Introduction: Laryngeal angioleiomyoma is a rare benign tumor of larynx with vascular origin. We report a case of laryngeal angioleiomyoma in a 52-year-old female. Case Presentation: A 52-year-old Caucasian female was referred to our institute with a chief compliant of severe midnight snoring. Her symptoms were progressive and began from two years ago. There was no history of hoarseness and laryngeal pain. The patient underwent a laryngoscopic examination and a large mass was seen on the left aryepiglotic fold. Surface of lesion was smooth and covered by laryngeal mucosa with no ulcer. There was a rapid enhancing mass on left aryepiglotic fold with bulging into the left piriformis sinus in contrast-enhanced computed tomography. The tumor was complicated by profuse bleeding after biopsy which was not controlled by conventional approaches. The patient was then administered a general anesthesia and the tumor was completely removed via laryngosurgery accompanied by left superior thyroid artery ligation. The specimen was histopathologically compatible with laryngeal angioleiomyoma. Conclusion: Angioleiomyoma of larynx is of benign nature and rarely recurs. However, it can be complicated by profuse bleeding on biopsy and contrast-medium imaging should be considered before surgical intervention to diagnose the tumor properly and prevent life-threatening complications.

IntroductionUrinary system fistula to the hip joint is a rare complication. We report a case of delayed posterior urethral fistula to the hip joint following penetrating gunshot wound injury.Case presentationA 37-year-old Iranian Balochi male was shot with a firearm in the superior part of his right pelvis. He underwent primary closure on the same day. Ten months later, he developed urinary retention. He underwent retrograde urethrography and antegrade cystography which showed a stricture measuring 5 cm in length. There was also a history of progressive pain in the right hip joint accompanied by low grade fever which started 2 months after the initial injury. Hip X-ray showed evidence of an acetabular cavity and femoral head destruction diagnostic of complicated septic arthritis. The patient subsequently underwent reconstructive surgery for the urethral stricture and urethral fistula via a transperineal approach followed by total hip arthroplasty.ConclusionHip joint contamination with urine following a urethro-acetabular fistula can lead to severe and disabling complications such as septic arthritis. We recommend that every clinician should keep these fistulas in mind as a complication of penetrating urethral injury and every attempt should be made for their early diagnosis and prompt treatment.

Renal Doppler sonography has proved efficacious in detection of several important underlying causes of secondary hypertension. Its application in diagnosis of congenital arterial abnormalities has also recently received attention. Herein, we presented a patient who was diagnosed with coarctation of the aorta (COA) using renal Doppler sonography during work-up for secondary hypertension.

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In the absence of hepatobiliary symptoms, opioid consumption has been shown to cause dilatation of the common bile duct (CBD). The main objective of this study was to measure with sonography CBD diameters in opioid addicts as compared with nonaddicts. The research was done on 208 individuals; 104 were opioid addicts using various routes of administration (inhalation, oral, or intravenous), and 104 had no history of addiction (control group). All patients underwent abdominopelvic sonography, and the internal diameters of the proximal part of the CBD were recorded. The average CBD diameter in the control group was 4.13 ± 1.14 mm, which significantly increased to 8.16 ± 2.54 mm in the case group. A significant increase in the average diameter of CBD in the case group with the oral route was 10.7 ± 2.26 mm, compared with 7.5 ± 1.64 mm and 7.6 ± 3.05 mm, respectively, for those using inhalation and intravenous routes. The diameter of CBD was age dependent. The dilatation of the CBD detected by sonography occurring in opioid addicts in all age groups was attributed principally to the effect of opioids. Oral administration of opioid caused the highest dilatation effect on CBD. Keywords common bile duct, sonography opioid addictsSince the late 1980s, sonography has become a major diagnostic modality in suspected biliary diseases as it is inexpensive, available, and noninvasive. 1 Transabdominal sonography accurately identifies dilatation of the common bile duct (CBD) with a sensitivity of 96% and a specificity of 95%, but it is less accurate (sensitivity 55%-77%, specificity 98%) in detecting CBD stones. 2,3 The etiology of CBD dilatation also might be observed by sonography in conditions of obstruction such as CBD stones, tumors of the pancreatic head or tumors of Vater's ampula, masses, and enlarged hilar lymph nodes of the liver. However, when the etiology of the obstruction is not evident, more investigations are required to discover the cause of CBD dilatation.In the absence of an obvious cause for mechanical obstruction for dilated CBD by sonography, predicting factors have been found to explain the dilated CBD. Among these factors are age, body mass index (BMI), portal vein diameter, and opioid addiction. 4 It is important clinically to consider these predicting factors to save the time and expense of further assessment by invasive methods to discover the etiology of CBD dilatation.The number of opioid addicts of newer opioids, such as heroin-the most widely abused semisynthetic form-is on the increase orally, intravenously, or by inhalation. 5 Contraction of biliary smooth muscle is known to be one of the important effects of opioids. The sphincter of Oddi (SOD) may contract, resulting in reflux of biliary and pancreatic secretions and elevated plasma amylase and