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Research paper thumbnail of Diagnosis difficulty of histiocytosis in the thyroid region of a child: a rare case report with literature review of differential diagnoses

The Egyptian Journal of Otolaryngology, Nov 12, 2022

Background: Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and ra... more Background: Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and radiological aspects are non-specific, and etiological reasoning is quite difficult considering the tremendous number of differential diagnoses. Case presentation: This is the case of a 6-year-old girl who came to the emergency room with an acute presentation bulging of the anterior and left lateral regions of the neck. The palpation of the mass showed tenderness; there was no sign of inflammation, nor was there any fistula to the anterior border of the sternocleidomastoid muscle. The patient was stable. She did not have any signs of compression. The initial blood showed anemia and inflammatory syndrome. She underwent cervical ultrasound exam that showed a mass at the expense of the left thyroid lobe; the mass extends through the sub-hyoid muscles to the lateral cervical region. A CT scan with and without contrast injection was performed. It showed a heterogenous mass, which seemed centered in the anterior compartment, and from which it extended to the left lateral compartment, as well as the posterior compartment, invading the prevertebral muscles and englobing the carotid and the internal jugular vein. The patient underwent surgical biopsy. A basal cervical incision was made, dissection with the myo-cutaneous plane. Per-operative observation established that the mass breeched the infrahyoid muscles, as well as the sternocleidomastoid muscle. A biopsy was performed without opening the middle line. The pathological exam showed an eosinophilic granulomatosis, associated with Stembergoid cells. The immunehistochemical exam concluded that the lesion is histiocytosis. The patient underwent a cervicothoracic and pelvic CT scan to rule out systemic forms. The diagnosis of isolated histiocytosis of thyroid region was confirmed. The patient underwent hemithyroidectomy, associated with careful dissection of extension of the mass to lateral compartment of the neck. Postoperative exam showed no abnormalities. No dysphonia and no hypocalcemia were observed. The 8-month follow-up showed satisfactory results, no cervical swelling, and no signs of inflammation or compression. Postoperative naso-fibroscopy was normal. Conclusions: The most important takeaway message of this work is that methodical approach of neck masses allows to rule out the most aggressive lesions frequently encountered, which allows clinicians to establish thorough diagnosis and management without further delay.

Research paper thumbnail of Ludwig’s angina in a child: a case report and literature review

The Egyptian Journal of Otolaryngology, Apr 26, 2023

Background Ludwig's angina is a diffuse cellulitis in the sub-mandibular space, which extends to ... more Background Ludwig's angina is a diffuse cellulitis in the sub-mandibular space, which extends to the sublingual space. It is an emergency that often occurs in adults as a complication of oral infections. It is rare in children and is particularly life-threatening due to the smaller size, as well as the characteristics in these spaces in a child. This is the case of Ludwig's angina in a 2-year-old boy, with rapid onset of signs of respiratory discomfort, no dental or systemic etiology, and great evolution. Case presentation A little boy was brought by his mom to the emergency room for the onset a firm swelling in the sub-mental region along with pain and fever, which appeared 3 days prior to the consultation. He was first examined by a pediatrician who prescribed oral broad-spectrum antibiotics (amoxicillin). The symptoms worsened over 48 h, as the little boy presented respiratory discomfort in supine position. He was admitted in the emergency department. Without dysphagia or respiratory distress. The clinical examination showed swelling in the sub-mental and sub-mandibular region with/without trismus or signs of oral infection. The laboratory investigations showed hyper-leukocytosis with a microcytic hypochromic anemia. CRP = 300; HIV test was negative. The computed tomography (CT scan) showed a diffuse abscess in the sub-mental and sub-mandibular and sublingual regions.No mediastinal collection was found. The diagnosis of Ludwig's angina was established. The patient underwent percutaneous surgical drainage of 15 ml of pus, which alleviated his symptoms, the treatment was carried out through broad-spectrum antibiotics, analgesics, and daily cleaning of the wound and change of surgical dressing. Bacteriological exam found gram-positive cocci in chains. The culture showed a Staphylococcus aureus. The patient presented clinical and biological improvement and was discharged after 7 days. Six months follow-up showed a healthy child, without signs of infection or any other complication. Conclusion Ludwig's angina in children-however rare-is a potentially life-threatening, rapidly spreading, bilateral swelling of the sub-mandibular. Its management is based on airway control, drainage of the collection and broadspectrum intravenous antibiotics, as well as surveillance of the biological parameters. Early diagnosis and appropriate management enhances outcome and decreases mortality significantly.

