Spontaneous haemopneumothorax: a rare clinical entity.

A 39 yr old man presented with a spontaneous pneumothorax. On initial pleural drainage 120 ml of haemorrhagic fluid were collected. Twenty four hours, after re-expansion of the lung, shock developed and 1,200 ml of haemorrhagic fluid were spontaneously collected. The diagnosis haemopneumothorax was considered and at operation a bleeding vessel, which originated from the parietal pleura, was located and coagulated. The occurrence of an air fluid line at radiological examination, the development of a haemorrhagic pleural effusion and shock should alert the physician of this entity. This case stresses the importance of early recognition and surgical intervention because of the possible lethal evolution.     

Spontaneous colonic perforation: a rare complication of collagenous colitis

Collagenous colitis is a clinicopathologic syndrome characterized by chronic watery diarrhea and unique histopathologic features. Spontaneous colonic perforation in the setting of collagenous colitis is a highly unusual complication, with only three cases reported in the literature to date. We present a fourth case and propose a potential pathologic mechanism for acute colonic perforation in this patient population.     

Choledochoduodenal fistula and gall bladder perforation complicating Hodgkin's disease

A patient is presented with obstructive jaundice secondary to Hodgkin's Disease. This relatively uncommon occurrence is complicated by a choledochoduodenal fistula demonstrated radiographically. Terminal galllbladder perforation through areas of tumor occurred and perhaps was related to chemotherapy.     

Primary oesophageal tuberculosis: a rare entity.

Tuberculous infection of the oesophagus is rare and primary oesophageal tuberculosis is seen even more infrequently. We report a case of oesophageal tuberculosis in a 32-year-old female patient who presented to us with odynophagia and weight loss. Endoscopy showed a solitary ulcerative oesophageal lesion. Further investigation resulted in a diagnosis of oesophageal tuberculosis with no manifestations of tuberculosis elsewhere. She responded well to antitubercular treatment. This case was classified as primary oesophageal tuberculosis.     

Polymicrobial polyarticular septic arthritis: a rare clinical entity.

Polymicrobial polyarticular septic arthritis is a rare clinical entity, with only a few cases having been reported to date. We report a case due to Streptococcus pyogenes and Staphylococcus aureus in an IVDU, complicated by fatal streptococcal toxic-shock syndrome, and review the current literature. We conclude that whenever polymicrobial polyarticular septic arthritis is diagnosed, a high index of suspicion should be maintained for the detection of locally destructive infectious processes as well as systemic complications, and that a high mortality rate should be expected.     

Bilateral spontaneous pneumothorax: a rare entity

A young otherwise healthy man presented with bilateral spontaneous pneumothorax that resulted in near respiratory failure and severe cardiac dysrhythmia. The magnitude of the patient's clinical manifestations resulted from his severely compromised pulmonary function with its attendant cardiovascular compromise. Prompt bilateral tube thoracostomy relieved his cardiopulmonary distress. This rare clinical entity should be considered in any individual with abrupt onset of severe cardiopulmonary distress.     

Esophageal bronchogenic cyst: a rare entity

BACKGROUND/AIMS: Bronchogenic cysts are congenital lesions of foregut origin, usually found in intrapulmonary or mediastinal locations. However, an esophageal bronchogenic cyst is an uncommon occurrence. The definitive diagnosis is based on histological findings after extirpation of the cyst. Surgical excision of bronchogenic cysts is considered appropriate because of the high complication rates of subsequent infection, rupture, hemorrhage, and malignant degeneration if left untreated. RESULTS: A 42-year-old man presented with a two-year history of progressive dysphagia. An esophageal bronchogenic cyst was evidenced by esophagography, Computed tomography, magnetic resonance imaging, and endoscopic ultrasound, followed by confirmation with surgical exploration. CONCLUSION: Esophageal bronchogenic cysts should be included in the differential diagnosis of a mediastinal tumor, especially when the tumor is within or near the tracheobronchial tube, even though it is a rare condition.     

Adrenal cortical phaeochromocytoma: a case report of a rare entity.

Adrenal cortical phaeochromocytomas (pseudo-phaeochromocytomas) are a very rare entity and a diagnostic challenge. Of the few cases previously reported, most have incomplete data or lack clinical and biochemical follow-up documenting the cure of the excess secretion of catecholamines after resection of the tumour. We report herein a 62-year-old patient with clinical and biochemical findings diagnostic of a phaeochromocytoma associated with a 2-cm adrenal mass on CT scan. Surgery revealed the presence of an adrenal cortical adenoma with positive staining for the neuroendocrine marker synaptophysin, but negative for chromogranin, as has been previously reported for these rare cortical phaeochromocytomas. After removal of the tumour the clinical symptoms resolved and biochemical markers normalized, demonstrating the causal relationship between the cortical tumour and the excess production of catecholamines.