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Pellet embolism to the heart following gunshot injuries is an unusual event that requires a fast diagnosis. Imaging assessment is necessary to locate the projectiles and look for associated injuries. We present a case of a 41-year-old woman admitted after sustaining 2 gunshot wounds in the abdomen and left thigh, with the initial computed tomography (CT) scan showing a metallic object next to the right ventricle. Further radiological evaluation included transthoracic echocardiography and electrocardiogram-gated cardiac CT scan which confirmed the diagnosis of a migrating pellet to the right ventricle, entrapped within the trabeculations. Electrocardiogram-gated cardiac CT has a major role in detailed evaluation of bullet embolism to the heart cavities and guides the management.

History Part one of this case appeared 4 months previously and may contain larger images. An 8-year-old girl presented to our hospital with painful swelling of the left thigh and soft-tissue swelli...

Intramuscular Myxoma(IM) is a rare benign soft tissue tumor, and its etiology and histology source is still unclear. It is important to understand the pathological components of IM and its corresponding imaging features, as well as performing accurate and careful imaging assessments of IM before surgery. We present a case of a 43-year-old male who presented a lump in his left thigh and gradually enlarged during the past 8 years. The patient underwent CT, MRI, and CTA examined and was later pathologically confirmed as IM. This article will combine the literature，to explore the imaging manifestations and its pathological basis of intramuscular myxoma.

Deep Vein Thrombosis (DVT) is uncommon in children. We describe a case of DVT in children, highlighting importance of early diagnosis of rare disease. Here we report a case of 10-year-old boy presented with persistent pain and swelling of the left thigh. Detailed investigations led to diagnosis of DVT.

Lepidopterism is a term that refers to a spectrum of medical conditions in humans that usually involve the skin and result from worm-like contact with an adult or larval form of specific butterflies and moths. Lepidopterism is isolated but certain people may be more prone to exposure to moths. Caterpillar’s sting is not an everyday diagnosis; however, the physician should be alert and make awareness regarding caterpillar envenomation. Herein, we present the case of a 31-year-old man who presented to the hospital with a history of a caterpillar’s sting associated with unilateral rashes and prickly sensation on his left thigh and lower extremity. On examination, his vitals were stable and he does not develop systemic manifestations or anaphylaxis. In view of his present compliance, he was successfully managed with antihistamines and steroids. This case is being presented not only as the event is rare but also to create awareness and it will help the clinicians to manage the case appropriately.

Myxoid liposarcoma (MLS) is a common subtype of liposarcoma in children and adolescents and can occur anywhere in the body. Cardiac metastases from MLS are very rare. We report a rare case of postoperative recurrence of MLS in the left thigh with ectopic and metachronous pericardial metastases. Cardiac metastases from MLS are rare, the prognosis is poor, and long‐term follow‐up of patients after discharge is necessary., A 53‐year‐old man with heterotopic and heterochronic pericardial metastases after recurrence of postoperative left thigh myxoid liposarcoma (MLS). He was found to have a cardiac abnormality that was initially thought to be a pericardial cyst, but was later pathologically confirmed to be MLS metastasis.

Case We present a male patient in his third decade of life who presented with a painful mass in his left thigh 2 weeks after being involved in motor vehicle accident. The mass was found to be a piece of bone from a second person who had been involved in the same accident. Conclusion This report highlights a most unusual type of injury.

Made available in DSpace on 2022-04-29T08:45:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-01 Tuberculosis verrucosa cutis is a rare medical condition that is caused by the inoculation of Mycobacterium tuberculosis into the skin of a previously sensitized individual. This clinical form of tuberculosis corresponds to 1–2% of all cases of tuberculosis and due to the paucibacillary characteristic of the lesions, patients can be misdiagnosed, accounting for the chronification of the skin infection. Herein, we report the case of a 26-year-old male farmer, presenting plaques with verrucosa and hyperkeratosis features in the left thigh and buttocks during 15 years. M. tuberculosis was identified by PCR and the patient was treated with standard anti-tuberculosis drugs, with subsequent improvement of the skin lesions. University of São Paulo Medical School Clinics Hospital São Paulo State University (UNESP) Institute of Biosciences São Paulo State University (UNESP) Institute for Advanced Studies of Ocean Fundação Universitária do ABC (FUABC) ABC School of Medicine University of São Paulo Medical School Laboratory of Pathology of Infectious Diseases São Paulo State University (UNESP) Institute of Biosciences São Paulo State University (UNESP) Institute for Advanced Studies of Ocean

