We report the case of a 4-year old girl who was admitted to our ENT outpatient clinic with a cervical neck mass without other signs and symptoms. The patients history revealed, that she had previously been treated several times for odynophagia with cervical tumescence within the last two month. Symptoms and swelling disappeared temporally after the antibiotic treatments. However, the cervical mass rapidly reappeared after the end of the treatment. Otolaryngological examination showed no particularity, beside a firm lateral cervical mass. A cervical CT scan (Fig ) revealed a deep subcutaneous collection, suggesting the presence of an cervical abscess. Potential infectious origins such as the tonsils, the salivary glands, teeth or the facial skin were calm. Despite an intravenous antibiotic treatment with decrease of the cervical mass, an ultrasound control 10 days later showed a persistent subcutaneous liquid collection. We then opted for incision and drainage of this collection. The drainage and cleaning of the abscess cavity unearthed a blade of grass within the purulent discharge (Fig ).\nReviewing the patients history, the parents suddenly recalled she had complained of a transitory foreign body feeling during several days after chewing a blade of grass two months ago. Follow-up showed no further recurrence of the neck swelling.
A 62-year-old man visited our hospital emergency room with dizziness and diaphoresis. He received an acupuncture treatment on the subxyphoid area (lower 2 cm and left 1 cm point from the lower xyphoid process border) directly an hour ago because of facial numbness. He had a history of cerebral infarction and permanent atrial fibrillation on warfarinization (2 mg warfarin per day). Surprisingly, the acupuncture needle () was still sticking into his substernum. The initial vital signs were blood pressure of 80/50 mm Hg and heart rate of 110 beats/min. We instantly removed the needle, but he went into cardiac arrest and was rescued within 10 minutes after cardiopulmonary resuscitation. At that time his prothrombin time international normalized ratio was 1.99, therefore, we administered 2 pints of fresh frozen plasma and 5 mg of vitamin K. The transthoracic echocardiography revealed pericardial effusion with early diastolic collapse of the right ventricle. We performed emergent pericardiocentesis using a subcostal approach. After drainage of 500 mL of sanguineous effusion, the patient stabilized hemodynamically. Two hours later, however, the drainage of pericardial effusion persisted up to the total amount of 1000 mL, and the cardiac arrest redeveloped. After resuscitation, an emergent operation was performed under cardiopulmonary bypass (CPB). A median sternotomy allowed visualization of huge hematomas over right atrium and ventricle (). After we evacuated the hematomas, a pumping of acute marginal branch of the right coronary artery was identified. The vessel was torn into pieces, and it was ligated with 4-0 Prolene suture, thereby leading to termination of bleeding (). The aortic cross clamp time was 25 minutes and CPB time was 45 minutes. Thereafter, the patient showed hemodynamically stable vital signs and uneventful condition. Finally he was discharged without any complications.