Osteosarcoma is a primary malignant bone tumor with a well-established tendency for pulmonary metastasis; however, gastrointestinal (GI) involvement is exceedingly rare. Intra-abdominal metastases may occur years to decades after the initial diagnosis. Hematogenous spread, following pulmonary metastasis, is the presumed mechanism. Due to delayed presentation and atypical manifestations, recognition of GI complications in patients with a remote history of osteosarcoma is essential. In this report, we present a case of an 80-year-old male with chronic GI complications decades after original metastatic osteosarcoma diagnosis involving the stomach and colon. He described recurrent, dull, constant left lower quadrant abdominal pain associated with poor oral intake and constipation. Physical examination demonstrated focal left lower quadrant tenderness. CT abdomen and pelvis revealed dilated small bowel loops concerning for partial small bowel obstruction, while esophagram demonstrated esophageal dysmotility with mild reflux. These findings are linked to the sequelae of complications following initial metastatic osteosarcoma. The patient had a history of numerous surgeries and required continuous opioid use for pain management. Conservative management consisted of bowel rest, laxatives, and supportive care resulting in transient symptom improvement; however, symptoms recurred frequently following discharge, leading to multiple readmissions for recurrent obstructive and dysmotility-related symptoms. This case highlights several gastroenterological considerations. Metastatic osteosarcoma and further GI sequelae should remain within the differential diagnoses of chronic abdominal pain or bowel obstruction in patients with a remote history of osteosarcoma, even decades after initial treatment. For gastroenterologists, recognition of both structural and functional GI sequelae of osteosarcoma is critical to guide symptom-directed, nonoperative management strategies and reduce recurrent hospitalizations.

An accurate preoperative evaluation of mandibular anatomy is essential before placing dental implants safely in the posterior region, where the submandibular fossa and proximity to the inferior alveolar nerve present serious risks. A precise preoperative evaluation of the mandibular anatomy is essential. This retrospective cross-sectional study evaluated the depth of SF using cone beam computed tomography (CBCT) and its correlation to the mandibular canal (MC) and alveolar crest (AC) in 200 adults (116 males, 84 females). Measurements were performed using the I-CAT Vision software and Intraclass Correlation Coefficient was used for the confirmation of intra- and interobserver reliability. Statistical analyses included Pearson correlations, t-tests, linear mixed-effects models (to account for bilateral correlations), multivariable regression and Benjamini-Hochberg false discovery rate correction. When controlling for within-subject correlation, sex differences remained significant on the right (β = 0.24, p = 0.009) but not the left (p = 0.081). Right side showed a weak negative correlation between SF depth and MC distance (r = -0.189, p = 0.007, r[2] = 0.036), but this was not observed on the left side (p = 0.404). A lower MC position on the right was associated with higher SF depth (p = 0.027, q = 0.089). No relation with AC height. Despite sex- and side-related differences, the effect size is very weak (r = -0.189) and thus not suitable for prediction. Fossa depth was not a predictor of alveolar crest height, nor did it replace MC position evaluation. Sex and side specific anatomical risk varies, thus quadrant specific evaluation is necessary. These findings do not support standardized planning or SF depth alone as a clinical predictor. Instead, direct, independent CBCT measurements of both SF depth and MC distance at each implant site are necessary. Still, accurate 3D visualization of the SF-MC relationship is important to reduce the risk of lingual perforation and nerve injury. However, this visualization should be based on direct measurements rather than inferred correlations.

Nutcracker syndrome is a rare clinical entity characterized by external compression of left renal vein (LRV) disturbing the outflow of blood into inferior venacava. We present a case of a 35-year-old female who presented to gynecology outpatient department (OPD) with abdominal pain of right lower quadrant initially which later shifted to left flank associated with dysmenorrhea. Laboratory investigations revealed microscopic hematuria and anemia. Imaging with computed tomography revealed decreased aorto-mesenteric angle with dilatation of left renal vein, left ovarian vein, pelvic veins on left side and cross collateral venous dilatation on right side of pelvis suggesting nutcracker morphology leading to pelvic congestion syndrome. This case demonstrates atypical clinical presentation of NCS with shifting pain.

