Iatrogenic fetal goiter. Conservative management and spontaneous resolution

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Margarita Alvarez de la Rosa ◽  
Olga Rosales Aedo ◽  
Ricardo Darias Garzón ◽  
Ana Isabel Padilla Pérez ◽  
Juan Mario Troyano Luque
Keyword(s):  
Conservative Treatment ◽  
Perinatal Asphyxia ◽  
Mass Effect ◽  
Neck Mass ◽  
Spontaneous Resolution ◽  
Anterior Neck ◽  
Case Presentation ◽  
Fetal Goiter ◽  
Fetal Thyroid ◽  
Intrauterine Treatment

AbstractObjectivesWe aim to report a case of a fetal goiter with postpartum spontaneous resolution. Fetal goiter can be secondary to maternal treatment and range from clinically asymptomatic or cause alterations in the fetus, from impaired swallowing to difficulty in vaginal delivery and even perinatal asphyxia due to the mass effect. The need for intrauterine treatment remains controversial.Case presentationWe present a case of fetal goiter with postpartum resolution. A 34-year-old multigravida presented to the emergency department with hiperemesis gravidarum at 10 weeks’ gestation. During evaluation for severe vomiting, Graves disease was diagnosed and treated with propylthiouracil. A routine ultrasound scan at 28 weeks gestation revealed a fetal anterior neck mass suggesting a fetal goiter. Cordocentesis showed fetal iatrogenic hypothyroidism. Conservative treatment was decided. Pregnancy concluded uneventful and the mass resolved spontaneously in the newborn.ConclusionsThe fetal thyroid gland is a structure that usually goes unnoticed during the process of prenatal diagnosis. In cases of maternal Graves diseases, fetal thyroid needs monitoring during pregnancy and conservative treatment is an option. Fetal goiter should be searched for secondary to thyroid alterations of the gravida, and in selected cases it can be managed without intrauterine treatment.

Neck

2016 ◽  
Vol 10 (3) ◽  
pp. 256-270
Author(s):  
Costin Berceanu
Keyword(s):  
Treatment Options ◽  
Late Pregnancy ◽  
First Trimester ◽  
Cystic Hygroma ◽  
Neck Mass ◽  
Tracheobronchial Tree ◽  
High Association ◽  
Tertiary Center ◽  
Fetal Goiter ◽  
Fetal Thyroid

ABSTRACT Cystic hygroma (CH) is the most frequently seen fetal neck mass on the first-trimester ultrasound (US). Overall prognosis is poor with a high association with chromosomal and structural anomalies. When diagnosed prenatally, fetal karyotyping and detailed US evaluation should be offered. Prenatal and postnatal surgical or nonsurgical treatment options are available. Fetal goiter (FG) and fetal thyroid masses are rare fetal conditions and may occur as part of a hypothyroid, hyperthyroid, or euthyroid state. Screening for FGs should be carried out in pregnancies of mothers with thyroid disease. If a FG is detected, a detailed US examination should be performed. Congenital high airway obstruction syndrome (CHAOS) is characterized by bilaterally enlarged lungs, flat or inverted diaphragms, dilated tracheobronchial tree, and massive ascites. It is usually a lethal abnormality. Fetuses with suspected CHAOS should be referred to a fetal medicine center able to perform ex utero intrapartum treatment (EXIT) delivery. Neck teratomas are associated with high mortality rates. Prenatal US diagnosis of cervical teratoma can be made at 15 and 16 weeks of gestation. Planning of delivery in a tertiary center allows the performance of EXIT. Lymphangioma of the neck usually diagnosed in late pregnancy could be traditionally referred to as CH, but there is a different prenatal history and outcome. How to cite this article Vladareanu R, Vladareanu S, Berceanu C. Neck. Donald School J Ultrasound Obstet Gynecol 2016;10(3): 256-270.

scholarly journals Substernocleidomastoid Muscle Neck Lipoma: An Isolated Case Report