Aim There are few publications on the surgical management of a colocutaneous fistula in the thigh. Here, we describe a patient who presented with a 2-year history of fecal fistula in the left thigh, following a history of drainage of a psoas abscess. This is followed by a discussion of appropriate treatment modalities for this type of fistula. Methods To determine the appropriate treatment for our patient with chronic fistula, we thoroughly reviewed the relevant literature in an Internet-based search and selected a staged operative approach for our patient. Results Using a staged surgical procedure, we were able to resolve the colocutaneous fistula without the occurrence of comorbidities. Conclusion Substantial morbidity is associated with the presence of colocutaneous fistulas. The best possible approach is prevention of its occurrence, but this is not always feasible. Measures for management of an acute fistula differ from those in patients with chronic fistula. Medical management can be more effective in acute cases, while chronic cases require surgical management. We used a staged surgical method with a few risks for our patient and he is in good health 1 year after treatment.

Nevus comedonicus is an extremely rare adnexal hamartoma of pilosebaceous apparatus, with approximately 200 cases reported in the literature so far. It appears as cluster of adjacent honeycomb-like dillated follicular openings with firm pigmented keratin plugs resembling comedones.The comedones oftentimes arranged in linear pattern paralled to Blaschko’s lines. We report a case of a 5-year-old boy with open brown to black comedones in a linear pattern localized on the back of the left thigh that appearing since birth. Pain, itch and discharge were not obtain. There were some episodes of infection, due to manual removal done by his mother which left some hypertrophic scars. Dermoscopic examination revealed the distinctive pattern consisting of pigmented, sharply demarcated keratin plugs of 1-3 mm in diameter, some open pores, multiple structurless, various shades of brown homogenous circular areas surrounding the plugs. Histopathological examination showed an aggregation of dilated follicular infundibulum with laminated keratinous material plugging. This case report prove that dermoscopy examination, a simple non-invasive diagnostic tool is very helpful in diagnosing nevus comedonicus. We recommend this tool to differentiate the diagnosis of other rare epidermal nevi while histopathological examination should be performed only in uncertain cases.

The present study aimed to analyze the acute effects of a myofascial release session (MFR) with a portable electric massager (PEM) at different frequencies (25 Hz and 52 Hz) on the superficial and deep fascial motion.The limbs of fourteen participants (12 men and 2 women, age = 34 ± 10 years; height = 1.74 ± 0.09 m; weight = 72.77 ± 13.1 kg; right thigh fat thickness = 4.18 ± 3.49 mm; left thigh fat thickness = 4.13 ± 3.35 mm) were randomized to one of the two PEM frequencies (25 Hz vs. 52 Hz). All evaluations were carried out at the same time of day and by the same evaluator (blind). The protocol consisted of 9 min of MFR on the vastus lateralis, alternating between three sites of 5 cm. Before and after the MFR session, the fascial motion was measured in the vastus lateralis (superficial and deep layer) using B-mode ultrasound at two knee positions (0° and 45°).The superficial and deep layers presented significant increases in fascia length after myofascial release with the knee extended 0° (p 0.001) and flexed 45° (p 0.001). In addition, the fascial motion was not influenced by the frequency applied during the experimental protocol and was independent of layer and knee position. However, the deep layer showed an increase at knee flexed at 45° compared to the superficial layer. On the other hand, there was no difference between layers when the knee was extended (0°). The findings of this study indicate that PEM appears to be effective in changing the fascial motion of the vastus lateralis.

A thin profunda artery perforator flap harvested from the left thigh is shown in this video. Preoperative computed tomographic angiography is used to assess morphology of the perforators and its branches, pedicle length and vertical location of the two branches from the ischial tuberosity. These measurements are translated on to the patient. Locations of both branches are confirmed with a handheld doppler. The authors concluded that preoperative computed tomographic angiography is a useful technique to provide detailed anatomic information on morphology of perforators, course through the septum or muscle above the deep fascia and skin thickness. Computed tomographic angiography allows quick and easy assessment of the whole vascular anatomy of the leg and helps to arrive at the decision about selection of the best flaps based on the characteristics of the defect and on the individual anatomy of the patient.

