New Horizons in Clinical Case Reports最新文献

{"title":"Neurocysticercosis Presenting with Psychosis","authors":"Aml ElemamaliI, Shafa Talyb, A. Awad","doi":"10.1016/J.NHCCR.2017.06.188","DOIUrl":"https://doi.org/10.1016/J.NHCCR.2017.06.188","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"48 1","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86057738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful outcome in perinatal intravaginal torsion of testis in neonate: Long-term outcome","authors":"Kashif Chauhan *,&nbsp;Gemma Bown,&nbsp;Brian Davies,&nbsp;Shailinder Singh","doi":"10.1016/j.nhccr.2017.06.170","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.170","url":null,"abstract":"<div><h3>Introduction</h3><p>Perinatal testicular torsion can be intravaginal or extravaginal. Extravaginal torsion can be managed in an elective manner. Intravaginal torsion needs an urgent operation to maximize the viability of the testis. The history is vital to distinguish between the two diagnoses. We report a case in which a perinatal intravaginal torted testicle was successfully salvaged due to a timely exploration. This was a retrospective review of a case and literature review of perinatal testicular torsion.</p></div><div><h3>Case description</h3><p>A term baby was transferred to a tertiary pediatric surgical unit in the for surgical management of exomphalos minor. The child was noted to have normal testes. On the seventh day of life, he was noted to have a firm swelling in his right scrotum with purple discoloration. He was promptly reviewed by the surgical team. A perinatal torsion of intravaginal type was suspected and he was booked for emergency exploration. The surgical findings were 1) significant edema of the right scrotal wall, 2) a thickened tunica vaginalis and small volume of hemolyzed fluid, and 3) a bluish and congested torted testicle in intravaginal plane. Testis was de-rotated and color returned within 5 minutes. A three-point testicular fixation was performed bilaterally. He was reviewed in clinic for the following 2 years and found to have equal growth of the testicles, both of which were appropriately positioned within the scrotum.</p></div><div><h3>Results and conclusions</h3><p>This case highlights the importance of being aware that perinatal torsion can be extravaginal or intravaginal. The patient history is important to distinguish between the two diagnoses as proven by the above case. A positive outcome can be achieved with judicious assessment and emergent management of perinatal intravaginal torsions.</p></div><div><h3>Take-home message</h3><p>Clinicians should maintain a high level of suspicion of intravaginal torsion in all cases of perinatal testicular torsion.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 16"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91722947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One center experience of pneumatosis cystoides intestinalis","authors":"Viktorija Mokricka ,&nbsp;Polina Zalizko * ,&nbsp;Maris Pavars ,&nbsp;Arnis Abolins ,&nbsp;Aldis Pukitis","doi":"10.1016/j.nhccr.2017.06.195","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.195","url":null,"abstract":"<div><h3>Introduction</h3><p>Pneumatosis cystoides intestinalis (PCI) is a rare benign condition, in which gas is found in a linear or cystic form in the subserosa or submucosa. The subserous cysts are most frequently found in the small bowel while the submucous localizations are predominantly seen in the colonic wall. Peritoneal pneumatosis, abdominal gas cysts, cystic lymphopneumatosis, intestinal emphysema or intestinal gas cysts are terms used to describe the occurrence of multiple, gas-filled cysts, of the gastrointestinal tract. Incidence of PCI was reported to be 0.03% in the general population. It is a radiographic finding and not a diagnosis, as the etiology varies from benign conditions to fulminant gastrointestinal disease.</p></div><div><h3>Case description</h3><p>A 77-year-old patient was admitted in Pauls Stradins Clinical University Hospital with complains of abdominal discomfort and bloating during two years. Blood laboratory tests revealed no changes in the blood count, CRP (C reactive protein) was 77.6mg/l (N&lt;5mg/l). A colonoscopy showed <em>c.sigmoideum, c.descendens</em> submucosal lesion in 10-15cm zone with submucous cystic formations, visually reminiscent of \"a bunch of grapes, which are connected to each other\", filled with a whitish, in some areas bluish content, with unchanged superficial mucosae.