Tessei Kuruma

Lacrimal dacryostenosis with severe facial pain misdiagnosed as trigeminal neuralgia.

A 47-year-old woman developed intermittent shooting pain around the right side of the nose and eyes. A neurologist initially diagnosed trigeminal neuralgia, but carbamazepine did not improve the pain. Two months later, she presented with a pus-like eye discharge and was referred to us for further examination. Poor saline irrigation from the lacrimal puncta and computed tomography findings of a swollen lacrimal sac indicated a diagnosis of lacrimal dacryostenosis. At this point, the pain and dizziness as a side effect of carbamazepine had become intolerable. Endoscopic intranasal dacryocystorhinostomy confirmed stenosis of the nasolachrymal duct and a thickened lacrimal sac. The postoperative course was uneventful, and the facial pain disappeared. This experience suggests the importance of recognizing lacrimal dacryostenosis as a differential diagnosis of facial pain around the eyes and nose. We also recommend a review of an original diagnosis of trigeminal neuralgia if carbamazepine fails to relieve facial pain.

Adult retropharyngeal abscess

A 60-year-old man was referred to our hospital after complaining of throat pain for several days. He described the condition as a cold with sore throat. A physical examination revealed swelling of the posterior wall of the oropharynx. Sagittal computed tomography revealed a 3 × 1 cm abscess with ring enhancement in the retropharyngeal space (Fig. 1). Therefore, he was diagnosed with a retropharyngeal abscess

Bilateral presentation of peritonsillar abscesses

A 22-year-old man with no medical history was seen complaining of a five-day history of worsening sore throat, fever elevation, and odynophagia progressing to trismus and muffled voice. His primary care physician had given NSAIDs with the diagnosis of “common cold”. Physical examination revealed a symmetrical swelling of the soft palate and enlarged tonsils with a midline uvula (Fig. 1). Computed tomography showed bilateral hypodense masses with thick rim enhancements measuring 2.5 × 2.5 cm on the right and 2.5 × 2.0 cm on the left in on the superior peritonsillar regions (Fig. 2). He was diagnosed with bilateral peritonsillar abscesses. Aspirations of purulent material from both sides were performed with a 21-gauge needle; a total of 6 mL of purulent material was obtained from the left side and 8.5 mL from the right side. A subsequent wide incision and drainage procedure was performed under local anesthesia. Clindamycin and cefoperazone sodium therapy was also given; his symptoms disappeared 7 days later (Fig. 3).

Large Cholesterol Granuloma of the Middle Ear Eroding into the Middle Cranial Fossa

Background Cholesterol granuloma of the middle ear is extremely rare in comparison to cholesterol granuloma of the petrous apex but sometimes shows an aggressive course. Case Report We report herein a case involving a large, aggressive cholesterol granuloma of the middle ear that eroded the middle cranial fossa. A 64-year-old woman presented with pain in the left ear and hearing loss. Cholesterol granuloma was finally diagnosed from diffusion-weighted imaging, and cortical mastoidectomy was performed with canal wall down tympanoplasty type III. Recovery was uneventful recovery and the patient well at the 3-year follow-up. Conclusion This case demonstrates the rare but clinically important pathology of aggressive cholesterol granuloma of the middle ear.