Left-sided acute appendicitis (LSAA) is a rare clinical entity, most commonly associated with midgut malrotation (MM) or situs viscerum inversus (SVI). Its atypical presentation poses a significant diagnostic challenge for emergency physicians, radiologists, and surgeons. We report the case of a 53-year-old man who presented with a two-day history of left-sided abdominal pain, fever, and vomiting. Laboratory investigations revealed marked leukocytosis. Abdominal ultrasonography identified an appendix-like structure with surrounding inflammation in the left iliac fossa. Contrast-enhanced computed tomography (CT) of the abdomen confirmed midgut nonrotation, with the ascending colon positioned on the left side and an abnormal superior mesenteric artery-to-vein relationship. The patient underwent open appendectomy through a midline incision. Intraoperative findings confirmed LSAA with large bowel nonrotation. The postoperative course was complicated by peritonitis, which was managed with surgical intervention and broad-spectrum antibiotics. At the 21-day follow-up, the patient was asymptomatic. This case highlights the importance of maintaining a high index of suspicion for LSAA in patients presenting with atypical left lower quadrant pain. Thorough preoperative imaging, particularly CT, is essential for accurate diagnosis and operative planning. Prompt surgical management remains the cornerstone of treatment to prevent life-threatening complications.

Axenfeld-Rieger anomaly is a rare, congenital disorder characterized by neural crest-derived defects of the ocular anterior segment, traditionally presenting with high bilateral symmetry. This case report highlights a significant diagnostic pitfall involving a profoundly asymmetric presentation of bilateral Axenfeld-Rieger anomaly in a systemically healthy 23-year-old male student, complicated by late-onset secondary congenital glaucoma and an associated cystoid macular edema. Due to severe, unilateral microcystic epithelial and stromal corneal edema confined strictly to the left eye, the underlying congenital structural anomalies were heavily masked. This advanced unilateral decompensation led two independent tertiary institutions to misdiagnose the condition as an acquired, strictly unilateral iridocorneal endothelial (ICE) syndrome. Meticulous bilateral evaluation resolved the diagnostic dilemma. While the right eye was completely asymptomatic, with normal visual parameters, gonioscopy unmasked silent, subclinical congenital angle anomalies, including an anteriorly inserted iris root and isolated iridocorneal strands distributed across all four quadrants. Crucially, bilateral specular microscopy revealed an absence of pathognomonic ICE cell changes in both eyes, establishing the true bilateral, developmental nature of the pathology. Initial multi-drug medical intraocular pressure-lowering therapies, including the Rho kinase inhibitor ripasudil 0.4%, failed to reverse the advanced left corneal endothelial failure, ultimately necessitating a successful left penetrating keratoplasty for visual rehabilitation. This case underscores the clinical necessity of routine, thorough bilateral gonioscopic and specular evaluations of the clinically unaffected companion eye to avoid diagnostic errors when a young adult presents with sudden, highly asymmetric glaucoma.

A single-system ectopic ureter draining a solitary functioning kidney is a rare cause of lifelong continuous urinary incontinence in girls and may be accompanied by a hypoplastic, poorly compliant bladder and a deficient bladder neck. This anatomy renders urethral continence unattainable and places the only kidney at risk, demanding complex lower urinary tract reconstruction. A 16-year-old girl presented with continuous urinary incontinence since birth and inability to void a stream. Imaging showed an absent right kidney and a solitary, grossly hydronephrotic left kidney with cortical thinning, drained by a dilated, tortuous single ectopic ureter opening near the bladder neck. Cystoscopy revealed a low-capacity bladder (~40 mL) with an incompetent bladder neck. Serum creatinine (2.5 mg/dL) improved to 1.4 mg/dL after a left percutaneous nephrostomy. She underwent single-stage reconstruction comprising ileal augmentation cystoplasty, bladder neck closure, left ureteric reimplantation, and an appendico-caecal Mitrofanoff continent catheterisable channel brought out as a right-lower-quadrant V-flap stoma. The postoperative course was uneventful, and clean intermittent catheterisation via the stoma was established by the sixth postoperative week. Continent cutaneous urinary diversion with augmentation cystoplasty provides a durable solution that restores continence, creates a low-pressure reservoir, and preserves renal function in a patient with a solitary kidney, achieving social continence and improved quality of life.