</p></div><div><h3>Results</h3><p>Since 2011, lesion was increased in size of 5cm. Endoscopic ultrasound showed formation of submucosal anehogenic mass; 11-17mm thick, blurring, palpable densely, minimally vascularized with no signs of malignancy. A computer tomography (CT) scan of the abdomen and pelvic area, and retroperitoneal space revealed infiltrative mass in the wall of the <em>c.sigmoideum.</em> Colonoscopy was performed for tumor location, followed by laparoscopic resection of the tumor mass. Morphological examination of full specimen revealed pneumatosis cystoides intestinalis in size of 11.5x5.6x4cm, with multicore foreign body type gigantic cells on the inner surface of the cysts, and no signs of malignancy.</p></div><div><h3>Take-home message</h3><p>Our case, pneumatosis cystoides intestinalisis is a rare disease, which is difficult to diagnose by radiology or endoscopy, even for exclusion of malignancy. PCI is an indication for surgery if the lesion is growing in size and may cause the symptoms of colon obstruction.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 26"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute pulmonary embolism in a dengue fever patient co-infected with influenza B","authors":"Wen-Chi Hsu *,&nbsp;Wen-Liang Yu","doi":"10.1016/j.nhccr.2017.06.173","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.173","url":null,"abstract":"<div><h3>Introduction</h3><p>The main pulmonary embolism is a blockage of blood flow to the lungs by a blood clot which is composed of clumped platelets and condensed fibrin lodged into an artery in the lungs. A condition associated with thrombotic events due to loss of endothelium non-thrombogenic protective factors and severe dehydration might occur in the early course of severe dengue, thereby increasing the risk of embolic formation. We report acute pulmonary embolism in a severe dengue patient co-infected with influenza B, which might additionally predispose to an acute embolic event.</p></div><div><h3>Case description</h3><p>This 71-year-old diabetic woman with hypertension suffered from the dizziness, episodic fever, and general weakness since September 13, 2015. The data of dengue virus IgM, IgG and NS1 antigen were all positive. The presenting platelet count was 11000/uL. She felt worsening malaise, dizziness, anorexia, and newly developed dyspnea. The brain CT did not indicate obvious lesion except mild atrophy. The chest X-roentgenogram (CXR) revealed the opacity in left lower lung field. Abnormal liver function tests were noted, including S-GOT (AST), 1526 U/L; S-GPT (ALT), 709 U/L; total bilirubin, 2.71 mg/dL and direct bilirubin, 1.84 mg/dL. Under the impression of severe dengue with pneumonia, she was admitted for the further management. Antibiotic therapy with cefuroxime was given. However, the patient had worsening dyspnea and tachycardia 5 days later. Laboratory data showed elevated lactate (4.1 mmole/L), hypoxemia with mild decrease PaO2/FiO2 ratio, and elevated D-dimer (3271 ng/m). CXR showed resolution of pneumonia patch. As suspected pulmonary embolism, chest CT was arranged, which revealed partial thrombosis of right pulmonary artery at superior lobar branch. Therefore, she was admitted to the intensive care unit. In addition, the result of rapid influenza diagnostic test for influenza B antigen was positive. A 5-day course of oseltamivir and antibiotic therapy with levofloxacin were given. After treatment, fever subsided and dyspnea was improved. Follow-up platelet count rose to 91000/uL. Then, she was transferred to ward. After heparin therapy, subsequent daily warfarin was titrated to daily 2.5mg to achieve the desired prothrombin time ratio. As stable condition, she was discharged after 16 days of hospitalization.</p></div><div><h3>Conclusion</h3><p>Pulmonary embolism has been reported in association with dengue fever or severe influenza, particularly influenza A(H1N1). Co-existence of severe dengue, influenza B and acute pulmonary embolism was sparsely reported before. Awareness for these complications should be recommended to all practitioners who treat patients with severe dengue fever, particularly co-infected with influenza.