IntroductionLipomas can be found anywhere in the body with the majority located in the head and neck region as well as in the shoulder and back. They are not very common in the hand and those involving the fingers are very rare. Although, it is not the only case reported, lipoma of the index finger is very uncommon.Case presentationA 52-year-old Caucasian man presented with a lipoma of the right index finger. He complained of no pain but he had difficulty in manual movements. Treatment was surgical excision of the lipoma. There has been no recurrence for two years.ConclusionAlthough lipomas of the fingers are rare entities, their awareness is imperative since the differential diagnosis from other soft tissue tumors and from the special lipomatous subtype involved is quite extensive.

IntroductionPenile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported.Case presentationWe report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment.ConclusionsAlthough these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.

A 43-year-old Caucasian male with an uneventful medical history presented to ER complaining of sore throat and fever of 38.3°C. Clinical examination revealed unilateral right sided tonsillitis. Over the next 4 days, he developed malaise, shortness of breath, right-sided neck swelling and chest pain and he was admitted. The patient was systematically unwell with clinical manifestations of persistent neck swelling and pain radiating to the right shoulder, fever, slight discoloration of overlying skin, subcutaneous crepitation, mild trismus, odynophagia and decreased oral intake, in the setting of a peritonsillar abscess.Within a few hours after hospitalization, the patient presented upper airway obstruction due to massive edema, resulting in acute respiratory insufficiency that necessitated tracheal intubation and transfer to the ICU, while planning for surgical intervention.MDCT scan of the cervical and thoracic region (Fig. A,B,C) showed a parapharyngeal abcess descending into the mediastinum, spreading towards the diaphragm, with bilateral pleural effusions, along with diffuse necrotizing fasciitis, collection of gas in mediastinal compartments and soft tissue infiltration with loss of normal fat planes. The patient underwent combined extensive neck and thorax drainage in conjunction with limited surgical debridement consisting of cervicotomy. Swabs identified a polymicrobial infection with predominant species of Streptococcus pyogenes, anaerobic Peptostreptococci and Streptococcus viridans. The empirical antibiotic regimen included piperacillin -tazobactam and vancomycin.After 29 days of intubation and ventilation in ICU, the patient was extubated and transferred to the ward in order to complete the 6-weekcourse of IV antibiotic therapy. By this time the patient presented no residual deficits. CommentNumerous series of patients suffering of mediastinitis have been reported, especially the descending necrotizing type both focal and diffuse, that lead Endo et al to develop a classification system of the extent of the disease on the basis of the CT findings. Type I disease represents mediastinitis confined above the carina, type IIA disease extends to the anterior lower mediastinum and type IIB disease involves both anterior and posterior mediastinum. Patients with type I mediastinitis may not require drainage at all, while type IIA patients require drainage without sternotomy (via the subxiphoid approach) and type IIB patients require drainage with open thoracotomy.MDCT is the study of choice for evaluation of mediastinal emergencies such as DNM, since it provides sagittal/coronal reconstructions, is readily available, non invasive and easy to perform. There are both primary and secondary CT features of DNM, both of which were present in our case. Primary features include free gas bubbles in the mediastinum and/or localized fluid collections, or even abscess, and secondary CT findings include increased attenuation of mediastinal fat, pleural and/or pericardial fluid, enlargement of lymph nodes and rarely lung pa...