Research paper thumbnail of Diagnosis difficulty of histiocytosis in the thyroid region of a child: a rare case report with literature review of differential diagnoses

The Egyptian Journal of Otolaryngology

Background Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and rad... more Background Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and radiological aspects are non-specific, and etiological reasoning is quite difficult considering the tremendous number of differential diagnoses. Case presentation This is the case of a 6-year-old girl who came to the emergency room with an acute presentation bulging of the anterior and left lateral regions of the neck. The palpation of the mass showed tenderness; there was no sign of inflammation, nor was there any fistula to the anterior border of the sternocleidomastoid muscle. The patient was stable. She did not have any signs of compression. The initial blood showed anemia and inflammatory syndrome. She underwent cervical ultrasound exam that showed a mass at the expense of the left thyroid lobe; the mass extends through the sub-hyoid muscles to the lateral cervical region. A CT scan with and without contrast injection was performed. It showed a heterogenous mass, which seemed centered ...

Research paper thumbnail of A rare case of oral cavity lipoma in the inferior vestibule: a case report and literature review

The Egyptian Journal of Otolaryngology

Background Lipomas are ubiquitous tumors. They are mostly present in the trunk as well as the pro... more Background Lipomas are ubiquitous tumors. They are mostly present in the trunk as well as the proximal portion of the limbs. However, 15–20% are located in the head and neck regions, and only 4.4% are found in the oral cavity. They normally present as a bulge with signs of compression, without signs of infiltration. Case presentation This is the rare case of a 36-year-old man, who was admitted to ENT consultation for a bulge in the left inferior vestibule of the oral cavity. The bulging was not painful, with no inflammatory signs, no dental mobility, or abnormalities in the vestibular mucosa. No other masses were found in the general clinical exam. The patient underwent a dental panoramic X-ray, which showed a low opacity lesion next to the left inferior vestibular space, without signs of bone invasion. There was no hypoesthesia in the territory of the alveolar nerve was found. The patient underwent a craniofacial MRI which showed a mass which was hypointense on T1 and hyperintense ...

Research paper thumbnail of Diagnosis difficulty of histiocytosis in the thyroid region of a child: a rare case report with literature review of differential diagnoses

The Egyptian Journal of Otolaryngology, Nov 12, 2022

Background: Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and ra... more Background: Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and radiological aspects are non-specific, and etiological reasoning is quite difficult considering the tremendous number of differential diagnoses. Case presentation: This is the case of a 6-year-old girl who came to the emergency room with an acute presentation bulging of the anterior and left lateral regions of the neck. The palpation of the mass showed tenderness; there was no sign of inflammation, nor was there any fistula to the anterior border of the sternocleidomastoid muscle. The patient was stable. She did not have any signs of compression. The initial blood showed anemia and inflammatory syndrome. She underwent cervical ultrasound exam that showed a mass at the expense of the left thyroid lobe; the mass extends through the sub-hyoid muscles to the lateral cervical region. A CT scan with and without contrast injection was performed. It showed a heterogenous mass, which seemed centered in the anterior compartment, and from which it extended to the left lateral compartment, as well as the posterior compartment, invading the prevertebral muscles and englobing the carotid and the internal jugular vein. The patient underwent surgical biopsy. A basal cervical incision was made, dissection with the myo-cutaneous plane. Per-operative observation established that the mass breeched the infrahyoid muscles, as well as the sternocleidomastoid muscle. A biopsy was performed without opening the middle line. The pathological exam showed an eosinophilic granulomatosis, associated with Stembergoid cells. The immunehistochemical exam concluded that the lesion is histiocytosis. The patient underwent a cervicothoracic and pelvic CT scan to rule out systemic forms. The diagnosis of isolated histiocytosis of thyroid region was confirmed. The patient underwent hemithyroidectomy, associated with careful dissection of extension of the mass to lateral compartment of the neck. Postoperative exam showed no abnormalities. No dysphonia and no hypocalcemia were observed. The 8-month follow-up showed satisfactory results, no cervical swelling, and no signs of inflammation or compression. Postoperative naso-fibroscopy was normal. Conclusions: The most important takeaway message of this work is that methodical approach of neck masses allows to rule out the most aggressive lesions frequently encountered, which allows clinicians to establish thorough diagnosis and management without further delay.