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 17"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive pulmonary aspergillosis in three nasopharyngeal cancer patients","authors":"Wen-Liang Yu *","doi":"10.1016/j.nhccr.2017.06.168","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.168","url":null,"abstract":"<div><h3>Background</h3><p>The importance of invasive pulmonary aspergillosis (IPA) in patients with haematological malignancy or solid organ transplantation has been highlighted, but IPA has been neglected in the patients with nasopharyngeal cancer (NPC).</p></div><div><h3>Case 1</h3><p>A 58-year-old woman of NPC had fever and cough due to right lung consolidative pneumonia. Initial laboratory data showed WBC 300/µL, platelet count 77000/µL, procalcitonin 26.64ng/ml, CRP 310.3mg/L, lactic acid 4.2mmole/L, and albumin 2.2g/dL. Sputum culture <em>yielded Pseudomonas aeruginosa</em> and yeast-like organisms. Blood <em>Aspergillus</em> antigen index revealed 0.38 and 0.11 twice. Antibiotics with imipenem and levofloxacin did not achieve improvement. Then BAL <em>Aspergillus</em> antigen revealed 0.54 (&gt;0.5, positive). Voriconazole was added, but pneumonia was getting worse. Although with intensive care, patient died after 30 days of hospital stay.</p></div><div><h3>Case 2</h3><p>A 51-year-old man of NPC had fever, cough and dyspnea due to bilateral interstitial pneumonia. Laboratory data showed WBC 10400/µL, band form 12%, platelet 341000/µL, CRP 470.5mg/L, lactic acid 1.6mmole/L, and albumin 4.2g/dL. Sputum culture yielded mixed normal flora. Blood <em>Aspergillus</em> antigen index revealed &gt;7.84 (positive). Chest CT showed reticular micronodules and interstitial infiltration over both lungs. Piperacillin/tazobactam, levofloxacin and voriconazole achieved improvement. Two weeks later, blood Aspergillus antigen index became 3.69. He was discharged after 22 hospitalized days with oral voriconazole for maintenance therapy.</p></div><div><h3>Case 3</h3><p>A 70-year-old man of NPC had frequent chocking episodes, cough and high fever, suspected of aspiration pneumonia. Laboratory data showed WBC 7,200/µL, platelet 208000/µL, procalcitonin 4.41ng/ml, CRP 145.8mg/L, lactic acid 1.2mmole/L, and albumin 0.7g/dL. Blood culture yielded <em>Enterococcus faecalis</em>. Sputum culture yielded mixed flora. Amoxicillin/clavunanic acid was used but was changed to piperacillin/tazobactam as worsening pneumonia by <em>Klebsiella pneumoniae</em> and septic shock developed. Blood Aspergillus antigen index revealed 0.74 (positive), but voriconazole was not administered as improved condition. The patient was discharged after 19 days of hospital stay with residual interstitial process over bilateral lungs.</p></div><div><h3>Conclusions</h3><p>In conclusion, we reported on 3 NPC patients with IPA-related worsening pneumonia. Blood <em>Aspergillus</em> antigen was positive during early course in 2 patients, but was negative in one patient who showed positive BAL <em>Aspergillus</em> antigen in the late course. IPA should be considered early in the NPC patients with pneumonia.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 15"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced GO/NOGO ACC-sensitive activity in a case of Parkinson's disease with impulse control disorders","authors":"Sara Palermo * ,&nbsp;Rosalba Morese ,&nbsp;Maurizio Zibetti ,&nbsp;Francesca Dematteis ,&nbsp;Maria ConsueloValentini ,&nbsp;Leonardo Lopiano","doi":"10.1016/j.nhccr.2017.06.155","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.155","url":null,"abstract":"<div><h3>Introduction</h3><p>The incidence of impulse control disorders (ICDs) in Parkinson’s disease is as high as 20%. Dopamine agonists can induce alterations in those frontostriatal networks that manage reward and mediate impulse monitoring and control. Indeed, tonic stimulation of dopamine receptors may damage inhibitory control mechanisms and reward processing, while promoting compulsive repetition of behavior. The neurocognitive approach considers two measurable executive-functions from which ICDs can be detected: 1) response-inhibition, which neural substrate is located in the inferior portion of the prefrontal cortex<span>; 2)</span> integration of reward/punishment contingencies in individual choices, which neural substrate is located in the orbital-prefrontal cortex.