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Sinus histiocytosis: A rare cause of rapidly progressive pediatric cervical adenopathy
Otolaryngology Head and Neck Surgery Scientific Posters
Volume 115 Number 2
cess. Although some studies suggest ossification of the cochlea can occur in far advanced otosclerosis, we are unaware of previous reports of clinically significant ossification of the cochlear duct by otosclerosis identified during cochlear implantation. We present a patient with obliterative otosclerosis in whom bilateral attempts at stapedectomy and amplification failed. Cochlear implantation was considered and preoperative imaging studies were obtained. High-resolution CT and MRI suggested absence of a fluid-filled basal turn of the cochlea. These findings were confirmed at the time of surgery, necessitating extended drilling of the cochlea until a patent lumen was entered. The full length of a multichannel Nucleus cochlear implant was inserted into the second turn of the left cochlea. This case demonstrates both the extent of neoossification otosclerosis can produce and the importance of MRI as a preoperative adjunct to the traditional highresonance CT evaluation of cochlear implant candidates. 107
Traumatic Pseudoaneurysm of the Internal Carotid Artery GILBERTO O. ALEMAR, MD, VINOD K. ANAND, MD, FACS, JAMES R. MCAULEY, MD, and SCOTT E. HARRISON, MD, Jackson, Miss.
Objective: The management of traumatic internal carotid artery pseudoaneurysm can be specially complex in the following situations: (i) bilateral pseudoaneurysm, (2) high location at the skull base with extension into the carotid canal, (3) rapid progression, (4) associated control and peripheral neurologic injuries, and (5) presence of infection. Many aspects of the management of such injuries remain controversial. Methods: A retrospective chart review of four case studies of pseudoaneurysm of the cervical portion of the internal carotid artery. Results: Different facets of management issues are highlighted by each of the four cases, including two bilateral cases. Conclusions: Early angiographic information should be supplemented with current methods of cerebral blood flow determination to reduce the risk of thrombosis, emboli, or progression of dissection. 108
Sinus Hlstlocytosls: A Rare Cause of Rapidly Progressive Pediatric Cervical Adenopathy JOHN M. LASAK, MD, DIRAN O. MIKAELIAN, MD, and PETER McCUE, MD, Philadelphia, Pa.
Objective: Cervical adenopathy, fever, and leukocytosis after an acute upper respiratory tract infection in the pediatric age group is a common presentation to the otolaryngologist. Although typically related to an infectious etiology, the differential diagnosis is broad. We present an
P 193
unusual case of rapidly enlarging massive cervical adenopathy in a pediatric patient that ultimately required incisional biopsy to establish the diagnosis. Excisional biopsy of a cervical lymph node revealed sinus histiocytosis with massive lymphadenopathy (SHML), or Rosal-Dorfman disease. The diagnostic evaluation, treatment, and response to treatment of this case of rapidly progressive SHML is presented and compared with other cases reported in the world literature. Review of this case will enable otolaryngologists to more rapidly identify and treat pediatric cases of SHML. Methods: Described is a case study of an 18-month-old child with rapidly progressive massive cervical adenopathy extending into the superior mediastinum. Histopathologic analysis was consistent with SHML. Results: Lymphadenopathy resolved by 50% over 2 months with close observation and no specific therapy. Conclusions: SHML is an obscure cause of pediatric cervical adenopathy. The onset of adenopathy may be massive and rapid. SHML may mimic both infection and neoplasia, requiring biopsy to establish the diagnosis. Histologic evidence of lymphocytophagocytosis is characteristic. SHML is a poorly understood clinical entity with an unpredictable clinical course and no current standard of treatment. The otolaryngologist should be familiar with this disease entity, its histopathologic findings, and its varied clinical course.
109
Bilateral Cervical Lymphadenopathy: An Uncommon Presentation of Syphlll$ BEN E. LEFF,MD, and JOHN R. WANAMAKER, MD, Cleveland, Ohio
The etiology of bilateral cervical lymphadenopathy may be difficult to ascertain and very often requires a biopsy for diagnosis. A broad differential diagnosis should be used in the evaluation of each patient. Neoplastic, inflammatory, and infectious etiologies are often given strong consideration. Although the spread of HIV has raised our suspicion for this diagnosis, the increasing incidence of syphilis has not been well recognized. There are very few reports of syphilis manifesting in the head and neck. A 33-year-old woman who presented with bilateral cervical lymphadenopathy, recent tonsillitis, and weight loss developed a diffuse, pruritic, erythematous maculopapular rash on her arms, legs, and palms. Serologic testing proved Treponema pallidum infection without antibodies to HIV. She was treated with multiple injections of penicillin. The natural history of syphilis as well as diagnosis and treatment modalities are discussed. The differential diagnosis of bilateral cervical lymphadenopathy is quite diverse. It is necessary to acquire a complete history, including sexual history, to focus the examination and evaluation. Serologic testing may obviate the need for biopsy.
