SESSION TYPE: Miscellaneous Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION:

Pancoast's syndrome is characterized by a mass of the superior sulcus of the lung and involvement of the brachial plexus and cervical sympathetic nerves. Apical bronchial carcinoma is the most common cause of Pancoast's syndrome. Of the many other causes reported, infection is a rare one. A case of Pancoast's syndrome, secondary to apical lung abcess is reported.

CASE PRESENTATION:

45-year-old Caucasian female with past medical history including type 2 diabetes, hypertension, dyslipidemia, who presented to ED with increasing malaise, fatigue, weakness, and right-sided chest pain, neck pain and shortness of breath. Her chest x-ray on admission revealed no abnormalities. She was treated with pain medication. Her symptoms persisted. She had a CTA of the Chest which revealed a soft tissue mass located at the right lung apex medially and abuts the trachea, esophagus, and adjacent vertebral body. CT soft tissue of the neck revealed right apical lung mass, which is partially contiguous with the right scalene musculature. Patient complained of right hand numbness and weakness, for which MRI of the neck was done and confirmed earlier findings. Bronchoscopy showed normal endobronchial tree, and an ultrasound guided transbronchial needle aspiration of the right upper lobe mass was negative for malignant cells. Aspirate from the mass grew Streptococcus Viridans. Patient treated wit antibiotics and underwent anterior neck exploration of the right apical lung mass to relieve her brachioplexopathy

DISCUSSION:

Pancoast's syndrome includes Horner's syndrome, atrophy of he hand muscles and shoulder, axilla or arm pain. This syndrome is caused by an apical thoracic lesion, most commonly a bronchogenic carcinoma. Causes of Pancoast's syndrome not related to malignancy are recognized. Among the benign conditions causing Pancoast's syndrome, infections are extremely rare. A wide variety of organisms were identified but no single organism could be labeled as the most prevalent. Overall, bacteria (54.8%) seem to be the most common organisms with S aureus being the most frequent of these. Infection is a treatable etiology of Pancoast's syndrome.

CONCLUSIONS:

Infection is a treatable etiology of Pancoast's syndrome.1) Pancoast's Syndrome Secondary to Infectious Etiologies: A Not So Uncommon Occurrence Heath D. White, DO, MS, Bobbie Ann A. White, MA, Carl Boethel, MD and Alejandro C. Arroliga, MD. Send to: Pancoast's syndrome secondary to infectious etiologies: a not so uncommon occurrence. White HD, White BA, Boethel C, Arroliga AC. Am J Med Sci. 2011 Apr;341(4):333-6.2) Mehrotra A, Raj A, Tripathi K. Apical pulmonary tuberculosis presenting with Pancoast syndrome like features. J Assoc Physicians India 2001;49:380-13) Comet R, Monteagudo M, Herranz S, et al. Pancoast's syndrome secondary to lung infection with cutaneous fistulisation caused by Staphylococcus aureus. J Clin Pathol 2006;59:997- 8.DISCLOSURE: The following authors have nothing to disclose: Anas AlsadiNo Product/Research Disclosure Information, Temple, TX.

An 8-year-old, male neutered Siamese cat was presented with Horner syndrome and right head tilt. A soft tissue mass was observed in the right tympanic cavity, and bulla osteotomy was performed. Tissue samples retrieved from the tympanic cavity were sent for histology, and a middle ear fluid swab was sent for bacterial culture and sensitivity. Histologic diagnosis was of otitis media associated with cholesterol granuloma (CG). Bacterial culture yielded Pasteurella multocida and Leifsonia (Corynebacterium) aquaticum. Middle ear CG is frequently seen in human beings and is associated with a variety of middle ear diseases including otitis media. Cholesterol granuloma of the middle ear has been experimentally induced in cats. The clinical and pathological findings of a spontaneous case of CG in the tympanic cavity of a cat with otitis media are described herein.

A 37-year-old woman experienced a generalized tonic-clonic seizure. Subsequent to the seizure, the patient observed left-sided face and neck pain. A left Horner syndrome was noted on examination. An MRI and magnetic resonance angiogram revealed a left skull base carotid artery dissection without infarction (figure, A and B). Previous MRI had shown normal carotid flow voids. The patient was treated conservatively and magnetic resonance angiogram 1 month later revealed recanalization (figure, C).

Abstract

Purpose:

In patients referred with blepharoptosis, the possibility of an underlying systemic cause for their ptosis can warrant a more detailed evaluation. The purpose of this study is to determine both the incidence and demographic characteristics associated with different types of ptosis in patients referred to the oculoplastics division at a tertiary care center.

Methods:

A retrospective chart review was performed on all patients referred to the oculoplastics division between 2007 and 2010. Final etiology for each patient's ptosis was determined based on history, standard eyelid measurements, and ancillary testing. Based on etiology, ptosis was categorized as aponeurotic, neurogenic, myogenic, traumatic, congenital, or mechanical. Demographics, including median age and sex were analyzed for patients in each category of ptosis.

Results:

Of the 251 patients, aponeurotic ptosis was the most common type of ptosis (60.2%), followed by traumatic (11.2%), congenital (10.4%), mechanical (8.8%), neurogenic (5.6%), and myogenic (4.0%). Of the neurogenic group, 35.7% of patients had cranial nerve 3 (CN 3) palsy, 28.6% had myasthenia gravis, 14.3% had aberrant regeneration, and 7.1% had Horner's syndrome. Thirty percent of the myogenic group had chronic progressive external ophthalmoplegia (CPEO). The congenital group had the youngest median age (10.5 years), yet the aponeurotic group had the oldest (62 years).

Conclusions:

A significant proportion of patients referred with ptosis had more serious conditions such as neurogenic or myogenic ptosis. Thus, clinicians should maintain a high degree of suspicion and thoroughly evaluate all patients with ptosis in order to properly assess for underlying systemic associations.

A young girl presented to the ENT acute clinic with a persistent cough and a bulge in the left oropharynx. As there were no clinical signs suggestive of a quinsy, an MRI was performed that showed a large mass extending from the base of the skull to the epiglottis medialising the lateral and posterior pharyngeal walls. The patient subsequently underwent an excision biopsy which demonstrated a ganglioneuroma, however developed a left-sided Horner's syndrome and mild vocal cord palsy after.

The medical records for 133 total ear canal ablations combined with lateral bulla osteotomies (TECA-LBOs) performed on 82 dogs (121 ears) and 11 cats (12 ears) between 2004 and 2010 were reviewed to determine if the duration of preoperative clinical signs was associated with the incidence of postoperative facial nerve injury and Horner's syndrome. Other perioperative complications, such as a head tilt, nystagmus, incisional drainage, draining tracts, hearing loss, as well as bacterial culture results, were noted. Postoperative facial nerve paresis occurred in 36 of 133 ears (27.1%), and paralysis occurred in 29 of 133 ears (21.8%), with no significant difference between species. Thus, postoperative facial nerve deficits occurred in 48.9% of ears. The median duration of clinically evident temporary facial nerve deficits was 2 wk for dogs and 4 wk for cats. Dogs had a significantly longer duration of preoperative clinical signs and were less likely than cats to have a mass in the ear canal. Dogs were less likely to have residual (> 1 yr) postoperative facial nerve deficits. The incidence of postoperative Horner's syndrome was significantly higher in cats than dogs. The duration of preoperative clinical signs of ear disease was not associated with postoperative facial nerve deficits.