</p></div><div><h3>Case description</h3><p>A 51-year-old man with a 12-year story of Parkinson’s disease, presenting motor fluctuations, and stable on 375 mg/day of levodopa was admitted to the hospital for the ascertainment of requirements for DBS surgery (MDS-UPDRS-III OFF=56; Hoehn-Yahr=2). In 2014, the patient developed an impulse-control disorder, including compulsive intake of sugary and high-fat food, and video-games dependence. Grazing behavior and hyper-focus on in-game achievements interfered with the patient’s everyday life. During neuroimaging data acquisition, the subject was asked to perform a response-inhibition ACC-sensitive task in which the subject had to respond to GO stimuli inhibiting the response to infrequent NOGO stimuli.</p></div><div><h3>Results and conclusions</h3><p>Examination findings included the following: bilateral bradykinesia and tremor of the upper limbs. The remaining neurological examination was negative. The neuropsychiatric assessment revealed significant levels of anxiety. Although the patient exhibited a normal global cognitive profile, reaching normative scores on the screening tests, abnormalities were detected for the performance on conceptualizing and response-inhibition tasks. The MRI showed no alterations in the brain parenchyma signal. The patient showed no response-inhibition abilities as measured by the GO/NOGO task and action-monitoring deficits (error awareness). Moreover, fMRI acquisition revealed absent task-sensitive recruitment of cingulo-frontal regions for the contrast <span>NOGO</span> vs <span>GO</span>.</p></div><div><h3>Take-home message</h3><p>In our experience, fMRI response-inhibition task may be useful in PD for better characterizing the clinical profile evaluating treatment options. A frontostriatal – cingulofrontal dysfunction may reflect impairment in metacognitive-executive abilities (such as response-inhibition, action monitoring and error awareness). Interestingly, impaired response-inhibition is an example of the motor/behavioral aspect of impulse control. Its assessment is supposed to be particularly useful in the PD post-diagnostic phase, to better identify individuals at risk of developing ICDs wit","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 9"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus pneumonia coexisting invasive pulmonary aspergillosis in an old aged diabetic patient after prolonged intensive care","authors":"Huang Hui-Ling *,&nbsp;Yu Wen-Liang","doi":"10.1016/j.nhccr.2017.06.185","DOIUrl":"10.1016/j.nhccr.2017.06.185","url":null,"abstract":"<div><h3>Introduction</h3><p><em>Cytomegalovirus</em> (CMV) pneumonia is an important cause of morbidity and mortality in transplant recipients, hematological malignancies on chemotherapy, and HIV-infected patients. Invasive pulmonary aspergillosis (IAP) occurs primarily in patients with severe immunodeficiency. Both infections have dramatically increased in the patients with impaired immune state associated with critically ill patients and those with chronic obstructive pulmonary disease.</p></div><div><h3>Case description</h3><p>The 93-year-old diabetic woman was admitted to the intensive care unit (ICU) due to urosepsis. Antibiotic therapy with piperacillin-tazobactam was given. As clinical progression to profound shock and multiple organ failure, high-dose vasopressors, hydrocortisone and fluid resuscitation were given. After short course of continuous venovenous hemofiltration was used, the hyperkalemia and metabolic acidosis were improved. The patient was maintained on regular haemodialysis. However, active gastric and duodenal ulcers with bleeding were identified by endoscopy. Hemostasis and high-dose pantoprazole infusion were given. As stable condition after ICU stay for one month, she was transferred to respiratory care center for weaning ventilator. However, CXR showed partial consolidation over bilateral lung, favoring inflammatory process. The sputum culture showed Acinetobacter baumannii and Aspergillus species. Meanwhile, the results of CMV-PCR for serum and sputum samples were positive. Blood CMV virus load was 8140IU/mL. In spite of one week therapy with imipenem and ganciclovir, the sepsis and pneumonia did not improve. The CXR still showed severe pulmonary edema and high airway pressure was noted. The serum Aspergillus galactomannan (GM) antigen revealed &gt;5.59 index (normal, &lt;0.5). As rapid deterioration of clinical conditions, the families agreed palliative treatment and she died after 43 days of hospitalization.