Volume 115 Number 2
cess. Although some studies suggest ossification of the cochlea can occur in far advanced otosclerosis, we are unaware of previous reports of clinically significant ossification of the cochlear duct by otosclerosis identified during cochlear implantation. We present a patient with obliterative otosclerosis in whom bilateral attempts at stapedectomy and amplification failed. Cochlear implantation was considered and preoperative imaging studies were obtained. High-resolution CT and MRI suggested absence of a fluid-filled basal turn of the cochlea. These findings were confirmed at the time of surgery, necessitating extended drilling of the cochlea until a patent lumen was entered. The full length of a multichannel Nucleus cochlear implant was inserted into the second turn of the left cochlea. This case demonstrates both the extent of neoossification otosclerosis can produce and the importance of MRI as a preoperative adjunct to the traditional highresonance CT evaluation of cochlear implant candidates. 107
Traumatic Pseudoaneurysm of the Internal Carotid Artery GILBERTO O. ALEMAR, MD, VINOD K. ANAND, MD, FACS, JAMES R. MCAULEY, MD, and SCOTT E. HARRISON, MD, Jackson, Miss.
Objective: The management of traumatic internal carotid artery pseudoaneurysm can be specially complex in the following situations: (i) bilateral pseudoaneurysm, (2) high location at the skull base with extension into the carotid canal, (3) rapid progression, (4) associated control and peripheral neurologic injuries, and (5) presence of infection. Many aspects of the management of such injuries remain controversial. Methods: A retrospective chart review of four case studies of pseudoaneurysm of the cervical portion of the internal carotid artery. Results: Different facets of management issues are highlighted by each of the four cases, including two bilateral cases. Conclusions: Early angiographic information should be supplemented with current methods of cerebral blood flow determination to reduce the risk of thrombosis, emboli, or progression of dissection. 108
Sinus Hlstlocytosls: A Rare Cause of Rapidly Progressive Pediatric Cervical Adenopathy JOHN M. LASAK, MD, DIRAN O. MIKAELIAN, MD, and PETER McCUE, MD, Philadelphia, Pa.
Objective: Cervical adenopathy, fever, and leukocytosis after an acute upper respiratory tract infection in the pediatric age group is a common presentation to the otolaryngologist. Although typically related to an infectious etiology, the differential diagnosis is broad. We present an
P 193
unusual case of rapidly enlarging massive cervical adenopathy in a pediatric patient that ultimately required incisional biopsy to establish the diagnosis. Excisional biopsy of a cervical lymph node revealed sinus histiocytosis with massive lymphadenopathy (SHML), or Rosal-Dorfman disease. The diagnostic evaluation, treatment, and response to treatment of this case of rapidly progressive SHML is presented and compared with other cases reported in the world literature. Review of this case will enable otolaryngologists to more rapidly identify and treat pediatric cases of SHML. Methods: Described is a case study of an 18-month-old child with rapidly progressive massive cervical adenopathy extending into the superior mediastinum. Histopathologic analysis was consistent with SHML. Results: Lymphadenopathy resolved by 50% over 2 months with close observation and no specific therapy. Conclusions: SHML is an obscure cause of pediatric cervical adenopathy. The onset of adenopathy may be massive and rapid. SHML may mimic both infection and neoplasia, requiring biopsy to establish the diagnosis. Histologic evidence of lymphocytophagocytosis is characteristic. SHML is a poorly understood clinical entity with an unpredictable clinical course and no current standard of treatment. The otolaryngologist should be familiar with this disease entity, its histopathologic findings, and its varied clinical course.
109
Bilateral Cervical Lymphadenopathy: An Uncommon Presentation of Syphlll$ BEN E. LEFF,MD, and JOHN R. WANAMAKER, MD, Cleveland, Ohio
The etiology of bilateral cervical lymphadenopathy may be difficult to ascertain and very often requires a biopsy for diagnosis. A broad differential diagnosis should be used in the evaluation of each patient. Neoplastic, inflammatory, and infectious etiologies are often given strong consideration. Although the spread of HIV has raised our suspicion for this diagnosis, the increasing incidence of syphilis has not been well recognized. There are very few reports of syphilis manifesting in the head and neck. A 33-year-old woman who presented with bilateral cervical lymphadenopathy, recent tonsillitis, and weight loss developed a diffuse, pruritic, erythematous maculopapular rash on her arms, legs, and palms. Serologic testing proved Treponema pallidum infection without antibodies to HIV. She was treated with multiple injections of penicillin. The natural history of syphilis as well as diagnosis and treatment modalities are discussed. The differential diagnosis of bilateral cervical lymphadenopathy is quite diverse. It is necessary to acquire a complete history, including sexual history, to focus the examination and evaluation. Serologic testing may obviate the need for biopsy.