Mature cystic ovarian teratomas, also called dermoid cysts, are the most common ovarian neoplasms in women, especially those of reproductive age. While the general clinical approach and treatment of teratomas do not differ in a patient with a concomitant diagnosis of Rett syndrome, the presentation, surgical preparation, and clinical course can be influenced by the pathophysiology of the condition. We report the case of a 35-year-old nonverbal woman with Rett syndrome presenting with symptoms of abdominal pain, constipation, abdominal distension, nausea, and vomiting. Computed tomography of the abdomen and pelvis revealed a mass in the left lower quadrant, originating from the left adnexa. During an exploratory laparotomy, a large cystic mass was identified in the region of the left adnexa with associated adnexal torsion, and the patient underwent a left salpingo-oophorectomy. Microscopic examination of the adnexal mass confirmed a diagnosis of mature ovarian cystic teratoma. This report adds to the limited literature on gynecologic pathology in Rett syndrome.

Intestinal nonrotation is an uncommon subtype of intestinal malrotation that may place the cecum and appendix in the left lower quadrant, creating a diagnostic pitfall in patients with left-sided abdominal pain. A 49-year-old man presented with a 3-day history of progressive left lower quadrant pain, fever, vomiting, and diarrhea. Contrast-enhanced CT demonstrated predominantly right-sided small bowel and left-sided colon, with the cecum and appendix located in the left iliac fossa. The appendix measured 9 mm in diameter and showed wall thickening, hyperenhancement, surrounding fat stranding, a suspected focal wall discontinuity, and adjacent tiny extraluminal air foci, findings strongly suggestive of appendiceal microperforation. The neighboring sigmoid colon showed mild focal wall thickening and fat stranding, a small localized abscess was also identified adjacent to the sigmoid colon, but no definite colonic wall defect, or inflamed diverticulum. After CT re-evaluation and surgical consultation, the initial concern for sigmoid perforation was revised to left-sided appendicitis with CT-suspected microperforation. Given the localized imaging findings and clinical stability, the patient was managed nonoperatively with antibiotics and close monitoring, with subsequent clinical and radiologic improvement. This case emphasizes the importance of identifying the malpositioned cecum and appendix, determining the inflammatory epicenter, and assessing the distribution of extraluminal air in patients with left lower quadrant pain.

A 53-year-old woman presented complaining of enlargement of her right breast; 12 years earlier she was treated elsewhere for an invasive ductal carcinoma of the right breast with breast-conserving surgery, adjuvant chemotherapy, anti-HER2 therapy, radiotherapy and endocrine therapy. One year postoperatively, a group of microcalcifications was seen in the ipsilateral breast on mammography. In the following years, the area of microcalcifications progressively increased, but instead of vacuum-assisted biopsy, the treating physicians performed core needle biopsies that were negative for malignancy. Twelve years after initial diagnosis, when we first examined the patient, the right breast was diffusely hard on palpation and larger than the left. On ultrasound, a large area of architectural distortion was seen in the lower-inner quadrant; after core needle biopsy, histology showed extensive fibrosis with almost complete absence of cells. Due to the progressive enlargement of the area of microcalcifications, simple mastectomy with sentinel lymph node biopsy was performed. Final histology showed extensive areas of high-grade ductal carcinoma in situ (DCIS), pTis, pN0. This case highlights the long period of time that DCIS may exist without progression to invasive disease and possible caveats that may delay diagnosis of DCIS with potentially serious medicolegal implications.

Beaver tail liver, also known as a sliver of liver, is a rare anatomic variant in which the left hepatic lobe extends laterally to the splenic region. Although usually asymptomatic, its imaging appearance may simulate perisplenic pathology and result in diagnostic confusion. A 55-year-old man presented to the infectious disease clinic with cough and dyspnea. Because of persistent respiratory symptoms and a history of tobacco use, non-contrast chest computed tomography was performed to evaluate possible pulmonary parenchymal abnormalities. On the lower sections of the scan, a structure with attenuation similar to that of the liver parenchyma was noted in the left upper abdominal quadrant adjacent to the spleen. Multiplanar reconstructed coronal and sagittal images demonstrated direct continuity of this structure with the left hepatic lobe, extending as a narrow tongue-like projection toward the spleen. These findings were consistent with beaver tail liver. No evidence of splenic injury, hematoma, perisplenic fluid collection, or focal mass was identified. The patient was managed conservatively for the respiratory symptoms, and no additional diagnostic or therapeutic intervention was required for this benign hepatic variant. Beaver tail liver is a rare but clinically important anatomic variant that may mimic perisplenic disease on imaging studies. Recognition of its continuity with the left hepatic lobe on multiplanar imaging and its similar attenuation to normal liver parenchyma is essential for accurate diagnosis and avoidance of unnecessary intervention.