</p></div><div><h3>Conclusion</h3><p>Early diagnosis and treatment of CMV infection is important in view of the poor prognosis of established infection. Strategies include pre-emptive therapy when viral load increases or CMV-PCR becomes positive on serial monitoring. As cultures for Aspergillus spp are positive only in few cases, serum GM assay is useful for early diagnosis of IPA even before the clinical symptoms and signs becoming obvious. Old age, diabetes, hemodialysis, steroid use and prolonged ICU stay might predispose our patient to develop IPA and CMV pneumonia. Voriconazole was not given for our patient in time, which also highlighted the importance of early diagnosis and therapy.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 22"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84142666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of recurrent and progressive respiratory failure","authors":"N. Oblizajek, J. Chen, Mazie Tsang, T. Chon","doi":"10.1016/J.NHCCR.2017.06.197","DOIUrl":"https://doi.org/10.1016/J.NHCCR.2017.06.197","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"8 1","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84489498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral empyema thoracis due to Lactobacillus gasseri. Has anything changed since Hippocrates","authors":"A. Esquibel, A. Dababneh, R. Palraj","doi":"10.1016/J.NHCCR.2017.06.190","DOIUrl":"https://doi.org/10.1016/J.NHCCR.2017.06.190","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"38 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78137195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skenes gland cyst causing urinary retention","authors":"Mariam Malallah ,&nbsp;Mohammed Zohair ,&nbsp;Adel Al Tawheed ,&nbsp;Gopendro Singh Naorem ,&nbsp;Khaled Al Otaibi * ,&nbsp;Tariq Al Shaiji","doi":"10.1016/j.nhccr.2017.06.152","DOIUrl":"10.1016/j.nhccr.2017.06.152","url":null,"abstract":"<div><h3>Introduction</h3><p>Skene`s gland also known as paraurethral glands are bilateral prostatic homologues glands. It was first discovered and described by Alexander Johnston Chalmers Skene in 1880. Paraurethral glands are located posterolaterally to the urethra. Embryologically derived from the urogenital sinus. Skene`s gland secretes a small amount of mucoid material which has a role in sexual stimulation and lubrication. The etiology of paraurethral cysts remains unknown. The obstruction of Skene's ducts as a result of infection or inflammation usually in response to skenitis, of which gonorrhea is the most common cause, or cystic degeneration of embryonic remnants of the paraurethral glands, have been assumed to be possible causes of paraurethral cysts. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of Skene's duct cyst in a female which presented with acute urinary retention secondary to the lateral displacement of meatus.</p></div><div><h3>Case description</h3><p>A previously healthy female presented to casualty with gradual onset of suprapubic pain, associating with a sudden onset of the inability to void for 6 hours. The patient was complaining of obstructive lower urinary tracts symptoms for 2 weeks. She had 3 uncomplicated normal full term vaginal deliveries with an unremarkable past medical or surgical history. Examination of the external genitalia revealed an ovoid, fluctuant, tender swelling located just inferior to pubic symphysis and completely displacing and stretching the external urethral meatus to the opposite side. Compression of the swelling did not result in fluid extravasation through the urethra. Vaginal patency was also verified. Insertion of 14 Fr foley’s catheter was managed with difficulty and drained 600cc clear urine. MRI showed normal kidneys, ureters and urinary bladder with a simple 2.1x2.7x3.3cm lower vaginal cyst with high protein/hemorrhagic content mostly a paraurethral gland duct cyst. Patient underwent examination under anesthesia, cysto-urethroscopy and skene’s duct cysts excision was done. Histopathology examination displayed the presence of benign cystic lesion lined by transitional and squamous epiltleium with focal surface ulceration; thereby confirming the diagnosis of paraurethral cyst. Foley’s catheter was removed after 5 days and she voided freely.</p></div><div><h3>Results and conclusions</h3><p>Skenes gland cyst should be listed in the differential diagnosis of a female patient who comes with an acute urinary retention.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 8"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73399435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}