No abstract

BACKGROUNDA cute compartment syndrome (ACS) remains a diagnostic challenge today even with technological advances, where time to diagnosis is a determinant of the outcome. ACS occurs when the pressure within a closed muscle compartment exceeds the perfusion pressure resulting in ischemia and is most commonly seen after a traumatic event, especially involving fractures; hence, it is commonly encountered by orthopedic surgeons. [1,2] The consequences associated with delayed or missed diagnosis of ACS includes muscle necrosis which can potentially lead to rhabdomyolysis and renal failure in the short term and later on results in ischemic contractures, hence, being previously known as Volkmann contracture. [2][3][4] Volkmann et al. described the consequences of increased compartmental pressures as a result of ACS, which he subsequently noted nerve deficits of the involved compartment and the development of contractures. [4] Due to the devastating consequences associated with ACS, patients presenting with features highly suspicious for the syndrome have to be treated urgently with fasciotomy. This immediately releases the compartment pressures and restores myoneural perfusion. [2,5,6] The first reported fasciotomy for ACS was by Petersen Ueber, in 1888. [7] Later, in 1914, Murphy noted that the increased compartment pressures found in ACS could be due to the collection of necrotic debris and hemorrhage, whereas Peterson noted that it was due to inflammation and arterial occlusion back in 1888. However, both authors had similar viewpoint concerning the treatment of ACS that fasciotomy was necessary to prevent nerve injury and contracture development.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Though the presentation is diverse, patients typically have a history of “B” symptoms and lymphadenopathy in areas such as the neck, mediastinum, or abdomen. However, a growing body of evidence suggests DLBCL can present as a cystic mass in diverse tissues. We present the case of a large cystic left retroperitoneal mass of unknown origin in a patient subsequently diagnosed with DLBCL. The diagnosis was obtained via percutaneous biopsy of the cystic mass in preparation for surgical excision. Upon diagnosis, surgical intervention was aborted, and the patient was started on chemotherapy treatment. However, four weeks into her treatment, she slipped and fell while in the bathroom and presented to the emergency department in shock with a computed tomography (CT) scan suggestive of splenic rupture. She underwent emergent splenectomy and resection of the cystic mass. She was discharged on postoperative day 7 and is currently continuing with outpatient chemotherapy. The presentation of DLBCL is notoriously diverse, however, this patient represents a unique presentation that adds to a growing body of literature suggesting DLBCL can present as a cystic mass. Pathological diagnosis should be obtained in all patients with cystic lesions of unknown origin before any surgical intervention to avoid unnecessary surgery and provide an optimal management plan.