Search

A 61 year-old-man was referred to the emergency room with intense and acute epigastric pain after a large meal, without experiencing symptoms of nausea or vomiting. His medical history included obsessive neurosis and a Billroth I gastric resection due to a duodenal ulcer. The patient was hemodynamically stable and had a distended abdomen that was painful to the touch, with maintained peristalsis and possible peritoneal tenderness. Bowel sounds were present. The PA chest radiograph (Fig. 1) showed a crescent-shaped air image at the left infradiaphragmatic level which suggested pneumoperitoneum. A CT examination was performed using intravenous and oral contrast. The results showed no evidence of pneumoperitoneum but it confirmed that the pseudopeumoperitoneum image was the result of a marked dilatation of the gastric remnant (Fig. 2). This dilatation was due to an obstruction of the jejunum, secondary to a well-defined “pseudomass” resembling feces, consistent with a bezoar. A MPR reconstruction was performed showing dilatation proximal to the bezoar (Fig. 3). Esophagogastroduodenoscopy (EGD) confirmed the existence of a bezoar. A Coca-Cola® lavage treatment was performed via a nasogastric tube. Four days later the ECG demonstrated the complete disappearance of the bezoar.

Caso clínico: Se describe un caso de afectación metastásica del seno cavernoso secundaria a un carcinoma epidermoide de laringe. El cuadro clínico debutó como una parálisis del VI par derecho que evolucionó progresivamente a una oftalmoplejía dolorosa con TAC y RMN iniciales, normales. Discusión: Debe sospecharse la afectación del seno cavernoso ante la existencia de parálisis craneales en pacientes con historia de neoplasias aunque los hallazgos radiológicos no sean concluyentes. La diseminación tumoral hacia la base del cráneo está descrita en las neoplasias faríngeas pero es excepcional en carcinomas de laringe. Case report: We present a case of metastatic larynx cancer in the cavernous sinus. It presented itself as a right sixth cranial nerve palsy which progressed into a painful ophthalmoplegia with normal CT and RNM in its early stages. Discussion: We must suspect a cavernous sinus invasion in patients with cranial nerve palsies and with a history of malignancy, despite negative radiologic findings. Tumoral invasion of the skull base has been described in pharyngeal neoplasms but it is exceptional in larynx carcinomas.