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Ferdinand Rico ◽  
Dustin Hoang ◽  
John Lung ◽  
Olivia Puccio ◽  
Michelle Brito ◽  
...  
Keyword(s):  
Small Volume ◽  
Neck Mass ◽  
Anterior Neck ◽  
Chyle Leak ◽  
Case Presentation ◽  
Level Ii ◽  
Rare Benign Tumor ◽  
Prevertebral Fascia ◽  
Mild Dysphagia ◽  
Large Neck

Introduction. We report this large neck mass, located behind the sternocleidomastoid (SCM) within the posterior cervical space and anterior to the prevertebral fascia. The mass is displacing the carotid sheath and its neurovascular contents medially. It extends almost the whole length of the SCM muscle all the way down to the lung apex. Case Presentation. A 30-year-old female patient presented to our clinic with a left anterior neck mass for a few months with dysphagia. The lipoma was excised completely along with level II to IV lymphadenectomy. A very small volume chyle leak was noted intraoperatively. The drain was removed 2 weeks later only to recur in one month. A new drain was placed by interventional radiology, and the drainage resolved completely. Discussion. The patient with mild dysphagia had a lipoma large enough to push vital structures away from their normal anatomical position. Due to the difficult location and the size of the lipoma, a meticulous formal lateral neck dissection was required. A 3D imaging like CT or MRI would be helpful to preoperatively plan the dissection. Substernocleidomastoid neck lipoma in our case is a rare benign tumor that was challenging to excise.

scholarly journals Fetus diagnosed with cervical teratoma delivered by exit procedure (Extra uterine intrapartum treatment)

2021 ◽  
Vol 10 (4) ◽  
pp. 107-109
Author(s):  
Sally Damra Elnour Mohammed ◽  
Rami Salaheldien ◽  
Badreldeen Ahmed
Keyword(s):  
Head And Neck ◽  
Neck Mass ◽  
National Hospital ◽  
Maternal Circulation ◽  
Anterior Neck ◽  
Female Fetus ◽  
Case Presentation ◽  
Cervical Teratoma ◽  
Exit Procedure ◽  
Rare Tumours

Congenital cervical teratomas are rare tumours of germ cells that should be diagnosed antenatally by ultrasound during anomaly scan or even earlier. The incidence of teratomas of the head and neck is 3-5%. We are presenting a case of rare cervical teratoma.1 Congenital cervical tumours are often clinically dramatic, though basically benign. Prognosis is favourable only if the airway is quickly stabilized and necessarily surgical procedure is planned and executed effectively.2 Case presentation: A 34-year-old female presented at 32 weeks of gestation, at Al Amal National Hospital where an ultrasound examination revealed a single viable cephalic fetus with a huge irregular heterogeneous anterior neck mass suspected as congenital cervical neck teratoma. The delivery was planned at 37 weeks gestation. The team was assembled for EXIT procedure which includes the obstetricians, neonatologist, anthologist, ENT surgeons. At 37 weeks of gestation, the child was maintained on maternal circulation after caesarean section until successfully intubated (Extra Uterine Intrapartum Treatment (EXIT) was performed at Al Amal National Hospital after liaison with the anesthetist, neonatologist and the pediatric surgeon. A female fetus weighing 3.8 kg was delivered and intubated immediately. Unfortunately, the newborn died at 48hours of age. Conclusion: Prenatally diagnosed head and neck teratomas can result in early neonatal death if the delivery was not planned correctly with right multidisciplinary team. In this case EXIT is the procedure of choice.

Two cases of malignant thymoma presenting as an anterior neck mass and misdiagnosed as thyroid carcinoma

1999 ◽  
Vol 4 (2) ◽  
pp. 118-120 ◽  
Author(s):  
T. Kobayashi ◽  
Hideki Asakawa ◽  
Kazunori Taniguchi ◽  
Yoshifumi Komoike ◽  
Yasuhiro Tamaki ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Neck Mass ◽  
Anterior Neck ◽  
Malignant Thymoma

scholarly journals The spontaneous resolution of a vortex vein varix: case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara L Weidmayer ◽  
Hakan Demirci
Keyword(s):  
Case Report ◽  
Natural History ◽  
Extended Period ◽  
Spontaneous Resolution ◽  
Case Presentation ◽  
Clinical Resolution ◽  
History Of ◽  
Vortex Vein ◽  
Insight Into

