ; Retrospective Studies

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting various organs. Among its manifestations, inflammatory pseudotumor (IPT) is an extremely rare disease about which no case has been reported of it occurring in the liver. We present a case of a SLE patient with hepatic IPT (hIPT) successfully treated with immunosuppressants. A 16-year-old male with elevated liver enzymes visited our clinic and was diagnosed as SLE. Although no lesion was observed in the initial abdomen ultrasonography, the abdominal CT on hospital day 7 revealed a new hepatic mass resembling an abscess. Despite 5 weeks of antibiotics treatment, the hepatic mass remained, and was re-diagnosed as hIPT secondary to SLE with an abdominal MRI. After high dose prednisolone and mycophenolate mofetil treatment, lupus activity subsided and hIPT disappeared in the follow-up CT. This case suggests that hIPT should be considered as a differential diagnosis among hepatic mass in SLE patients.
Abdomen ; Abscess ; Adolescent ; Anti-Bacterial Agents ; Autoimmune Diseases ; Diagnosis, Differential ; Follow-Up Studies ; Granuloma ; Granuloma, Plasma Cell ; Humans ; Immunosuppressive Agents ; Liver ; Liver Neoplasms ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Magnetic Resonance Imaging ; Male ; Plasma Cells ; Prednisolone ; Rare Diseases ; Tomography, X-Ray Computed ; Ultrasonography

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.
Abscess ; Calcaneus ; Delayed Diagnosis ; Diagnosis ; Foot ; Heel ; Humans ; Middle Aged ; Mycobacterium tuberculosis ; Orchiectomy ; Osteomyelitis ; Polymerase Chain Reaction ; Testis ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary ; Wounds and Injuries

Ventriculoperitoneal (VP) shunt insertion is the standard treatment for hydrocephalus; shunt-associated infection is the most common complication after surgery. However, fungal infections are unusual. We present a case of cryptococcal meningitis complicated by a brain abscess and an infected intra-abdominal pseudocyst that developed 14 weeks after VP shunt insertion to treat hydrocephalus in a 74-year-old patient. Cryptococcal central nervous system (CNS) infection has a high mortality rate; however, diagnosis is challenging. Therefore, prompt diagnosis and treatment are required when a cryptococcal CNS infection is suspected in patients with VP shunts.
Aged ; Brain Abscess ; Brain ; Central Nervous System ; Cryptococcus ; Diagnosis ; Humans ; Hydrocephalus ; Meningitis, Cryptococcal ; Mortality ; Ventriculoperitoneal Shunt

Pylephlebitis (septic thrombophlebitis of the portal venous system) is a rare but serious complication of intra-abdominal infections that drain into the portal venous system. Its diagnosis is based on imaging; computed tomography may reveal a thrombus in the portal vein. Bacteremia may also be evident. As the symptoms are nonspecific, early clinical diagnosis is difficult, and delayed treatment can compromise outcomes. We report a case with extensive pylephlebitis and a liver abscess associated with Streptococcus intermedius sepsis; the case was treated successfully with antibiotics and anticoagulants. Such cases have not been widely reported.
Anti-Bacterial Agents ; Anticoagulants ; Bacteremia ; Diagnosis ; Intraabdominal Infections ; Liver Abscess ; Liver ; Portal Vein ; Sepsis ; Streptococcus intermedius ; Streptococcus ; Thrombophlebitis ; Thrombosis