Objective: To report a rare case of inverse Kipplel-Trenaunay. Case description: A 16-year-old girl with a grayish-depressed plaque on her left thigh. Angioresonance showed a vascular malformation affecting the skin and subcutaneous tissue. Comments: Inverse Klippel-Trenaunay is a Klippel-Trenaunay syndrome variation in which there are capillary and venous malformations associated to hypotrophy or shortening of the affected limb. Modifications on the limb’s length or width result from alterations in bones, muscles, or subcutaneous tissues. It has few described cases. Further clinical and molecular studies must be performed for a proper understanding.

A 60-year-old woman with long-standing type 2 diabetes mellitus (T2DM), hypertension and hypothyroidism presented with progressive pain and swelling of her left thigh for nearly 2 weeks without any fever. She had, without benefit, received courses of several antibiotics on the suspicion of

A 19-year-old woman presented in the emergency room with a painful white streak on her left thigh. She had been cleaning the limestone in the bathroom at home. After finishing the procedure, she noted some burning and stinging pain.

A 58-year-old man was presented for congenital melanocytic nevus, located on the left thigh. The nevus was present from birth and was growing in line with the biological growth of the patient. Four months earlier, he noticed a brighter shade of brown in the central part of the nevus. For that reason, the patient asked for dermatological consultation. Dermoscopic examination revealed a pigmented network on the edges of the lesion which corresponded to the normal structure of the reticular pigment pattern of congenital melanocytic nevus, while in the central part of the lesion an area of regression was noticed, corresponding to melanoma arising in a congenital melanocytic nevus. The lesion was surgically excised and confirmed by a pathologist, Breslow thickness 1.2 mm.

Background: Mesh erosion is a well-known complication after use of mesh for pelvic organ prolapse repair. The most common site of mesh erosion is the vagina. Nonvaginal mesh erosions into ...

As dissemination of Tuberculosis (TB) to soft tissue is not a usual finding, sometimes it is not considered for differential diagnosis and, if so, is overlooked by most health care professionals. Although rare, TB should be considered in the differential diagnosis of cysts of the thigh, especially in endemic areas. We report the case of an 80-year-old female presented with cyst with purulent discharge in her lateral left thigh that was persistent to other surgical and antibiotic treatments. Polymerase chain reaction (PCR) showed positive results for TB. Anti-tubercular therapy had promising results. Our case serves to highlight the importance of considering a reactivated TB infection in individuals with chronic discharge, especially if symptoms are not classic or fail to respond to conventional therapy. Histological study and MRI are useful tools to guide diagnosis, with confirmation provided by PCR.

A 7-year-old boy with left thigh kicking injury and left knee pain progressively worsening for 3 months.

Low-grade fibromyxoid sarcoma (LGFMS) is a type of high metastatic potential of the fibrosarcomas. Most of the time there is a long interval between tumor presentation and metastasis. We present 2 cases of LGFMS. The first is a 31-year-old female with a mass in anterior aspect of her left thigh, and the other is a 68-year-old female with mass in posterior of her neck. Both cases underwent operation for several times and confirmed as LGFMS histopathologically, there is no exact protocol for postoperative follow-up to detect early metastases according to the relative variety of LGFMS. So informing the patients about the long-standing metastatic potential of their disease is important.

The purpose of this study is to evaluate and compare 2-point (2pt), 3-point (3pt), and 6-point (6pt) Dixon magnetic resonance imaging (MRI) sequences with flexible echo times (TE) to measure proton density fat fraction (PDFF) within muscles. Two subject groups were recruited (G1: 23 young and healthy men, 31 ± 6 years; G2: 50 elderly men, sarcopenic, 77 ± 5 years). A 3-T MRI system was used to perform Dixon imaging on the left thigh. PDFF was measured with six Dixon prototype sequences: 2pt, 3pt, and 6pt sequences once with optimal TEs (in- and opposed-phase echo times), lower resolution, and higher bandwidth (optTE sequences) and once with higher image resolution (highRes sequences) and shortest possible TE, respectively. Intra-fascia PDFF content was determined. To evaluate the comparability among the sequences, Bland-Altman analysis was performed. The highRes 6pt Dixon sequences served as reference as a high correlation of this sequence to magnetic resonance spectroscopy has been shown before. The PDFF difference between the highRes 6pt Dixon sequence and the optTE 6pt, both 3pt, and the optTE 2pt was low (between 2.2% and 4.4%), however, not to the highRes 2pt Dixon sequence (33%). For the optTE sequences, difference decreased with the number of echoes used. In conclusion, for Dixon sequences with more than two echoes, the fat fraction measurement was reliable with arbitrary echo times, while for 2pt Dixon sequences, it was reliable with dedicated in- and opposed-phase echo timing.