Abstract Background The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring. Case presentation An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix. Conclusion This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.

scholarly journals Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takeshi Ueda ◽  
Tetsuya Tanaka ◽  
Takashi Yokoyama ◽  
Tomomi Sadamitsu ◽  
Suzuka Harada ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Abdominal Cavity ◽  
Vital Signs ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
Case Presentation ◽  
Free Air ◽  
Spontaneous Pneumoperitoneum ◽  
Upper Abdominal ◽  
Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

scholarly journals Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Esha M. Kapania ◽  
Christina Link ◽  
Joshua M. Eberhardt
Keyword(s):  
Case Report ◽  
Complete Resolution ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Spontaneous Resolution ◽  
Radiographic Evidence ◽  
Case Presentation ◽  
Chilaiditi Syndrome

Background. Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation. Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions. This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.

scholarly journals Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

2017 ◽  
Vol 31 (1) ◽  
pp. 8-16
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Subdural Hematomas ◽  
Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

scholarly journals Pancreatic inflammatory myofibroblastic of the pancreatic neck: a case report and literature review

2020 ◽  
Author(s):  
Zhitao Chen ◽  
Yaoxiang Lin ◽  
Mengxia Li ◽  
Ting Zhang ◽  
Lele Zhang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Inflammatory Myofibroblastic Tumor ◽  
Inflammatory Cell ◽  
Pancreatic Neuroendocrine Tumor ◽  
Neck Mass ◽  
Pathological Diagnosis ◽  
Unique Case ◽  
Case Presentation ◽  
Histological Features ◽  
Pancreatic Neck

Abstract BackgroundPancreatic inflammatory myofibroblastic tumor (IMT) is a relatively rare disease, which is often confused with pancreatic cancer or pancreatic neuroendocrine tumor. Its histological features are fibroblast and myofibroblast proliferation, accompanied by varying degrees of inflammatory cell infiltration. Case presentationHerein, we presented the management of IMT occurring at the neck of pancreas. A 66-year-old female patient was diagnosed as pancreatic neck mass after a series of tests. Then she underwent enucleation of pancreatic neck tumor followed by pathological diagnosis of IMT. Meanwhile, we reviewed the clinical features and pathological diagnosis and treatment of pancreatic IMT which were previously reported. To our knowledge, this is the unique case of enucleation of pancreatic IMT. ConclusionIn the management of pancreatic IMT, we concluded that enucleation may be a safe and efficient surgical method for the management of pancreatic IMT and may also provide a better prognosis. Further accumulation of cases is required to explore the surgical measure of pancreatic IMTs.

Treatment of Pancreatic Pseudocysts

2005 ◽  
Vol 94 (2) ◽  
pp. 165-175 ◽  
Author(s):  
Å. Andrén-Sandberg ◽  
C. Ansorge ◽  
K. Eiriksson ◽  
T. Glomsaker ◽  
A. Maleckas
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Pancreatic Juice ◽  
Granulation Tissue ◽  
Spontaneous Resolution ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Pancreatic Trauma ◽  
Choice Of Procedure ◽  
Substantial Risk

According to the Atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of acute pancreatitis or pancreatic trauma, whereas a chronic pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of chronic pancreatitis and lack an antecedent episode of acute pancreatitis. It is generally agreed that acute and chronic pseudocysts have a different natural history, though many reports do not differentiate between pseudocysts that complicate acute pancreatitis and those that complicate chronic disease. Observation — “conservative treatment” — of a patient with a pseudocyst is preponderantly based on the knowledge that spontaneous resolution can occur. It must, however, be admitted that there is substantial risk of complications or even death; first of all due to bleeding. There are no randomized studies for the management protocols for pancreatic pseudocysts. Therefore, today we have to rely on best clinical practice, but still certain advice may be given. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic neoplasias. Conservative treatment should always be considered the first option (pseudocysts should not be treated just because they are there). However, if intervention is needed, a procedure that is well known should always be considered first. The results of percutaneous or endoscopic drainage are probably more dependent on the experience of the interventionist than the choice of procedure and if surgery is needed, an intern anastomosis can hold sutures not until several weeks (if possible 6 weeks).

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