Thymic epidermoid cysts are an extremely rare entity. These arise from epidermal cells that migrate to the thymus. The radiologic diagnosis of this rare lesion is challenging. We describe a case of an otherwise healthy 35-year-old woman who presented with an acute onset of chest pain and shortness of breath. She was found to have an anterior mediastinal mass. The imaging findings were, however, not characteristic for any single diagnostic entity. Since the imaging was inconclusive, surgical resection was performed for definitive diagnosis. The mass was found to be a thymic epidermoid cyst. This case underlines the significance for radiologists to be aware that epidermoid cysts can occur in the thymus and should be considered in the differential diagnosis for a heterogeneous anterior mediastinal mass.
A 25-year-old male patient presented with a 3-day history of persistent, painless semirigid erection. He had no history of recent trauma, hematological disease or drug use (recreational, psychotropic or oral supplement). On examination the penile shaft was turgid and nontender. Diffuse ecchymosis was noted along the shaft and scrotum. Arterial blood gas analysis from cavernous aspirate showed pH 7.45, pCO2 36.9, pO2 71.8 and HCO 3 24.3. Complete blood count and urinalysis were normal. The clinical findings were consistent with arterial, nonischemic (high flow) priapism.Color Doppler ultrasound (CDU), requested to identify the presence of a potentially treatable arterio-lacunar (AL) fistula, showed asymmetric increased arterial flow in the left cavernosal artery. The right cavernosal artery was patent with a peak systolic velocity of 19 cm per second and the left cavernosal artery had elevated peak systolic velocity greater than 120 cm per second. The left cavernosal arterial spectral Doppler also showed spectral broadening and color Doppler revealed a blush in the left mid shaft consistent with an AL fistula (see figure). There was no flow in the left cavernosal artery immediately beyond this blush but collateral flow was present distally.Priapism is a persistent penile erection lasting more than 4 hours unrelated to a sexual stimulus.
Aim:We sought to establish the impact on vaccine uptake of sending out a single appointment letter inviting patients to attend a vaccine clinic.Background:Coeliac disease is associated with splenic dysfunction and so patients with coeliac disease are at a higher risk of overwhelming infection. Additional vaccinations are recommended for these individuals to provide additional protection against infection.Methods:We retrospectively identified 54 patients with diagnosed coeliac disease, and all vaccines previously received by these patients. By comparing this to the Green Book [Department of Health (2013) Immunisation of individuals with underlying medical conditions: the green book, chapter 7, London: Department of Health. Retrieved 26 February 2019 from ], we determined the patients who were due vaccinations and the specific vaccines they were due. An invitation letter was then sent out to patients requiring further vaccinations and vaccine uptake for these patients was re-audited six months later.Findings:Our results show a mild increase in the total uptake of vaccines six months after the letter was sent out, from 38.6% to 49.2%.
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