A 49-year-old man with a medical history significant for diabetes mellitus, a left thigh sarcoma that was resected 5 years prior, and a seizure disorder on valproic acid presented with 2 months of progressive numbness and weakness. Symptoms began with painful paresthesias in both thumbs that progressed to numbness. His feet subsequently became numb, and within 3 weeks he noted gait unsteadiness. During this time he also experienced a 25-pound weight loss. He subsequently developed intermittent diplopia, worst on downgaze. He denied recent sick contacts, prior exposure to tuberculosis, or tick bites. He was admitted to an outside hospital and subsequently transferred to our facility for further care.

A fragmented marble sculpture was found during the construction works on the canalisation collector in Skelani (Municipium Malvesatium). The sculpture presents a life-size bird’s torso with his right webbed foot placed on a female’s left thigh, part of a folded cloth and a child-like hand placed on the lower part of the bird’s torso. It was identified as a mythological scene favoured in antiquity, of Leda and Zeus in the guise of the swan, at the moment of Zeus’ seduction of Leda. This sculptural fragment holds even greater significance in the comprehension of Roman provincial art, since to date, it represents a unique example of this iconographic type, not only in sculpture, but in any other work of art in the territory of the Central Balkans. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 177007: Romanization, urbanization and transformation of urban centres of civilian and military character in the Roman provinces in the territory of Serbia]

Rubber projectiles are used as an alternative to metal bullets owing to their lower morbidity and mortality rate. There are few reports of vascular lesions of extremities caused by rubber projectiles in the literature. The authors report the case of a 37-year-old man who was the victim of a penetrating injury to the left thigh with a rubber projectile. He reported only pain at the site of the injury; pulses were decreased in the affected limb. After arteriography confirmed an injury to the superficial femoral artery, he underwent an arterial and venous femorofemoral bypass using a reversed contralateral saphenous vein. Keywords: Vascular trauma, Nonlethal projectile, Penetrating trauma

A 3 year old girl presented with a two- day history of multiple fluid filled lesions on buttocks and back of left thigh. As informed by the child's mother, she had fever 4 days back and was irritable with pain and discomfort on back of the left thigh. The pain was episodic and radiated from buttocks to the leg. On examination, multiple fluid filled lesions of various sizes with surrounding erythema were present involving the S1, S2, S3 dermatomes extending from buttock to the sole sparing few areas in between the vesicles. On further examination of whole body, there were multiple discrete fluid filled lesions on erythematous base ranging from 0.1 to 0.3 mm diameter in size on chest, abdomen and back. Multinucleated giant cells with acantholytic cells were found in Tzank smears. Diagnosis of concurrent varicella with herpes zoster was made.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 38-40

Background : Long-standing groin pain (LSGP) is a chronic painful condition resulting in both impaired performance and time loss from participation in multidirectional field sport. Research question : What are the differences in intersegmental coordination strategy and variability of trunk-pelvic and thigh coupling during change of direction in subjects with athletic LSGP and asymptomatic control subjects? Methods : A motion analysis system was used to collect 3-D kinematic data of the continuous relative phase and the variability of the right and left leg hip. Thoracic-thigh segment data were also collected during multiple ipsilateral turns at a self-selected pace from 16 males with LSGP and 16 asymptomatic controls. It is worth mentioning that, for a more detailed analysis, we divided each cycle diagram into four phases. Independent T-tests were used to compare the two groups. Results : Subjects with LSGP demonstrate except in phase 2 of the left foot, more out-of-phase movement with both increased variabilities in right/ left thigh - pelvic coupling, right/ left thigh-thoracic, and pelvic- thoracic in every 4 phases and in the decoupling of segmental coordination. Significance : Decrease in coordination with higher variability is apparent in subjects with LSGP and this aberrant coordination may lead to unexpected compensatory strategies and control impairments.

