Physiology and Anatomy

The association between atrial fibrillation and left atrial thrombus had been widely described; on the contrary, the relation between atrial fibrillation and right atrial thrombus hasn’t been demonstrated. We always thought that right atrial thrombus originated from deep venous thrombosis and named as “emboli in transit”. We report the case of a 91 year-old male patient, presenting with a permanent atrial fibrillation, his echocardiography showed a huge floating right atrial thrombus complicated with a bilateral pulmonary embolism. Our aim is to demonstrate through this case the association between atrial fibrillation and right atrial thrombus, using our findings in the literature, and comparing between the prevalence of right and left atrial thrombi in association with atrial fibrillation, explaining the difference between the both, and discussing therapeutic options.

Acoustic neuromas represent 6-7% of all intracranial tumors and develop slowly in the internal auditory canal, in the cerebellopontine angle. It is usually unilateral. The bilateral forms are exceptional and suggest neurofibromatosis type 2 "NF2". It can cause neurological disorders because of its development but also because of its volume and the compression caused on adjacent neurological structures. Magnetic resonance imaging (MRI) is the standard imaging modality for the diagnosis of the disease. which shows a mass of the cerebellopontine angle of intermediate signal in the T2-weighted sequence, heterogeneous, strongly enhanced after injection, with the famous sign of the ice cream cone aspect testifying to damage of the VIII nerve in the internal auditory canal, these tumors are classified according to their extent and size, which conditions the therapeutic management, the treatment is based on microsurgery, radiosurgery or therapeutic abstinence, depending on the tumor stage.

Myoepithelioma is a rare benign tumor of the salivary glands, considered a variety of pleomorphic adenoma, the palatal location of which is most common in the oral cavity. Our work reports a case of a myoepithelioma of the accessory palatine salivary glands in a 63-year-old man, clinically he presented a lobulated, firm palatal swelling covered with a healthy mucosa. The diagnosis was based on clinical and pathological arguments. The interest of imaging lies in the appreciation of the extension of the tumor process to the mucosa and to deep tissues. Tumor excision must be large to avoid the risk of recurrence and malignant transformation. Through this observation and in the light of the literature we will focus on the anatomo-clinical aspects.

Bone metastases from cervical cancer are rarely seen, their frequency is rarely observed, their frequency is estimated to average 3-4% of bone metastases. The most common locations of these metastases are in the spine and pelvis. We report the observation of a 51-year-old patient treated in 2015 for stage IIIa cervical cancer with chemo-radiotherapy combination. Six years later, she was admitted for low back pain. A thoracoabdomino-pelvic CT scan was performed objectifying a lytic tissue mass of the vertebral body and posterior arch of 3rd lumbar vertebra with endocanal extension. The patient underwent a bone biopsy, the histological study of which confirmed the epidermoid nature of a carcinomatous proliferation of cervico-uterine origin given the context. The originality of this observation lies in the bone location of these metastases and the interest of the CT scan in the diagnosis, as well as in the delay between the complete remission and the appearance of the bone lesion. The occurrence of bone metastases during cervical cancer has a very poor prognosis.

Cystic dilatation of the bile ducts is a rare congenital malformation. It’s due to an abnormality of the biliopancreatic junction involving the extra and intrahepatic bile ducts. It’s the second leading cause of congenital disabilities of the bile ducts after atresia. According to Todani, several types depending on the site, shape, and distribution of the malformation. It’s evoked in front of the inconstant clinical triad: pain, jaundice, and mass. Ultrasound and better sectional imaging confirm the diagnosis. Surgical excision is the treatment of choice to prevent malignant degeneration of the cyst wall and bile ducts.

The dedifferentiated liposarcoma of the spermatic cord is a rare tumor, and the epididymal localization is even rarer. The treatment is based on inguinal orchi-epididymectomy, with resection of adjacent structures if invaded. Adjuvant radiotherapy may be an attractive approach, given the high rate of local recurrence. Metastatic patients and dedifferentiated subtypes constitute the main indications of chemotherapy, even if her role is still debated. We describe the case of a 58-year-old man who underwent surgery for a dedifferentiated liposarcoma of the epididymis. A review of the literature for the various facets of this condition is also provided.

Retroperitoneal nonfunctioning paraganglioma are rare tumors. They are defined as an extra-adrenal chromaffin tumors and represent approximately 1/5th of chromaffin tumors. They can develop in contact with the pancreas, whose puncture or surgical resection can lead to serious complications. They are most often asymptomatic, and can reach important dimensions. We report a case of a 49-years-old female patient who was admitted to the hospital for epigastric pain and vomiting. CT-scan showed a posteriorly developing mass. The diagnosis of retropancreatic paraganglioma, was made by EUS-guided fine needle aspiration(FNA), this diagnosis was initially taken for a pancreatic lésion at endoscopy ultrasound(EUS). Complete surgical excision was performed after specific anesthetic preparation and anatomopathological study of the biopsied material. The treatment of paraganglioma is surgical, but management must be multidisciplinary. It is important to search whenever there is a juxtapancreatic tumor, arguments that can guide to the diagnosis of paraganglioma and use reliable means of diagnosis to confirm it.

Encapsulating peritonitis (EP) is defined as diffuse peritoneal fibrosis which can progress to true sclerosis, sheathing the intestinal loops and forming the cocoon, its diagnosis is often intraoperatively during laparoscopies or laparotomies. It is a rare complication with an unfavorable prognosis. Its clinical presentation can range from an asymptomatic patient to an occlusion. It is often secondary to peritoneal dialysis, intraperitoneal chemotherapy or tuberculous peritoneal inflammation syndrome. Imaging makes it possible to approach the diagnosis, but surgical exploration provides diagnostic certainty and allows a therapeutic procedure, histological examination shows a deposit of fibrin. Medical treatment is often disappointing, and surgery which consists of enterolysis is indicated in complete bowel obstructions, repetitive subocclusions and urgent situations (perforations, necrosis, hemorrhages). In the absence of treatment, the outcome is fatal in the majority of cases. Despite current progress in the therapeutic management of encapsulating peritonitis, the prognosis remains relatively poor. We report this exceptional case of encapsulating peritonitis to educate the medical team about its rare occurrence, which will be of paramount importance, due to diagnostic difficulties and in order to improve the prognosis.

Malleus head fixation is a rare but not exceptional pathology. It may be apparently congenital or acquired, and can be associated with stapes fixation. In the acquired secondary process two histological types of malleus head fixation were found: the first corresponded to non-tympanosclerotic bone remodeling and the second to localized tympanosclerosis.

Adrenocortical tumor is a rare tumor of the adrenal developing depending on the adrenal cortex; most often responsible for an endocrine syndrome. We report a case of a 41-year-old woman who presented with treatment-resistant chorionic low back pain, whose radiological exploration revealed a retroperitoneal mass dependent on the adrenal gland measuring 108 x 84 x 88 mm (APxTxH) metastatic of the liver of segment VII and segment VII, the management of which was surgical in two stages.