Open Access Case Study

A Ligamentum Flavum Cyst of Lumbar Spine in a 67-Year-old Man Presenting with Neurogenic Claudication

Recep Gayir, Doğa Gurkanlar, Fikret Dirilenoglu, Ozum Tuncyurek, Gamze Mocan, Ahmet Ozgul

Asian Journal of Case Reports in Medicine and Health, Page 1-5

Aims: Ligamentum flavum cysts are rare and may lead to compression of the spinal cord or surrounding structures which ultimately may require surgery. We report a case of a ligamentum flavum cyst presenting with neurogenic claudication with its clinical, radiological, and histopathological features.

Presentation of Case: We present a case of a 67-year-old male with chronic back pain, progressive bilateral neurogenic claudication, and worsening radicular symptoms in the right leg. A 9-mm cystic mass was revealed by MRI in the epidural space at the L4-5 disc level. After successful resection of the cyst, complete remission was achieved.

Discussion: Ligamentum flavum cysts may be confused with other benign cystic lesions called juxtafacet cysts comprising synovial cysts and ganglion cysts. In addition to typical histopathological findings, the anatomic location confirms the diagnosis. Surgical decompression with complete excision has been shown to be the most successful treatment strategy.

Conclusion: Ligamentum flavum cysts are uncommon causes of spinal compression. Removal of these lesions provides the disappearance of patients’ complaints.

Open Access Case Study

Sewing Needle in the Kidney after Being Ingested 13 Years Before

Benatta Mahmoud

Asian Journal of Case Reports in Medicine and Health, Page 6-10

Foreign body ingestion occurs, especially in childhood. But we saw it among adults. most foreign bodies pass through the gastrointestinal tract, causing no damage. Migration of an ingested needle to the kidney is very rare. We report a case of a 30-year-old female who was admitted to the urology department for right lumbar pain which appeared three months later. The interrogation found a notion of accidental ingestion of a sewing needle 13 years ago. On physical examination, there was lumbar pain caused by the shock. Radiography of the abdomen showed a needle in the right hypochondrium.

Computed tomography (CT) was performed. CT showed a linear density in the right kidney, lower pole. At follow-up, stabbing pain in the right upper abdominal quadrant was noted. Surgical exploration was planned; We then performed surgical removal; we easily removed the needle in this fashion. The postoperative period was uneventful, and the patient was discharged on the second day following the operation.

The presence of an ingested foreign body in the renal parenchyma remains exceptional. It follows negligence or inability to remove the foreign body immediately after its ingestion. The clinical symptomatology is not specific, it can range from abdominal pain to infection and up to renal failure. It is the conventional imagery or even the uro-tomo-densitometry which localizes the exact seat of the foreign body, its relationship with the urinary excretory tract, and the consequences of its presence. The extraction strategy depends on imaging or and endoscopic data, and the means and skill of the surgical teams. Minimally invasive surgery is desirable when it is workable; otherwise open surgery is still the order of the day. The importance of preventing this type of accident in children and adults is indisputable. In case of an occurrence, urgent medical care is necessary before reaching the stage of complications.

Open Access Case Study

Renal Tuberculosis Presenting as a Tumour of the Upper Urinary Tract: A Very Rare Case

Benatta Mahmoud

Asian Journal of Case Reports in Medicine and Health, Page 11-15

Urinary tract tuberculosis is a relatively common form of extra-pulmonary tuberculosis, accounting for 3-5% of all cases of tuberculosis [1].

We report a very rare case of a 44-year-old man who presented with right flank pain and weight loss. CT SCAN showed a tumour of the right upper urinary tract. This smoking patient with no pathological history underwent surgery, nephro-ureterectomy with a bladder circular patch was performed in open surgery, but pathology described tuberculous lesions without tumour. An anti-tuberculosis therapy of nine months was started; the patient had a good result after two years.

This type of situation is exceptional, but this tuberculosis localization must be considered in the differential diagnosis of carcinoma of the upper urinary tract, especially in areas where tuberculosis is endemic. Endoscopic exploration with or without biopsy may be the tool to make the diagnosis and avoid radical surgery.