Many factors affect the comfort of automotive seats including pressure distribution, vibration, temperature, and backrest inclination. However, one aspect of seating that has not been well studied is leg splay; splay is a rotation at the hips which causes the knees to move outward. The work presented here identified the ranges of "comfortable" splay in different styles of seats and related changes in seating pressure due to leg splay. Sixteen midsized male participants were tested in six seats: a flat control, three mid-sized sedan, a sports car, and a pickup truck. Participants sat with two leg conditions: 1) shoulder width apart and 2) rotating their legs to splay to a self-identified, comfortable position. For each test, the participant placed his left leg on a foot support and right leg on a depressible pedal to mimic a driving position. In each posture, leg angle and seat pan pressures were collected. Of the seats tested, the flat wooden seat had the highest possible splay (24.5°). The three sedan seats had similar splay angles (16.1-18.5°). The lowest splay values were in the sports car seat (8.96°) and truck seat (7.46°). This reduction in splay was attributed to the more aggressive bolsters in the sports car and a higher seat design position in the pickup truck seat. Following participant splay the pressures in the seat bolsters increased while the pressure in the left thigh and left buttocks regions decreased. By determining the comfortable ranges of splay and how pressure distribution is affected, seat designers and automobile manufacturers can use these data when evaluating seat designs and occupant positioning.

Cutaneous leiomyosarcoma is a rare malignant mesenchymal tumor of smooth muscle origin of unknown etiology. Leiomyosarcomas located on the skin include superficial leiomyosarcomas and metastatic leiomyosarcomas. Superficial leiomyosarcomas represent 7-10% of all cases of leiomyosarcoma and are subdivided into cutaneous and subcutaneous lesions based on skin location. We report a case of an 81-year-old woman who presented a slow growing tender single nodule on the left thigh and describe its clinical and dermoscopic features.

Echinococcal cysts are usually found in liver and lungs (90%); spleen, heart, and brain are affected more rarely. Muscular hydatidosis accounts for < 1% of all cases, the most common locations being the thigh and paravertebral muscles1,2. A 51-year-old Spanish male with a painless mass in his left thigh was referred to the rheumatology clinic in the University Hospital of Burgos in …

We present a unique case of displaced simultaneous bilateral fractures, Garden 3 type, in a 49 year woman treated with non-cemented total hip arthroplasty. The patient showed a Harris hip score of 86 on the right hip and a 81 on the left side on the fourth postoperative year, besides a bilateral Trendelenburg gait, more pronounced on the right side. She needed a cane to walk, and felt pain in the left thigh. The X-ray showed a shortening of 0.9 cm and a left femoral varus. The other arthroplasty components showed good osseointegration and position. We found that the use of the uncemented total hip arthroplasty to treat a simultaneous bilateral fracture in renal osteodystrophy patients has satisfactory results at a four year follow-up. According to the OCEBM Levels of Evidence Working Group, this study is graded as a Level of Evidence IV.

Introduction. Amniotic band syndrome is a rare congenital disorder with clinical presentation of constricting bands in different parts of extremities or whole extremities. Conservative or surgical treatment is provided depending on the type and severity of the anomaly. Case Outline. The paper presents the case of a neonate patient with constriction bands localized on the left leg. During the second week of life, a surgery was indicated, and a single-stage multiple Z-plasty was performed to correct the anomalies on the left lower leg. Postoperative edema in the distal part of the lower leg was easily managed by incisions and drainage. Two months later, the correction of the stricture of the left thigh was managed using the same procedure. The postoperative course was uneventful and the outcome was satisfactory after a two-year follow-up. Conclusion. Evaluation of a patient with amniotic band syndrome, as well as diagnosis, monitoring, treatment and postoperative care, should always be multidisciplinary. A single-stage correction approach provided satisfactory both functional and aesthetic results. Given many morphological variations of the syndrome, a decision on the strategy of treatment should be made individually for each patient.

Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.

Site 1: the Chauvet-Pont-d’Arc Cave, discovered in southern France in 1996. It contains the earliest and best preserved and perhaps the most sophisticated figurative cave art in the world. It has been dated to the Aurignacian period, 30000–32000 BP. A charcoal drawing in the Salle du Fond, the deepest chamber of the cave, shows a bull’s head above a female vulva. This composite drawing is ambiguous. The left thigh of the depicted female merges with what can easily be read as the massive shoulder of a bull, but the shoulder appears more human than bovine. Thus is depicted the first image of the Minotaur: the Minotaur in close proximity to the Maiden. Earth pigments of ochre and blacks from charcoal were applied by hand or blown on to the rock faces, which were sometimes inscribed for relief effects (fig. 1). The cave gave rise to the notion of the labyrinth, a metaphysical concept and image, the origins of which are lost in the mists of time. No ancient constructed labyrinth has been found, though the ruins of the palace at Knossos as well as the long and tangled passageways of the cave near the ancient town of Gortyna on Crete have elicited hopes and claims, all more or less refuted, as prototypes for the labyrinth (fig. 2).