1/37. Focal bacterial nephritis (lobar nephronia) presenting as renal mass. A focal infection of the kidney can cause a diagnostic dilemma by mimicking a neoplasm. We describe a case of focal bacterial nephritis (acute lobar nephronia) caused by escherichia coli in which the diagnosis was confirmed only after surgical exploration. Although the patient had fever on admission, urine and blood cultures were negative and fine needle aspiration of the kidney could not rule out a well-differentiated carcinoma. ( info) |
2/37. Toxic shock syndrome occurring in children with abrasive injuries beneath casts. Staphylococcal toxic shock syndrome has been reported in a number of nonmenstrual settings, including orthopedic patients with postoperative staphylococcal wound infections. We describe two cases of toxic shock syndrome in children with focal cutaneous staphylococcal infections occurring beneath casts placed for limb immobilization. These cases illustrate a new and potentially hidden site of staphylococcal infection leading to toxic shock syndrome. ( info) |
3/37. Acute focal bacterial nephritis in an 8-year-old . Acute focal bacterial nephritis or acute lobar nephronia is an acute localized non-liquefactive bacterial kidney infection. Clinically, it may develop as an abscess and present as acute pyelonephritis but is distinguishable by the presence of a focal mass on imaging studies. The authors report the case of an 8-year-old girl with fever up to 39 degrees C and left flank pain of 6 days duration. On physical examination, she had nothing remarkable except tenderness and knocking pain over the left costovertebral angle. Post-contrast abdominal computed tomography revealed several wedge-shaped hypodense lesions in the left kidney. urine culture grew escherichia coli. Acute focal bacterial nephritis was diagnosed. The patient was treated with antibiotics and discharged on the 12th day of hospitalization. ( info) |
4/37. Imperforate hymen complicated with pyocolpos and lobar nephronia. An imperforate hymen is not a rare condition in female newborns, but is often ignored in a genital examination by physicians. Lobar nephronia is a rare condition in pediatric patients that can be screened by ultrasound or computed tomography to distinguish it from a renal abscess. Treatment for lobar nephronia requires at least 14 days of antimicrobial therapy and a follow-up assessment by renal ultrasonography or dimercaptosuccinic acid scan. We report an unusual case of a 2-year-old girl with an imperforate hymen and pyocolpos. The pyocolpos compressed the left lower ureter to cause hydroureter, hydronephrosis, and nephronia. Partial hymenotomy was performed to drain the pus, and antibiotics were administered for a total of 3 weeks. There was a good outcome. This case demonstrates the need to perform a full physical examination, particularly a genital examination, in newborns. Further, if gynecologic pathology is suspected, then urologic screening studies are recommended to rule out potential associated anomalies. ( info) |
5/37. focal epithelial hyperplasia of the oral mucosa. A case report from the United Kingdom. A case of focal epithelial hyperplasia of the oral mucosa (Heck's disease) is presented, which appears to be the first to be described in the United Kingdom. Virus particles were found in tissue from the lesions studied by electron microscopy, and identified as belonging to the papilloma virus sub-group of the family of papovaviruses. ( info) |
6/37. Local infection after percutaneous transluminal coronary angioplasty: relation to early repuncture of ipsilateral femoral artery. We describe two cases of groin infection following repuncture of the femoral artery to perform coronary angioplasty soon after diagnostic coronary arteriography. This serious complication can be avoided by using the contralateral femoral artery in this setting, even if the previously used entry site appears benign. ( info) |
7/37. Migratory lobar nephronia. Lobar nephronia or focal bacterial nephritis is a pre-abscess stage of localized cellulitis and has been shown to represent a focal imaging manifestation of what is frequently a diffuse renal process. To the best of our knowledge, although multi-focal bacterial nephritis has been described, a migratory pattern has not been observed. This report describes a previously healthy 32-year-old woman with pathologically proven lobar nephronia that exhibited a migratory pattern on serial computed tomography (CT) and a prolonged course on antibiotic therapy. Possible etiologies for this unusual course, along with the CT, sonographic and needle biopsy features of this disease are discussed. ( info) |
8/37. Fatal mediastinitis secondary to odontogenic infection. A case of necrotizing mediastinitis that caused death in a 38-year-old man has been reported. The cause of his infection was proved, both radiographically and clinically, to be dental infection associated with the lower molars and their supporting structures. A diffuse cellulitis involving the submandibular, masticator, and parapharyngeal spaces ensued. Sudden onset of severe pleuritic chest pains and a 100% pneumothorax of the left lung developed, which ultimately led to his death. ( info) |
9/37. Utility of the indium 111-labeled human immunoglobulin g scan for the detection of focal vascular graft infection. The ability to diagnose and localize vascular graft infections has been a major challenge. Recent studies in animal models and humans with focal bacterial infection have shown that radiolabeled, polyclonal, human immunoglobulin g accumulates at the site of inflammation and can serve as the basis for an imaging technique. This study investigated this new technique for the diagnosis and localization of vascular graft infections. Twenty-five patients with suspected vascular infections involving grafts (22), atherosclerotic aneurysms (2), and subclavian vein thrombophlebitis (1) were studied. Gamma camera images of the suspected area were obtained between 5 and 48 hours after intravenous administration of 1.5 to 2.0 mCi (56 to 74 mBq) of indium 111-labeled, human, polyclonal immunoglobulin g. Scan results were interpreted without clinical information about the patient and were subsequently correlated with surgical findings, other imaging modalities, and/or clinical follow-up. In 10 of 10 patients found to have positive scan results, localized infections were confirmed at the involved sites. In 14 of 15 patients whose scan results were interpreted as negative, no vascular infections were identified at follow-up. The patient with false-negative results and recurrent bacteremia from an aortoduodenal fistula was found to have a negative scan outcome at a time when his disease was quiescent. These data suggest that nonspecific, human, indium 111-labeled immunoglobulin g scanning can be a useful noninvasive means of localizing vascular infections. ( info) |
10/37. Cryptococcal meningoencephalitis presenting transient focal cerebral symptoms. Cryptococcal meningoencephalitis (CM) is a fatal disease if untreated. We have presented an unusual case of CM clinically diagnosed as transient ischemic attacks. Therapy with amphotericin b and flucytosine cured the infection and the patient had no further episodes of transient focal cerebral dysfunction. In patients with transient focal cerebral symptoms, study of the cerebrospinal fluid may prove helpful. ( info) |