Research paper thumbnail of Ludwig’s angina in a child: a case report and literature review

The Egyptian Journal of Otolaryngology, Apr 26, 2023

Background Ludwig's angina is a diffuse cellulitis in the sub-mandibular space, which extends to ... more Background Ludwig's angina is a diffuse cellulitis in the sub-mandibular space, which extends to the sublingual space. It is an emergency that often occurs in adults as a complication of oral infections. It is rare in children and is particularly life-threatening due to the smaller size, as well as the characteristics in these spaces in a child. This is the case of Ludwig's angina in a 2-year-old boy, with rapid onset of signs of respiratory discomfort, no dental or systemic etiology, and great evolution. Case presentation A little boy was brought by his mom to the emergency room for the onset a firm swelling in the sub-mental region along with pain and fever, which appeared 3 days prior to the consultation. He was first examined by a pediatrician who prescribed oral broad-spectrum antibiotics (amoxicillin). The symptoms worsened over 48 h, as the little boy presented respiratory discomfort in supine position. He was admitted in the emergency department. Without dysphagia or respiratory distress. The clinical examination showed swelling in the sub-mental and sub-mandibular region with/without trismus or signs of oral infection. The laboratory investigations showed hyper-leukocytosis with a microcytic hypochromic anemia. CRP = 300; HIV test was negative. The computed tomography (CT scan) showed a diffuse abscess in the sub-mental and sub-mandibular and sublingual regions.No mediastinal collection was found. The diagnosis of Ludwig's angina was established. The patient underwent percutaneous surgical drainage of 15 ml of pus, which alleviated his symptoms, the treatment was carried out through broad-spectrum antibiotics, analgesics, and daily cleaning of the wound and change of surgical dressing. Bacteriological exam found gram-positive cocci in chains. The culture showed a Staphylococcus aureus. The patient presented clinical and biological improvement and was discharged after 7 days. Six months follow-up showed a healthy child, without signs of infection or any other complication. Conclusion Ludwig's angina in children-however rare-is a potentially life-threatening, rapidly spreading, bilateral swelling of the sub-mandibular. Its management is based on airway control, drainage of the collection and broadspectrum intravenous antibiotics, as well as surveillance of the biological parameters. Early diagnosis and appropriate management enhances outcome and decreases mortality significantly.

Research paper thumbnail of Diagnosis difficulty of histiocytosis in the thyroid region of a child: a rare case report with literature review of differential diagnoses

The Egyptian Journal of Otolaryngology

Background Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and rad... more Background Isolated histiocytosis of thyroid region is very rare; clinical history, exam, and radiological aspects are non-specific, and etiological reasoning is quite difficult considering the tremendous number of differential diagnoses. Case presentation This is the case of a 6-year-old girl who came to the emergency room with an acute presentation bulging of the anterior and left lateral regions of the neck. The palpation of the mass showed tenderness; there was no sign of inflammation, nor was there any fistula to the anterior border of the sternocleidomastoid muscle. The patient was stable. She did not have any signs of compression. The initial blood showed anemia and inflammatory syndrome. She underwent cervical ultrasound exam that showed a mass at the expense of the left thyroid lobe; the mass extends through the sub-hyoid muscles to the lateral cervical region. A CT scan with and without contrast injection was performed. It showed a heterogenous mass, which seemed centered ...

Research paper thumbnail of A rare case of oral cavity lipoma in the inferior vestibule: a case report and literature review

The Egyptian Journal of Otolaryngology

Background Lipomas are ubiquitous tumors. They are mostly present in the trunk as well as the pro... more Background Lipomas are ubiquitous tumors. They are mostly present in the trunk as well as the proximal portion of the limbs. However, 15–20% are located in the head and neck regions, and only 4.4% are found in the oral cavity. They normally present as a bulge with signs of compression, without signs of infiltration. Case presentation This is the rare case of a 36-year-old man, who was admitted to ENT consultation for a bulge in the left inferior vestibule of the oral cavity. The bulging was not painful, with no inflammatory signs, no dental mobility, or abnormalities in the vestibular mucosa. No other masses were found in the general clinical exam. The patient underwent a dental panoramic X-ray, which showed a low opacity lesion next to the left inferior vestibular space, without signs of bone invasion. There was no hypoesthesia in the territory of the alveolar nerve was found. The patient underwent a craniofacial MRI which showed a mass which was hypointense on T1 and hyperintense ...